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Public health measures in Germany
PUBLIC HEALTH, April, 1942
130 technical schools, colleges, and universities should also be submitted to periodical X-ray examination, and large firms are asked to do the same for their office staffs as well as factory hand.s. Public education should aim at making the people receptive of the idea. The memorandum of the N.A.P.T. is timely, although its tendency to focus attention on the adolescent and young adult is perhaps more politic than administratively sound, for it is probable that X-ray examination confined to these ages would miss many symptomless cases, at least among male towndwellers. For some groups of the population contemporaneous tuberculin tests should also be carried out, and in .this connection recent improvements in the patch test have made this simple procedure more reliable. T h e memorandum proposes at any rate a big enough programme for a start. Until recently American workers have expressed a preference for full-sized paper radiographs, but Major de Lorimer of the U.S.A. Army Medical Corps has come down strongly on the side of miniature films.* This journal drew attention to the modern development of miniature X-ray plants early in 1940t and again in 1941,$ as an economical and expeditious way of approaching the problem. The Royal Navy is using routine radiography extensively, but an unfortunate pronouncement by a Government committee early in the war discouraged the examination of recruits in this way, as has been done so extensively in Australia and the U.S.A. The reported findings as regards tuberculosis in recruits to the Armies of the U.S.A. have recently been ~ summarized by Helen S. Canny, Statistical Assistant of the National T u b e r culosis Association. § She points out that uniformity of results was not to be expected, since in some areas all recruits were examined by X-rays but not in others. Further, new recruits have passed through a double filter (soon to be eliminated), the first being a local board similar to our national service boards, the second an " induction centre " on entry into the Army, so that results at this second examination would be affected by the exclusion of cases of tuberculosis at the first. While X-ray examination is available for all entrants at the induction centres of some Corps Areas, it has not been so complete in othors, although it is expected that it will be possible to X-ray every man entering the Army from the beginning of this year. T h e proportion found to have disqualifying tuberculous lesions at local boards in Pennsylvania was 0.63 per cent. before X-rays were used as a routine, b u t rose to 1-83 thereafter. I n the Broadway-Chinatown area of New York, where rejections from all causes are high, the proportion found tuberculous with the aid of X-rays reached 8.7 per cent. There was much less variation between the findings at those induction centres for which data are available, the lowest percentage being 0.45 in New Hampshire and the highest for a presumably mixed racial group 1.50 in parts of Delaware. At one such centre in New York, however, where the findings among white and coloured groups were given separately, the positives were 0.84 per cent. in the former and 4.35 in the latter. T h e general conclusion is that about 1 per cent. of men of this age may be expected to show X-ray lesions. This is in fairly close accord with the experience of the two British Dominions from which results have been published---viz., Canada with 1.06 per cent. and Australia with 1.04 per cent. I n Australia only 0.56 per cent. were regarded as having active disease. It is understood that the Ministry of Health is now taking steps to make available miniature X-ray apparatus and promote X-ray surveys. It is important that the plants should be of such a nature as to give a very high measure of accuracy in the hands of those-competent to use them. It appears that two types of mobile apparatus are available, a four-valve type with petrol generator or a condenser set. T h e latter has the advantage of easier portability but, as at present designed, is considered by some experts to have insufficient condenser capacity to give completely satisfactory results. It is to be hoped that the Ministry and authorities proposing to acquire *Bull. Nat. Tub. Ass., 1941, 27, 153. "~PUBLIC HEALTH, 1940, 53, 74. Ib/d., 1941, 54, 72. § Bull. Nat. Tub. Ass., 1942, 28, 21.
a set wilt take the best informed opinion on these matters and not rely merely on the assurances of the makers. If the outfit is to be purchased an initial expenditure of about £5,000 has to be contemplated, including the cost of a specially designed van properly insulated and heated, so that the machine may be taken to the vicinity of any group of persons to be examined.
