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different strains of human diphtheria bacilli were used, the virulence of four of them being fully tested." Massive and repeated feeding with highly virulent

cultures (in one case on 11 occasions) were quite withouteffect. Kittens whose throats were inoculated by swabswith enormous numbers of diphtheria bacilll, either aloneor mixed with staphylococci and streptococci grown directfrom human cases of diphtheria, remained unaffected, andthe bacilli had disappeared within 24 hours. The possibilitythat the failure to infect the kittens was due to the absenceof a local nidus of growth was met by creating such a nidusby a preliminary scarification of the throat, and with otheranimals by painting with strong silver nitrate solution.Subsequent massive inoculation with diphtheria bacilli stillfailed to produce any infection or, what was remarkable,any persistence of the bacilli locally. The same strikingfact was brought out by a series of nose-swabbings withheavy doses of diphtheria bacilli. In every, instance thebacilli rapidly disappeared, and neither local -nor constitu-tional symptoms resulted. These results were exceptionallyuniform and concordant. It was found impossible either toinfect the kittens or produce a carrier condition, even oneof very short duration."

The whole series of experiments led Dr. Savage tothe opinion that the common and widely accepted viewthat cats could suffer from a naturally acquired diseasecaused by the diphtheria bacillus was entirely withoutfoundation. The reported cases of such an associationwere based upon insufficient examination and differ-entiation of the bacilli found, due to a failure to realisethat a large proportion of healthy, normal catscontained in their throats bacilli closely resembling,and difficult to distinguish from, the true B. diphtheriæ.

TUBERCULOSIS.

Dispensary Treatment: : the Ideal and the laecel.IN a report published as an appendix to the L.C.C.

Report of the C.M.O. and S.M.O. for the year 1919

(P. S. King and Son, Ltd., price 5s.) there is an

illuminating and admirably candid review of the work,and in some cases of the want of good work, at varioustuberculosis dispensaries in London. - The disclosuresmade certainly warrant revision of the conduct of a

system on which the whole tuberculosis campaignhinges. One of the most valuable functions of the

dispensary medical officer is visiting the patient in hishome. Yet it appears that the tuberculosis officerattached to St. Thomas’s Hospital is not allowed by therules of the hospital to consult at the. homes of patients.On this point the report is emphatic. " This is anunfortunate restriction, and it is desirable in theinterests of efficiency that the rule should be revised."A fault of certain tuberculosis officers appears to be alack of intensive study of the individual case. Cases inwhich the diagnosis is doubtful are kept dancing inattendance for perhaps a year; more and more are addedto their number, till the machinery of the dispensarybecomes clogged and there is no time for the physicalexamination of even a tithe of the patients. As thereport puts it: "...... the observation cases cease to beobserved, and the only thing that is done for them isthat their medicine is repeated." The number ofattendances made at these peccant dispensaries isaccounted for mainly by the large number of childrenwho receive treatment without diagnosis.A far more efficient system was found to be adopted

in other dispensaries, where great pains were taken tostudy each case intensively for a short period and toarrive quickly at a diagnosis. As for the actual treat-ment given at the various dispensaries, some seem tobe perpetuating the pernicious " bottle-of-medicine "system. In one dispensary the drug bill amounted tomore than £900, and the extent to which " drugging "still exists is illustrated by a hospital dispensary where4569 prescriptions were dispensed for a total attendanceof 4853. The medicine included 1785 bottles of cod-liveroil, alone or combined. In another case large quantitiesof virol were used. As the report points out, this

wholesale" drugging" tends to make the patient relymore on the medicine and less on such essential mattersas hygiene and diet. With regard to treatment by the

general practitioner, the attitude of the tuberculosisdispensary officer seems to have undergone a markedchange. Formerly he wished to treat every tuberculouspatient himself. At present many such officers realisethat it is essential to maximum efficiency that thegeneral practitioner should not be excluded from thetreatment of this disease. It also appears to be ad-mitted that the treatment of the individual case by thetuberculosis officer does not yield materially betterresults than when treatment is left to the general prac-titioner. Many other aspects of the dispensary problemare discussed in this report, which does not mincematters, and which, instead of attempting to whitewashthe backslidings of badly run dispensaries, goes so faras to name the worst managed districts and to indicateclearly the lines along which reforms should be made.

