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573 THE SPREAD OF TUBERCULOSIS. of defaulters, and the location of centres apart from hospitals does not seem to deter patients. A warning is sounded against inadequate treatment. A short course of arsenobenzol and mercury is often followed by relapse, and it is important that medical officers should be convinced of the necessity for prolonged treatment. Practitioners are reminded that the signs of venereal disease in pregnancy are often absent or very slight, and are urged to follow up the clue given by infected children or stillbirths. Treatment of the congenitally syphilitic child, also, should be com- menced while the disease is latent and doctors should act on suspicion. Experience in Plymouth has shown that detection of the disease before it is manifest would considerably raise the standard of health of the population. Maternity and Child Welfare. This work has been expanded and the gloomy fore- bodings as to the effect of the strike on the physique and vigour of school-children were not fulfilled, partly as the result of provision of meals at school and the distribution of free milk. The maternal mortality-rate was 4-12, a slight rise. The importance of making provision for treatment of puerperal pyrexia and for antenatal supervision is stressed. There are now 772 antenatal centres, 105 homes for unmarried mothers, and 2324 infant welfare clinics. The report remarks that money expended on centres and health visitors brings perhaps a greater return than any other form of expenditure on maternity and child welfare, and points out that the Adoption of Children Act, 1926, may prove prejudicial to the welfare of illegitimate children, whose foster mothers may adopt them to avoid supervision. Although provision for ophthalmia neonatorum is good in most areas there still seem to be administrative loopholes, and the responsibility for notification has now been laid wholly on the medical practitioner. The care of the pre-school child is described as a problem awaiting satisfactory solution. Dr. Margaret Hogarth’s examination of 1000 unselected children of 3 years of age revealed a large amount of preventable disease, but also created an impression of a much higher standard of parental care than was evident ten years ago. The most striking feature was the prevalence of rickets, the forerunner of all that is required to produce a C3 nation. The effects of treat- ment by sunlight and cod-liver oil appear to wear off when the course is discontinued. Diseases of the throat, nose, and ear formed an important group of defects, and the prevention of otitis media and of the sequelse of enlarged tonsils and adenoids alone make systematic supervision desirable. Special attention is drawn to the danger of forgetting the mental develop- ment of the child through focusing attention on his physical welfare. The Conference on Child Welfare, held at Geneva in September, agreed to investigate the value of preventive measures against scarlet fever, diphtheria, and measles, to prepare a note on the arrangements in different countries for the training in pediatrics of doctors, nurses, and health visitors, and to hold an inquiry into infant mortality in selected districts over a period of 12 months. The areas chosen in England were Sunderland and parts of Staffordshire (high rate) ; Croydon and Oxfordshire (low rates). This is the first international inquiry of the kind, and is to be clinical rather than statistical. N at’ional Health Insurance. The number of persons entitled to benefit in 1926 was 14,102,000, one-third of the population, bread- winners on whose health and capacity the living of the great majority of the remainder was dependent. Increase in the number of certificates during the strike and in the aggregate cost of prescribing are commented on. Late in the year six full -time regional dental officers were appointed and dental benefit is now almost universal. More than £400,000 a year has been allocated to ophthalmic benefit. The statement that the service " does not tend to the prevention of disease " is strongly combated and the educational work carried on by panel committees is reviewed. ’ Food in Health and Disease. Gratification at the awakening of public interest in diet is expressed, and caution and discrimination in making didactic statements are called for. Recent research has shown that the keynote of a successful diet is variety and has thrown doubt on the belief that primitive man was better off in regard to his diet than man of the present day. It is pointed out that this country is eminently suited to the production of the essential foods, milk, and vegetables, and that they should be distributed widely and cheaply enough for them to be in everybody’s daily diet. Describing the improvements in milk preparation the report states that there has been a satisfactory increase in the amount of Grade A (T.T.) milk supplied. Great stress is laid on cooperation between M.O.H., public analyst, and sampling officers. There is immense and con- tinuing improvement in purity of foodstuffs, and more tests for preservatives were carried out during the first two months of the year than during the whole previous decade. Analytical methods need revision, especially for traces of boric acid, and this has been the main work of the laboratory. Forty-eight food- poisoning outbreaks are reviewed. Research Work. Work on the haemolytic streptococci has been published and supports the view that these organisms. are the cause of scarlet fever. Some research on pneumococcal virulence and immunity will be com- pleted shortly. A good deal of statistical analysis was. done for the Scarlet Fever Committee and on school anthropometry. The factors in puerperal mortality have been investigated, as have also the incidence of disease in cotton-spinners in wet and dry sheds, and health in the printing industry. It is becoming clear that the conception of herd immunity as distinct from individual immunity is a very important one for prophylaxis. The steady increase in the number of requests for advice and help in research work arising out of the ordinary duties of medical officers is viewed with great satisfaction as the most valuable work of the department. A review of progress in artificial light treatment lays stress on the necessity for medical control and supervision. A disquieting increase is noted in the deaths from anaesthesia, and the Ministry is anxious to ascertain the real fatality ratio and to relate it to different anaesthetics and methods of administration. International Health. The report concludes with a review of the work of the League of Nations Health Committee, the Office International, the International Sanitary Conference in June, and the International Pacific Health Confer- ence. Other chapters deal with the Port Sanitary Authority and the Poor-law. THE SPREAD OF TUBERCULOSIS. EXAMINATION OF CONTACTS. THE eradication of tuberculosis depends on the solution of a problem that has hitherto baffled an army of investigators. The problem is concerned with the manner of its spread. A husband, for instance, is consumptive ; his wife, subject to daily and nightly opportunities for infection, apparently escapes the disease. One child, perhaps, dies of miliary tuberculosis, two or three children become " tuberculous seedlings," and after a school career, chequered by frequent visits to clinics, dispensaries, and sanatoriums, reach adult life without revealing any obvious signs of tuberculous disease. In another similarly infected family, by contrast, the children pass through school life apparently free from disease, but when adolescence is reached, one or more of them suddenly develops signs of active phthisis, possibly many years after the death of the consumptive parent. In some cases the tragedy of " Wuthering Heights "