Public Health Measures in Germany A recent article in the Bulletin of War Medicine* gives an excellent summary of measures which have been adopted in Germany during the present war to combat epidemics and to raise the physical standard of the nation. T h e following is a brief summary of the article, which should be read by all those interested. As in this country, a circular was issued in September, 1939, dealing with typhus exanthematicus. T h e temperatures for killing lice are much higher than those recommended in this country. It is recommended in another circular that children should be vaccinated against smallpox during the second year and re-vaccinated at the age of 12 ; two incisions are to be used; of at least 3 ram., 3 cm. apart. Inoculation against diphtheria is advised, especially in areas where a spread of the disease is feared. The instructions to Sanitary Authorities with regard to germ carriers are stringent. Carriers must have bacteriological examinations of excreta whenever required and the police must report yearly on the carriers living in their area. Carriers may not be employed by dairies, butchers, pork butchers, food factories, or bakers, and the occupations of hairdresser and cellarman are also prohibited to them. Much use is being made of miniature radiography. I n certain areas it is proposed to establish a " tuberculosis register " by this means, and by 1939 more than 500,000 persons had already been examined in Mecklenburg. A decree on venereal diseases issued on September 27th, 1940, is stringent. Tracing of the source of infection is made compulsory, and the police have wide powers. Under the law of 1927, treatment of syphilis by arsenical preparations, mercury, or bismuth, was poasihle only with the consent of the patient. This law is in abeyance, and the consent of the patient is now required only for lumbar punctures, cystoscopy, ureteral catheterisation, or urethral dilatation. The Minister of the Interior ordered that a census of new cases should be made during June, 1940. By decrees in August and September, 1939, the rationed amounts for bread, milk, fats, meat, sugar and farinaceous foods were fixed, and the sale of eggs, cheese, coffee, tea, cocoa and spice was regulated. Expectant mothers receive half-a-litre of unskimmed milk and 150 grammes of farinaceous foods daily. Pregnancy must be certified by a doctor or midwife. Supplementary meat (250 grammes) and farinaceous foods (100 grammes) per week are also given to blood-donors during the fortnight after the bleeding. It is interesting to note that the diseases for which supplements are allowed are intestinal affections, gastric ulcer, diseases of the liver and kidneys, and tuberculosis. Tuberculous patients treated at home can obtain a supplement of 250 grammes of butter, 3½ litres of milk, and three eggs per week. This should be compared with the recent decision of the Ministry of Food in this country. A study of tables of the distribution of rationed foodstuffs in the late autumn of 1939 and of 1940 respectively shows that there was a reduction of 125 grammes in meat for all members of the community for a four-weeks' period. There was a slight reduction of the fat ration and also a 511 per cent. reduction in the ration of unskimmed milk to pregnant and nursing women. T h e ration of sugar was reduced, b u t that of jam, eggs and cheese was increased. Much use has been made of animal blood in the preparation of sausages, and an Order stipulates that the blood used--as prepared by a special process--may come only from bovines, pigs, sheep and goats. Great use is also made of bones, from which edible fat and gelatine are extracted and a paste manufactured for spreading on bread. Synthesis of fats has passed the experimental stage and such fats are stated to have been successfully used for foodstuffs. At Altona a factory has been perfected for the preservation of whale flesh. T h e lupin has * Medical Research Council, 1941. September.
Pages 1-10.
