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formation and promulgation (towards the ultimateobject of enforcement) of a mathematical basis ofassessment by which the activities of the public healthdepartment of any city may be arbitrarily adjudged.In other words, the private membership associationsand private foundations feel themselves competentand entitled to compile and promulgate standardsby which the work of city health departments shallbe adjudged. Inasmuch as this will probably applyin practice only to those cities in receipt, officially or-otherwise, of financial assistance from these agencies,there can probably be little objection to those agenciesframing standards by which to judge the extent ofresponse to their generosity. But the situation is,in essence, unhealthy. In an educated and self-governing community the measures provided forthe people must be such measures as are promptedby the conscious will of the people-i.e., by the Govern-ment-or they cannot be permanently successful.On the other hand, in New Zealand the over-

whelming success of the movement for the care ofinfants has been entirely due to the work of a voluntary- Society. It was by aligning the women of New Zealandbehind his crusade for the protection of infants, andby this means alone, that Sir Truby King was able tosecure such striking results. But it has now beenfound advisable to make a governmental activityof this movement, at least in part, and Dr. King hasbeen joined to the Health Department as an officerof that Department-the whole work being underHealth Department jurisdiction.

uoverrzment uoittrot or A;vpervtston.There appears to be a growing opinion amongst

these private agencies in the United States that allthe work they are doing should properly be part ofthe work of Government, whichever form or functionof government was best adapted to control anyparticular part of the work, and that the function,if any, of private agencies was to assist governments,not to act as their substitutes. It is - impossible toconceive any course of action, other than autocraticgovernmental prohibition, which would prevent thespontaneous formation of such associations or societies,or prevent some philanthropically-disposed wealthyperson bequeathing his money for some purpose ofthe kind now under discussion.

The State of Alabama has in its legal code an ’,unusual provision :-

’

" No board, body, or organisation shall engage in anypublic health work except under the sup3rvision and controlof the State Board of Health."

This method does not entirely prevent trouble.The simplest way to avoid complications arising fromthis source, a way which would at the same time bemost calculated to bring lasting good to the com-munity, would be for Governments, or, rather, thepeople whom Governments represent, themselves toperform those simple duties in the field of publichealth which apparently are being left more and morelargely to private agencies. Private agencies cannotoperate effectively in respect of environmentalsanitation which is exclusively a matter for Govern-ment. Private agencies find their most profitable andmost dramatic field for work in the various phases of

. individual hygiene, but individual hygiene in almostall its aspects depends for success upon efficientenvironmental sanitation. The mother, in her relationto public health-i.e., at the time of child-bearing-is influenced by her environment in respect of food,occupation, and infection. The infant at the timewhen it is the concern of the State-i.e., during thefirst year of life-is liable to environmental influencein respect of food and infections. The infantilediarrhoeas are to a large extent referable to the sameenvironmental factors of sanitation as are the typhoidand cholera group, and are controllable by the samemeasures as have been used successfully in thosediseases. In tuberculosis it is now accepted thatenvironment—i.e., housing, occupation, food (oreconomic status, which determines all three)-=playsa part at least equal in importance to infections.

Control of the environment cannot be secured by anyhaphazard efforts or transient stimulations of publicinterest by official or unofficial agencies, but must besolidly based upon a legal code deliberately framsdby experienced sanitarians and backed by a solidpublic opinion demanding the enforcement of at leastthe major provisions.

Public Health Not Purchasable.One of the most misleading public health epigrams

is that officially used by the New York City HealthDepartment-" Public health is purchasable "-asif public health were a tangible commoiity. Theimplication is that with sufficient money the irre-ducible minimum of mortality- and morbidity-ratescan be secured. All experience shows that this is nottrue. Public health is merely the expression of privateindividual health which in turn is regulated by thestandard of education (upon these matters of health)attained by the individual and the degree to whichthe knowledge possessed is used. Money will notmake a people wise. One can, without surrenderingany convictions, welcome gladly the enormous

assistance being rendered by these private agenciesto the advancement of public health. The Inter-national Health Board is, beyond all question, thegreatest single force in public health to-day. But,in the end, public health, to be successful, mustbe the practical expression of the conscious will ofthe people themselves-which is Government.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

