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822 Reading. To the Reading Pathological Society will fall the honour of having been the first in this country to recognise the claims of I-em-hetep to be regarded as the Deity of Medicine. " I-em-hetep is," to quote the late Sir William Osler, " the first figure of a physician to stand out clearly from the mists of antiquity." ____ ALCOHOLISM AS AN INTERNATIONAL PROBLEM. INTERNATIONAL movements are always suspect; it is often suggested that they are a kind of sport which enables reformers to visit foreign countries and hold enjoyable meetings. That the internationalism of the campaign against alcoholism is of real significance was the thesis of a lecture by Dr. R. Hercod, of Lausanne, before the Society for the Study of Inebriety on Oct. 13th. Certain countries, he said, have newly taken up vine growing ; others have reduced their consumption by legislation or propaganda ; economic depression has reduced markets ; and the result of these things is a crisis in the wine-producing countries which has forced the growers to seek new custom. A French Minister for Agriculture encouraged the people to drink more wine on the grounds that this " temperance beverage " was really the best weapon in a serious fight against alcoholism (although an average annual wine consumption of 30 gallons per head suggests that the French population was already doing its duty) ; but however much sympathy may be felt with such enthusiasm, it is less easy to condone the methods adopted by France and Spain in forcing the importation of their produce on foreign countries. Iceland has been obliged to except Spanish wines from her prohibition laws because Spain could starve Iceland by refusing to admit her exports of fish, and Norway has suffered in much the same way at the hands of France. German breweries have considerable stakes abroad, and they and their methods are implanted in the Far East; and Scotch whisky is not without its influence on distant peoples. According to Dr. Hercod, Africa is suffering from a veritable scourge of alcoholism, which is the outcome of Western civilisation and which is inadeauatelv controlled by the Convention of Saint-Germain-en- Laye. In partly Moslem countries the influence of religion is being overcome, and everywhere the lands which are producing more alcohol than they can consume are pressing their produce on others, in ways both legitimate and illegitimate. The support of the press has greatly helped the international campaign against prohibitive legislation, which has therefore been as successful as might be expected ; but it is not merely in reaction against the activities of the liquor traffic, Dr. Hercod considers, that the cause i of temperance will be helped by international cooperation. More information is needed on the experiments, both individual and social, of other countries, and the United States has lost a great opportunity by failing to organise a systematic and continuous investigation of the facts of prohibition. A strong educative campaign must be based on truth, and as yet there are gaps in scientific knowledge which should be filled. There are, for instance, discrepancies between the results of Dr. H. M. Vernon and Prof. E. M. Widmark, to name two workers only, and such discrepancies should be cleared up. Though it may be possible, even now, to come to an inter- national agreement on the manufacture and distri- bution of alcohol on a smaller scale, it will be impossible to contemplate its total suppression so long as the population in general is unwilling to admit such a measure. Study of the propaganda methods of other countries, and especially their work in schools, is most valuable, and the International Bureau Against Alcoholism, of which Dr. Hercod is director, will do much to help. All who are imbued with the scientific spirit will approve the dissemination of the truth, about alcohol or anything else, but it is evident from the increasing stress laid by temperance workers on the social side of their work that scientific facts do not always impress the public. Alcohol has not been damned by being called a narcotic-for a narcotic is just what most people most enjoy. It has been truly remarked that " Mankind has never needed a stimulant, but rather something to take the edge off things." CRITERIA OF PATHOGENICITY. THE time-honoured criteria for the identification of a microbe as pathogenic are those familiarly known as Koch’s postulates. The difficulty in apply- ing these criteria lies in the fact that the majority of pathogenic organisms do not produce in experimental animals a disease exactly identical with that which they produce in man. This holds not only for organisms whose r6le in human disease is still open to doubt, such as Pfeiffer’s bacillus, but also with the most firmly established species, whose pathogenicity has been proved both purposively and accidentally upon the human subject, such, for example, as the typhoid and cholera organisms. Consequently, in attempting to prove the relationship of a given organism to a supposed disease the experimental demonstration often breaks down over this point, and this is the crux of the difficulty which lies in the way of proving or disproving the truth of claims which are constantly put forward. In a recent paper 1 Dr. W. M. Crofton suggests that two criteria may be safely substituted for the third of Koch’s postulates. The first is that if a vaccine from a given organism will reduce the morbidity and mortality of a certain disease, then the organism composing the vaccine is the one which causes the disease, and, in evidence thereof, he cites the case of typhoid vaccine and the incidence of typhoid fever. This contention may be admitted in the absence of direct evidence to the contrary, but it must be remembered that not only are all the factors in play in such a case extremely hard to control, but that non-specific effects in immunity reactions are not uncommon, and in clinical meaicine ouner paraueis may oe iouna uo -une case of small-pox and vaccinia. Dr. Crofton’s second contention is even less tenable. He asserts that if in a given disease a vaccine or bacterial preparation produces a reaction-e.g., the tuberculin reaction- which is not obtained with the normal individual, and its injection is followed by amelioration or cure of the disease, then such a vaccine is composed of the causal organisms. He instances his own results with influenza vaccine in encephalitis lethargica, and those of Dr. H. W. Crowe, who claims to have cured cases of rheumatoid arthritis by a Staphylococcus albus vaccine prepared from organisms recovered from the urine. Both of these instances are uncon- vincing, since the association of influenza and encephalitis is very generally agreed to be a negative one, and, further, the present treatment of rheumatoid arthritis by bacterial vaccines, for which considerable success is claimed, is avowedly non-specific, such organisms as B. typhosus being frequently used. Whether or no they embody final truth, Koch’s postu- lates cannot be set aside without substituting a habit of extreme and rigid self-criticism in bacteriological research. ____ HOME SERVICE AMBULANCES. A LEGACY of the war was the inception of the ambulance facilities we now enjoy in this country. Before 1914 in only a few of even the great cities had the municipal authorities established a motor ambu- lance service. The County of London was still content with the service of hand-propelled wheeled litters established by the police, and it was not until 1915 that the motor ambulance service was inaugurated to deal with accidents. During the war, as everyone knows, splendid work in the provision and maintenance of ambulance service was done through the cooperation of the Order of St. John of Jerusalem in England and the British Red Cross Society, and happily after the signing of the armistice these two organisations 1 Journal of State Medicine, vol. xxxiii., No. 10.