PUBLIC HEALTH, April, 1942 been used in the baking of pastry, and attempts have been made to cultivate the soya bean. Extensive research has been carried out on the resistance of different vitamins in canning. In November, 1939, a decree was issued providing for antirachitic prophylaxis for each infant. A large-scale experiment has also been carried out on the prophylaxis of scorbutic conditions. The course for a medical diploma was reduced in 1939 from eleven to ten semesters and various alternatives were introduced to the compulsory period of a year in a hospital service at the end of the course. Since then additional steps have been taken to speed up the course. I n order to increase available hospital beds steps have been taken to reduce the n u m b e r of maternity cases treated in hospitals. A close liaison was established between the school medical inspection service a n d the Hitler Youth organisation. School medical officers n o w have the title o f " Youth Doctors." A " Service for the Health of Young Persons " is responsible for them from the ages of 6 to 18 years, and regular medical examinations--" health call-ups" and " d e n t a l c a l l - u p s " - - a r e arranged. These arrangements, it is claimed, closes the gap between the schoolleaving age and the eighteenth year. It is hoped in the future to link up the health service for young persons with those of the labour camps and the army. Several police orders have been issued dealing with the conduct of young persons--such as prohibition of their being at places of amusement after 9 p.m., or being served with spirits or tobacco for their own USe.
A circular of 1939 stated that new buildings should be constructed with some view to the possibility of aerial bombardment. T h e number of beds must not exceed 600, except where the institution is used for university teaching or includes specialist departments. The number of stories should be two or three. Shelters, preferably constructed in the interior of the building, must be large enough to accommodate the staff a n d beds and must include an emergency operating room and other facilities. As a tail-piece to the above summary, w e may note the instruction given to Nazi writers of M.D. theses that " Jewish authors may be quoted only if that is absolutely necessary for scientific exactitude ; in such cases the fact that non-Aryans are quoted must always be specified and their works must be placed in a special category in thc index of authors cited."
The Health of India in 1940 The annual reviews of the P u b l i c Health Commissioner with the Government of India* always contain a large amount of interesting material, and this latest volume proves no exception. I n the past, because of the difficulty in collecting complete statistical data, these health reports have appeared about eighteen months after the year to which they related. Detailed statistic~s will in future appear in supplementary volumes, and the speedier appearance of official information o n health matters has met with general approval both from public health workers and from the general public. As might be expected, the health of India during 1940 was not affected by war conditions, and, in fact, no abnormal outbreaks of the common epidemic dise~es were recorded. Cholera has not yet been mastered, but Bombay Presidency has demonstrated during the past four years the possibility of preventing epidemics associated with religious festivals by insisting that every person attending a certain large pilgrim centre shall be protected with anti-cholera vaccine. T h i s measure seems to have had a considerable influence in reducing the spread of cholera throughout the Province, and it is gratifying to note that the public are co-operating with the authorities in carrying out these mass inoculations. T h e incidence of plague has fortunately decreased considerably during the past decade, but the occurrence of fresh outbreaks in one or two areas in Bombay Presidency indicates that the danger still exists. However, experiments carried out during the past six years in an endemic area have so fully established * Annual Report of the Public Health Commissioner with the Government of India for 1940. Published by the Manager of publications, Delhi. Printed by the Government of India Press, New Delhi, 1941. Price 12 arenas or ls.
131 the value of cyanogas fumigation of rat burrows as a preventive measure that the Plague Advisory Committee of the Indian Research F u n d Association have now recommended the intensive application of the method in all plague-infected areas. Since it was established in 1939, the Tuberculosis Association of India has made further important advances in organising preventive measures. Not only have Provincial and State branches of the Association got to work, but a model Central Tuberculosis clinic has been opened in New Delhi, and still more recently a large sanatorium was opened. During 1940, the war may have exercised little influence on the health of India, but it certainly has increased the danger of the introduction of yellow fever. For several years past the Government of India have taken stringent measures to avert the possibility of such a calamity and, though the Government's stiff attitude was the subject of repeated criticism at international conferences and elsewhere, their estimate of the potentialities of the situation in East Africa has been confirmed by the sudden appearance of a serious outbreak of yellow fever in the Sudan. There can no longer be any doubt that the danger of the carriage of yellow fever infection from East Africa to India, and beyond, has become more acute and additional precautions have recently been instituted. I n 1937 a Central Advisory Board of Health was established. The Board held its third meeting during 1940 and discussed a wide variety of subjects, including reports from two of its special committees. These dealt with the compulsory inoculation of pilgrims against cholera and with food adulteration. The fact that the Board were able to recommend compulsory inoculation indicates the progress made during recent years in regard to health matters; health education has obviously had the desired effect. The same remark applies to the serious problem of adulteration of food. The Indian is beginning to realise that the food racketeer has f a r too long enjoyed immunity from punishment and many will welcome further measures for the control of the purity of food supplies. T h e teaching of hygiene in schools, and the medical inspection of school children were also discussed. These are rightly considered to be two of the foundation stones of national health. Space forbids the mention of other important sections of the report, b u r one of the most interesting chapters, as usual, is that which reviews the medical researches in progress. The whole report breathes of vigorous and enthusiastic activity in many fields of public health endeavour, and is one which health officers in this country may be expected to peruse with feelings of sympathy and admiration for those who continue to bear the torch of health in this great and important part of the Empire.