The Recrtcdescence of Alcoholism.DuRtNG the last few years an increase in alcoholism

has been noticed in France, which compares unfavour-ably with the marked diminution of the war period.A commission appointed by the Academy of Medicinehas recently been inquiring into this. In his hospitalexperience during the course of six months, Dr. Achardhas found obvious alcoholic stigmata in 44 men out of418 entrants, and in 38 woman out of 579 entrants(roughly 10-5 per cent. of men and 6-3 per cent. ofwomen). This represents only the minimum, formany drinkers did not as yet show any stigmata.Apart from those diseases which had been aggravatedby drinking, there were 21 cases-of cirrhosis,delirium tremens, polyneuritis, and gastritis-inwhich the illness could have been avoided by temper-ance. Cirrhosis was more frequent amongst women;in 100 alccholics the proportion of cirrhotics was18 per cent. for women and 9 per cent. for msn.

This increase in alcoholism is a reflection of theincrease of alcohol consumption in France, which fellfrom 1,413,000 hectolitres in 1914 to 584,000 in 1918,but has risen again to 1,016,000 hectolitres in 1923and 968,000 in 1924. The probable causes seem tobe : The relative increase of wages amongst manualworkers compared with other citizens ; the eight-hourday with its increase in leisure ; and the reappearanceof absinthe in disguised forms. Complete prohibitionhardly seems applicable to France, but it would beproper not to give official recognition to fermenteddrinks as " hygienic," and not to encourage the alreadyexcessive production of wine. The use of fresh grapejuice, and the employment of alcohol industrially,ought to be developed. The oft-demanded suppressionof the privileges of those who distil their own fruitseems an impossibility under the French politicalsystem. Some restriction of the number of licencesmight perhaps be considered, but the electoral powerof the wine merchants gives them Parliamentaryfavour. Private campaigns against alcoholism haveonly a limited sphere of action. Propaganda shouldbegin in the schools ; it cannot be given to adults bytheir employers because of the distrust which wouldbe excited. The workers’ organisations would havemore chance of success, and it is their leaders thathave to be won over ; but perhaps it is the doctor who

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is most qualified for the task in his role of disinterested Iadviser. It has been suggested that a special com-mission should be formed under the Commissariat de iSanté to undertake a campaign against alcoholism. ’

Encephalitis and Vaccination against Small-pox.M. van Bonwdyk Bastiaanse, of The Hague, in ’,

collaboration with MM. Bijl and Levaditi, have given.an account of their observations on the aetiology ofencephalitis in children following vaccination against ’,small-pox. They were concerned with cases which,10 or 12 days after vaccination, showed signs of !encephalitis, characterised by sleepiness, fever, signs Iof irritation of the pyramidal tract and sometimesparesis, without spinal lymphocytosis. These accidentswere noticed during an epidemic of encephalitis.Experiment and pathological research have shownthat this form of the disease is not due to the virus ofJenner’s vaccine. The various stocks of vaccine usedwere from a supply obtained from the calf whichshowed no exceptional neurotropic affinities. Thereis every reason to suppose that in these cases therewas a latent infection by the virus of encephalitislethargica, and that vaccination merely hatched itout. This agrees with the experience of Levaditiand Nicolau, who have shown that a neurotropicvirus can bring out a latent infection due to a differentbut equally neurotropic virus (e.g., hydrophobia andvaccination). The fact that in the cases underobservation the encephalitis developed in a site already affected by the vaccine virus explains the special Ihisto-pathological changes seen.

Insulin in Non-Diabetics.The trophic action of intramuscular injections of

insulin in diabetes is well known. At the timeof surgical intervention this substance is capableof hindering the development of toxic accidents;it facilitates the cicatrisation of the operationwound, and diminishes the time required for healing.H. Chabanier has reported a similar trophic action ofinsulin in the case of atonic wounds in diabetics-e.g.,in perforating plantar ulcers and varicose ulcers.This action may also be observed in non-diabeticsubjects. In small doses, given by injection, insulinleads to rapid cicatrisation of varicose ulcers insubjects with normal blood-sugar content ; but he hasemployed it by injection and by local application inthe form of dressings with an ointment of insulin.In every case the remedy has been well toleratedand a notable improvement observed in the patient’sgeneral condition in addition to the local change(modification of the skin in the periphery of the ulcer, Iwhich regains its normal supply and rosy aspect).In some cases cicatrisation was rapid. Alone or in combination with general treatment such localapplications of insulin are able to render great serviceto the surgeon.

