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Experience of gelatin is confined almost entirely to theUnited States : apart from its relatively brief effect,and the need to convert it from a gel to a sol by warmingbefore use, it seems satisfactory. Dextran is used in manyhospitals here and in Scandinavia and Holland : itrestores blood-volume satisfactorily, and remains in thecirculation long enough to sustain it until the amount ofcirculating plasma-protein is again sufficient for this

purpose. The third substance mentioned, P.v.p., is anewcomer to this country, though as Periston ’ it hasbeen used in Germany during and since the war, and as’Subtosan’ it enjoys a vogue in France. Two reports onP.v.p. made here under a British proprietary name’Plasmosan’ appear in our present issue. It seems to be

easy and cheap to make ; it is apparently non-antigenicand non-toxic ; and it does not need special conditionsof storage. Urinary excretion accounts for some 50-55%in twenty-four hours ; and the question arises whethera substance to be used for restoring blood-volume couldnot with advantage be retained longer in the blood-stream- result that might be attained by adjusting the relativeproportions of the smaller and larger molecular fractions.The fate of the P.v.p. which does not appear in the urineis not known with certainty. German reports state thatnone is excreted in the bile. Examination of the tissuesof animals given large doses of P.V.P. has revealed nomorphological changes, but it would be instructive tohave reports on chemical analyses of tissues. The per-formance of certain clinicopathological tests is said to beaffected.The preliminary report of the clinical results suggests

that P.v.p. can be used with advantage, particularlyduring surgical operations, in which " shock " occurs ;but its blood-volume-restoring properties-in other words,its value as a plasma substitute-cannot properly beassessed until its effects on the circulation are known inmore detail. Observations in burns patients and thosewho have suffered blood-loss or trauma will be neededto permit a full evaluation : in particular we shall wantserial records of blood-pressure and pulse-rate, of plasma-protein, haemoglobin, and haematocrit levels, and if

possible of cardiac output and right-auricle pressure.The main function of any plasma substitute is to restoreand maintain the circulating blood-volume until the

patient’s own plasma-protein returns to the circulation,and success in doing this is the main criterion by whichsuch substances must ultimately be judged.

ILLEGITIMATE CHILDREN

THOSE who undertake to help unmarried mothers needto know a great deal about the law, especially the statutesrelating to custody and maintenance of illegitimatechildren, legitimation, adoption, paternity and blood-tests, affiliation, inheritance, and nationality-as wellas the benefits to which the mothers are entitled, andthe arrangements for fostering and boarding out thechildren. In a new booklet,l decoratively bound andnicely printed, Miss Lena M. Jeger, on behalf of theNational Council for the Unmarried Mother and herChild, sets out all this necessary information and more.Her clear well-written paragraphs are like an arc-lampin the dark thicket of legal terminology ; and a goodcontents page, well-chosen headings, and an index helpto make the way still plainer.As Prof. Alan Moncrieff says in an introduction, illegiti-

mate babies start their lives under grave disadvantages.Since 1918 there have never been less than 40 illegitimateinfants for every 1000 children born alive. The peakwas reached in 1945, but even in 1949 the rate was50-7 per 1000 live births. Miss Jeger reminds us in aforeword that in 1918 the death-rate during the first

1. Illegitimate Children and their Parents. London: NationalCouncil for the Unmarried Mother and her Child, 21, CoramStreet, London, W.C.1. 1951. Pp. 72. 3s. 6d.

year of life was 91 per 1000 liveborn legitimate children,and 185--more than double-per 1000 liveborn illegiti-mate children. In 1949 the comparable figures were 32and 45-the rates, in fact, are drawing nearer to eachother, but even so are grossly different. The neonataldeath-rates have always been closer : in 1918 they were34-5 per 1000 legitimate live births and 66-4 per 1000illegitimate live births ; in 1948 the comparable figureswere 19-3 and 27-4. This bears out the common experienceof social workers that it is not in the first month of lifebut later in the first year that the illegitimate infant isexposed to specially unfavourable influences. His chieftrouble, of course, is that his mother has to go out towork, and she may not earn enough to get him welllooked after. But it is not only on the physical side thathe suffers ; lacking his mother for a great part of theday, he may become backward in his emotional develop-ment ; and moreover, as Miss Jeger points out, "he isgoing to miss a father in the same way that any child wholoses his father early, through death or separation, misseshim." The baby whom the young mother was courage-ously determined to keep may grow into " a difficult,naughty and exhausting child " ; and both he and hismother will then need help.The National Council, founded in 1918, has always

worked for legislative reform to help the illegitimatechild. Much progress has been made, as this little bookbears witness. But, as Miss Jeger puts it,

" no legislation

can compel anybody to give the unmarried mother whatshe usually most needs-friendship, understanding, andcompanionship in what is almost inevitably a lonely anddeeply traumatic experience." Armed with this guide tothe statutory provisions, the social worker-or even theuntrained well-wisher-should be able to deal fairlyeasily with the material problems and turn her attentionto the more fundamental needs of the pair she is anxiousto help.

