THE The Red Cross and the Influenza Epidemic. By JANE A. DELANO, Director Department of Nursing. HE WORK accomplished by the American Red Cross and other relief organizations in preventing and controlling the recent influenza epidemic, stands out with striking force, now that the receding of the wave gives us an opportunity to review the situation and analyze the more or less complete reports that are coming in. It was the belief of the Department of Nursing of the American Red Cross, that with the organization we had built up and the enrollment not only of nurses for military service, but Home Defense as well, we should be able to mobilize our resources and render efficient service in a national emergency. The epidemic appearing at so critical a time became a supreme test of the flexibility and efficiency of the Red Cross Nursing Service. The appropriation by the Red Cross War Council of $575,000 to be used in combating the disease, followed close on the heels of its first appearance in the New England States. A special committee representing the American Red Cross and the Federal Public Health Service was formed to outline a general plan for co-operation between the two organizations. How the Epidemic Was Handled Definite instructions were at once sent to the Red Cross Division Headquarters, providing for utilization of local nursing resources to the utmost extent. Divisions were also instructed not to go outside their districts for assistance without notifying National Headquarters, and a standard schedule of prices was approved by the Federal Public Health Service, the surgeons general of the army and navy and the American Red Cross, in order that one organization might not bid against the other, or one State secure nursing personnel at the expense of an adjoining State equally in need. We recognized, in the very beginning of the epidemic, that, unless controlled, great injustices would be sure to develop, not only in regard to the community, but to the thousands of nurses who had sacrificed their personal interests in order to serve at this time. It is worthy of comment that nurses responded quite as rapidly to the call from the Red Cross before arrangements had been made or given in regard to rate of compensation or conditions of service. assurance Chapters also were instructed not to go out of their localities for nursing personnel, and urged to neglect no means of meeting the situation. They were recommended to establish local recruiting sta tions to secure the needed personnel, and to organize central diet kitchens in communities where the disease raged, to supply hot food to families in need of it. A motor service was also recommended for the quick transportation of personnel and supplies. Organization and Personnel The general plan for combating the disease throughout the country provided for the greatest possible co-operation between the Federal Public Health Service, the Army Nurse Corps and the American Red Cross. As army nurses reached the cantonments, Red Cross nurses were withdrawn and placed where most needed. Chapters were urged to establish central headquarters and to pool the resources of the community, establishing the close co-operation with existing nursing agencies, such as school nurses and public health nurses, in order to avoid confusion and duplication of effort. The central headquarters were urged to recruit graduates, undergraduates, nurses, nurses' aids, practical nurses, trained attendants, school teachers, if schools were closed, and lay volunteers. The necessity for continuing the assignment of nurses to military duty, both in France and in the cantonments in this country, disclosed an appalling shortage of nurses. Nurses Who Made the Supreme Sacrifice That hundreds of nurses succumbed to the disease, due no doubt to the extraordinary strain that has been placed upon them during the past few months, added to the difficulties of the situation. In many of the divisions activities were necessarily divided between local disasters and the influenza epidemic. Disasters The explosion of the powder plant at South Amboy, an accident which ordinarily would have taxed our nursing resources to the utmost, put a tremendous strain on the Atlantic Division; and, to add to the general misery, the influenza epidemic was accompanied by an outbreak of diphtheria among the explosion victims. In the Northern Division forest fires vied with the influenza epidemic to produce a frightful condition, and 600 cases of influenza broke out among In both the fire refugees gathered in Duluth. divisions the nurses and volunteers gave a splendid response. At the beginning of the epidemic more than 1,000 nurses were assigned to military establishments alone by the Central Division of the Red Cross. These were released by civilian hospitals of the division for this service, or gathered in from the highways and byways of the States of that disrict. Emergency Hospitals Emergency hopsitals were opened by the Red Cross in many communities, in an incredibly short time, in places where the local resources were insufficient to meet the need, and maintained by Red fifty nurses into the coal fields. They have been sent to Wilkes-Barre and Charleston and reassigned or distributed from those points. Volunteer Nurses The work of the volunteers and nurses' aids has been remarkable. They have risen to the emergency in a splendid manner and risked their lives most unselfishly; although 50,000 women have taken the Red