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large practice at Reigate, founded the Reigate CottageHospital, started a dispensary to which every medical manin the borough belonged, and served on the town counciland was the first magistrate to be sworn in on the boroughbench. This is a record of good work and Epsom Collegeparticularly owes to Constantine Holman a debt which canhardly be paid. It is fitting, therefore, that the testimonialabout to be raised for him, further subscriptions to which areacknowledged on p. 1172, should in some way increase theinfluence for good of the foundation of that institution.Dr. Holman was recently elected an honorary member of

the Medical Society, a compliment that is not often paid toBritish medical men.

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THE REGISTRATION OF NURSES.

AT a meeting of the executive council of the Associationof Poor-law Unions of England and Wales on April 12ththe parliamentary committee of the council, which has had-under consideration the Nurses and Private Nursing Homes(Registration) Bill, reported briefly that it disapproved of the measure since it believed that its passing would have aprejudicial effect on the supply of probationers for Poor-lawnursing. This opinion is noteworthy as supporting the ’,manifesto to which we had occasion to refer in THE LANCETof April 2nd (p. 946) and might, if it stood alone, be accepted iias confirming the position of those who object to State

registration. At the same meeting, however, a discussion on ’’

workhouse nursing took place which may be taken to in-

dicate the train of reasoning by means of which the aboveverdict was arrived at and we are fain to admit thatwhatever merit there may be in the conclusion the premissesare wofully lacking in appreciation of the true interests ofthe nursing profession. After a long debate the followingpropositions were adopted by large majorities :-

1. That the minimum age for commencing training should be18 years. !

2. That "qualified" nurses as distinct from fully certificated nurses should be recognised.

3. That an infirmary without a resident medical officer may yet be a ’,,training school for nurses.

Stronger evidence of the necessity for erecting some definite IIand suitable standard of technical education, conformity with which should alone justify the employment of the term I"nurse," could hardly be tendered. But will the Bill nowbefore the House of Commons supply that standard ? Thereis ample ground for thinking that it will not. In so far as itadmits the advisability of intrusting the registration of nursesto an independent authority rather than to any chartered

corporation of nurses the Bill is a step in the right direc- Ition. Everything, however, tarns upon the constitution ofthe central board which is to be formed, and it may be saidat once that the board described in Section 4 is not of akind to inspire confidence. In the first place, the women onthe board will be at least in the proportion of 2 to 1 ; ;indeed, it would be quite consistent with the Bill to havenone but female members. Now, many persons holdthat women rarely display that capacity for mutual con-.cessions which makes for a united policy. Although it is ofthe first importance to the efficient performance of a nurse’sduties that she should be under the direction of the medical

practitioner whom she is supposed to be assisting, the Billrequires that only three members out of the 21 making upthe board should belong to the medical profession. The,result will inevitably be the removal of medical supervisionfrom the training and examination of nurses and the reduc-tion of the medical man to a subordinate position in the con-trol of the wards of hospitals and infirmaries. This con-sideration applies more particularly to Poor-law institutions,under medical superintendents. As far as the hospitals sup-ported by voluntary subscriptions are concerned there can belittle change in this respect since in them the matron already.exercises a preponderating influence and faithfully exacts

her tribute of deference from staff and students. While thedefinition of a I I nurse " given in Section 17 covers both menand women it is quite clear that nurses of the former sexwill have no voice in the management of affairs and we arepromised the anomaly of a council dominated by womenattempting to regulate the training of a body of men whoseraison d’être is the very fact of their undertaking workwhich women are not thought competent to perform.It is further to be noted that such a large employerof labour in the way of nursing as the MetropolitanAsylums Board has no direct influence in deciding uponthe claims of various persons to the style and titleof nurse," and more remarkable still is the fact that noallusion is made in the Bill to the Local Government Boardwhich is, in effect, the court of appeal in nursing matters forthe large body of men and women, constituting a majority ofnurses, who work unier the Poor-law. Another point is

perhaps worthy of attention. No provision is made to

remove that ambiguity attaching to the word "person" "

which has so often given rise to trouble. There appearsto be nothing to prevent the formation of "nursing com-panies" by unqualified individuals who could set the Bill,if passed, at defiance, just as has been done in the caseof druggists and dentists. Altogether the Bill is unsatis-

factory and sinc3 it has little prospect of passing this yearit is to be hoped that drastic changes will be made in itif it is to be agaln introduced.

