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suspended in a propellent mixture of fluorochlorocarbons,and the suspension contained in a plastic-coated glassbottle fitted with a device which delivered 70 mg. of spraycontaining 0-1 mg. of dexamethasone phosphate sodium.Twelve sprays in a day therefore released 1-2 mg.of the phosphate ester, equivalent to 1-0 mg. ofdexamethasone.

In a clinical trial with this aerosol in 71 patients withchronic asthma, the mean duration of illness was 15.4 yearsand 54 of the patients had already been receiving predni-sone for two years before the start of the trial. Most ofthe patients were given three aerosol inhalations fourtimes a day (equivalent to 1.0 mg. of dexamethasone), butsome had as few as nine inhalations and others as manyas twenty. Before taking the steroid aerosol, the patientinhaled a bronchodilator aerosol to ensure maximum

penetration and retention of the steroid, or alternativelya bronchodilator was incorporated in the steroid aerosol.Clinical assessment was made weekly in all patients, andventilatory studies, including vital capacity, forced

expiratory volume at one second, and maximum

expiratory flow-rate, were carried out fortnightlyin 54. 35 (50%) of the patients were judged to show

striking clinical improvement, 23 (32%) moderateimprovement, and 13 (18%) no improvement on theaerosol therapy. Adverse reactions were noted in 10 cases(local irritation of the pharynx and tongue in 8, and " badtaste " in 2). Another patient had a large increase inappetite. There was no rise in the incidence of hyper-tension, peptic ulcer, diabetes, or tuberculosis, and noexacerbation of these conditions where they alreadyexisted.

It was possible gradually to withdraw oral prednisonein 21 of the 54 patients who had been having it, and ina further 27 to reduce the daily maintenance dose froma mean of 14.4 mg. to a mean of 5-6 mg. per day. Thegreatest reduction in oral therapy was possible in patientswho had uncomolicated bronchial asthma. In 6 vatientswhose asthma was complicated by emphysema or bron-chiectasis, it was not possible to reduce the daily dose oforal prednisone at all. In 12 patients who had been on10-20 mg. of oral prednisone daily, the reduction of

dosage made possible by the institution of aerosol therapycaused regression of signs of hypercortisonism such asmoon face, acne, and ecchymosis; and in 2 cases in whichattempts at oral prednisone therapy had to be abandonedbecause they gave rise to mental instability, aerosolsteroids relieved symptoms without causing this side-effect. In all but 1 of 17 cases in which steroid therapywas indicated when the trial started but had not previouslybeen given, treatment by inhalation produced satisfactorysymptomatic relief. In acute attacks of asthma precipi-tated by infection, aerosol therapy was unsuccessful, andlarge doses of oral prednisone were required to bring thedisease under control; so inhalation seemed unsuitablefor such episodes and for status asthmaticus.When steroids are inhaled some systemic effect is pro-

duced by absorption from the lung or from the gastro-intestinal tract.15 11 and Bickermann and Itkin 14 pointout that, like oral therapy, aerosol treatment shouldnot be used until conventional resources have beenexhausted. But they believe that in maintenance therapyfor bronchial asthma, providing the technique is adequate,inhaled steroids offer in most cases at least as effective

15. Strang, L. B., Knox, E. G. Lancet, 1960, ii, 550.16. Liddle, G. W. J. clin. Endocrin. 1960, 20, 1539.

symptomatic relief as steroids given by other routes andwith much less risk of side-effects. These results will

certainly revive interest in this form of treatment.