Cross course in "Home Hygiene and Care of the Sick," their response in such large numbers was unexpected. This experience in the influenza epidemic, however, was unexpected, and has convinced the Red Cross, as never before, of the desirability of developing in this country groups of women who can be depended upon to aid in similar emergencies. Although complete reports are not yet available as to actual numbers of nurses assigned to duty by the Red Cross, there is sufficient evidence on file at the Red Cross Headquarters to show that the nurses of the country have not failed in the quality of their patriotism, of their application of what it means to serve under the Red Cross. Don't Banish the Vaginal Douche. We trust Dr. W. E. Fothergill's criticism of the vaginal douche will not be taken seriously by members of the profession who may read his article in the September number of THE MEDICAL COUNCIL. No one has a greater abhorrence for humbuggery and quackery than I, but we were taught to "prove all things and hold fast to that which is good." The vaginal douche is too deserving and effective in many conditions to be the least demerited or for its employment to be abandoned or diminished. We should rather strive to improve the method and extend its use. As it is the only means of treatment many patients have those remote from hospitals or unable to attend the doctor's office hours. It is as logical to wash the vagina to relieve and prevent infection from any cause, as it is to spray the nose or gargle the throat. An astringent and antiseptic douche in cases of acute or chronic vaginitis or cervicitis is good practice and gives good results regardless of hypothetic reasoning to the contrary. I do not believe bichloride of mercury should ever be used in a vaginal douche, nor do I believe we should use a vaginal douche after normal labor; but for lacerations or abrasions with septic infection after labor there is nothing better when properly compounded or mixed, if used sufficiently often. When Dr. Fothergill knocks the bottom out of an old pan he should give us a new one with a bottom in it. D. B. JACKSON, M.D. Greer, S. C., R. D. No. 3. A The Future of Medical Practice The Coming Reconstruction Will Medicine Advance or Retrograde The war advanced medicine all along the NY CANDID STUDENT of affairs during the war must be struck by the fact that the Government recognized organization, even "trust-busting" having wonderfully slowed down. Loyal labor organizations have several times had the Government rush to their defense. Organizations of producers, even including the long-suffering farmers, were respectfully consulted. The trade organizations were continually called in counsel, more especially those representative of essential lines of industry; and above all have skilled industrialists and professionals been given privileges that were necessary to the successful conduct of the war. Perhaps a no more striking instance of what organization accomplishes occurred when the medical colleges, finding their students drafted, strongly presented their necessities at Washington and secured a special exemption for students in "acceptable" schools. Some persons think this exemption was too sweeping. But the American colleges in general, after the recent passing of the man-power bill, did not secure such an exemption for their students. Perhaps two factors prevented, aside from the war needs, and they are these: first, the colleges are divided into classes-state-supported, heavily endowed private corporations, church supported, locally supported small schools, and purely proprietary-and so there is no unit organization; second, most of them are devoted to cultural instruction, only the larger and best supported ones giving technical and professional training. Yet it would seem that, next to medicine, graduated engineers and chemists are necessary in the prosecution of any war and should get for their schools the same degree of exemption accorded to the medical colleges. It is not necessary to argue that question here, or even to defend the rather wide exemption accorded to medical students in "acceptable" schools; but it is a notable fact that, of all classes of col leges, the medical institutions were least disrupted in their courses and classes. Perhaps they were most essential, and also it must not be forgotten that they are organized into an Association and can present a solid front when occasion demands. So far as the medical schools are concerned, the only result has been the declension of "unacceptable" schools and some losses of faculty personnel in all classes of colleges. State Boards. But the State medical boards are a big factor here; for they largely determine which schools are acceptable and which ones are not. War necessities have not moved the boards to let down the bars in the least except, perhaps, in the matter of reciprocity and a fifth year hospital internship. Year by year the percentages of rejections by State boards are decreasing and of reciprocity cetificates increasing. Fifty-five medical colleges have full recognition in all States, and of the 27 not recognized by from 8 to 37 boards several have died since the war started and several more are slated to go. The War Department classed as "acceptable" schools, only those recognized by a majority of the State boards and accepted the students of these colleges in the Enlisted Reserve Corps. At the last report there were about 14 colleges having less