patient's memory is poor, don't say so, but cite examples to show how it is poor. Does he remember old events and not recent ones? Does he remember certain things and not others? It is the same way with association of ideas. You will note that certain patients are excited by a certain set of ideas, for example, fear may be limited to some certain object, such as a cat. Others become excited and upset by the mere approach of some sexual topic; others by some past misfortune in their lives. Note these things not as conclusions, but as facts. Silence is often an ominous symptom. It is golden we know, but, at the same time, a patient who sits in a ward all the day through, repelling advances, answering in monosyllables, or not at all, is probably suffering from some mental disturbance, which, for his own welfare and that of those who look after him, should be determined. This silence may be the result of suspicion, in that he fears that injury is coming to him, that he is to be poisoned, that people are coming to kill him; but it may be the result of profound depression, in that he thinks that things have gone so badly with him that there is no use talking. And in any event, with patients who are silent, try to find out what the cause of their silence is, and to see whether it is to lead them to a condition of depression or, perhaps, to some act which would prove dangerous to themselves or to others. Instead of saying the patient is delirious, state what they do in the delirium, how violent it is, and, if you can, write out what they say during their delirium. If the physician has a good report of all the words that are said by a delirious patient for twentyfour hours, he will often be able to tell from that alone the cause of the delirium and its probable outcome.

I hardly think that the few things I have mentioned as desirable in the nursing of nervous diseases are beyond the reach of any woman who is healthy, fairly intelligent, and who really has a desire to follow out what we think is the highest form of nursing. Everything that she can add to these simple qualifications will increase her efficiency. Every accession of knowledge, every advance in culture, the cultivation of any individual talents will aid her wonderfully in the prosecution of her duties.

CORNER OF CHILDREN'S WARD, SHOWING THE CRIB WARMER AND EXAMINATION TABLE.

THE CHILDREN'S WARD OF THE PRESBYTERIAN HOSPITAL, NEW YORK CITY, AND SOME OF ITS NEW ADDITIONS

BY JEAN G. HAYMAN, R.N.

Graduate of the Presbyterian Hospital

THE Children's Ward of the Presbyterian Hospital is divided into two spacious rooms, connected by a large archway, one part being used for medical and the other for surgical cases. One very large window extends to the floor doing service as a door leading to the open air balcony. There are two detention rooms entirely separated from the main ward, in which to place children developing symptoms indicative of contagious diseases. The ward accommodates twentyeight children. The cribs vary in size to suit the baby a few hours old or boys of eight and girls of ten years.

On admission to the hospital every child is received in the observation or reception ward, consisting of two small rooms connecting with a room for administration, a bath room, linen closet, and pantry. This arrangement is made so that a child showing suspicious symptoms can immediately be isolated in one of these rooms without infecting other children or preventing the admission of new patients. The child is held from one to five days in this ward, under strict observation. This allows time for a report on the cultures taken from the nose and throat of the child, and on the vaginal smears, which are taken from every female child whether or not a vaginal discharge is present.

In order to maintain "individual precautions," each child is cared for entirely in his own crib. Separate thermometers and utensils are supplied, the face basin, the buttock basin, bottle of liquid castile soap, shaker for powder, and comb, are kept in the drawer of a white enameled table that stands at the side of each crib. The bed pans are kept in a 2 per cent. solution of formaldehyde, other utensils are boiled.

On transfer to the children's ward, the same "individual precautions" are observed, except that it is found impossible to change the child in bed, because of the low temperature of the ward and the out-of-door treatment.

The attending physician visits the wards daily. The house physician makes morning rounds, as early as possible, inspecting the throats

and skins for contagious diseases. The stool examinations are made early and the feeding prescriptions made ready for the milk room by ten o'clock. The formulæ are written on small tags bearing the baby's name and date, and are inspected as carefully as medicine tickets. The changes in the feeding are based upon the result of stool inspection. The work in the milk room or laboratory is under the direction of a trained dietitian; the making of the prescriptions, the cleansing and boiling of the nipples, the cleaning of the room and all the utensils being done by a junior nurse or a probationer, especially instructed in these points. A gown covering the uniform is worn during the preparation of the feedings. The prescriptions vary largely, dextrinized barley water, peptonized milk, Loefluid's malt soup, all have a place on the daily list. The preparations made for the twenty-four hours are poured into sterilized feeding bottles (the exact amount for each feeding), they are then placed in the carrier already tagged, the tag with the prescription being fastened to the handle. These carriers are placed in an ice box kept for the purpose at a temperature of 40° F. As each bottle is taken out for use, a metal tag is placed about the neck for identification. The tag remains on the bottle until the feeding reaches the baby. The feeding is brought to the proper temperature by placing the bottle in a hot water bath.

All the children, when this is possible, spend part of each day on the balcony; many children spend the entire day. Since pneumonia and septic cases are treated entirely out of doors, half of the balcony is covered with a galvanized iron roof with white awnings, which keep out the direct rays of the sun in bright weather and the rain and snow of winter.

Ear examinations have become so frequent that it has been found convenient to keep a tray always ready with the usual ear instruments. Such examinations have been made much easier and more satisfactory by the use of an electric bull's-eye light (32-34 candle power) on an adjustable standard. A simple device constructed like a kitchen table, with an adjustable top (readily made by a carpenter), has proved most useful to the doctors, not only in making examinations, but in performing such operations as lumbar punctures, aspirations, etc.

A white enamel stand on castors, six feet high, is kept ready to give hypodermoclysis and similar treatments. The stand is furnished with three shelves, on the lower shelf the unsterile utensils are kept, kidney basin, jar of catgut, tube of silk, splint, adhesive plaster, and bandages; on the second shelf, the sterile bundles for