French Views on Rickets.In spite of the large amount of work carried out

within recent years on the aetiology of rickets, somephysicians in France still hold views which they refuseto modify in the light of recent knowledge. Puttingaside the opinions of Prof. Marfan, who still maintainsthe paramount importance of congenital syphilis asa causal factor in the production of rickets, evenmoderate French opinion by no means accepts, forexample, the vitamin theory, although cod-liver oilwas first used in France for the cure of this disease.At a recent discussion before the Société Médicale desHopitaux de Paris Dr. G. Variot sounded a note ofwarning on the subject of " sun-deficiency " as an

ætiological factor, pointing out that because ultra-violet light had such a striking effect in curing rickets,it by no means followed that deficiency of this lightwas an important cause of the disease. He thenelaborated the theory of

" dysalimentation," whichstresses incorrect diet at the period of weaning. Thisremained, in his opinion, the most important factor.He particularly indicted the removal of all milk fromthe dietary at this period and the substitution ofstarchy foods made with water. Prof. Comby, who

also took part in the discussion, agreed with this view,and, while not denying the importance of hygienicfactors such as the sun, air, light, and exercise, statedthat these factors did not play any vital part in themajority of cases. He pointed out that in this hisopinion had not changed materially since he firstaffirmed his belief in the alimentary factor 30 yearsago ; and in a review of the recent literature on thissubject published in 1923 he had still maintained thatdefective feeding, and especially over-feeding, playeda most important part in the production of rickets.That both lack of sunlight and defective feeding wereclosely related causes of rickets was advanced byDr. Apert, who holds that one of these factors is asnecessary as the other ; but in reply Dr. Variotdisagreed with this. It is noticeable that in the reportof this discussion no mention is made of any vitamin,and it is probable that the recent work of Mellanbyon the apparent antagonism between excessive starchyfoods and the antirachitic factor will be taken here asan additional proof (as, of course, it is) of the dangersof overfeeding with starch during the period of

growth. This is an illustration of the way in whichfacts can be made to bear slightly different inter-pretations according to prejudice.

The Comparative Action of Atropine and the TotalAlkaloids of Belladonna.

Differences in the physiological and therapeuticalaction of the total alkaloids of a plant and of theessential principle are already well known. P. Lemayand L. Jaloustre have tested the action of atropineand of the total alkaloids of belladonna in the rabbit,and have confirmed the facts already noted by Cushnyand Rothlin. The total alkaloids appear to be twiceas active as atropine in their action on the cardiacwave, and the authors conclude that there is reasonto use them in treatment (especially in spasm andvagotony) in preference to the galenical preparationsof the codex. The physician has in them a remedyalways of the-same composition and twice as activeas atropine without being more toxic.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Proposed Alterations in the Medical Curriculum.A SPECIAL committee appointed by the Ministry of

Education, in cooperation with the medical faculty ofVienna and the university boards of the three Austrianuniversities, has worked out a series of suggestions onthe future regulation of medical study in this country.The principal change advocated is the extension of theperiod of studies. Hitherto ten semesters (five years)have been required ; but the medical student will nowhave to work for a year longer at the university and atthe clinics before he can take his diploma of M.D.At the end of his fifth semester (half-year) he willtake three minor examinations (biology, chemistry,and physiology) and a severe examination in anatomy;after which he will serve during the next two years asjunior assistant in various clinics. Here he will obtainpractical instruction at the bedside in the moderntechnique of investigation, under the guidance ofregular assistants of the clinical professors. The finalexaminations will be held at the end of the eleventhand twelfth semesters, and for both these terms thestudent will be required to serve in clinics.. The"

hospital year " for the graduated doctor, which hasbeen adopted in Germany and some other countries,has not found favour here. The committee thinks itadvisable that the student should have a year ofthorough instruction at the bedside before he isgranted a diploma which, according to the law,entitles him to settle down and practise. It has beenthought wiser not to alter the fundamental legalregulation. Specialisation by the graduated doctorwill also be much more difficult than hitherto. Hewill only be allowed to style himself " specialist "after having spent at least four years in hospital as