during the period, that they may not by overexercise or ignorance, lay the foundation for future trouble. Rest and sufficient warmth help to maintain a normal period, as does regulating the bowels so as to avoid constipation at this time.

There is no certain cause of menstruation known. It was thought in biblical days to be an uncleanness.

In modern times, the theory has been advanced that it is a result of congestion brought about by the reflex irritation of the growth of a Graafian follicle in the

ovary.

We do not really know the cause, but it probably occurs most commonly in connection with ovulation, and is due to a periodic nervous excitation and congestion of the sexual organs governed by the sympathetic nervous system. It is analogous to the rut of lower animals. The unimpregnated ovum is probably discharged at the height of the menstrual congestion, though many believe this occurs previous to the flow. When the ovum is fertilized, menstruation does not take place. When the periodical activity of the ovaries ceases, menstruation disappears.

Before the menstrual period there is a congestion of the lining of the uterus and the small blood-vessels are dilated; later the blood escapes through the intercellular spaces and takes some of the cells with it. After the flow, the lining shrinks and returns to its usual condition until the next menstrual period, when the same process is repeated.

According to one view, the swelling and congestion of the membrane are a preparation for the reception of the fertilized ovum. If the ovum fails to be fertilized, then degenerative changes occur in the membrane and a part of it is discharged with the flow and the rest absorbed. This view assumes that ovulation precedes menstruation by a considerable period and that menstruation indicates that the ovum was

The other and less common view is that menstruation occurs before the ovum reaches the uterus and leaves a raw surface upon which to graft the ovum. To support this theory the fact is advanced that in dogs the flow of blood precedes fertilization.

The maturing and discharge of the ovum is known as ovulation. The ovum (Latin for egg) is the tiny cell (1/120 of an inch) which is a miniature egg, produced and matured in the ovaries in large numbers from an early age, but more actively during the time of life from puberty till the menopause. They are discharged one at a time usually, occasionally two or three, as seen by resulting twin or triplet pregnancies. Only a few ova, as compared to the large number in the ovaries, mature.

tents.

At puberty the ovaries enlarge, have an increased blood-supply and the sacs containing ova become larger, distend with fluid till they bulge on the surface of the ovary and rupture, discharging the conThe ovum passes through the Fallopian tube to the uterus (womb) probably by means of the current set up by the hairlike processes on the lining membrane of the tube. Then, if not fertilized by the spermatozoa meeting it, it is thrown off. Its exact relation to the time of menstruation is not known. Some think that the ovum is liberated from the ovisac and ready for impregnation in the uterus before the menstrual flow. Certainly women are believed to conceive more readily just before the menses than just after, although both are recognized as likely periods of conception and many claim to avoid conception by avoiding its possibility for a week after the menses.

Menstruation is certainly dependent on the periodical activity of the ovaries, since their removal is generally followed by permanent cessation of the menses, except that in instances where even a small portion of the ovary is left, menstruation

may con

However the variety of questions now being vigorously discussed may be settled, as to the length of time a nurse should spend in training, what she should be taught, how and when the teaching shall be done, and a hundred other phases of the subject, there has never been greater need for emphasizing the plain prosaic fact that is in great danger of being overlooked, namely, that the patient is the most important person in the hospital; that his comfort and welfare are never to be lost sight of during her training. In the shortening of hours of duty, necessary though this be, and the study of how to relieve the nurse from this, that and the other duty, there is serious danger that she will lose or fail to develop the sense of responsibility for the well-being and comfort of the sick, without which she will always be an indifferent workman, never capable of filling a very big place in the world's activities.

Chief among the things which she should be taught very early in her training is the fine art of making a patient comfortable, an art in which the nurses of an older generation excelled, even if they knew less about chemistry and psychology and bacteriology and some other ologies than the nurse of today,

If I were training nurses in this year, 1920, I would (at least I think I would) teach very early in the probationer's course. all the simple little methods of adding to a patient's comfort that I have learned in my dozen years of nursing. I would repeat the lesson at intervals till I felt sure no nurse of mine would forget that her neglect of these simple homely duties meant often a sleepless night and a retarded recovery. Even among well people the kind of bed and the way it is made, or not made,

often means the difference between comfort and discomfort-between a wellrested body in the morning and the opposite. It makes still more difference to the sick. I have long since learned that teaching the proper methods of bed-making to a class of probationers is only the first step toward getting that simple duty done every day in the proper way. It needs eternal vigilance during the early months of training to see that wrinkled sheets and crumbs are not adding to the keen discomfort of a newly operated patient.

