168

cholera, the typhus group, malaria, yellow fever, goitre,plague, beriberi and pellagra, fflariasis, elephantiasis,and schistosomiasis. It will certainly be a useful actto review the distribution of these conditions. Duringthe war years the contact of large groups of men frommilitary necessity, malaria prophylaxis, immunisation,mass acclimatisation to unaccustomed conditions,deficiency disease in prison camps, and the effects ofair travel on the spread of disease have combined toproduce drastic changes in the incidence of disease.One may hope that in time the atlas will be extended toinclude not only the U.S.A. but the whole world, servingas a tool of research rather than a textbook. Anattempt to prepare a global epidemiology 3 has alreadybeen begun elsewhere for the Medical Department of theU.S. Army, though in a less graphic manner and basedon a correlation of local geography and climate, publichealth, medical facilities, and diseases. It will be

interesting to compare this survey with the proposedatlas of diseases.

PASTEURISATION AND CHILD HEALTH

THE small party sent out to North America two yearsago to see the methods of production and marketing ofmilk in the United States and Canada 4 emphasise thefact that pasteurisation is almost universal in NorthAmerica; and the importance of this practice to childhealth has been brought out very clearly by Lethem,5who summarises the mortality from abdominal bovinetuberculosis in England and Wales during the period1921-44, as follows (actual number of deaths in paren-theses) :DEATH-RATES FROM ABDOMINAL TUBERCULOSIS PER MILLION

CHILDREN UNDER 5 YEARS OF AGE LIVING IN EACH AREA

Abdominal tuberculosis in young children, which is

predominantly bovine in origin, gives in its incidence-rate a better indication of the trend of the risk of milk-borne infection than any other clinical type of tuber-culosis. The table shows that the most dramatic declinein abdominal tuberculosis has been in the London CountyCouncil area, though a slighter decline has also occurredin other districts. These trends can be correlated with thecompleteness of pasteurisation in each of the areas.

Of the milk supplied in 1938, in London 98% waspasteurised, compared with only 60% in the countyboroughs, while the consumption of raw milk was

greatest in the rural districts. Despite the dangersinherent in "bulking" milk-supplies, and the environ-mental disadvantages of city life, the death-rate inLondon had declined by 1944 to a twenty-third of the1921 figure, whereas in the rural districts the rate hadfallen to a quarter of what it was in 1921. The death-ratein London in 1944 was a tenth of that in the rural districts.It would be unwise to assume from these figures,suggestive as they are, that pasteurisation alone wasresponsible for the happy state of affairs. Its effectsmust be considered in relation to all the improvementsin environmental conditions which have brought aboutthe consistent decline in tuberculosis mortality since1920. Nevertheless there is little doubt that pasteurisa-tion has been a major factor in the prevention of bovinetuberculous infection in children. In the recent House

3. Simmons, J. S., Whayne, T. F., Anderson, G. W., Horack, H. M.Global Epidemiology, Philadelphia and London, 1944.

4. Milk in North America. H.M. Stationery Office. 1946. SeeLancet, July 27, p. 127.

5. Lethem, W. A. Mon. Bull. Min. Hlth & E.P.H.L.S. April, 1946.

of Lords discussion of dairy-farming, the usual argu.ments about the deleterious effects of pasteurisationwere raised, but no figures comparable in scope andconviction with Lethem’s data were produced in sub.stantiation. Unless and until better statistical evidenceto the contrary is produced, we should do well to act onthe implications of his findings. The mission’s reporton milk-marketing methods in North America hascovered the practical details. It remains for administratorsto put these recommendations into effect, for the

country cannot afford the wastage of child life entailedby too sensitive a regard for the prejudices of part ofthe farming community.

THE INDEX-CATALOGUE

THis summer the United States Army Medical Libraryat Washington (more familiarly known as the Surgeon-General’s) has sent over the recent volumes of its famousIndex-Catalogue to bring up to date the sets in Britishmedical libraries. These volumes had been held in storesince the whole British consignment of 1941 was sunk inthe Battle of the Atlantic. Their arrival recalls thedebt we owe to the compilers and producers of theIndex-Catalogue and ultimately two the United StatesCongress, who pay for its printing and free distributionthroughout the world.The catalogue was launched with vision and enter.

prise by Dr. John S. Billings 66 years ago, and Billingstruly said that it would " be useful in St. Petersburg,for example, as well as in Washington, its measure ofutility in any locality being the extent of the collectionof medical literature therein." It has now reachedits 56th volume and is half-way through the alphabeticalarrangement for the fourth time, having listed 2,500,000articles and 400,000 books under their subjects, besideshalf a million entries under authors’ names. The distribu-tion list, published for the first time in the 1943 volume,shows that 800 of the 1000 copies printed are given awayby the American government, no less than 69 copiescoming to the British Isles, for libraries and othermedical institutions. The visitor to a medical libraryin any country will always be shown the position of theIndex- Catalogue, often with the grateful remark" Theyindex our collections for us," though naturally it is of

greatest value to English-speaking people. Withoutthis subject index the medical reader would have tomake a tedious search through the volumes of theIndex Medicus, each of which covers only six months’output, and for the earlier publications he would have towade through the long series of the periodicals themselves.

Criticisms of the Index-Catalogue have of course beenheard, for no work of such a scope can be perfect. Andit has been admitted that the library lived on its pastreputation through the slump of fifteen years ago, whilethe catalogue fell below its own high standard of compre-hensiveness. But under the wise and enthusiastic rule ofColonel Harold W. Jones, who has lately retired afternine years as librarian of the world’s greatest medicallibrary, both library and catalogue have been imbuedwith new life. The catalogue is in the able hands ofDr. Claudius F. Mayer, a distinguished medical scholar.The new connexion between the U.S. Army MedicalLibrary and the Library of Congress, and the correlationof the Index.Oatalogue with the American MedicalAssociation’s Quarterly Cumulative Index Medicus, willensure the maintenance of accuracy and inclusiveness.Everyone who seriously follows medical writings willacknowledge his deep debt to the famous referencework which Dr. William H. Welch called America’sgreatest contribution to medicine.

Mr. WiLUAM GEMMI1.L, professor of surgery in theUniversity of Birmingham and surgeon to the Queen,Elizabeth and General Hospitals, Birmingham, died athis home at Edgbaston on July 28.