1362 PARIS.

Another favourite argument advanced, that propermilk control means new hordes of officials, is singularlyinappropriate when applied to milk. Control overthe satisfactory production and handling of milk isbest judged by bacteriological methods. Suchmethods can pick out with tolerable certainty anduniformity the milk producers and others whosemethods of handling milk are below a reasonablestandard. One bacteriologist can examine a verylarge number of samples per day, and with his helpthe number of field inspections required is immenselyreduced. Attention can be concentrated upon theworst and a steady levelling up process inaugurated

summary of Remedies Proposed.With a subject of such magnitude as the milk

problem, and one which has been the object of somuch detailed study, it is impossible to cover everyphase in the limits of space available. What has beenattempted has been a rapid survey of the presentposition and an outline of those remedies which seemto me to be of most utility. As regards these remediesthe most essential may be summarised as follows :-

1. A continuance of the present system of grading,for its educative influence, but with the additionof a Grade C milk designed to repress the very dirtyminority of producers.

2. Systematic efforts to educate the consumers toappreciate the importance of good quality milk andthe value of milk as a food. Education of the milktrade as to the need for improvement in methodsand the financial advantages involved. In connexionwith such educative activities the medical professioncould play a powerful and influential part if theywere agreed as to the lines to follow.

3. Additional legislation : (a) To enable effectivepowers to be obtained to deal with bovine tuberculosis.(b) To define the minimal requirements of clean puremilk and provide for their compliance. (c) To giveextended control to prevent the infection of milk withpathogenic bacilli. (d) To simplify the control overmilk by its entire transference to the larger localauthorities. (e) To provide for the payment of grants

;. n aid from the Treasury through the Ministry ofHealth towards the cost of the supervision over milkproduction and distribution.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

French Vital Statistics for 1924.THE figures recently published by the Ministry

of Labour, Hygiene, and Social Welfare give aninstructive summary of the relation of births to deathsin France during 1924. There were 752,101 birthsto 679,885 deaths, or a surplus of 72,216-a surpluswhich, considering the greatness of the numbersconcerned, is a very small margin on the right side.The excess of births over deaths per 10,000 inhabitantswas 19 in 1924 as compared with 24 in 1923, 18 in 1922,30 in 1921, and 41 in 1920. It is extraordinary, onemight even say amazing, that this excess between1920 and 1924 should have fallen from 41 to 19 per10,000 inhabitants. Since 1920, when the number oflive births throughout France was 834,411, there hasbeen a marked decline in this figure ; in 1923 it hadfallen to 761,861, and in 1924 it was further reducedto 752,101. In 1920 there were 213 live births forevery 10,000 inhabitants, whereas in 1924 this figurewas reduced to 192. Local differences in the " coeffi-cient of natality " in 1924 were considerable. Thus,in Pas-de-Calais there were 306 live infants born per10,000 inhabitants, whereas in the Cotes-du-Nordthis figure was only 230. The number of infantsborn dead, or dying before registration, showed thesame decline as that in the number of live births.The divorce statistics showed some curious fluctuations.The year 1921 seems to have marked the crest of thepresent divorce wave with a total of 32,557, the number Iof divorces in 1924 being only 21,033. In 1900 there I

were only 7363 divorces, and in 1913 this figure hadjumped to 15,372. Divorces, it would seem, are

largely a matter of fashion and are probably muchmore subject to such influences as suggestion thanare births and deaths. A comparison of the numbersof divorces in the different areas indicates thatindustrialism gives rise to conditions favouringdivorce, the highest divorce figures being found inthe industrial Departments, and it is instructive that,while in one industrial area there were as many as241 divorces per 100,000 inhabitants (Department ofthe Seine) there were only 23 divorces per 100,000inhabitants in another area (Cotes-du-Nord). Withregard to the narrow margin between the births anddeaths in France, the modern tendency is to widenthis margin rather by measures calculated to improvethe general health and add to the longevity of theliving than to swell the numbers of the new-comers.

