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used in the institution and in the home for theroutine care of patients suffering from disease of amild or chronic type or in convalescence. It ispointed out that, whether approved of or not, thissubsidiary nursing service is an existing fact, and thatwomen whose only training is, say, a course in homenursing of a few weeks’ duration, such as those con-,ducted under the auspices of the American Red Cross,are actually engaged in nursing chronic cases through-.out the country. Since the existence of the subsidiarynursing group is a concrete fact, and in view of thevaluable results to be derived from the service of thisgroup in a definitely restricted field, it is consideredthat specific provision should be made for the trainingof workers of this type.The special hospital not served by affiliation with

a school of nursing, and the small general hospitalwhose facilities are inadequate for the maintenanceof a nursing school of standard grade might beconsidered as training grounds. The requirement forentrance should be a grammar-school course or itsequivalent and the period of training approximately-eight or nine months. It is essential in providing forthis type of education that hospital patients shouldbe protected from malpractice and students fromexploitation by an adequate graduate nursing servicefor the care of acute illness and for supervision ofthe students. Again, therefore, reasonable financialsupport must be assured before this, or any other,educational enterprise can be honestly undertaken.It is further believed that a useful development inthe training of nursing aides can be expected onlywhen the standards of the schools for such aides andtheir activities after graduation are controlled bya properly safeguarded system of State legislation,such as now exists in Missouri. The Missouri Act isunusually effective in.providing that " no person shallpractise as a nurse for hire or engage in the care of the:sick as an attendant for hire unless licensed by theBoard."

The Financial Problem.

It is held that the educational plan outlined aboveds sufficient for the solution of the problems involved 1in securing an adequate nursing service of all essential Itypes. The school for nursing aides wouid provide ’,the subsidiary worker needed for the care of the mild.and chronic and convalescent case. The hospitaltraining school, with adequate funds and an inde-pendent educational organisation, would attractmore candidates and better candidates and wouldprepare them adequately for the nursing of acutedisease. The university school of nursing wouldprepare the leaders in public health nursing, in

hospital supervision, and nursing education and wouldinspire and standardise the entire movement. It isclear that the attainment of these ends requiresfinancial support. It is time, in the view of the com-mittee, that the hospital should be relieved from thedilemma of exploiting student nurses on the one hand,or of diverting funds given for the care of the sick onthe other, by the provision of endowment specifically.devoted to the purposes of education.

NATIONAL MILK CONFERENCE.DISCUSSION ON PASTEURISATION.

ABOUT a year ago a conference on the milk problemwas held at the Guildhall, London, convened by the-National Clean Milk Society, and supported by a largenumber of societies interested in the public health,in agriculture, and in the dairying trade. On Nov. 21st,1923, a second conference was held at the Guildhallunder the same auspices and attended by manyrepresentatives of local sanitary authorities and thetrades concerned, including representatives from the-overseas dominions and foreign countries. The-object of this second conference, as Mr. Wilfred

IBuckley, who presided at the morning session in l

the unavoidable absence of Lord Astor, explained,was to throw light on all matters connected withpasteurisation.

Trade Aspects.Six papers were read and discussed, and of these

three were concerned mainly with the trade side ofthe question. Dr. Richard Seligman dealt with thehistory of methods and apparatus, and explainedthe difficulty of ensuring that every particle of milkpassed through an apparatus had been kept at thedesired temperature for the desired period of time.He expressed the opinion that this result was as yetsatisfactorily obtained by only one type of " positiveholder " machine, but that the last word had not beensaid. He appealed to scientific men to help in perfectingmethods, seeing that pasteurisation is, at the moment,absolutely necessary for the liquid milk trade. Mr.J. H. Maggs (United Dairies, Ltd.) considered thefinancial and commercial aspects of the question, andMr. A. T. R. Mattick, B.Sc. (Reading Institute),dealt with the alterations of the cream line andcream layer caused by the various temperaturesused for pasteurising. This is also a trade question.As long as the fat is in the milk, it does not matterfrom a public health or nutritional point of view howmuch of it comes to the top. To many people one ofthe attractions of homogenised sterilised milk inbottles is that the cream will not separate. However,the public naturally judge the richness of the milkfrom the thickness of the cream layer, and it wassatisfactory to learn from Mr. Mattick that if themilk is held for 30 minutes at a temperature notexceeding 145° F., there is not likely to be muchalteration in this layer. The other three papersdealt with the chemical, bacteriological, and so-calledbiochemical changes.