I remember once making rounds in the evening and being surprised with an outburst of weeping that met me in a room where lay a patient who had had an amputation of the breast a few days before. "I'm so uncomfortable," she cried, and the feeling that the nurse had neglected her or did not care was, I found, adding to the bodily discomfort. It was not the pain from the wound, she said. It needed only a casual investigation of that bed to find a badly wrinkled gown and sheet. A collection of crumbs and lint and cotton, an unwashed mouth, parched and dry and a variety of other small things that spelt neglect on the part of the nurse very plainly. It needed but a few minutes to completely change the conditions so that the patient fell into a restful sleep, but the nurse had not cared enough to see that it was done.

It seems to me that I would take up a whole lesson hour in just showing a nurse. how to arrange pillows, so that the patient would have the utmost comfort from them. I could have a variety of small pillows of different shapes and sizes and I would spend a good deal of time in showing how these might be adjusted to relieve strain on the various parts of the body. I would try to get them to understand the

importance of getting a wounded part supported at just the right angle; of elevating a part gradually and supporting it evenly; of turning the pillows often and shaking them; of keeping the window shades and the artificial lights so adjusted that sensitive eyes would not be annoyed by lights; of watching for cold feet and applying extra heat without being told; of letting the patient have his own way when it did not make any great difference; of trying to remember their likes and dislikes about food and drink; of closing doors softly; of keeping up a wholesome optimistic atmosphere so that the patient's mental condition would help and not hinder his physical healing or recovery.

I wish I had been given even a few lessons on psychology when I started to nurse. It would have meant much for me and much for my patients. I did understand in a crude way that it was a good thing to keep the patients' courage up and keep bad news from them as long as possible, but I did not realize how powerfully the mind influences bodily healing. I think every nurse should be taught that lesson very early in her course so that all the patients she cares for may benefit by it. I have always been glad that my first two years of training were spent in a small fiftybed hospital, where we learned to regard patients as persons and not as cases; where each nurse was responsible for the care and comfort of a definite number of patients, and the duties were not divided up so that the sense of responsibility was lost in the division. It has always seemed to me that when one nurse took temperatures and another gave medicines and baths and an

other was responsible for meals, etc., and the observations were recorded by some one else, that the hundred and one small things, which together make for comfort, were in sad danger of being overlooked. That the sense of responsibility for the welfare and comfort of a patient would be a hard thing to develop under those conditions.

Perhaps when the new scheme of things is at last evolved we shall find that making the patient comfortable will be classed as a menial task-considered beneath the dignity of the nurse of the new era. But when that time comes, if it ever does arrive, we shall find the human family evolving a substitute for the nurse of the period, one who will still be old-fashioned enough to believe that the art of making a patient comfortable is one of the most important of the fine arts; we shall find people paying well for having the art practised-regardless of all laws and rules on the subject, regardless of whether the nurse substitute is licensed or registered, regardless of what the nurse graduates of today may think about it. There is a law of supply and demand that is as powerful as any law that has yet been devised, and so long as the little attentions that make for bodily comfort can be secured with money, the American patient of today who has the money will reserve the right to pay for them. The attitude of mind which the nurse of the future has toward this important phase of nursing depends much on the instruction she gets and where the emphasis is placed during the first six months of her training.

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In the closing days of 1919, State registration of nurses became an accomplished fact in Great Britain, thus bringing to an end, it is hoped, the war between nursing factions that has lasted for well-nigh thirty years. The bill is in reality three bills one providing for the registration of nurses under a General Nursing Council for England and Wales, and similar bills for Scotland and Ireland.

It must be a little difficult for those of another country to understand the chequered career of the registration movement in Great Britain. It is not only that we are conservative here and reforms are slow to

come-slowest of all in a profession that has a semi-religious origin—it is that personal feeling has played such a disproportionate part in a matter of pure common sense and justice.

More than a quarter of a century ago there was a small but active party working for state registration, chief among whom were Mrs. Bedford Fenwick and the late Miss Isla Stewart. If registration is a good thing today, it was a good thing then, and we may well ask the reason for the delay in what seems to be a matter of British justice.