Re.catch in Industrial Medioine The Medical Research Council announce that they have appointed Professor A. W. M. Ellis, M.D., F.a.c.P., formerly Professor of Medicine at the London Hospital, to a wholetime position on their scientific staff as director of research in industrial medicine. T h e investigations to be undertaken by Professor Ellis and his assistants will in the first instance be directed to problems of industrial toxicology, which are of special importance during the war.
The Bulletin of the National A.R.P. Co-ordinating Committee for September/October states that of all the problems connected with evacuation, the evacuating of children under five has proved the most complicated. It states that some 216 residential nurseries have been set up in the country since the war, with accommodation for 6,800 children, but that this is quite inadequate. It goes on to state that if recommendations contained in the recent Ministry of Health Circular on wartime nurseries could be put into effect the situation would be considerably eased. This circular permits the setting up of day nurseries in all areas. The Maternity and Child Welfare authorities are to be responsible, and the Exchequer will bear the cost. This problem is referred to again in the November issue of the Bulletin, and delay in overcoming the various difficulties is attributed in part to " the reluctance of local authorities to get a move on."
130 technical schools, colleges, and universities should also be submitted to periodical X-ray examination, and large firms are asked to do the same for their office staffs as well as factory hand.s. Public education should aim at making the people receptive of the idea. The memorandum of the N.A.P.T. is timely, although its tendency to focus attention on the adolescent and young adult is perhaps more politic than administratively sound, for it is probable that X-ray examination confined to these ages would miss many symptomless cases, at least among male towndwellers. For some groups of the population contemporaneous tuberculin tests should also be carried out, and in .this connection recent improvements in the patch test have made this simple procedure more reliable. T h e memorandum proposes at any rate a big enough programme for a start. Until recently American workers have expressed a preference for full-sized paper radiographs, but Major de Lorimer of the U.S.A. Army Medical Corps has come down strongly on the side of miniature films.* This journal drew attention to the modern development of miniature X-ray plants early in 1940t and again in 1941,$ as an economical and expeditious way of approaching the problem. The Royal Navy is using routine radiography extensively, but an unfortunate pronouncement by a Government committee early in the war discouraged the examination of recruits in this way, as has been done so extensively in Australia and the U.S.A. The reported findings as regards tuberculosis in recruits to the Armies of the U.S.A. have recently been ~ summarized by Helen S. Canny, Statistical Assistant of the National T u b e r culosis Association. § She points out that uniformity of results was not to be expected, since in some areas all recruits were examined by X-rays but not in others. Further, new recruits have passed through a double filter (soon to be eliminated), the first being a local board similar to our national service boards, the second an " induction centre " on entry into the Army, so that results at this second examination would be affected by the exclusion of cases of tuberculosis at the first. While X-ray examination is available for all entrants at the induction centres of some Corps Areas, it has not been so complete in othors, although it is expected that it will be possible to X-ray every man entering the Army from the beginning of this year. T h e proportion found to have disqualifying tuberculous lesions at local boards in Pennsylvania was 0.63 per cent. before X-rays were used as a routine, b u t rose to 1-83 thereafter. I n the Broadway-Chinatown area of New York, where rejections from all causes are high, the proportion found tuberculous with the aid of X-rays reached 8.7 per cent. There was much less