PRISONS

THE Prison Commissioners, in their report 1 for 1962do not discuss the implications of their absorption int(the Home Office. What will happen, for instance, to thi:annual report, which contains so much information ointerest to penologists and penal reformers ? It would b<

regrettable if it were transformed into a few pages at thend of a Home Office document. Prison affairs occupydisproportionate space in the Press, and it is crucial thathe Commissioners should have this annual opportunityto put " the other side". In fact, we should like to knovmore of what the Commissioners really think: sometime:their grievances pierce the diplomatic language-folexample, their regret that so many approved-schoofailures come to detention centres, with the problems thebring and their poor record after discharge. They wouldevidently like aftercare for these lads, and they do noseem to think much of magistrates who give short prisorsentences for petty larcency to borstal boys out on licence

But the Commissioners are too restrained in their com-ments on the cuts which Government economies imposecon the educational programme during the year.On the whole, the report describes a year of progress,

despite an average prison population (31,063) that was7 &deg;,% up on 1961. Discipline was decidedly better, withfewer riots, acts of violence to officers, escapes, andawards of corporal punishment to prisoners. The

improvement may well be related to the favourable res-ponse to the recruitment campaign for prison officers:which must have raised the morale of the existing staflas well as easing their burden. Pre-release hostels are

proving successful, though unemployment has held updevelopments in some places where they were most

needed. The impact of trade recessions often falls hardeston those whose " need " for regular work is greatest.The report notes that of 335 men discharged from suchhostels up to the end of 1961, 290 had not been recon-victed one year later-a much higher proportion thanamong men of the same type who did not go to hostels.As with so much of the Commissioners’ work, however,valid conclusions are bedevilled by selection, for menwere specially chosen for the hostels, and not allocatedto them at random. Penologists seem slow to learn thatexperiments are of limited value (and may even be a

handicap) unless they are constructed so as to give usefulcomparative results. The report states: " The hostel

prisoner has a suitable job found for him and somewhereto live and spend his leisure hours. If he finds the worldof free men confusing and frightening during the day, heat least has the security of a prison to return to of anevening, with a measure of comfort superior to that whichhe had previously known in prison." This fact that the

long-sentence prisoner may feel threatened and insecurewhen he is discharged is too little recognised, and under-lines the parallel between so many aspects of penal andpsychiatric endeavours. Both systems offer social, mental,and occupational rehabilitation within a protected environ-ment and have independently evolved techniques withmuch in common.

1. Report of the Commissioners of Prisons for the Year 1962. H.M.Stationery Office. Cmnd 2030. Pp. 125. 8s. 6d.

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The Commissioners are finding (as the psychiatristshave done) that, as experience with open establishmentsaccumulates, their use can be extended with great benefit-and slight, if any, increase in hazard. In August, 1962,Ashwell Prison was designated as the first open prisonfor recidivists, and the transition from " star " class mento recidivists is proceeding with success: it seems thatneither misconduct nor absconding have increased andthat the chronic offenders are no less hard-working ortrainable. " Further experience of the experiment at

Ashwell ", the report says, "may point the way to a wideruse of open prisons; this would need to be on a regionalbasis, so that men can be transferred and yet be visitedeasily by their relatives, and to facilitate arrangements forwelfare and after-care." On the other hand, news of theremand centre for boys at Ashford does little to offset theimpression gained last year when it was stated 2 that ladsthere spent many hours a day locked in cells. The psychiatricprison at Grendon got under way, and we hope that thereport’s " consideration is being given to the possibilityof evaluative research of the work " is less negative thanit sounds.

Research, in fact, is what penology seems to need morethan anything else, and the little list of studies in an

appendix to the report is not reassuring. Researchableideas spring from almost every page: there is a governor’sobservation, for example, that the number of youthssentenced to detention for violent crimes seemed to

decrease after a detention centre had been opened in thatarea; and the finding that 9 out of 22 drug addictsdiagnosed at one prison were Canadians.The prison medical services seemed to be static, with

general health slightly better but venereal disease ratherworse. The number remanded for psychiatric investiga-tion increased slightly to 7015. The number of prisondoctors rose by 4 full-timers and 8 part-timers, but theDirector of Medical Services rightly calls for a muchmore substantial addition to his staff. Only some radicalproposals from the committee now at work on the prisonmedical service are likely to give him a satisfactoryresponse.