Insurance against Pulmonary Tuberculosis.The Insurance Committee for Newcastle-on-Tyne

has issued a survey of sanatorium benefit in the periodJuly, 1912-December, 1919. The Committee’s medicaladviser, Dr. W. H. Dickinson, observes that in themajority of cases patients were not notified and reliefwas not sought till the disease was advanced. Thus,in 1918, 50 per cent. of the persons certified as dyingof pulmonary tuberculosis had not been notified beforedeath or had died within three months of notification.It was also ascertained that the average duration ofillness before notification was 15 months. Dr. Dickinsonmakes some very pertinent suggestions in this con-nexion. In his opinion there should be some form ofinsurance against pulmonary tuberculosis, subsidies toconsumptives being more urgently needed than pensionsfor persons over 65. As matters now stand, the expec-tation of life for pensioners of this age among theworking classes is very much longer than for patientsin whose sputum tubercle bacilli have been found.During the period under review only 66 per cent. of theinsured persons known to have died from pulmonarytuberculosis in Newcastle applied to the Committeefor treatment, and Dr. Dickinson is convinced that,were something more attractive than the ordinary64 slickness benefit " available for these patients, animportant step would have been taken towards securingthe earlier diagnosis so essential to the patient and hisfamily. Dr. Dickinson adds : " Obviously the con-sumptive who had been treated for months on endfor bronchitis’ would be far from satisfied when helearnt that he had been entitled to extra allowances.and had not received them. This dissatisfaction wouldsoon bear fruit." With regard to the establishment ofindustrial colonies, as recommended by the Inter-

Departmental Committee, Dr. Dickinson calculatesthat there are, roughly, 1200 cases of pulmonarytuberculosis living in Newcastle. Allowing for fourcontacts for each case, Newcastle alone would providebetween 5000 and 6000 occupants for an industrialcolony. Also, as about 200 new cases would for someyears be arising annually, with 800 new contacts, thesum to be expended on the colony would be enormous.

Suggested Application of the Public Health Acts.In the report of the Medical Adviser to the Belfast

Insurance Committee for the year ending Dec. 31st,1919, Dr. A. Trimble emphasises the relation tothe incidence of tuberculosis of "real" wages, thatis to say, the relation between wage and cost of

living, as distinct from mere wage irrespective ofthe purchasing value of that wage. In a table

showing the results of treatment it appears that 124out of 1840 patients were cured or their disease becamequiescent. In 738 cases there was a family history oftuberculosis, 113 patients having a father and 160 havinga mother who had suffered from tuberculosis. Thedeath-rate from pulmonary tuberculosis shows a fallfrom 2’7 per 1000 in 1918 to 2’1 in 1919. While thetuberculosis officer for Newcastle-on-Tyne advocatespensions for the tuberculous as a means towards stamp-ing out the disease, the medical adviser to the Belfastcommittee advocates more drastic remedies. He writes:" What is urgently required is that not only shouldtuberculosis be placed on the list of infectious diseases,but the patient should be subject to all the provisions

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of the Public Health Act, so that where a patient iswithout proper lodging or nursing accommodation,’and where the local authority is willing to provide forhis institutional treatment, he should not be allowed toremain at home, a source of injury to himself and amenace to the health of those with whom he lives."

THE LEAGUE OF RED CROSS SOCIETIES:THE MEDICAL ADVISORY BOARD.

THE first meeting of the Medical Advisory Board ofthe League of Red Cross Societies was held at Geneva,at the headquarters of the League from July 5th to IJuly 8th under the honorary presidency of ProfessorEmile Roux, director of the Pasteur Institute at Paris. IDr. Simon Flexner, director of the Rockefeller MedicalResearch Institute, served as chairman, and ColonelS. Lyle Cummins and Professor Giuseppe Bastianelli acted as secretaries. ’

The majority of the recommendations submitted tothe Board by the Medical Section of the GeneralCouncil of the League in March were approved. Thosewhich will not be put into effect at this time were con-cerned chiefly with the establishment of laboratoriesand a museum, it having been decided that for the timebeing it would be wiser for the League to utilise existingfacilities.

A Policy of Coöperation.In general, the Medical Advisory Board outlined for

the League a policy of cooperation with national RedCross Societies and other health agencies, and of actingas a clearing-house for medical information. The latterfunction will continue to be accomplished through theLeague’s publications and through the free medicalinformation service of the Department of MedicalInformation. The publications include the InternationalJournal of Public Health, a scientific organ ; theBitlletin of the League of Red Cross Societies, a

popular monthly, both published in four languages;and pamphlets of various kinds.The support of national Red Cross Societies for the

campaign against typhus and other communicablediseases in Poland was asked, and the cooperation ofthe League of Nations was requested.The immediate organisation of a child welfare unit,

and its despatch to some country which would engagegradually to take over its work and to duplicate itsactivities, was sanctioned. The work of this unit is toinclude the training of doctors and nurses, as well asthe education of the public in child welfare. TheMedical Advisory Board also suggested that the Leagueof Red Cross Societies participate in creating or assistingin creating schools of puericulture or child welfarecentres, and in providing scholarships for doctors andnurses in existing schools. A limited investigation intothe causation of rickets in Vienna was recommended, ifit seemed feasible.

