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that if the average yield per cow in the United Kingdomcould be increased by one-tenth of a gallon per day thecost of milk at present prices would automatically fallabout 2d. per gallon without affecting the profit made bythe farmer. By paying stricter attention to the methodsof feeding it is reckoned that an increased yield from1 to 2 gallons per cow could be effected, which wouldsolve the problem of scarcity and materially bring downprices. Then comes the suggestion of official milk-recording centres being established, a scheme which, inthe opinion of the Committee, has been by far the mosteffective agent in the improvement of dairy stockthroughout the world. Sensible proposals are also madein regard to the selection of dairy bulls, the real test ofwhich should be the power to beget offspring whichwill yield large quantities of rich milk.

Conclusion.

Such are some of the salient features of the report,a study of which shows how thoroughly the Committeehas gone into the great and manifold questions involved-questions, amongst many others, of improved transportfacilities, preservation, and uncontaminated supplies.Agricultural developments apart, which deserve theserious consideration of the dairy industry with a viewto increased production, the hygienic or scientificdemands have received anxious attention, the Com-mittee evidently having settled upon the need of

adopting a policy which should lead to the ultimate

provision of both a clean and an abundant supplyof milk to the community.

CONTROL OF VENEREAL DISEASES.

The Anti- Venereal Campaign.THE campaign against venereal disease so ably

inaugurated by the National Council for CombatingVenereal Diseases is in danger of losing in effective-ness from an internecine struggle with the Society forPrevention of Venereal Disease, of which it was the

predecessor and in large measure the progenitor.The position of the N. C. C. 1.D.-In their memorandum

of Nov. 10th the National Council made these amongother statements :—

2. It is no part of our policy to conceal the truth, and wehave always acknowledged the value of cleansing and dis-infecting materials, applied early and thoroughly, indiminishing the risk of disease.

3. Abstention from exposure to infection is the onlycertain safeguard against the ordinary risk of disease ; con-tinence is to be encouraged by every means and on everyground, both social and hygienic.

4. No person who has indulged in promiscuous intercoursecan be sure that he is not infected, and every such personis, therefore, bound in duty to him- (or her-) self and tosociety to seek means of cleansing at the earliest moment.

5. For this purpose a thorough local application of soap-and-water is of great value, followed (if possible) by the useof such disinfectants as may be recommended by a medicalpractitioner.

It is evident from these clauses. that the NationalCouncil believe in the efficiency of immediate self-disinfection and advocate its application. The work ofthe Council, freely spent in the inculcation of chastity,needs no emphasis from us.

The position of the S.P. V.D.-The Venereal PreventionCommittee, or, as it has now become, the Society forthe Prevention of Venereal Disease, advocates theimmediate application by the individual concerned ofcertain disinfectants, selected by a consensus of opinionon the part of the medical members of the society. Inthis respect the suggestion enunciated by the N.C.C.V.D.in Clause 5 of their memorandum is complied with.With regard to the attitude of the society to the

question of morality, there is no colour for the sugges-tion which has been made that its members are indif-ferent to the importance of promulgating the value ofchastity. Lord Willoughby de Broke, in his speech inthe House of Lords on Dec. 10th, made it clear that theimportance of chastity was realised by the society overwhich he presides. Because the immediate objectiveof the society is the direct prevention of disease, andbecause it takes the dictates of morality as read, thisdoes not imply indifference or antagonism. At a recent

1 meeting, held under the auspices of the InsuranceFaculty, Miss Norah March enunciated the views of the

1 society thus:-T "In the meantime we must face the problem of the; unchaste. Are they to be allowed to continue unaware or

insufficiently appreciative of the possible consequencesof unchastity? or are they to be impressed with the necessity-if they are determined on anti-social behaviour-for safe-

Lguarding themselves, in so far as it is humanly possible, inthe interests of others, from the possible consequences oftheir action? Surely it is a matter of moral responsibilityto take all possible precautions, and such education as the

. Society for Prevention of Venereal Disease proposes to putat the disposal of the public is intended to thro2v onus upon theindividual, to make him responsible, if he does not conformto the social code, for limiting the evil results of his anti-social behaviour to the narrowest degree possible." The society does not advocate free distribution of

prophylactic packets or the indiscriminate urging of

people to provide themselves with them. Its members,while recognising the value of chastity, realise also thatmany individuals will, in spite of all deterrents, indulgein promiscuous intercourse, and they regard it as theirduty to the community to ensure that such individualsare acquainted with methods of reducing their chanceof acquiring and conveying infection. The societywould confer a greater gain on the community bylaying more emphasis, in the instructions which theyissue, upon the value it attaches to the practice of con-tinence, and upon the undoubted fact that, whileproperly applied medicaments will in the majority ofcases ensure safety, yet there can be no absoluteguarantee.

