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Is it not obvious that efficient executive and technicalability, especially for posts in the borderline sciences,outweighs academic prowess ? P Until such time as theuniversities make provision for the biochemist by offeringsuitably abridged medical training, it would seem thatfor hospital chemists the paper qualification par excel-lence is the F.B.I.c. (branch D). However that may be,Sir Philip Panton, consultant adviser in pathology tothe Ministry of Health, has affirmed that a science

graduate should be in charge of the biochemistrylaboratory.London, N.W.10. D. WATSON.

Public Health

Tuberculosis in London

THE report for 1947 of the county medical officer ofhealth for London 1 shows that the mortality-rates fromtuberculosis were the same in that year as in 1946(pulmonary 0-62 per 1000 and non-pulmonary O.ORper 1000) ; these rates " for the present at least may beregarded as having reached the level to which theymight have declined if the pre-war trend had not beeninterrupted." ,

The morbidity figures, on the other hand, "indicatethat the over-all cost of war in terms of tuberculosis isnot yet fully paid." The rate of primary notificationsof pulmonary disease, after rising to 1-83 per 1000 in1941, fell to 1-57 per 1000 in 1946, while in 1947 it rosevery slightly to 1-58 ; the morbidity level is still morethan 20 % higher than it was immediately before thewar. Both relatively and absolutely the incidence ofpulmonary, infection in children has taken a disturbingupward trend ; the rates per 1000 for the 0-14 age-groupfrom 1943 to 1947 have been : 0.85, 0-85, 0-83, 0-94,and 1-04. With regard to pulmonary disease in adultsthe war-time emphasis on males has disappeared andthe male-to-female ratio has fallen below the pre-warlevel, " indicating that the pre-war excess of females inthe important 15-24 age group has been accentuated andsuggesting that beyond age 25, either marriage does notgive so much relaxation from strain as formerly or thatin the middle age groups women are now suffering fromover employment and hardship during the war years."

Influenza

The number of deaths in the great towns of Englandand Wales in the week ended Feb. 19 was 158 (comparedwith 94 in the previous week) ; 87 of these occurredin London and the south-east. The majority of thedeaths (135) were in people over 55, so there is no signof any relative increase in the number of deaths in youngpeople. There has been some increase in incidence inLondon and the south-east, but generally speaking thedisease seems to be mild.

Scotland’s Vital Statistics for 1948Mr. E. A. Hogan, Registrar-General for Scotland,

announced in Edinburgh last week that the totalpopulation in the middle of 1948 is estimated at 5,169,200—an increase of 30,500 over mid-1947. This is due toa natural increase of 43,300, reduced by a net emigrationof 12,800 of which 12,100 was overseas and 700 to otherparts of the United Kingdom.The birth-rate was 19-4 per 1000 population ; this is

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2-6 below that for 1947, but 0-2 above the average ofthe previous 5 years.The death-rate was 11-8 per 1000. This is 1-1 below

the rate for 1947, and 0-8 below the average for the 5 years1943-47 ; it is the lowest rate ever recorded in Scotland.

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The marriage-rate was 8-5 per 1000-01 below thatfor 1947, but 0-2 above the 5 years’ average (1943-47)and 0-9 above the pre-war average (1934-38). The infant-mortality rate was 45 per 1000 live births.

This is 11 below that for 1947, and 14 below the 5 years’average (1943-47). It is the lowest rate ever recordedin Scotland, being 9 below the previous lowest rate in

1. London County Council : Report of the County Medical Officerof Health and School Medical Officer for the Year 1947.Obtainable from Staples Press Ltd., 14, Great Smith Street,London, S.W.1. Pp. 102. 2s. 6d.

1946. The neonatal rate was 25 and is also the lowestever recorded for Scotland ; it is 4 below that for 1947and 5 below the average.The death-rate from all forms of tuberculosis was

76 per 100,000-4 below the rate for 1947, and 1 belowthe average for the previous 5 years. The rate forrespiratory tuberculosis-66 per 100,000-is the same asthat for 1947, but 6 above the average for the previous5 years.The maternal mortality was 1-5 per 1000 live and still

births. This is the lowest on record. It is 1-2 below the5 years’ average and 0-5 below the mortality for 1947.The rate is only a quarter of that of 22 years ago, andis only about half the rate experienced as recently as1944.

Parliament

Safe MilkIN moving the second reading in the House of Commons

on Feb 21 of the Milk (Special Designations) Bill, whichhas passed through the House of Lords, Dr. EDITHSUMMERSKILL, parliamentary secretary to the Ministryof Food, described it as " a triumph over ignorance,prejudice, and selfishness." It could, she continued, beregarded as an ancillary to the National Health ServiceAct, because it would reduce the incidence of tuberculosisand disablement, and the death-rate. She would alwaysthink of it as the " Milk (Save the Children) Bill," andshe believed that most of the medical profession woulddo likewise.

It was a reform of great social significance. Since1944 the number of attested herds in the country hadbeen doubled and it now comprised 16 % of the cattlepopulation. But the cleaning up of our dairy herds,and particularly the eradication of animals infectedwith tuberculosis, would take many years to complete.Quicker progress could have been made by the removalor destruction of all animals reacting to the tuberculintest, but the cost and the drop in milk productionwhich it would entail would be prohibitive. As eradica-tion must be a gradual process it was vitally necessarythat milk should be pasteurised before sale for humanconsumption. Today the consensus of opinion amongstresponsible medical people and health authorities wasstrongly in favour of pasteurisation. Prof. G. S. Wilsonhad recently put the number of deaths due to milkinfected by the tubercle bacillus at about 1500 annually,and many thousands more were crippled. Among childrenthe percentage of deaths was ten times greater in ruralareas, where more milk was drunk raw, than inLondon.The Cattle Diseases Committee estimated that about

40 % of our dairy cows would react to the tuberculintest, and that about 0-5 of milch cows suffered fromudder tuberculosis. There were also other diseaseswhich the.Government were anxious to eradicate, suchas contagious abortion and mastitis. The Governlnent’s

responsibilities in this matter were greater by reasonof the official encouragement given to the drinking ofmilk through various welfare food schemes in schoolsand elsewhere. Pasteurisation, if carried out efficiently

- and under proper conditions, destroyed all pathogenicorganisms in milk. It did not make poor milk good orgood milk better, but it made all milk safe. At presentsome 70 % of the milk sold for liquid consumption inthis country was subject to some form of heat-treatment.Pasteurisation had practically no effect on the nutritionalvalue of milk.

Describing the machinery of the Bill Dr. Summerskillsaid that probably the first area under it might bespecified in a year or 18 months, but it -might take5-10 years before the country as a whole wascovered.

Mr. SOMERVILLE HASTINGS said that anyone who hadseen the frustration, continued ill health, and incapacity,as well-as the premature deaths, due to drinking tuber-culous milk, must be keenly in favour of the principlesof the Bill. He was glad that children and others werenow drinking 50 % more milk than before the war,but we must see to it that the milk was pure. In London98 % of the milk was pasteurised. Repeated tests for