Venereal -Di.3ectse; Tuberculosis; Malaria.Education in sex hygiene and antivenereal propaganda

are to be continued by the Social Hygiene Departmentof the League, which also is to study the means bywhich it would be possible to reduce the cost ofsalvarsan ; to promote regional conferences dealingwith venereal disease ; and to take measures to diffusemoral and physiological knowledge.The antituberculosis measures to be undertaken by

the League include the creation, in certain districts ofseveral countries of Europe, of antituberculosis demon-strations. Each would carry out a preliminary survey oflatent tuberculosis and open infection in the entire popu-lation of its chosen district according to age, sex, pro-fession, and social groups; a statistical study of tuber-culosis mortality and of the types and forms of thelocalisation of the disease; the establishment of anadequate number of dispensaries, run by speciallytrained physicians and visiting nurses; the organisa-tion of open-air schools for children ; and the educationof the medical profession, as well as of the public,regarding the social fight against tuberculosis.

The proposed antimalaria programme of the Leagueof Red Cross Societies in Spain was approved by theMedical Advisory Board, which also believed it suit-able that the League study means of reducing the costof quinine.

Sa.nitafy Surveys.The work outlined for the League’s Department of

Sanitation comprises the making of sanitary surveys,such as have already been carried out to a certainextent in Roumania and Slovakia; the promotion ofpublic knowledge upon housing, pure water-supplies,and kindred sanitary subjects ; a demonstration of theefficiency of chlorination in water purification ; and theestablishment of liaison officers in sanitation with thenational Red Cross Societies.National Red Cross Societies were advised to create,

where possible, medical bureaux to maintain com-

munication with the League of Red Cross Societieswith regard to health. Adequate and full registrationof vital statistics, international standardisation offorms and methods, and the stimulation of interestin statistical methods among physicians and thegeneral public were urged. It was pointed out in thisconnexion that the major part of the collection andpublication of statistics must remain under Governmentauspices, but that until international cooperation isfully established in this field the League of Red CrossSocieties can do much effective work.The Medical Advisory Board gave its approval of the

work already carried out by the League of Red CrossSocieties, and passed an especial resolution to thiseffect.The different nations were represented on the Board

as follows : Belgium, Dr. J. Bordet; Denmark, Dr. T. S.Madsen; France, Professor Emile Roux, Dr. AlbertCalmette, Dr. Leon Bernard ; Great Britain, Colonel S.Lyle Cummins, Sir Walter Fletcher, Sir George Newman;Italy, Professor Giuseppe Bastianelli, Professor AldoCastellani ; Japan, Professor Takasugi; United States,Dr. Simon Flexner.Dr. William H. Welch and Dr. Hermann M. Biggs, of

the American delegation, were unable to attend theconference, as was Dr. Carlos Chagas, of Brazil, theSouth American member of the Board. ProfessorTakasugi, while not a member of the Board, attended itssessions as a substitute for Professor Kinnosuke Miura,the Japanese representative.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

The Nationalisation of Drug Stores and Apothecary Shops.THE Austrian Board of Health has laid before the

National Assembly (our present House of Parliament) a.Bill for nationalising all the existing apothecary shopsand drug stores as well as pharmaceutical factories.The leading idea is that all such commercial enterprisesshould become property of the State, although they neednot be run by the State. The present owner may rentor duly qualified government officials may conductthe business. All the existing State apothecary stores-in public or military hospitals-will be opened forpublic use. No new licence will be issued to privateindividuals ; the old ones will be gradually cancelled.If an apothecary intends to dispose of his store he mustoffer it first to the State, and only if his offer isrefused may he put it up for sale to private persons.The 20-fold average profit of the last seven yearsis the basis of the transaction. Besides this sum,the quantity of drugs, the stock, and outfit mustbe paid for by the State. If the possessor diesthe same procedure holds good for the benefit ofhis family or heirs. The establishment of new

drug stores in a certain place can be demanded bythe municipality or the legal representatives of themedical profession, the apothecaries, or the " sick clubs" (Krankenkassen), and can be effected only by the State.The rentability of the existing drug stores in the neigh-bourhood must not be endangered by the new licence.