than a majority recognition. The State board regulations are resulting in more and more high-grade students from well-equipped colleges; and the war draft of students from nonacceptable colleges resulted in closing up most of these institutions. Thus the war raised medical standards of education and licensure. For all the falling off in total attendance in medical schools, the number of students, both absolutely and relatively, in the Class A schools has for three years been on the increase, while the percentage of students in B and C class schools has fallen very rapidly. Eleven of these schools closed during the past year, according to the August report of American medical colleges. So rapidly did the war force the low-grade colleges to the wall, that while 12 Class C colleges were listed in the August report, six are now closed or will not open for this winter's term, and two are listed as "nondescript" of those still "hanging on by the skin of their teeth." The war positively killed off the low-grade medical school. There are only four or five Class C schools at all liable to be in existence one year from now. Canada has none left in this class. Distinctly encouraging is the fact that more equal standards are solving the question of reciprocity in medical licensure, a tendency bound to grow after the war. Sectarianism. The rank and file of Homeopathic and Eclectic practitioners are coming to see that mere therapeutic differences constitutes small justification for the very expensive proposition of keeping up modern medical colleges on a competitive or a sectarian basis, and that their school ideas will not thrive unless the schools representing them are fully equipped in the modern sense. Better by far, many argue, is for the presentation of sectarian principles in non-sectarian schools; and they contend that certain features of Homeopathy and Eclecticism will not die under such a régime. Be this as it may, there were 22 Homeopathic colleges in 1900, with 413 graduates; and in 1918 there are 6 schools with 114 graduates. The 10 Eclectic schools have been reduced to 2, and the graduates from 221 to 42 in the same period. These two schools-Homeopathic and Eclectic-together now constitute only 5 per cent. of the medical student body. Three of the Homeopathic schools are Class A and in them sectarianism is far from dominant. There were 4 such schools a year ago but one has dropped sectarianism, as the other 3 probably will, in time. One Eclectic school is Class B and one Class C, the latter recognized by only 36 per cent. of the State boards. These figures may be very discouraging to many most estimable Homeopathic and Eclectic practitioners; but they show the trend of the times-a tendency very much accentuated by the war and the equalizing influence of Army and Navy medical service, in which sectarianism almost instantly dropped out. Osteopathy seems to be making alliances with medicine. One Class C school not recognized by 31 State boards has formed an osteopathic alliance, giving the degree of M.D. to Osteopaths after some little additional study. Another Class C school not recognized by 28 State boards was formerly an Osteopathic college but has taken out a new charter as a medical school. Naturally, these osteopathicmedical schools are low-grade, though they may build up, as many B and a few C class schools have done. The really interesting point is this: the Osteopaths feel contracted and are moving toward medicine. Probably in time their schools will all be medical schools and some of them doubtless will develop into excellent institutions. Osteopaths are not accepted in the medical services of the Army and Navy, and doubtless this fact has had a bearing on their tendency to gravitate toward medicine, which they at first fought. Medical Societies. Medical societies are more a measure of efficiency than of union, and the efficient and would-be efficent men are keeping pretty close track of medical society work, while the drifters in the profession are not. Yet the absences in the medical ranks and the busy condition in practice are not tending much to the strengthening of the societies. Furthermore the man-power bill put so many physicians in the draft that less society recruiting work is necessary. It is rather unfortunate that the societies have not yet attracted the drifters and the disgruntled to their standards; and a move towards democracy in the societies is needed. It would be well to begin it now, for when the men return from the war they will come back as comrades and with the old fights forgotten. If the physicians remaining behind can also forget them and stimulate comradeship among all classes of reputable practitioners, the medical societies should flourish after the war. The fact that the exponents of so-called Health Insurance are insisting on their fantastic "model bill" program being carried through while thousands of physicians are still in the Service and thus kept off of panels, to return with the whole field rigged against them by the extremists, will probably awaken the societies to this amateur raiding of the practices of the Men Over There and cause a united front to be presented to the crew of politicians. sociologists and insurance companies by the medical profession at large. If this is not done by the medical societies, it will not be done at all; and disaster to the profession will result. Surgery and Specialties. That the war advanced surgery goes without saying; but