Chemical Changes in Pasteurised Milk.Prof. G. B. Schryver (Imperial College of Science

and Technology) introduced the subject of chemicalchanges. His paper did not suggest that anyappreciable change was likely to occur as the resultof a temperature of 145° to 150° F. for 30 minutes.He referred to the question of the alteration of thecalcium and phosphate content of milk by heat andthe possible precipitation of some of the calciumphosphate. He also mentioned the work of Danielsand Loughlin at Iowa University in 1920 on thissubject, but, as these observers used boiling tempera-tures, their results had no bearing on the presentinstance. Mr. G. W. Monier Williams, Ph.D.,following Prof. Schryver, said that as far as we

knew chemical changes up to 145’F. were veryslight. Lactalbumin was not coagulated, the actionof rennet on milk was unaffected, and the calciumphosphate was not separated from the casein.Pasteurisation diminished the acidity and raised thefreezing-point, but these results might be due to thedriving off of the carbonic acid contained in freshmilk. Capt. Goulding (Reading Institute) thought wecould not speak with certainty as to the meaningof the apparently small changes which took place at1450 F.

I Bacteriological Changes.Prof. J. M. Beattie (Liverpool) read a paper on

the bacteriology of pasteurised milk. He submittedthe results of examining samples of pasteurised milkin all parts of the country, which indicated thatpasteurisation as at present carried out was anythingbut satisfactory. Prof. Beattie went on to quotethe very conflicting results obtained by variousobservers as to the thermal death-point of the tuberclebacillus in milk, and expressed his doubt as to whether30 minutes at 145° F. would render milk safe in thisrespect. Capt. S. R. Douglas (Medical Research Council)and Dr. R. Stenhouse Williams (Reading Institute)expressed the same doubt. Dr. Thomas Orr (Ealing)spoke in favour of the " positive holder " apparatusand considered that milk held at 145° F. for 30 minuteswas good commercially and safe for the consumer.He quoted the results of Dr. F. W. Campbell Brown, of

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Aberdeen,! which showed that 30 minutes at 145 F.or 5 minutes at 163° F. would kill the tubercle bacillusin milk. Dr. Stenhouse Williams emphasised theneed for the education of the workers, whether in thecowshed or in the milk dealer’s premises. Goodapparatus alone was not sufficient ; it must behandled by people with knowledge.

Biochemical Changes.Prof. F. Gowland Hopkins (Cambridge) dealt with

enzymes, immunising bodies, and vitamins. Some ofthe enzymes appeared to be of bacterial origin.They seemed to be rather accidental than essentialconstituents of milk. Their action was slight, wedid not know that they were of any use nutritionally,and their destruction in pasteurisation appeared to beunimportant. The immunising bodies were of no useto the human species, though their presence in milkwas one more argument for breast-feeding. Thethree or four vitamins were all present in milk,nicely balanced, and in quantity leaving little marginof safety. Only vitamin C was likelv to suffer fromheating processes and could easily be compensatedfor. He did not favour pasteurisation, as even ifthere was no proved biochemical harm, his workgave him a bias in favour of altering foods as little aspossible. Dr. Harriette Chick (Lister Institute),following Prof. Hopkins, referred to a New Yorkoutbreak of scurvy as a result of the temporaryabandonment of orange-juice among babies fed onpasteurised milk, and which was ended by theresumption of the orange juice. She emphasised thedanger of repeated pasteurisations, instancing herexperience in Vienna. Dr. S. S. Zilva (Lister Institute)mentioned that vitamin C was less easily destroyedby heat than was at one time thought, if alkalinityand oxidation were provided against. I

In the concluding general discussion Dr. Eric IPritchard, summing up, thought that the viewsexpressed indicated that the changes caused in milkby pasteurisation, as defined by the new regulations,were unimportant, and this was entirely in accordwith his own experience. ’

Advance or Makeshift ?Dr. W. G. Savage (Somerset) said pasteurisation

was a short cut in public health and a confessionof failure. He hoped the recent agitation for cleanermilk would not be discouraged. The trade wasup against the dilemma, "what is safe is not niceand what is nice is not safe." None of these apparatuswas fool-proof. There were three cardinal points ifpasteurisation were adopted as a temporary expedient.These were: (1) Efficient control, (2) a guaranteeagainst repeated pasteurisation, (3) no hindrance