Copyright of Medical and Pharmaceutical Lectures.The eleventh Chambre Correctionnelle has recently

been the scene of an interesting lawsuit concernedwith the copyright of the spoken word. A publisher,Mr. Lambert, had made use of shorthand notes oflectures given by professors of the faculties of medicineand pharmacy, circulating these lectures weekly tohis subscribers. In the course of the judgment passedby the Chambre, which imposed a fine of 50 francs onthe publisher, it was stated that " the laws concerningcopyright apply to the spoken word, particularly tothe lectures of professors." Each of the professorswhose lectures had thus been published without theirprevious consent was awarded 100 francs in damages.No one in court recalled the precedent of a hundredyears ago when Sir Astley Cooper and John Abernethybitterly resented the publication of their lectures inTHE LANCET. It is not yet clear what effect the decisionof the French court will have on the reporting oflectures and proceedings of medical societies, but theguess may be ventured that there will be little change.Indeed, as most professors are human, or nearly so,it is probable that if their spoken words were to beheld strictly sacrosanct and respectfully ignored,more pain would be inflicted than if a verbatim reportwere to be given all the publicity at the commandof the most pushing of impresarios. A verbatimreport is, by the way, to the carefully edited reportwhat the amateur photograph is to the touched-upproduct of the professional photographer, and it issometimes an act of refined cruelty to broadcastevery word of a volubly inaccurate speaker. Providedpublic speeches are edited as well as reported fairly(in fairness to the speaker rather than to the audience),there is seldom much likelihood of questions being-raised either in France or in England as to the copy-right of the spoken word. ,

P1’esence of Tubercle Bacilli in the Pharynx ofInfants with a Positive Skin Reaction.

The tuberculin skin test is of absolute and indisput-able value in the difficult matter of diagnosing tuberclein infants, but it is also of importance to know whetherthe infant, like the tuberculous adult, is liable tospread contagion. The infant, of course, does not sinby spitting, and the search for the tubercle bacillusin the pharyngeal mucus, taken directly or by meansof lavage from the stomach, has given very inconstantresults. The very small number of bacilli which maybe present are found with great difficulty. Drs.Lesne and Langle conceived the idea of injecting this-pharyngeal mucus subcutaneously into a guinea-pig.The results of their experiments showed that two-thirds of the infants with a positive skin reaction..who were infected with tubercle in either a latent oran active stage, carried virulent tubercle bacilli inthe pharynx. On the other hand, injections madefrom infants with a negative reaction produced noeffect on the guinea-pigs. The bacilli are probablyderived in most cases from pulmonary lesions opening-into the bronchi. Yet if no pulmonary lesions werediscoverable on radiographic examination, which is.not uncommon, or if the infant has succumbed without

1363THE VIENNA EXHIBITION OF HYGIENE.

a caseous focus being located, it may be permissibleto suppose that the pharynx was not the portal ofexit of the bacilli but the portal of entry. The organismmight be present in the pharynx and, without apparentlesion of the mucous membrane, might infect the sub-ject. However that may be, we should not regardinfants with a positive skin reaction as non-contagious,although they do not spit. They may infect healthychildren with whom they are placed in contact, eitherdirectly or indirectly by the medium of such articlesas indiarubber teats, spoons, and towels. Therefore,before allowing infants with a positive reaction toassociate with non-tuberculous children, the pharyn-geal mucus ought to be tested by inoculating aguinea-pig, and, if it is thus proved infective, allnecessary precautions should be taken.

The Vaccine B.C.G.

Before the Academy of Medicine Dr. Calmetterecently gave the clinical and experimental results ofpreventive vaccination against tuberculosis in new-born children by means of the vaccine Bilié-Calmette-Guérin, known as B.C.G. Many doctors make use ofthis vaccine, especially in cases where the childrenhave been born in a home in which tuberculosis isalready rife. The results have been very satisfactory.Not one of the 178 infants vaccinated three years agohas died of any infection which might be called tuber-culous ; 91 of them which.were recently examined arein perfect health and their growth has been normal.From July 1st, 1924, to June 1st, 1925, 2070 new-borninfants were vaccinated by the B.C.G. supplied bythe Pasteur Institute without any untoward results.The method of vaccination consists in administeringthree doses of the vaccine in a teaspoonful of milk atintervals of 48 hours when the baby is from 3 to 10 daysold ; 137 of these children vaccinated in this way infamilies where the exposure to tuberculous infectionwas great have not furnished a single case of deathfrom tuberculosis,while on the other hand the mortalityof unvaccinated children under the same conditionsstands at 32-6 per cent. in Paris during the first year oflife, and at 24 per cent., on the average, for the wholeof France. The experiments show that the vaccineB.C.G. confers on monkeys and young calves obviouspowers of resistance to tuberculous infection, whetherthe latter is natural or artificial. It would appeartherefore that this method of tubercle prevention inyoung children might be regarded as having nodangers and that its efficacy is beyond question.Further observations and the time factor will enablemore definite pronouncements to be made on thepractical value of this prophylactic measure.

