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nucleus. The normal turbulence of the granules may beended by exposing them- to a cytoplasmic poison like 1 %methylene-blue, but then the end comes suddenly whenthe cell barrier gives way and the stain enters the cell.Hope Simpson concludes that Brownian movementcannot explain so patently vital a phenomenon as thisgranular turbulence ; it is something more, he thinks,than a mechanical consequence of the colloidal nature ofthe cytoplasm, it is in some way an expression of theindividual properties of the granulocyte.

DIAGNOSIS OF PANCREATIC DISEASEACUTE pancreatitis is almost invariably associated with

a definite rise in the diastase in blood and urine. Thetest may readily be performed by a simple modificationof the Wohlgemuth technique, and the apparatus andtechnical skill required are hardly more complex thanthose used in a routine urine examination ; if the equip -ment is always kept at hand the answer may be hadwithin a few minutes. But a positive result may also beobtained in cases of cholelithiasis and cholangitis. Inthese conditions, however, there is usually some sug-gestion of jaundice ; so a considerable rise in blood orurine diastase without a rise in the icteric index may betaken to indicate an attack of acute pancreatitis. Withnormal diastase values during the first two days of anacute disease it is fairly safe to rule out acute pancreatitis.Loewi’s mydriasis test appears to be unreliable. Thediagnosis of chronic pancreatitis can be confirmed byseveral laboratory tests. It may be associated with fattystools (traditionally with a low percentage of split fat),microscopic signs of undigested protein in the faeces,abnormal glucose-tolerance curves, sometimes with

glycosuria, high blood- and urine-diastase values, highblood-lipase, and a deficiency in many of the pancreaticenzymes as obtained through a duodenal tube. Thesetests do not detect the lesser degrees of pancreaticdisorder and not one of them is positive in all cases ofsevere chronic pancreatitis ; moreover, with some ofthem (for example, high faecal fats and abnormal glucosetolerance) many conditions other than pancreatitis givepositive results. The secretin test developed in Stock-holm by Hammarsten, Agren and Lagerlof is more

specific in both acute and chronic pancreatic disease. Ina recent monograph Lagerlof 1 summarises the Stockholmtechnique and adds a further series of cases proved byoperation or autopsy to be of pancreatic disease. Aftergiving an intravenous injection of secretin, the Stockholmworkers quantitatively recover all gastric and pancreaticjuice for the next 60 minutes through a double tube, theouter section of which opens into the stomach and theinner-30 cm. longer-into the duodenum. Correctionsfor regurgitation of duodenal contents into the stomachcan thus be made by determining either bicarbonate orbilirubin in the gastric juice. The volume, and the bi-carbonate, amylase trypsin and lipase content of the juiceare also determined. In 15 out of 19 cases of acute

pancreatitis there was a decrease in the amylase with nodecrease in the volume of the juice. All cases showed arise in blood and urine amylase ; this test, which shouldalways be performed in suspected cases of pancreatitis isoften positive only during the first 2 days of the illness,whereas the secretin test is usually positive during thefirst 2 weeks. In all cases of chronic pancreatitis there °was a decrease in the volume, the bicarbonate content orthe enzyme content of the juice, or of all three. In a

simplified test Lagerlof determines only the amylase andbicarbonate, the two most stable constituents. Absenceof the amylase indicates acute pancreatitis and of bicar-bonate chronic pancreatic disease, for the bicarbonatewas reduced in 19 of the 23 cases of chronic pancreatitis.This was also true for 2 out of 4 cases of cystadenomaand 6 out of 9 cases of carcinoma. In 67 healthy personsand 44 cases of disease of the gastro-intestinal tract and

1. Lagerlöf, H. O. Acta med. scand. 1942, suppl. 128.

uncomplicated disease of the gall-bladder and bile-ductsthe values for all of the indices of the secretin test werenormal. Abnormal values were, however, found inacidosis and dehydration. This compares more thanfavourably with other methods now in use for the

diagnosis of pancreatic disease in its milder forms andwill doubtless be given further extensive trials when

happier days bring supplies of purified secretin and timefor duodenal intubation.

GOOD CHEER AT CHRISTMAS

" WE are feeling cheered by the recent good war news ;may I suggest that we should provide the means ofcheerfulness and encouragement for our beneficiaries onChristmas Day." In these words Sir Thomas Barlow

prefaces a final appeal for the Christmas Gifts fund of theRMBF. More than .S1000 is needed to make a gift ofE2 to each of those who are dependent on the fund forcomfort, warmth or even enjoyment on Christmas Day.Contributions should be addressed to the hon. treasurer,Royal Medical Benevolent Fund, 1, Balliol House, ManorFields, London, S.W.15 and cheques should be madepayable to the " Christmas Gifts Fund."