Ito progress in obtaining better milk. Prof. H. R. IKenwood (Stoke Newington) said more knowledgewas needed. Conflicting views were partly due tothe loose use of the term " pasteurisation." Hethought Prof. Beattie’s results had been unsatis-factory because the milk had not been treated inthe most up-to-date " holder " machines. Hefavoured the idea of a team of experts, appointed incooperation with the trade, for the purpose ofendeavouring to settle the points on which opinionswere at variance. This suggestion was stronglysupported by Lord Dawson, who took the chairduring the afternoon session.On the whole, the impression the conference left in

our minds was that no appreciable advance in know-ledge could be recorded since the Guildhall meeting ayear ago. A third conference on the milk questionwas convened by the Society of Arts on April 25thlast and was presided over by Mr. F. B. Acland. Itis probably too soon to expect any information as tohow the new regulations for pasteurisation are

working, but we may venture to hope that beforeanother milk conference is convened, the team ofexperts suggested by Prof. Kenwood will havesomething to report.

1 THE LANCET, August 18th, 1923, p. 317.

MEDICINE AND THE LAW.

Criminal Acts and Mental Deficiency.Two cases recently tried at the Central Criminal’

Court appear to have had some common features butdifferent results, which should be of interest to those-who desire to see the mental condition of personscommitting criminal acts carefully weighed in estitpat-ing the treatment, punitive or otherwise, to be metedout to them. Cuthbert Rice, 26 years of age, the son ofa clergyman, was charged with unlawfully attempting:to forge a public document, the London Gazette ofApril 4th, 1923, with intent to deceive. Havingserved in the army he had afterwards gone to Cam-bridge and had been convicted at Quarter Sessions andsent to prison for stealing from the rooms of under-graduates. He then seems to have conceived the ideathat he could reinstate himself in the eyes of hisrelatives and friends by getting printed, in a spuriouspage, purporting to be from the Gazette, statementswith regard to military honours and awards accordedto him. This obviously would be a course which couldhardly escape detection. Dr. Henry Head gaveevidence that Price was not certifiably insane, but thathe was, in his opinion, a person of

" feeble will anddoubting purpose liable to fits of depression," whocould best be dealt with under medical care in suchan institution as Camberwell House. Dr. W. N. East,medical officer of Brixton Prison, concurred in theseviews, and Judge Atherley Jones, who accepted them,bound the accused over to come up for judgment ifcalled upon, with the object that he might be treatedat Camberwell House. In doing so Judge AtherleyJones said that the law only enabled the court to orderthe detention of persons as mentally defective who hadshown such deficiency from birth, or at an early age.

In another court the Recorder had before himrecently the case of Doreen Taylor, 20 years of age,said to have been a domestic servant, who had com-mitted perjury in connexion with the arrest of twoyoung men, having witnessed the occurrence in thestreet. Her evidence, which involved grave chargesagainst the police, was designed to secure their release,and was clearly of a nature to cause investigation.She had also described herself as a waitress, giving heralleged address, and the untruth proved easy to bringhome to her. Dr. J. H. Morton, of Holloway Prison, saidthat she had thre .tened to commit suicide, and was inhis opinion ment.y deficient but not certifiable.She had committea thefts of suit cases and otherarticles, of which she was also convicted. Sir ErnestWild, in sentencing her to imprisonment amountingto nine months with hard labour, told Taylor that hercareer had been deplorable and that the only thing toteach her was " a hard, sharp sentence."

There appears to be some inconsistency between thetreatment accorded to Rice and the " hard, sharpsentence " which is to teach Taylor to do better,whatever the differences may be in their mental con-dition and other circumstances. No doubt the formerhad relatives who could take charge of him, and thelatter had not, but that hardly seems to relieve theState from a duty to provide in such cases as herssomething more likely to prove beneficial than prisonand hard labour.

An Indecent Exhibition Closed.Sir Chartres Biron commented in scathing terms

upon the conduct of Laurent Wynant, a Belgian, andVictor Luxemburg, a Pole by birth and a Britishsubject by naturalisation, summoned recently at Bow-street police-court for being concerned in exposing inCharing Cross-road an indecent exhibition consistingof wax models of human bodies and of parts of them,and anatomical specimehs preserved in alcohol. SirChartres Biron expressed himself as having beendoubtful on two points only : whether he should ordercertain exhibits to be destroyed, and whether, havingregard to the employment of a girl, 15 years of age,to sell catalogues inside the exhibition, he ought notto send both defendants to prison. Wynant had