The nurse's problems in sanatorium management are many and varied and at times quite difficult to work out. If, when a nurse is appointed as superintendent the patients are given to understand what is expected of her, the way is paved for successful work. With such an introduction she will take inventory in her mind of the institution, the plan, the place it occupies in the community. She will find out whether the people living in the vicinity are friendly or afraid, if not hostile; whether the sanatorium detracts from or adds to the value of property; the number and type of patients in the institution; the number of nurses and employees; the problem of boarding and housing the employees, and the distance from markets, which is frequently a problem when managing a tuberculosis sanatorium. She must find out about the water supply, the plumbing, sewerage, heating and lighting systems, in fact she must be familiar with everything, that is included in a city plan on a small scale, and the smaller the plant the more difficult the problem. All these details must be mastered by the superintendent.

The comfort of the patient is the object in mind and the things most necessary must be mastered first. These are usually the water and sewerage systems, and the nurse must become thoroughly conversant with them. If some thoughtful person preceding you has preserved the blue prints the problem is an easy one, if not, when you find your water storage tanks emptying more quickly than they should although the faucets and fire hydrants are all in good repair, the whole system must be gone over. If you have a large enough leak in your pipe line the water will seep through the ground in time, if you are patient. By that time you have likely found the man that installed it. You insist on his doing your repairs; he can't blame some one else if everything is not properly done and you are sure to get good service.

The markets will be difficult if you are a stranger. It is amusing now to recall buying green peas over the telephone. It appears that they are so much per pound and you had always been accustomed to buying by the measure, peck or bushel. You may be perfectly familiar with how many measures of peas for a household of seventy-five, and be helpless in the matter of pounds until you see them.

While you have been learning the geography of your institution, finding, locating and overhauling the water and sewerage systems, finding your markets and the ice supply, you have been getting accustomed to the type of employees you have, what each one considers his or her duty and how they avoid doing anything else, or as the case may be, how they assist one another.

Then you have your heating and lighting sys. tems. The latter you may have forgotten until you find everything in darkness and you realize you haven't found out where the different

switches are located, but you take your flashlight and find them. It may be only a fuse blown out. You look for the reason and find someone has attached a defective electric iron; it always did blow out a fuse but they thought they would try it once more. You have it repaired or buy a new iron.

You find a generous supply of wood on hand, but it must be sawed. You engage a sawyer and when you receive his bill you find more cords on the bill than in the woodpile. You take the trouble to look up the original wood bill and find more wood on the bill than the shed will hold. You send for the man and have him go over the wood bills. He sees the mistake and tells you he bought the wood by the carload and it must have been billed wrongly to him, when all the time you know he thought, "Well, being a woman she won't know the difference and I'll get the money." This is a problem that a man never meets; a nurse meets it always, but not often twice in the same place.

While getting acquainted with these different phases of the work, the every day routine of the sanatorium has been going on, perhaps not as quietly as you would like, but going. The nurse is planning the meals, noticing how they are cooked and served which is quite as important as cooking, and very likely keeping the books after an ordinary day's work is done.

The employees are getting into the routine fairly well, but still find it hard to make a list of everything they will need in a day in their particular work and to have that list filed at a certain hour six days in the week. The old way, of every one going to the store room for everything that was needed at any time and on any day, seemed so much easier. The nurse becomes unpopular when she puts new locks on the store room doors and retains the key until a responsible person is found whose business it is to issue supplies. But much money may escape through open doors and at the risk of being unpopular this method must be employed. At the same time one must be quite sure that every nurse and employee shall have just as much good food as he or she can eat but nothing to waste. By teaching them the value of everything, it is surprising how interested they become when you show them your problem in dollars and cents. When the scarcity of paper began to be felt a nurse suggested that we eliminate one napkin from our trays. We did so without making any difference in the appearance of the tray or without any inconvenience to the patient. We counted the cost and found we saved at that time $3.60 every thirty days. If your institution is dependent entirely for support on the board paid by patients it is well to have the staff and employees keep that fact in mind. It is interesting to note how careful they can be when they realize that a person who is ill is paying for the material they are using. It has pleased me

greatly to find that occasionally when an em. ployee became careless or irritable there was a ready response to some such appeal as the following: "We who are well can stand any inconvenience, but if this particular work is not well done a patient will be made uncomfortable." I am constantly reminding my whole staff that the sanatorium is maintained only to assist sick people to get well and would not be necessary at all as a place of employment.

When there is no resident physician, the problem of caring for patients between visits of the medical directors falls on the nurse in charge, and in addition to carrying out his orders she must buy and dispense the drugs. She must learn all the details of the routine and emergency treatment, must be able to explain just what the doctor meant when he answered a patient's anxious inquiry in a certain way, convince the patient that the doctor was not indifferent in regard to his particular condition, even if he has forgotten some trivial thing. Many patients ask questions to obtain needed information, others to see what the nurse will say. The tactful nurse will explain just enough to relieve the patient's mind for the time being and have the doctor explain the matter when he comes. She will never make a positive statement regarding some question that belongs only to the physician. If she does she is sure to be confronted with the humiliating experience of having the patient ask the doctor the same question, and hearing the patient say when he has answered: "The nurse said thus and so."

The question of diet is always difficult. En

courage the patients to tell their likes and dislikes. Constructive criticism is always helpful. When you have a group that seems unusually hard to please, it is well to have them explain in detail all the delicious things they had to eat at home, just how they were cooked and served. When you have led them to believe you think they are telling the truth, it is well to remind them that with all this good food and care they got sick at home, that with all the defects in the sanatorium we are helping people to get well, and that if they allow us we will help them back to health, but they must try our methods. There is no doubt left in their minds, then, about your desire to help and they have something to think about.

Getting capable nurses that are not afraid of tuberculosis is most difficult. So many feel perfectly safe in a general hospital or in private practice who would not consider work in a sanatorium because of the supposed danger of infection. Patients feel this keenly. This makes another problem for the nurse. She must create a wholesome, cheery, helpful atmosphere that will counterbalance such depressing influences. Ex-patients can assist greatly in bringing cheer if they are made to feel their responsibility in this matter and invited to visit the sanatorium after being discharged. This cooperation is well worth while, and your problems, big and small, fade away when you follow the orders and advice of a clever physician carefully and see the patients slowly coming back to health and strength and realize you have had some small part in the work.

When you're down on your luck
And you're feeling mighty blue,
You've been told that you're a lunger,
You can hardly believe it's true.
'Tis then the world looks darkest
And not a thing seems right,

Then it's up to you to fight, fight, fight.

Then you make up your mind
There is no use repining,

For soon the clouds will turn about
And show their silver lining.

So you might as well be happy
To pass the time a while,

Then it's up to you to smile, smile, smile.

There are days when we're unhappy And our fighting strength ebbs low, There are times when it seems useless To try to overcome our foe,

But my dears, we've got to do our bit
And our Lord will see us through it,
If we show our grit, grit, grit.

Then you go to a San,
Meeting many others there,
They seem to be quite happy
Living in God's pure, fresh air.

And you know that you'll be happy-what luck,

For it's going to help the others

If you show your pluck, pluck, pluck.

So we'll cast aside the shadows,
Looking ever toward the light;
Let us then be up and doing,
Chasing gloom with all our might.
We'll show them what we're made of
Even though our lungs are punk,

For we can not stand for funk, funk, funk.
HELEN KOLB, R.N.