A RURAL MOH CONSIDERS PASTEURISATION

IN a comprehensive report to the Cumberland countycouncil on milk and some of its problems Dr. KennethFrazer, county MOH, points out that Government policyin recent years has tended to increase the consumption ofmilk, with priority to certain classes, without anyconcurrent steps to raise the standard of purity. Existinglegislation fails to provide either clean or safe milk, andhe doubts if any substantial improvement is possibleunder existing conditions. Certainly the figures hesubmits for Cumberland suggest little progress. So farmost experts will agree with him, but he takes an unusualview of pasteurisation. While admitting that it has nodetrimental effect on the nutritional value of milk, andthat properly carried out it makes milk safe, he thinksthat it cannot offer complete protection because of theopportunities for human error in carrying out the pro-cess. The need for more fool-proof methods of pasteuri-sation is admitted by all authorities, and they could beachieved. He would surely do better to- emphasise theneed for establishing such methods. He does not favourthe extended use of pasteurisation in Cumberland, reviv-ing the old argument that pasteurisation is an admissionof failure to raise milk to a satisfactory standard of

purity. Actually the evidence is the other way as

Wilson 1 has shown : compulsory pasteurisation mightbe used to raise the standard of cleanliness of milk pro-duction throughout the country, rather than to lower it.In 1934 the Committee on Cattle Diseases coupled theirpasteurisation recommendations with another that allmilk, if to be pasteurised or not, should reach a certainstandard of cleanliness on the farm. Frazer suggeststhat if higher standards of cleanliness were attainedpasteurisation would be unnecessary ; but clean milk haslittle to do with safe milk-clean milk as readily as dirtycan convey the acute infections or the tubercle bacillus.LCC figures show that the percentage of tubercle bacilliis, year after year, higher in " accredited milk " (cleanmilk) than in raw ungraded milk. In Cumberland,Frazer points out, there have been few milk-borne epide-mics and little non-pulmonary tuberculosis ; but hementions 2 milk-borne outbreaks of Sonne dysentery, 2 ofsore throat and some cases of undulant fever ; and, with80 notifications of non-pulmonary tuberculosis yearly,the bovine proportion is probably not negligible, thoughhe makes no attempt to estimate it. But an area may gofor years without epidemics, and it would be as culpableto allow the use of a polluted water-supply on theground that no harm had come of it as to perpetuate thesale of unpasteurised milk. His last point is- that

1. Wilson, G. S. The Pasteurisation of Milk, London, 1942.

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pasteurisation is impracticable in rural areas because ofdistribution difficulties. In many rural areas abroad-for example throughout Ontario-pasteurisation isenforced ; and there seems to be no reason to supposethat compulsory pasteurisation is any less practicable inrural England than in rural Ontario. Frazer’s pamphletis so fair and thoughtful that it is unfortunate he shouldhave based his argument on the somewhat unusual condi-tions in Cumberland. He is careful to remark and repeatthat he is only dealingwith conditions there, but opponentsof pasteurisation are not likely to respect that caveat andmay try to apply his views to the country generally.

Special ArticlesFREEDOM FROM WANT

FIRST THOUGHTS ON THE BEVERIDGE REPORT 1

" Primarily social security means security of income up to aminimum, but the provision of an income should be associatedwith treatment designed to bring the interruption of earningsto an end as soon as possible."-Sir WILLIAM BEVERIDGE.THE greatest single cause of ill health and sub-optimal

health, mental and physical, is not a virus or a bacteriumbut poverty. So it is, the doctor’s duty to fight. povertywith even greater vigour than he fights the diphtheriabacillus. A complete plan for this campaign has nowbeen placed before us by Sir WILLIAM BEVERIDGE, andif when we have studied it from our special point of viewwe are satisfied that it is a good plan it will be up to usto support it with all our might. The picture Beveridgepaints can be studied from two main angles-that ofthe individual and that of the whole country.Consider the individual. Whoever you are, so long as