variation between the findings at those induction centres for which data are available, the lowest percentage being 0.45 in New Hampshire and the highest for a presumably mixed racial group 1.50 in parts of Delaware. At one such centre in New York, however, where the findings among white and coloured groups were given separately, the positives were 0.84 per cent. in the former and 4.35 in the latter. T h e general conclusion is that about 1 per cent. of men of this age may be expected to show X-ray lesions. This is in fairly close accord with the experience of the two British Dominions from which results have been published---viz., Canada with 1.06 per cent. and Australia with 1.04 per cent. I n Australia only 0.56 per cent. were regarded as having active disease. It is understood that the Ministry of Health is now taking steps to make available miniature X-ray apparatus and promote X-ray surveys. It is important that the plants should be of such a nature as to give a very high measure of accuracy in the hands of those-competent to use them. It appears that two types of mobile apparatus are available, a four-valve type with petrol generator or a condenser set. T h e latter has the advantage of easier portability but, as at present designed, is considered by some experts to have insufficient condenser capacity to give completely satisfactory results. It is to be hoped that the Ministry and authorities proposing to acquire *Bull. Nat. Tub. Ass., 1941, 27, 153. "~PUBLIC HEALTH, 1940, 53, 74. Ib/d., 1941, 54, 72. § Bull. Nat. Tub. Ass., 1942, 28, 21.
a set wilt take the best informed opinion on these matters and not rely merely on the assurances of the makers. If the outfit is to be purchased an initial expenditure of about £5,000 has to be contemplated, including the cost of a specially designed van properly insulated and heated, so that the machine may be taken to the vicinity of any group of persons to be examined.
Public Health Measures in Germany A recent article in the Bulletin of War Medicine* gives an excellent summary of measures which have been adopted in Germany during the present war to combat epidemics and to raise the physical standard of the nation. T h e following is a brief summary of the article, which should be read by all those interested. As in this country, a circular was issued in September, 1939, dealing with typhus exanthematicus. T h e temperatures for killing lice are much higher than those recommended in this country. It is recommended in another circular that children should be vaccinated against smallpox during the second year and re-vaccinated at the age of 12 ; two incisions are to be used; of at least 3 ram., 3 cm. apart. Inoculation against diphtheria is advised, especially in areas where a spread of the disease is feared. The instructions to Sanitary Authorities with regard to germ carriers are stringent. Carriers must have bacteriological examinations of excreta whenever required and the police must report yearly on the carriers living in their area. Carriers may not be employed by dairies, butchers, pork butchers, food factories, or bakers, and the occupations of hairdresser and cellarman are also prohibited to them. Much use is being made of miniature radiography. I n certain areas it is proposed to establish a " tuberculosis register " by this means, and by 1939 more than 500,000 persons had already been examined in Mecklenburg. A decree on venereal diseases issued on September 27th, 1940, is stringent. Tracing of the source of infection is made compulsory, and the police have wide powers. Under the law of 1927, treatment of syphilis by arsenical preparations, mercury, or bismuth, was poasihle only with the consent of the patient. This law is in abeyance, and the consent of the patient is now required only for lumbar punctures, cystoscopy, ureteral catheterisation, or urethral dilatation. The Minister of the Interior ordered that a census of new cases should be made during June, 1940. By decrees in August and September, 1939, the rationed amounts for bread, milk, fats, meat, sugar and farinaceous foods were fixed, and the sale of eggs, cheese, coffee, tea, cocoa and spice was regulated. Expectant mothers receive half-a-litre