DETECTION OF SPINAL BLOCK

THE Queckenstedt test is well known for its value indemonstrating spinal block ; but in some cases ofpartial block the findings are equivocal, and occasionallythere may be a normal rise of cerebrospinal-fluid pressureeven though myelography or operation discloses com-pression of the spinal cord. Kaplan and Foster Kennedv 1have investigated the effect of different positions of thecervical spine on the response to bilateral jugularcompression (usually the test is carried out with thecervical spine straight or very slightly flexed). Of 294patients with various neurological disorders, 12 showed anabnormal response to jugular compression with thecervicaf spine in either full flexion or full extensionwhile there was a normal rise of pressure with the neckin the neutral position. In 8 of these 12 patientsexploratory laminectomy was performed ; none had a

spinal neoplasm, but in 4 there was a " compressingexostosis of the cervical spine," due either to arthritisor to a calcified disc protrusion at C5-6 level ; in 2 adisc protrusion at C5-6 or C6-7 level; and in 2 adhesivearachnoiditis around the - mid or lower cervical cord.The whole series included 31 cases in which cervical-cord

compression was diagnosed clinically ; these comprisedthe 12 cases already referred to ; 3 in which there wasa complete Queckenstedt block with the neck in anyposition ; and 16 with normal responses to jugularcompression even with full flexion or full extension ofthe neck. Exploration was performed in 7 of this lastgroup ; no demonstrable compressing lesion was foundin 6, while in the 7th there was a slight filmyarachnoiditis.

Kaplan and Foster Kennedy regard this modificationof the Queckenstedt test as helpful in the diagnosisof spinal compression at C5-6 level, which is the pivotal

1. Kaplan, A., Kennedy, F. Brain, 1950, 73, 337.

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point for movement of the cervical spine on an immobilethoracic spine. In their cases no removable cause ofspinal compression was demonstrated by the manoeuvre,but it entails no especial inconvenience to the patientand would be worth carrying out in patients withcervical-cord lesions before deciding about the need formyelography.

OUR MENTAL HOSPITALS

As our population grows, so do the numbers of ourmentally sick. For years now our mental hospitals havebeen getting more and more crowded, and-as the Boardof Control note in their latest report —the overcrowdingon Jan. 1, 1950, amounted to 14%, as against 12-2% onJan. 1, 1949. The results, as they point out, are not to bemeasured only in terms of actual overcrowding (thoughthat is bad enough) : the pressure on beds also obligesthe hospitals to limit the number of voluntary. admissions.This means that preventive work and early treatmentare both gravely hindered, which can only bring a greaterload on the hospitals in the future.

Three factors, the board find have contributed to thisserious situation. In 1949 some 3034 mental-hospitalbeds were still being used for other purposes ; and

though by 1950 the number had fallen to 2753, even thesecould be spared very ill. At the end of 1949 there were146,228 people under mental-hospital care-an increaseof over 1500 on the preceding year. The board commentthat the return of borrowed beds is not proceeding asrapidly as necessary ; moreover, of the beds so farreturned, over 2600 are still awaiting reconditioning andre-equipment. In the course of the year 1949-50 only 87of these returned beds had been refitted ; and thenumber of new beds provided for mental patients by theregional hospital boards was only 92-a total increase of179 beds in a service treating an additional 1500 people.This can only mean the setting up of extra beds in wardsalready full. The situation would be eased if all the bedsnow available could be fully staffed ; but at the end ofthe year a further 2279 beds were out of commission

merely because staff could not be found for them.