THE NAUHEIM SPRINGS.

THE paper read before the Hunterian Society on

March 23rd by Dr. Paul C. Franze on the physiologicalaction of the Nauheim springs and the indications for theiruse chiefly in circulatory disorders once more directs theattention of the medical profession in this country to thevalue of those springs in the treatment of affections of theheart and blood-vessels. The first effects produced on

entering a Nauheim bath are acceleration of the pulse andcontraction of the peripheral vessels of the skin andsubcutaneous tissue. Congestion of the internal organsensues ; soon, however, the contraction ceases, the super-ficial vessels dilate, and the pulse becomes slower and

stronger; "reaction" is manifest. Dr. Franze considers thatthe presence of the salts in solution and the carbonic acid

gas intensify the stimulation of the skin and modify theaction of the coldness of the water, the aggregate resultbeing that in a Nauheim bath reaction supervenes muchsooner and with a greater intensity than is possible withordinary fresh water. Many authorities on balneology con-sider that the salts in solution in the various mineral watersare not absorbed by the skin to any appreciable extent.Dr. Franzs, however, whilst admitting that it is improbablethat any salts completely permeate the skin, believes thatthey are imbibed by the epidermis to a sufficient extent

directly to stimulate the peripheral nerve endings and

capillaries of the corium. The salts then maintain theiraction for some time after the conclusion of the bath.The entire nutrition of the skin is thus increased, itholds a greater amount of blood, and its excretory func.tions exhibit a revivification which is more than transitory.It must be acknowledged that as yet no scientific basis for

balneo-therapeutics has been established but it must never-theless be granted that special bathing and drinking "cures" "

are most efficacious in many chronic morbid conditions andcannot be replaced by any other mode3 of treatment. Weventure to suggest, however, that the good results oftenobtained at Nauheim in patients suffering from chroniccardiac affections cannot altogether be assigned to the

virtue of its waters. Patients may purchase "salts"

brought from Carlsbad or other spas, dissolve them,and drink the solutions in their own homes in England

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but they will not experience the eame beneficial effectsas from a course of treatment at one of those spas.The difference is that at the continental resort the

patient is subjected to a ’l’égime which is highly bene-

ficial. So it is at Nauheim. The hour of rising, the time,quality, and quantity of meals, the journey to and from thebathhouse, and particularly the amount and nature of

exercise are most carefully regulated. Cases of "cardio-

vascular neurosis are especially favourable cases for treat-ment at Nauheim and doubtless the strict ’l’égime underwhich they are placed has much to do with their recovery.It is exceedingly difficult, if not impossible, to impose thesame restrictions upon these patients in their own homes;they are therefore sent to Nauheim for a special purpcse anddevote all their energies to ’"getting well." "

SPRING SLACKNESS.

THERE are certain persons to whom the advent of spring,instead of biinging that sense of rejuvenescence which wasreferred to in an annotation in our columns last week, pro-vides a very different sensation. The youth of the year, whennature seems to revel in growth and development, ought togive, it might be thought, to the human species too a

sense of vigour and of the natural joyfulness of fecundity.When the birds are breaking into song and the plantsinto flower poor man might also exult in life and its annualtime of awakening growth. Yet to many the return of

spring is only the return of a vague feeling of listless languor,a slack sense of fatigue that comes without labour and ofweariness that is uncalled for by any unusual effort. To

those who dwell in cities, at any rate, spring has trials thatare peculiar to itself. To some extent these arise from the

knowledge that abroad in the country all is new life, re-

freshened vigour, and inspiring atmosphere, while in townthe wonted thraldom is enhanced by the suspicion of thesethings that is ga.ined from the trees and the plants of publicparks and open spaces, where poor little bits of nature

bloom only to suggest in vain all that awaits the towndweller if he could escape. It is not only dissatisfactionthough at beirg unable to partake in nature’s gaiety thatproduces the feeling of which we speak : something is due toclimatic conditions. Who does not know the enervatingsense that accompanies the first warm day of the 3ear.We may agree with Johnson that he is a weak creature

who is influenced by the weather but if we do we mustconfess with the same breath that to-day most of us areweak creatures. If, like Johnson, we lived in more

leisurely times and regaled ourselves heartily in Fleet-streetabout the middle of the day, following the meal with acomfortable discussion, may be we, too, should be indifferentwhether the sun shone or the rain fell. Unfortunately wework our nervous systems more and our alimentary organsless than did our grandparents. Inevitably we have a

sensitiveness that was unknown to most of them. Their fitsof "the spleen" were well earned, probably, by loads withinthe stomach. We acknowledge no such consoling cause forthe ennui that often in the spring assails the town dweller.Happy he who can dispel it by a week-end in the country orat the sea before his regulation summer holiday arrives.