of unskimmed milk and 150 grammes of farinaceous foods daily. Pregnancy must be certified by a doctor or midwife. Supplementary meat (250 grammes) and farinaceous foods (100 grammes) per week are also given to blood-donors during the fortnight after the bleeding. It is interesting to note that the diseases for which supplements are allowed are intestinal affections, gastric ulcer, diseases of the liver and kidneys, and tuberculosis. Tuberculous patients treated at home can obtain a supplement of 250 grammes of butter, 3½ litres of milk, and three eggs per week. This should be compared with the recent decision of the Ministry of Food in this country. A study of tables of the distribution of rationed foodstuffs in the late autumn of 1939 and of 1940 respectively shows that there was a reduction of 125 grammes in meat for all members of the community for a four-weeks' period. There was a slight reduction of the fat ration and also a 511 per cent. reduction in the ration of unskimmed milk to pregnant and nursing women. T h e ration of sugar was reduced, b u t that of jam, eggs and cheese was increased. Much use has been made of animal blood in the preparation of sausages, and an Order stipulates that the blood used--as prepared by a special process--may come only from bovines, pigs, sheep and goats. Great use is also made of bones, from which edible fat and gelatine are extracted and a paste manufactured for spreading on bread. Synthesis of fats has passed the experimental stage and such fats are stated to have been successfully used for foodstuffs. At Altona a factory has been perfected for the preservation of whale flesh. T h e lupin has * Medical Research Council, 1941. September.
Pages 1-10.
PUBLIC HEALTH, April, 1942 been used in the baking of pastry, and attempts have been made to cultivate the soya bean. Extensive research has been carried out on the resistance of different vitamins in canning. In November, 1939, a decree was issued providing for antirachitic prophylaxis for each infant. A large-scale experiment has also been carried out on the prophylaxis of scorbutic conditions. The course for a medical diploma was reduced in 1939 from eleven to ten semesters and various alternatives were introduced to the compulsory period of a year in a hospital service at the end of the course. Since then additional steps have been taken to speed up the course. I n order to increase available hospital beds steps have been taken to reduce the n u m b e r of maternity cases treated in hospitals. A close liaison was established between the school medical inspection service a n d the Hitler Youth organisation. School medical officers n o w have the title o f " Youth Doctors." A " Service for the Health of Young Persons " is responsible for them from the ages of 6 to 18 years, and regular medical examinations--" health call-ups" and " d e n t a l c a l l - u p s " - - a r e arranged. These arrangements, it is claimed, closes the gap between the schoolleaving age and the eighteenth year. It is hoped in the future to link up the health service for young persons with those of the labour camps and the army. Several police orders have been issued dealing with the conduct of young persons--such as prohibition of their being at places of amusement after 9 p.m., or being served with spirits or tobacco for their own USe.
A circular of 1939 stated that new buildings should be constructed with some view to the possibility of aerial bombardment. T h e number of beds must not exceed 600, except where the institution is used for university teaching or includes specialist departments. The number of stories should be two or three. Shelters, preferably constructed in the interior of the building, must be large enough to accommodate the staff a n d beds and must include an emergency operating room and other facilities. As a tail-piece to the above summary, w e may note the instruction given to Nazi writers of M.D. theses that " Jewish authors may be quoted only if that is absolutely necessary for scientific exactitude ; in such cases the fact that non-Aryans are quoted must always be specified and their works must be placed in a special category in thc index of authors cited."