THE GROWTH OF A NAIL

THE epidermis and its appendages must have come infor observation since first man decided he was his own

proper study. Yet skin, hair, teeth, and nails are still

wrapped in more than their fair share of mystery andold-wives’ tales. Twenty years ago, Prof. W. B. Bean 3was apparently so impressed by the wealth of dogma anddearth of substantiated fact about nail growth that hebegan a piece of research wholly remarkable in thenuclear age-namely, a record of the rate of growth ofhis own left thumb nail.

His experimental method was simple. At the beginningof each month he filed a mark at the base of the nail whereit emerged from under the. cuticle; and he then noted thenumber of days elapsing before the mark grew out at thenail margin. Later he added refinements: a woodenframe was constructed in which the nail could be repeatedlyphotographed at standard magnification; progression ofthe filed marks from a reference point tattooed on theskin at the nail base was then observed weekly.Bean found that, when he started the investigation at

the age of thirty-two, the nail grew at an average daily2. Conference on Remand Homes, Brighton, Oct. 31, 1962.3. Bean, W. B. Arch. intern. Med. 1963, 111, 476.

rate of 0.132 mm. Twenty years later this had fallen to0.102 mm. and the mark took nearly a month longer togrow out. Slower nail growth, he concludes, is a featureof ageing; but, although the slowing was most strikingduring the past three years, he has not been aware of anysudden parallel decline in his general activity. In 1950Dr. Bean had mumps, and this infection was reflected bya precipitate fall in the rate of growth of the nail. Butthe rate was little influenced by changes of environmentor occupation (none of which were, in fact, very great),and no seasonal variation was apparent.Thus, Bean has been able to satisfy his curiosity, on

some points at least, by applying the old " do it yourself "principle that used to be the mainstay of the scientificapproach. This principle has been losing place to themodern alternative of scouring published reports forother people’s opinions; but Dr. Bean is refreshinglyold-fashioned.

THE WELLCOME TRUST

THE many activities and interests of the WellcomeTrust are reflected in its fourth report,! covering 1960-62,and the increasing support given by the Trust to medicaland allied research is plain from the E2 million allocatedduring these years-nearly twice the sum distributed in1958-60. The geographical extent of the Trust’s work is,under the terms of Sir Henry Wellcome’s will, unlimited,and it has become virtually worldwide in its influence.Sl million has been allocated for building and for researchequipment in the United Kingdom alone; but the largestbuilding grant was E120,000 to the University of Otago fora medical research institute at Dunedin. Special attentionhas been given to the needs of workers from overseas whowish to do research in the United Kingdom and who mightfail to get help from other sources. There are clearlymany difficulties in judging the merits of the complexinvestigations for which financial support is sought (theyconcern topics as diverse as primitive skeletal remains,temperature regulation in wild animals, and the immuno-logical properties of lymphocytes), and the report acknow-ledges the valuable services of outside experts acting asassessors and the cooperation of other organisations, suchas the Nuffield, Wolfson, and Ciba Foundations and theLeverhulme Trust Fund.A Henry Dale research professorship in medical science

has been established by the Royal Society and endowed bythe Trust (the first holder is Dr. J. L. Gowans); and asystem of senior research fellowships in clinical science hasbeen inaugurated, to be awarded on nominations fromprofessors rather than on direct applications. In 1960 thetrustees acquired the contents of the Wellcome HistoricalMedical Museum and Library, and the library premiseshave now been improved to house the Guerra collectionon the early history of American medicine and a newOriental collection.

Despite the recent and necessarily increased attentionto the needs of the library and the historical museum, it isclear that the Trust has not allowed its scope to be in theleast narrowed. At a time when Government funds forresearch in this country are inadequate and when heads ofresearch departments often spend much time in search ofmoney for their projects, staff, and even accommodation,the Trust has repeatedly risen to the occasion. Research-workers in many countries will wish to renew their thanksfor the powerful support of the Wellcome Trust.

1. Obtainable from the Trust at 52, Queen Anne Street, London, W.1.