112or2ument to the 2vIembers of the Paris JlJ.edical.Faculty who Fell in the War.

A monument raised to the memory of the doctorsand medical students who died during the war wasrecently set up in the medical faculty of Paris. Themonument, which has been placed in the Salle desPas Perdus at the foot of the staircase which leads tothe library, is a bas-relief designed by the sculptorRaoul Besnard. It represents a corner of a battlefieldwhere, on the right, a young military doctor in apensive attitude is gazing at a group of stretcher-bearers carrying a wounded man to the aid-post.Above, the inscription runs " Facultas Parisiensiserexit suorum memor, 1914-1918," and beneath areplaced the names of nearly 500 doctors or students ofthe faculty who died for their country. The Presidentof the Republic performed the unveiling ceremonyand was assisted by Mr. Appel, the Rector of theUniversity ; Mr. Colville, the Director of HigherEducation; Mr. Rouget, the Director of SanitaryServices; Mr. Guillaumin, President of the Muni-cipal Council ; Dr. Roger, Dean of the Faculty ofMedicine : and several other dignitaries, includingthe President of the Academy of Medicine. Speecheswere delivered by the representatives of various medicalbodies. Prof. Chauffard spoke for the Société des Amisde la Faculte de Medecine de Paris, by whose efforts

subscriptions had been secured to raise the monument,and Mons. Beau spoke on behalf of the students.A poem composed by Prof. Charles Richet wasdeclaimed by Mlle. Madeleine Roche, of the ComedieFrancaise.

___ __

THE VIENNA EXHIBITION OF HYGIENE.

I I (FROM OUR OWN CORRESPONDENT.)

IN May of this year there was opened in Viennaan Exhibition of Hygiene which is attracting largecrowds of visitors and which will add considerably togeneral knowledge of this subject. The exhibitionconsists of three distinct sections. The first sectiondeals with man, his anatomy and physiology; thesecond with hygiene in general, and the third withthe modern household from a hygienic view. Thedominating idea in promoting the exhibition wasthat hygienic knowledge and hygienic empiricism-should become the common property of the public.

The An,atomy of Man.By means of large wax and plaster-of-Paris models,

diagrams, and pictures of the different parts of thebody, by comparative charts and original wet and dryspecimens of anatomical and physiological interest,the lay public is enabled to learn what kind cfmachine the human body really is. The value ofsocial hygiene, the knowledge of the laws governingthe development and destruction of life-in short,the " legislature cf living "-is impressed on eventhe most unobservant and incurious visitors. Thesection pertaining to man in general has beenbrought over from Dresden, where it formed the bulkof the celebrated hygienic exposition there. It issubdivided into sections dealing with prehistoricdevelopment of mankind, the osseous system, themuscles, the organs of nutrition, respiration, circula-tion and secretion, the brain and nervous system, andthe organs of the senses (eyes, ears). Dynamometers,accessible to every visitor, show the " man in thestreet," what force is exerted by his own flexormuscles of the hand, or how the jaw is able to exerta pressure of more than 50 kilos to the square centi-metre in cracking a hazel-nut. The method ofconverting food articles into energf, as effected bythe digestive organs, is explained by means of largemodels. An exhibit called the " transparent man "is a great attraction. It coasists of a collection ofspecially treated specimens, made transparent or

translucent without dissection. By means of a

secret process, entire organs, like the legs or arms ofbabies, the stomach of an adult, the pregnant uterusat various stages, the adult kidney or heart,have been made so transparent to strong light thatall the details are visible. The collection shows wellthe development of a human embryo from the fifthweek up to birth, the centres of ossification, and thegradual development of all other organs. The exhibitis contained in a dark room, and the objects areviewed against strong electric light.

Hygiene and Public Health.The second section of the exhibition, which is

devoted chiefly to the problem of hygiene, is sub-divided into individual hygiene, collective hygiene,and general hygiene or public health. The leadingidea is here also to impress upon the mind of thevisitor the necessity of adapting life to the laws sof hygiene-i.e., cleanliness, soberness, ventilation.Diagrams, charts, pictures, and statistical data serve ethis purpose. Thus numerous pictures illustrate theways of infection with tuberculosis ; dust inhaled bychildren, contamination by spitting, playil-g in thegutter, eating dirty food, kissing or careless coughingby diseased persons are shown-in rather crudepictnres-to be the potent source of propagating allsorts of illness, especially tuberculosis. We see alsothe prophylactic measures taken by large institutions,such as the sickness insurance clubs or Krankenkassen,