you are in work, you will be called on to pay 4s. 3d. a weekif you are a man, or 3s. 6d. to 3s. 9d. if you are a woman.You will make this payment by buying a stamp fromthe local Security Office. Thus, there is to be a flatrate of contribution for all. If you are an employer,vou will have to contribute about 3s. a week for eachemployee to the security fund. Thus, the poll tax onindustry which the present insurance schemes embodyis to continue. In return for your contribution, you willbe insured against sickness or accident and unemploy-ment, at the benefit rate of 40s. a week if married, or24s. a week if single or with gainfully occupied spouse.You will receive a basic retirement pension at similarrates, at 65 if you are a man or at 60 if a woman, but onlyif you cease work ; if you go on working your pensionwill go up Is. or 2s. for each extra year you work. Youwill get a marriage grant of up to S10, a maternitygrant of 14, and a funeral grant of 1:20. If you aredisabled, you will receive a pension related to yourprevious earnings, not exceeding S3 a week and not lessthan your sickness benefit, if the disability is total. Foreach child after the first you will receive 8s. a week,and if you are drawing benefit for sickness or otherreasons you will also get 8s. a week for your first child.If you are a working woman and have a baby you willget 36s. a week for 13 weeks to make up for your loss ofearnings and encourage you to stay away from work aslong as is really necessary ; if you become a widow,you will get 36s. a week for 13 weeks, and if you haveno children you will be given training in a new job ifyou need it ; if you have children to care for, you willget a guardian’s benefit of 24s. a week at the end of the13 weeks as well as children’s allowances. Whoever youare, if you are out of work for more than 26 weeks andthere is no job in your old trade, you will be trained fora new one. Finally, your contributions will cover

medical treatment for you and your family at home, inhospital and at a rehabilitation centre, but when youare in hospital, you will have to pay the 10s. a weekout of your benefit which you would otherwise be

1. Social Insurance and Allied Services. Cmd 6404. HMSO. 2s.

spending on food and heat and clothes at home. That,in outline, is the plan as it affects us all. The reportdeals in detail with every human financial situation thatseems likely to arise, and each is carefully provided for.It is, in fact, a complete blue-print for implementing thefifth clause of the Atlantic Charter in Britain; it offersus for the first time freedom from want.

Turning now to the picture as a whole. One of

Beveridge’s prime assumptions is that Britain in futurewill be free from mass unemployment. If a prosperouscommunity shares its purchasing power equitably, therewill be plenty for all. But in a depression of trade,with real scarcity of the products of labour, no amountof redistribution of wealth will supply the necessities oflife to all who need them. It was not part of Beveridge’sduty to prescribe cures for unemployment ; buteconomic scientists, and even some politicians, knowthat such cures exist. The difficulty lies rather in theirapplication. The annual cost of the scheme, workingfull blast, is some 850 million pounds, or about aneighth of our present national income. This is not anunreasonable price to pay. About E130 million of thisis to come from employers, and E520 million from theExchequer, largely in the form of income-tax. Thus,the employer will be called on to pay three times-asan ordinary citizen, as an employer, and as an income-tax payer. It may be argued that this is neither fairnor good for industry. A simple answer would be toabolish the employer’s contribution and increase thatfrom the Exchequer. This would combine the benefitof a uniform payment for all with graduated payment(via income-tax) based on capacity to contribute.A fortnight ago we published the interim report of

Medical Planning Research. That its conclusionsshould have come so close to Beveridge’s is not acoincidence, though it is a tribute to the economicskill of our younger medical planners ; the problemsexamined were the same. MPR’s benefits were slightlymore liberal, but slightly less comprehensive. Theirtotal budget was 1050 million, whereas the Beveridgebudget is 850 million. This difference is accounted for

by MPR’s inclusion of first children for allowances-anextra cost of 200 million. MPR proposed gradedcontributions for all. MPR proposed a social securityboard, and gave cogent arguments in favour of thisform of administrative machine ; Beveridge proposes aMinistry, with an additional board to run voluntaryindustrial insurance, but gives no detailed argumentsfor his first choice. On the purely financial side it seemsto matter little, but on the medical administrative side,untouched by Beveridge, doctors may hold strongviews. On the central aim medical planners will surelyfeel that they can give Beveridge their full support.

MEDICINE AND THE LAWPunishment under the Scabies Order

RECENT prosecutions at Leeds for offences against theScabies Order may have useful effect in informing thepublic of the measures available for checking this verycontagious disease. The medical officer of health, Dr.J. Johnstone Jervis, told the magistrate that the Leedscorporation had opened five centres for treating patients.Since last June some 1500 cases had been notified ; fromthese notifications more than 4000 other cases had beendiscovered. The Scabies Order was made by theMinister of Health a year ago under Defence Regulation33A. Under its authority a medical officer can inspectpremises accommodating verminous persons and canrequire those persons to submit themselves to medicalexamination and to present themselves for, and undergo,cleansing and treatment. Where the order relates to achild, the parent or guardian must do what is necessaryand must comply with any reasonable requirements orinstructions. In the Leeds cases a man and three womenwere summoned for failing to attend for examination ;two of the women were also charged with failing to submittheir children for examination. Another woman, stated