1417PASTEURISATION AND THE NUTRITIVE VALUE OF MILK

wait until the report of the Astor DepartmentalCommittee in 1912 before the dream of its founderwas realised. Flick has pointed out that the periodof voluntary hospital development in this countrysaw a marked decline in tuberculosis mortality. In1848 the death-rate was 2-97 per 1000 living ; in1888 it had fallen to 1-54. Now it has been nearlyhalved again, and although these declines in

mortality cannot be attributed to any oneagency, there can be no doubt whatever thatthe dispensary movement has justified the faith ofits founder’!

IN DEFENCE OF RESEARCH

Prof. G. Grey Turner, professor of surgery in theUniversity of London at the British PostgraduateMedical School, who has recently been elected a vice-president of the Research Defence Society, willdeliver the eleventh Stephen Paget memorial lectureat the annual general meeting of the society which isbeing held on Tuesday, June 15th, at 3 P.M., at theLondon School of Hygiene and Tropical Medicine,Keppel-street, W.C. Prof. Grey Turner will speak onwhat research owes to the Paget tradition, and thechair will be taken by Lord Lamington, president ofthe society, who will be supported by Sir ArthurStanley and Prof. A. V. Hill, F.R.S. Members areinvited to bring their friends to the meeting. The

society may be addressed at 11, Chandos-street,Cavendish-square, London, W.l.

INDUCTION AS A ROUTINE

Mathieu and Holman 2 of Portland, Oregon,compare the results in some 750 consecutive casesin which premature labour was induced, with thosein another 750 contemporary cases in which the onsetof labour was left to Nature. A study of these twoseries should (but may not) leave the reader convincedthat no woman ought to be allowed to go into labourspontaneously. In the series in which induction wasperformed, the maternal mortality (one death) washalf what it was in the other group, while the foetal

mortality (corrected) was in the same proportion.The length of the first stage of labour was considerablydiminished in the induced series, and there was nodifference in the morbidity-rate. The method ofinduction used is said ’to have been completelysuccessful. At 7 A.M. an enema is given, followed at7.30 by a variable dose of pentobarbital. The patient isasleep in half an hour, and pituitary extract in 3-minimdoses is injected at half-hour intervals afterwards.If labour has not started after the third or fourth

injection and the membranes are still intact, theyare ruptured artificially. (It should be noted thatthis is not advised if there is a malpresentation or ifthe fcetal head is not engaged.) The injections ofpituitary extract are then continued until the patient isdefinitely in labour. In Mathieu and Holman’s seriesthere were no untowards results-no pituitary shock,no premature separation of the placenta, no precipitatelabour-and it is somewhat ironical that the onlycase of rupture of the uterus was in the series ofcontrols in whom labour was not induced. Theindications for induction are stated most brieflyas

" those cases which promised trouble, the toxaemias,large babies, contracted pelvic outlets, apprehensiveand nervous patients, &c." The results seem tohave been excellent, yet we are not altogether

1 A tribute is paid by the Edinburgh medical school to SirRobert Philip’s work in the Edinburgh Medical Journal forMay, 1937.

2 Mathieu, A., and Holman, A., Amer. J. Obstet. Gynec.Feb., 1937, p. 268.

surprised that many of the speakers at a meetingto which they were related commented adverselyupon the procedure, and suggested that it is betterto allow labour to start spontaneously unless thereis some definite reason for the termination of

pregnancy. Be this as it may, certain facts dodemand careful attention. The method was employedover a large number of cases, and the incidence ofcomplications was negligible. Pituitary extract wasused as a routine but in small repeated doses, and itsadministration was stopped as soon as labour painswere established. There was no report of uterine

inertia, and this is of interest in view of the attentionlately drawn to the high incidence of inertia of theuterus in women in whom labour had been startedby the insertion of bougies. The advisability of

administering pituitary extract during induction oflabour needs further examination.

PASTEURISATION AND THE NUTRITIVE VALUE

OF MILK

THE dangers of raw milk as a vehicle for the

conveyance of disease are well known and repeatedlyemphasised in our columns, as well as the safetygiven by efficient pasteurisation. These are demon-strable facts that cannot be gainsaid ; so the opponentsof pasteurisation, who fear its advent chiefly becauseof the disturbance they believe it will cause in presentmethods of distribution, have to fall back on the

argument that heat reduces the nutritive value ofmilk. They are apt to talk vaguely of the possiblepresence of some component that might be affectedby pasteurisation, but they cannot isolate or define it.A valuable report issued by the Milk NutritionCommittee provides no reason for thinking thatmilk contains any such factor and shows that thereis little difference between the nutritive value ofraw and pasteurised milk. Further evidence maybe found in a report on the nutritive value of raw andpasteurised milk for calves by Prof. Wilson, Prof.Minett, and Mr. Carling.2 2 Their experiment, whichlasted over two years, was made with milk from a

healthy shorthorn herd. Calves as they were bornwere allotted alternately, without any selection,into two groups, one fed on the raw milk and theother on the same milk after pasteurisation. Mixedmorning milk was used, and it was given in measuredquantities in strict relation to the weight of the calves.This impartial allocation was not perfectly satis-

factory and in fact operated against the pasteurisedgroup because fewer bull calves happened to beallocated to this group while it included two weaklingswho died from other causes. Apart from these two,all the animals throve well and showed no signs ofrickets or anaemia. The average increase in weightover the eight-week period for the animals in theraw-milk group (25 calves) was 53-72 lb. ; in the

pasteurised-milk group (23 calves) it was 53-86 lb.

Incidentally the highest individual gain among thebull calves and also among the heifer calves was inan animal fed on pasteurised milk. No physicaldifferences could be noted by any observers betweenthe animals in the two groups. Prof. Wilson and his

colleagues conclude that " there is nothing in theseresults to suggest that the nutritive value of

pasteurised milk for calves is in any way inferiorto that of raw milk." Earlier studies have suggestedthat one effect of pasteurisation is to diminish theavailability of the calcium and phosphorus in milk.

1 See Lancet, May 15th, 1937, p. 1179.2 Wilson, G. S., Minett, F. C., and Carling, H. F. (1937)

J. Hyg. 37, 243.