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Bullough of Essex, was that the building for the sickmust in future be a part of a local centre for preventiveas well as curative medicine. Such a scheme, in whichthe hospital itself would be merely a necessary detail of

. the whole, had been worked out at Grantham but post-poned owing to the war. A new idea was embodiedin the Harvard Hospital (somewhere in Wessex) whichwas a base for a field unit with its laboratories, combinedwith a hospital for infectious diseases. Mr. Elcockfavoured the policy of using hospitals for education inhealthful living ; the building was as important as whathappened inside it. As regards size it seems clear thatthe day of small, scattered special hospitals is over.

For historical reasons, as Dr. Harkness pointed out, theisolation hospital, sanatorium, maternity hospital andso on had risen independently ; there was no reason whythey should not now be grouped and the isolation of theirmedical and nursing staffs ended. This would accentuatethe importance of circulation ; as many as 20 traffics

might have to be considered in a modern general hospital.Mr. Elcock claimed that his continuous veranda type ofward, with beds parallel to walls, ensured a far largeramount of sunlight per patient ; this had been shownexperimentally at the Building Research Station and inpractice at the Hertford County Hospital. On one

point both architects and doctors were agreed-the needfor specialisation in hospital construction by both

professions. The day of the benevolent amateur is over.The local architect’s plans, adapted by clinicians with thematron called in as an afterthought, produce a buildingwhich is often more cottage than hospital. The

Emergency Hospital Service has revealed the need forspecialist hospital officers. The effective coroner is- ablend of lawyer and doctor ; should not the centralauthority, at least, have on its staff a doctor who is

qualified in architecture ?

RISKS OF PARACHUTE-JUMPINGNEw methods of warfare tend to produce new types of

injury as missiles and machines change, and to someextent treatment changes accordingly, although basicsurgical principles remain unaltered. The pathology ofparachute-jumping is the latest offspring of aviationmedicine, itself so recently a lusty infant, and in whatmust be one of the first reviews of these injuries inEnglish, Tobin, Cohen and Vandover have surveyedthe accidents occurring during the first year of parachute-training in the United States. They note that the fourphases of a jump are each associated with a special groupof injuries. The first arise at the time of leaving theplane and are due to entangling of equipment or failureof the parachute to open, and these are usually fatal,although in one case where the jumper got hooked tothe tail of the plane he escaped with a dislocated hip.In the second phase, when the parachute opens, theshock may produce serious abdominal or thoracic

injuries, a danger that may be lessened by distributingthe shock over as wide an area of the body as possible.During the third stage of actual descent, diverse lesions

.

may occur, and in this connexion Boothby, Benson andLovelace 2 have pointed out the risk of fatal anoxiawhen the pilot has bailed out from over 30,000 ft. duringhis descent to sufficiently oxygenated air at 18,000-20,000 ft. The injuries on impact compose the fourthand by far the largest group, consisting mainly of moreor less complicated injuries to the lower extremities ;and fortunately these can be minimised by intensiveground-training in alighting before actual jumping is

begun. In all, 2-4% of the jumps made were associatedwith some injury, but only a quarter required hospital-isation ; 80% of these major injuries were fractures, noneof them compound, half of which were malleolar,, though1. Tobin, W. J., Cohen, L. J. and Vandover, J. T. J. Amer. med.

Ass. 1941, 117, 1318.2. Boothby, W. M., Benson, O. O. and Lovelace, W. R. J. Aviat.

Med. 1940, 11, 59.

fractures of every bone of the lower limb were recorded.Rather unexpectedly the os calcis was fractured onlyonce. Falls on the outstretched hand resulted in anoccasional fracture of the clavicle, humerus, or radialhead. The frequency of malleolar fractures must beascribed to uneven landing associated with cross-currents,unskilled guidance of the parachute, and irregularterrain, these factors combining to produce a violenttemporary shearing force across the ankle-joint. Theincidence of these injuries, which are of the type thattend to unfit a man for further jumping, is small, andTobin and. his colleagues attribute this to careful pre- ‘

liminary training in the art of jumping. This paperleads to the reflection that parachute-troops are one ofthe few groups of fighting-men separated from theirmedical services during active warfare ; but perhaps thisproblem, too, will be solved in time.

DRIED AND CONDENSED MILKS

THE deficit of liquid milk for the main body of thepublic owing to its welcome increased intake by childrenand pregnant and nursing mothers, and the large importof dried and condensed milks from the U.S.A. andCanada naturally raise the question of the relativenutritive values of these commodities. How far doescondensation and drying lower the food values of milk ?People who have heard that cooking destroys vitamin Crush to the conclusion that heat treatment of milk

destroys all its nutritive value. They may take comfortfrom an article by S. K. Kon 1 of the National Institutefor Research in Dairying in which he gives a comprehen-sive table of the constituents of various forms of milk andthe loss of them, if any, in manufacture. The loss isremarkably small, except in vitamins B and C, andsince milk is of small value in supplying these vitaminsit matters hardly at all from a dietetic point of viewwhether milk is taken pasteurised, sterilised, condensedor dried. Milk is valuable mainly for its first-classprotein, its calcium and its vitamin A. It makes asubstantial contribution of riboflavin but its values forvitamins C and D are low. Fortunately vitamin Aand riboflavin are not reduced at all even by drying, noris the calcium rendered less available. There is possiblysome small reduction of the biological value of the pro-teins, but it is negligible. Even the drastic treatment ofmilk in spray drying destroys only 10% of its Bl and 20%of its C. Dried and condensed milks are therefore notto be despised by anyone, and there are hygienists wholook forward to the day when milk will bepurchasableonly at the grocers.

A SUPER DUST MAN

John Switzer Owens, whose death is announced,qualified at Trinity College, Dublin, in 1892 and tookhis M.D. four years later. He played truant from theMedical Directory to reappear in 1912 with high engineer-ing qualifications as hon. secretary of the Committeefor the Investigation of Atmospheric Pollution underthe chairmanship of Sir Napier Shaw, director of the

Meteorological Office. Of this committee our Mr. Vaseywas also a member ; much of the work was done inTHE LANCET laboratories, and the reports appeared assupplements in our columns. Owens had the bonhomieand the drive to make any collective investigation asuccess, he had a vision of what England might be withoutsmoke, and his agile mind was constantly devising newand better methods for trapping and measuring theparticles of dust in the air. He was also the instigatorof the Coal Smoke Abatement Society and whereverlinen can now be hung out to dry without gettinggrimy, or the reader in a city garden can turn over thepage of his novel without first blowing the smuts off it,the name of Owens should be held in honoured

memory.

1. Nature, Lond. 1941, 148, 607.