it also advanced medicine, especially preventive medicine and immunology. While not so apparent on the face of things, even therapeutics was influenced by the war, for a lot of hard-headed surgeons were also compelled to study therapeutics and treat cases that were non-surgical. These men were neither therapeutic nihilists nor obsessed over the wonders of drugs, and they had a splendid opportunity to study hosts of cases under advantageous circumstances; and the result is some very valuable therapeutic studies. Many physicians who were in general practice were in the army required to practice specialties more or less, and when they return to civil practice they will treat a range of cases which before they did not undertake. International Medicine. The most international factor in the war was medicine. The physicians of the Allies all worked right together and learned from each other. A lot of medical barriers are being broken down. After the war this will become very apparent, especially in the reconstruction work in which American physicians and sanitarians will have so large a part. Doubtless it will do the American profession a world of good. It takes little experience in camp to realize that officers are gentlemen-considerate, courteous and broad; and it is especially noticeable that physicians in the Services fast learned this lesson and treated with distinguished consideration men they used to fight. It is not meant as an invidious comparison of pre-war and present conditions, but city men in the Services are fast learning that the "country doctor" really is a man of resource and ability in medicine. Medical Literature. The war is destined to make a vast and badly needed improvement in medical literature. It is rather anomalous that laymen are appreciating the solid periodicals and they are becoming the best sellers, while the lurid and loud in the magazine field is losing out; and yet some editors and managers of medical journals often do not see that the outré in pre-war medical journalism is as dead as the erstwhile pharisaism that used to be rampant. Such journalists need to take a new grasp on the situation, for there is a growing demand that our medical journals must be managed by people intelligently in touch with modern medical thought and affairs and in full sympathy with high ideals of medical service. This is coming, and the war has hastened it. Already a marked improvement is noticeable in many journals, and in books issued from medical publishing houses, for they are solid, scientific, possess the critical spirit, and are fast getting away from the narrowness that has been such a blight on American medical literature. Yes, the war advanced true medicine all along the line; and it is distinctly the province of every physician to keep up with the current advances, while hospitals, institutions, publishers, and supply houses catering to the medical profession simply must get in line or lose out in professional esteem and patronage. BEST CURRENT MEDICAL THOUGHT Surgical Scissors As Wielded by DOUGLAS H. STEWART, M.D., F.A.C.S. 128 W. 86th St., New York What Every Young Naval Surgeon Should Know. H. C. Curl, M.D., Med. Inspector, U. S. N., in U. S. Naval Med. Bulletin. This abstract is made because it answers so many everyday questions and because the author has formulated an opinion of what might be termed the "standard" type. The standard should be a good all-round man and should on some one subject be a little more proficient than most of his associates. But the man who has specialized till he takes no interest in general work is not as useful as the man who does most things fairly well. An all-round man with the added ability to do special work will be available anywhere and can be depended upon under all conditions. The author advises the young man to learn how to do an appendectomy, a mastoid drainage, to know well one type of intestinal suture, to trephine the skull and to perform a good amputation. The man who has done none of these must do them his first time; how much better for him and all concerned if he does it under the direction of an experienced operator? Acute Infection of the Joints. By James K. Young, M.D., F.Ă.C.S., Philadelphia, in Medicine and Surgery.-There are two joint conditions that deserve far more consideration than they have hitherto received from the medical profession, since their lack of recognition not infrequently has led to loss of function, or to death of the individual. These conditions are acute septic synovitis and acute septic arthritis, respectively; a synonymous term being phlegmon of the joints, because of the acute character of the inflammatory process. These affections all too often offer an obscure etiology. A traumatism of the foot or leg is quite frequently followed by a septic inflammation of the glands of the groin, subsequently leading to an in-. fection of the deep glands, later to be succeeded by involvement of the hip-joint. A patient suffering from gonorrheal urethritis, may have as a sequence a traumatism of his hip, or may be exposed to cold, affecting the hip, and this in turn may give rise to a rapid and fatal septic synovitis of the hip-joint. A puncture wound of the knee or elbow or a voluntary incision of a joint by an uncleanly operator is not infrequently followed by an acute septic synovitis and arthritis of any joint. Again, a patient suffering from a stricture may have had a divulsion effected by an infected instrument, |