The future of these two bodies.-It would be a nationalcalamity if the effort associated with either of thesebodies were to be eliminated. Should the NationalCouncil sink into abeyance, its valuable educational andpropaganda work at home and abroad would be nullified.In view of the fundamental similarity of policy in theprogrammes of the N.C.C.V.D. and the S.P.V.D. thereis nothing to preclude members of the one body fromassuming or retaining membership of the other. Bysuch a condition of dual membership a better under-standing might be reached and unnecessary friction

obviated. There is no logical reason against the dualallegiance, since, as we have seen, both bodies inculcatethe need of immediate self-disinfection and both arealive to the importance of the practice of chastity. A

conjoint crusade would be to the national gain. TheNational Council has the machinery, the experience,and the staff for organising and effectively carrying outeducational measures. The Prevention Society appearsthe better adapted for stamping out disease by sanitarymethods. By a sympathetic and broad-minded coöpera-tion in principle and a wise division of specialised labourthere is an opportunity of benefiting both the generation ’that is and those which are to come.

A Plea .for an Experimental Early Treatment Centre forLondon.

Whilst controversy rages with regard to the respec-tive merits of immediate disinfection and early treat-ment, hundreds of individuals are daily becominginfected in London alone. Insistence is laid by theadvocates of early treatment upon the necessity whichexists for individuals to seek assistance within a fewhours after exposure to infection. In order that thisadvice may be put into practice it is necessary for an

early treatment centre to be available during the wholeof the 24 hours of the day. As far as we are aware nosuch accommodation exists. We strongly urge thenecessity of at once instituting such a centre, andthus rectifying a position which is as illogical as itis callous. The advantages of an all day and nightcentre would be multiple.

1. It would undoubtedly prevent the development of muchdisease, especially amongst those (and they will long bewith us) who for various reasons do not have recourse toimmediate self- disinfection.

2. It would, after trial, give a substantial idea as to thenecessity, quantitative and topographical, which exists forsuch centres.

3. Being admittedly of an experimental nature, improve-ments in technique and organisation which presentedthemselves could readily be adopted. After the attainmentof a reasonable standard of perfection other clinics couldthen be founded and worked on similar lines.

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The organising, equipping, and staffing of an experi-mental pioneer centre need occupy but a short time.If instructions were given to-day such a centre could bein full working order in two to three weeks. Knowledgeof the existence and the situation of the centre couldbe promulgated by the same methods as are alreadyutilised for making known the ordinary V.D. clinics.The number of cases attending these clinics are

increasing rapidly, and we are justified in regardingthe carrying out of the above suggestion as essentiallyan emergency measure. We commend it to the Ministryof Health and the medical department of the LondonCounty Council.

The Appointment of Medical Officers to TreatmentCentres.

It was inevitable that, during the war, venerealclinics should be placed in charge of medical men whohad but little experience in the diagnosis and treatmentof venereal diseases. Now that the number of speciallyqualified practitioners has increased, it is necessary inthe interests of the community at large for clinics to beplaced in charge of those who have gained sufficientexperience to justify their acceptance of such posts.Unless a high standard of efficiency is insisted upontreatment will be prolonged and its cost unnecessarilyincreased. No electoral body should appoint a medicalofficer to take charge of a clinic unless he producesevidence of adequate instruction in a recognised institu-tion or has otherwise gained equivalent experience.The Low Venereal Record in the American Expeditionary

Forces.

Colonel Ashburn 1 of the United States Army statesthat the incidence of venereal disease in the AmericanExpeditionary Forces varied for the greater part of thetime, during which large numbers of American troopswere present in France, between 62 and 31 per 1000,the average being about 45 cases per 1000 men annually.The rate rose rapidly as troops were being sent home,but this rise was partly fictitious, and the true rate atthis time could not be determined. It was a remarkablefact that the corresponding incidence in the UnitedStates was always reported as higher than in France,averaging about 60 even after the armistice. In orderto set an explanation of the low incidence rate ofvenereal disease in France a questionnaire was sent outto obtain information on the following subjects : (1)What is the percentage of chaste men among soldiers? ’?

