The subjective valuation of the alienist cannot in practical life be the test of responsibility--the Judge, as representing 'common sense,' must decide. At the same time, it recognizes the enormous value of preventive medicine in relation to the detection of mental disorder in its earliest stages. Sir George Newman, in his recent work "An Outline of the Practice of Preventive Medicine" lays great stress upon this point. He states: "Here, as elsewhere, we must seek to begin at the beginning. An understanding of eugenic principles and practice, a new aptitude and alertness in the physician, a new type of clinic, special hospital and institution--"early treatment centres"--a system of "voluntary boarders" in approved homes and institutions, a wider education of the public in what causes and constitutes mental incapacity, a larger apprehension of the meaning of self-control--all this is necessary if we would prevent mental disease. It is obvious that such a policy raises many questions of science, law and administration. But the experience of the war and of our colleagues in America (at the Phipps clinic at Baltimore and the psychiatric hospital at Boston) all points in one direction, namely, the practicability of establishing suitable psychiatric clinics in this country for dealing with early cases of mental and nervous disorder." In order that the whole-time staff of the prison medical service should be kept fully acquainted with modern developments in medicine and surgery, a system of "study-leave" was inaugurated in 1909, whereby a certain number each year take up a post-graduate course at the large hospitals. Special leave is allowed for the purpose, and the Commissioners pay the fees. Each officer chooses his own course of study, subject to the approval of the Medical Commissioner, due regard being paid to the special requirements of the prison service. The nursing of sick prisoners is carried out by officers of the hospital staff, except in the smaller prisons where, for the present, outside nurses are engaged. The male officers are selected from candidates who have had nursing experience in the Royal Army Medical Corps or in Institutions, and they undergo a course of training in prison nursing and hospital duties at the invalid convict station at Parkhurst, Isle of Wight, before appointment to the hospital staff. As regards the female officers, these have, in the past, been officers trained in the larger female prison hospitals, but the question of securing more fully trained nurses for female prisons is now under consideration. With this object in view, a Voluntary Advisory Nursing Board has been established consisting, for the most part, of distinguished members of the medical and nursing professions to advise the Commissioners in formulating a scheme for a prison nursing scheme, and the Board will, it is hoped, be a useful auxiliary to the administration for this purpose in the future. CHAPTER XVI.