Why? There is no reason for not being frank in the answer, though it reflects little credit on us. The reason is partly conservatism and apathy, but mostly the tendency to let personal feeling over-ride logic. The leaders of the movement and their methods were not liked, and therefore the majority of the nursing world took the opposite side. It is rather small-minded, but it is human. Much the same thing happened in the suffrage movement: many women, without considering the right and wrong of the question, declared themselves against woman suffrage "because we do not approve of the militant methods."

At the time of which we are speaking-25 years ago the nursing profession might have been divided roughly into three parties. -a small progressive party working actively for state registration under the pioneers mentioned above; a small sincere antiregistration party led by the matron and chairman of the London Hospital, and the great majority of nurses ignorant and apathetic on the subject. For years the pioneers worked and very gradually they From the increased their following. apathetic mass a certain number began to think out the matter, to realise the need for this reform and to join the Society for the State Registration of Nurses founded by the pioneers. It took a certain courage to do so, and they had often to explain to criticising friends that, although they knew the leaders were unpopular and although they did not approve of the bitter personal attacks which formed part of the campaign, yet, believing in the principle, they felt it their duty to work for it. Still, however, the greatest number remained apathetic, or, worse still, signed anti-registration mani. festos without seriously considering the question, because, like the anti-suffragists referred to, "they did not approve of the methods." To be quite fair, one must make some excuse for them. The registration leaders, instead of merely preaching the justice of their cause, attacked their opponents in such a vulgar and abusive way that it had become a byword in the profession, and while the more frivolous spirits scanned the nursing papers each week to enjoy the personal attacks and wonder how long they would go on without leading to a libel action, the more thoughtful section deplored the degradation of nursing politics and kept themselves out of the muddy arena.

This was much the state of affairs when the war broke out. True, several registra

tion bills had been before the Houses of Parliament, and once a Committee of the House examined the matter. But the re

sult was always the same. Although the demand was reasonable enough, the opposition and the apathy were always present. Although the registrationists quoted the support of organized societies, the opponents could always reply that the membership of these was small, and that apart from active opposition there was no demand from the thousands of nurses working all over the country. The legislators were puzzled and naturally took the view that, until the nurses were agreed among themselves, the question had better wait.

Then came the war with its demand for trained nurses. At once the need for organization made itself felt. What was a trained nurse? There was no legal stand

ard. Of course three years in a general hospital" was the accepted criterion, but the need was great, and two-year trained were also asked for. Then came the V.A.D. members, women with a short Red Cross training how were they to rank and would they give themselves Out as "trained nurses" after the war by virtue of their experience in military hospitals? Again, what organisation was there to protect nurses in matters of pay, hours, conditions? There had always been a crying need for organisation.

Now at last it must be met.

Thus came into being the College of Nursing (Limited by guarantee, as the technical formula runs). It was founded on a plan that had been worked out several years ago by the matron and authorities of Guy's Hospital. A small committee was formed composed chiefly of matrons of the large training schools. This number was added to, and with Sir Arthur Stanley as Chairman, the College began its career. Its first step was to form a Register of trained

who had trained years ago, when shorter training was accepted, these were admitted during a time of grace, provided that they produced evidence of satisfactory training and of experience with reliable testimonials. This Register has been an undoubted success, having already nearly 16,000 names. Other objects of the College were the framing of a uniform curriculum, the provision for post-graduate courses, scholarships, etc., the establishment of Centres all over the country, the endowment of a Fund to be used partly for educational purposes and partly to help elderly and disabled nurses in need.

It will not surprise American readers to learn that very soon after starting its work, the College Council realised the need for State Registration and made it one of the

"planks" in their platform. Some rather

scornful criticism has been made by the old pioneers against those matrons on the College Council who formerly signed petitions against registration and who "in the twinkling of an eye," so to speak, became registrationists when they were on the College Council. We do not defend them; we merely return to the suffrage analogy and point out that as soon as registration was supported by more reputable methods, the reasonableness of it became obvious to those who examined it impartially. Moreover, the College of Nursing with its wide backing and its comprehensive programme, attracted that section of whom we have spoken who had supported the principle, while deploring the methods, and most of them joined the College, leaving the pioneer party rather lonely and cold. But true to its aim of solidarity, the College of Nursing made every effort to unite all parties. It almost amalgamated with the Royal British Nurses' Association, a venerable body with a Royal Charter which for some years had suffered from sleeping sickness. The combination would have been an all-powerful one. It did not suit the belligerent pioneer registrationists that this new body should