(2) What is the average number of unprotected venerealcontacts to each case of venereal disease’? (3) Whatproportion of men have been exposed to venerealdisease without using prophylaxis ? More or less

complete answers were obtained from 13,648 men

located in four base sections, principally at Bordeaux,St. Nazaire, Brest, and Tours. It was found that34 per cent., or about a third, had abstainedfrom sexual intercourse while in France. Anotherthird of all the men had indulged in intercourse so

infrequently as to make their chance of acquiringdisease quite small, so that relative continence was

probably next in importance to real chastity in keepingdown venereal disease. From a study of the repliesand from collateral evidence Ashburn came to the con-clusion that in France there were about 30 unprotectedcontacts with women of promiscuous sexual habitsfor each case of resulting venereal disease, whileprophylaxis reduced the incidence to about one-third ofwhat it was without prophylaxis. ’The much greaterrelative frequency of soft chancre in France, approxi-mately two-fifths of all venereal disease, and the lesserrelative frequency of gonorrhoea suggested that prophy-laxis was less effective against chancroid than againstgonorrhoea or syphilis. The contact rate among menon leave was very high. 50 to 70 per cent. of the venerealdisease in the army came from leave areas, and fromtowns en route thereto. According to statements madeby 614 men with venereal disease alcohol seems to haveplayed a smaller part as a factor predisposing to venerealdisease in the American Expeditionary Force thanmight-have been supposed. Of the 614 only 215 admitted

1 Journal of the American Medican Association, Dec. 13th, 1919.

the use of alcohol before exposure, and 85 admittedintoxication.

A Post-graduate Course of Instruction.A post-graduate course of instruction in the diagnosis

and treatment of venereal disease is being arranged byMr. K. M. Walker at St. Bartholomew’s Hospital Clinic,Golden-lane, E.C., established by the Corporation ofLondon. The first course will be confined to malepractitioners, of whom 15 can be accommodated. Thesuggested dates are Thursday afternoons at 5.30 P.M.The beds attached to the clinic are available for thereception and study of suitable cases in addition towork in the out-patient department. Any medicalpractitioner wishing to attend is invited to send hisname to the Medical Secretary, National Council for

Combating Venereal Diseases, 81, Avenue Chambers,Southampton-row, London, W.C. 1. If more than15 names are received a second course will be heldas soon as possible after the termination of the first.

TUBERCULOSIS.

Tuberculosis in Birmingham.THE report on tuberculosis in Birmingham in 1918 by

the chief tuberculosis officer, Dr. G. B. Dixon, bringsout many points of exceptional interest. In this year,3254 cases of tuberculosis were notified, as comparedwith 3543 in 1917. The mortality for 1918 was 1385, andas somewhat similar figures have been returned forearlier years, the calculation is made that the actualmortality among the cases notified is about 42 per cent.In other words, about 58 per cent. of the personsnotified recover. In Birmingham there are more than16,000 cases of the disease at any one time, the cost ofwhich to the city is at least one million a year. Thereis, therefore, every justification for the expenses incurredin stamping out the disease, all the more as there aremany indications that its incidence is being reduced.As judged by notifications, the report shows a definitedecline of the incidence of pulmonary tuberculosis.The war has, however, increased the mortality amongthe persons already suffering from tuberculosis. A

comparison with the notifications in five other largetowns shows that, with 248 notifications per 100 deaths,Birmingham comes first, the ratio of notifications to100 deaths being as low as 167 in Manchester, and176 in Leeds. A table showing the incidence of,and mortality from, tuberculosis at various ages bringsout the curious fact that whereas the incidence andmortality are about equal in the two sexes up to the age of15, at every age-period over 15 the incidence and mortalityare much higher in the male-often more than twiceas high. Those who maintain that bad housing is themost important factor in producing tuberculosis willbe surprised to find that in 1918, as in previous years,the incidence of the disease among males aged 35 to 45was 7’69 per 1000 living at these ages, as comparedwith 3’33 per 1000 females of the same age. Again,the mortality rates at these ages for males was 4’46,as compared with only 1’55 per 1000 for females. Yetwomen at these ages spend far more of their time inthe dwelling-house than do the men. The reportincludes an account by Mr. J. Malcolm, M.R.C.V.S., oftuberculosis with reference to the milk-supply.

Borough of Poplar Dispensary.The report of this dispensary, which was founded as

a memorial to King Edward VII., is for the years1917-18. Many pages are devoted to tables showingthe amount and -nature of the work done. The scopeof this work is ever widening and bringing the dis-pensary into some new official relationship or other.But the lack of suitable institutional accommodation foradvanced cases of pulmonary tuberculosis is deplored,and the fact that such cases are still dependent on the.Poor-law infirmary is recognised as a grave flaw in theantituberculosis campaign.

Sanatorium Benefit in Ayr.In the report for 1918, the Insurance Committee for

Ayr reviews the results of institutional and domiciliary