The Health of India in 1940 The annual reviews of the P u b l i c Health Commissioner with the Government of India* always contain a large amount of interesting material, and this latest volume proves no exception. I n the past, because of the difficulty in collecting complete statistical data, these health reports have appeared about eighteen months after the year to which they related. Detailed statistic~s will in future appear in supplementary volumes, and the speedier appearance of official information o n health matters has met with general approval both from public health workers and from the general public. As might be expected, the health of India during 1940 was not affected by war conditions, and, in fact, no abnormal outbreaks of the common epidemic dise~es were recorded. Cholera has not yet been mastered, but Bombay Presidency has demonstrated during the past four years the possibility of preventing epidemics associated with religious festivals by insisting that every person attending a certain large pilgrim centre shall be protected with anti-cholera vaccine. T h i s measure seems to have had a considerable influence in reducing the spread of cholera throughout the Province, and it is gratifying to note that the public are co-operating with the authorities in carrying out these mass inoculations. T h e incidence of plague has fortunately decreased considerably during the past decade, but the occurrence of fresh outbreaks in one or two areas in Bombay Presidency indicates that the danger still exists. However, experiments carried out during the past six years in an endemic area have so fully established * Annual Report of the Public Health Commissioner with the Government of India for 1940. Published by the Manager of publications, Delhi. Printed by the Government of India Press, New Delhi, 1941. Price 12 arenas or ls.
131 the value of cyanogas fumigation of rat burrows as a preventive measure that the Plague Advisory Committee of the Indian Research F u n d Association have now recommended the intensive application of the method in all plague-infected areas. Since it was established in 1939, the Tuberculosis Association of India has made further important advances in organising preventive measures. Not only have Provincial and State branches of the Association got to work, but a model Central Tuberculosis clinic has been opened in New Delhi, and still more recently a large sanatorium was opened. During 1940, the war may have exercised little influence on the health of India, but it certainly has increased the danger of the introduction of yellow fever. For several years past the Government of India have taken stringent measures to avert the possibility of such a calamity and, though the Government's stiff attitude was the subject of repeated criticism at international conferences and elsewhere, their estimate of the potentialities of the situation in East Africa has been confirmed by the sudden appearance of a serious outbreak of yellow fever in the Sudan. There can no longer be any doubt that the danger of the carriage of yellow fever infection from East Africa to India, and beyond, has become more acute and additional precautions have recently been instituted. I n 1937 a Central Advisory Board of Health was established. The Board held its third meeting during 1940 and discussed a wide variety of subjects, including reports from two of its special committees. These dealt with the compulsory inoculation of pilgrims against cholera and with food adulteration. The fact that the Board were able to recommend compulsory inoculation indicates the progress made during recent years in regard to health matters; health education has obviously had the desired effect. The same remark applies to the serious problem of adulteration of food. The Indian is beginning to realise that the food racketeer has f a r too long enjoyed immunity from punishment and many will welcome further measures for the control of the purity of food supplies. T h e teaching of hygiene in schools, and the medical inspection of school children were also discussed. These are rightly considered to be two of the foundation stones of national health. Space forbids the mention of other important sections of the report, b u r one of the most interesting chapters, as usual, is that which reviews the medical researches in progress. The whole report breathes of vigorous and enthusiastic activity in many fields of public health endeavour, and is one which health officers in this country may be expected to peruse with feelings of sympathy and admiration for those who continue to bear the torch of health in this great and important part of the Empire.
Re.catch in Industrial Medioine The Medical Research Council announce that they have appointed Professor A. W. M. Ellis, M.D., F.a.c.P., formerly Professor of Medicine at the London Hospital, to a wholetime position on their scientific staff as director of research in industrial medicine. T h e investigations to be undertaken by Professor Ellis and his assistants will in the first instance be directed to problems of industrial toxicology, which are of special importance during the war.
The Bulletin of the National A.R.P. Co-ordinating Committee for September/October states that of all the problems connected with evacuation, the evacuating of children under five has proved the most complicated. It states that some 216 residential nurseries have been set up in the country since the war, with accommodation for 6,800 children, but that this is quite inadequate. It goes on to state that if recommendations contained in the recent Ministry of Health Circular on wartime nurseries could be put into effect the situation would be considerably eased. This circular permits the setting up of day nurseries in all areas. The Maternity and Child Welfare authorities are to be responsible, and the Exchequer will bear the cost. This problem is referred to again in the November issue of the Bulletin, and delay in overcoming the various difficulties is attributed in part to " the reluctance of local authorities to get a move on."