Staffing, however, had improved on the whole since theprevious year : there had been an addition of 303 full-time and 618 part-time women nurses, and of 517 full-time male nurses, with a fall in the ratio of patients tonurses from 7-6 to 7-4 for women and 5-5 to 5-4 for men.This ratio is much too high. Loss of trained and experiencedstaff, moreover, has been progressive, and " continuanceof the service even at its present level is only possible bythe use of less trained persons and by the very substantialuse of part-time nurses." Part-timers, indeed, haveproved invaluable ; but their number cannot be increasedindefinitely, and their employment brings its own

administrative problems.Short-handed, cramped, and housed, in the main, in

inconvenient buildings, the mental service is yet givingan unflagging long-term demonstration of how to makethe best of things. The incidence and death-rate fromtuberculosis in mental-hospital patients is being steadilyif slowly reduced ; the death-rate from gastro-intestinalinfections has fallen to less than 1 per 1000 patients. Thedeath-rate per cent. of the average number of residents,though, in 1949, it was 1-17 above the rate of the previousyear, is nevertheless below the mean percentage for thepast ten years-which means that very good work hasbeen done during a time when overcrowding has beensteadily increasing.

Social and cultural activities-as well no doubt as

occupational therapy-are everywhere gaining ground.In 1949 the Council for Music in Hospitals was givingconcerts in 44 mental hospitals, while the PictureLibrary Scheme organised by the British Red Cross

1. H.M. Stationery Office, 1951. Pp. 9. 6d.

Society was already supported .by 30 hospitals. Thereport does not mention the progress made in establishingtherapeutic social clubs or in the setting up of art classes,but many hospitals are now interesting themselves iathese forms of therapy. In 56 hospitals the Women’sVoluntary Services continue to give help and are nowundertaking follow-up visits to patients-a piece of ser. ,vice which may do something to replace the communitycare formerly given throughout the country by theNational Association for Mental Health.Methods of collecting statistics from mental hospitals

have been revised, and an index card has been adoptedfor individual returns on patients admitted to mentalhospitals in England and Wales. The completed cardsare sent to the General Register Office, and punchedcards are prepared from them, from which statistics canbe produced mechanically. The system came into opera.tion at the beginning of 1949, and is working smoothly;and at the same time regulations for the keeping of hos.pital registers were brought up to date. A scheme isbeing prepared to deal with patients’ earnings. Sometimesconvalescent or stable patients go out to work for localemployers and earn several pounds a week. The hospitalis entitled to recover from them such part of the costof their maintenance and incidental costs as seems

reasonable. Part of the remainder is to be kept by thepatient as pocket-money, and the rest will be banked onhis behalf. This means that on discharge he has a

sum of ready money. Moreover, since his capacity toearn is well established, his status usually rises with hisrelatives and friends.

BREAST CANCER IN MOUSE AND MAN

THE discovery in mice of Bittner’s milk factor, a

virus-like agent transmitting heritable mammary tumoursto young sucklings, naturally led to attempts to identifya similar factor in human milk. It may cause surprisethat, though Bittner discovered the milk factor about1936, only in the last couple of years have similar reportsabout human milk come to hand. This is because inman identification of such a factor depends on a differentmethod. The mouse agent can be found by experimentaltransmission to other susceptible mice. Even these

experiments take nearly two years of the life of a mouse;and during this time the young test mouse is growing up,maturing, and herself becoming a cancer-prone breeder.Along those lines-and there is no other direct biologicaltest, for a human agent would not be transferable tomice-it will take a very long time, the collaboration ofseveral generations of observers, and much careful well-planned work to obtain similar information in manabout the relation between breast cancer in mothers,breast-feeding, and breast cancer in daughters and

grand-daughters. Nevertheless such records are beingundertaken.

Meanwhile some very small particles, varying indiameter from 200 to 1200 Angstrom, have been seenwith the electron microscope in preparations of mousemammary tumours and mouse milk both at Leeds andin the U.S.A. The precise relation of these particles toBittner’s milk factor is not yet decided, but it is signifi.cant that when the factor is known to be absent theparticles can be found only very rarely. The Leedsworkers have now reported some findings in humanmilk.2 2 These are tantalisingly equivocal; for althoughparticles were found in 11 out of 11 breast tumours andin 4 out of 4 samples of milk from patients with breastcancer, they were also found in 11 out of 12 samples ofnormal milk, 1 of which contained a large number ofparticles. It may be that some of the producers of these

1. Passey, R. D., Dmochowski, L., Astbury, W. T., Reed, R.Nature, Lond. 1947, 160, 565.

2. Passey, R. D., Dmoehowski, L., Astbury, W. T., Reed, R.,Eaves, G. Ibid, 1951, 167, 643.