THE DISTRIBUTION OF PLAGUE.

THE medical officer of health of the Cape Colony reportsthat for the week ending March 26th the plague state ofthe colony was as follows. No case of plague in human I,beings was discovered at any place in the colony during theweek in question but plague-infected rodents were found atPort Elizabeth and at East London. In the Cape Town andHarbour Board area 302 rats were examined during theweek but none was affected with plague. As regards theMauritius, a telegram from the Acting Governor received at

the Colonial Office on April 15th staes that for the weekending April 14th there were 2 deaths from plague. With

respect to the Transvaal a telegramfrom Lord Milner, datedApril 16 bb, states that the suspected cases up to that datenumbered 158: coloured persons, 140 ; and whites, 1&Deaths 75 : coloured persons, E8 ; and whites, 7.

THE PRODROMATA OF THE PSYCHOSES.

AN interesting article on the prodromata of the psychosesand their meaning is published by Dr. T. S. Clouston of

Edinburgh in the Jou’l’nal of Mental Science for April. Itis a fact of psychiatric medicine not sufficiently ecognised,says Dr. Cloufton, "that attacks of mental disease haveearly symptoms that are ofttn not mental in character and it;.is equally true that in neurology the fact has not attracted

sufficient attention that all sorts of sensory, vaso-motor, andmotor symptoms may be the mere preludes to an attack ofinsanity and not be of themselves the real disease." Such

prodromata are important because the recognition of theirtrue character might enable us in many cases to anticipateand possibly to ward off the mental attack. The practitionerwho is called to see a woman suffering from an unusualform of headache, with anorexia, insomnia, and obscure

parasstbetic sensations, often misses the real point of thecase because he does not realise that such symptoms aie, inthis particular patient, of higher cortical origin and maymean an attack of acute mania in a week if nothing can bedone to arrest their course. The occurrence of a widespreaddisorder of action of the highest cortical nerve centrea,such as underlies an attack of acute insanity, affectsalmost of necessity the sensorial, vaso-motor, and nutri-tive functions of the brain and the body. Often the indica-tions of oncoming disease are shown by disturbance ofsuch functions accompanied with insomnia for some timebefore insanity is developed. Of the sensory disturbancesheadache and obscure cephalic pains and sensations (parms-thesial) easily set up by slight causes are of warning-import. Indigestion, worry and anx:ety, mental over-

fatigue, constipation, and slight alcoholic excess may be-

exciting causes of such disturbances and may lead to slightor severe, but usually not serious, "nerve storms." The"

persistence of insomnia and of melancholic depression makesthe outlook a little more serious. Dr. Clouston reports a.typical case of a woman, 50 years of age, who had been subjectat times to headache and a " weary," painful feeling in the-back of her neck and back all her life when tired, but whootherwise was strong and well-nourished. During a periodof special anxiety and much exhausting nursing which she-had to go through these head and spine symptoms got worseand became continuous instead of being intermittent. Theyunfitted her for work, mental or bodily, and she had toremain in bed all day. There was neither rise of tempera-ture nor local tenderness. Their persistence exhausted herstrength and brought on insomnia and in a few weeksshe became depressed mentally. "When the melancholiacame on all the bodily pain went off. In the course of threemonths she was acutely melancholic and had to be placed ina mental hospital for treatment. She recovered but thefirst symptom of the passing off of the psychosis was

the recurrence of the headache and bodily pains." " She

has had several such attacks since, each one with the same

sequence of symptoms. She has now the impending feelingof danger and dread which so many melancholiacs havebefore an attack. This case is a type so commonly met with,says Dr. Clouston, as to cover very nearly half the field ofmelancholia. In most cases the headaches have not quite-the character of the ordinary "woman’s headache," theyare more constant and intense, more distracting and dis-abling, and attended with "peculiar sensations" as of

weight, lightness, local burning, or "bursting." Often they