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Bi[GGs of Yale, recently commemorated 4 by his Ifriend and colleague Dr. WINSLOW. Among themany appointments which BIGGS held were thoseof bacteriologist, consulting physician to varioushospitals, professor of anatomy, professor ofmateria medica, professor of therapeutics and clinicalmedicine, and professor of practice of medicine.He became successively director of the RockefellerInstitute and Commissioner of Health for New YorkCity, general medical officer of its reorganisedhealth service from 1902 to 1913, and, finally,Commissioner of Health for New York State.What more appropriate career can be imaginedfor a medical officer of health, but how is it possibleto introduce such men to the head of affairsin an established service such as ours ? 1The public health service in this country has

grown out of all recognition since its inception.Without losing its environmental interests ithas come to embrace almost the whole range ofclinical work. The men who have grown upin it during the last 30 years or more have beenactively engaged in the treatment of certaindiseases, some of which are almost side issues ofmedicine. To an increasing extent institutionalorganisation for the treatment of all sorts of diseaseis bound to be a dominating interest for the medicalofficer of the future, now that the functions of thepoor-law have been transferred. If this integrationof the medical services is to reach its full fruitionin benefit to the communal health, it is imperativethat these officers should be well and speciallytrained. The General Medical Council has shownits realisation of this need by issuing new regula-tions for the diploma of public health which,incidentally, are causing the medical schoolssome concern. But it is even more important thatthe method of selection of men for the senior postsof the service should be inquired into. There is noneof their responsibilities to which lay councils

cling more jealously than that of making appoint-ments, and yet it is impossible to believe that theyare fit for this task without expert guidance. Theuniversities have met similar difficulties by theformation of appointments boards and this suggestsa way which the Ministry of Health might pointout to the councils, at least of counties and countyboroughs. We fear, however, that the acceptanceof any such proposal by local authorities wouldbe long delayed. The Mayo librarian case inIreland, where appointments have been centralised,shows the need for caution, but the successes ofthe Irish scheme have also their lessons for us.The fetish of administrative capacity has to beexorcised. Clearly it is desirable that medicalofficers of health should be capable of applyingmedical knowledge to the day-to-day routine of theiroffice, but it is hard to see how sound administra-tion can be based on any foundation but professionalattainment and a close contact with the resultsof medical research. The medical officer of health,as BIGGS insisted, should be relieved as far as

possible of petty office routine. Much less office

4 The Life of Hermann Biggs. By G. E. A. Winslow, D.P.H.,Professor of Public Health, Yale School of Medicine. Phil-adelphia: Lea and Febiger. 1929. 15s.

discipline of medical staffs, for instance, wouldbe necessary if appointments were always made onmerit. The medical officer of health should befirst of all a man of professional and academicattainment and in the second place an admini-strator. There is a danger that the present methodof making appointments is tending in the oppositedirection.0

NUTRITIONAL ANÆMIA IN INFANCY.FOR the past five years Dr. HELEN MACKAY

has been investigating simple anaemia in infants.Some of her earlier conclusions regarding theprevalence of this condition and the means of

preventing and treating it have already been

published and are familiar to those who are

interested in paediatrics. Her more recent findings,however, emphasise the immense practicalimportance of this pathological condition, andthe full account of her work, which has just beenpublished, is likely to prove of great service tothose concerned in any way with the welfare of theinfant. Her main thesis is that simple anaemiain infancy resulting from iron deficiency is.

extremely common and is directly or indirectlyresponsible for a great deal of ill-health amonginfants, because it is associated with a loweredresistance to infection. The statement has oftenbeen made that this type of anaemia is rare. Byexamining blood samples from healthy breast-fedinfants and from infants in whom the existence ofanaemia was ruled out as far as possible by appro--priate prophylactic measures, it has been possibleto draw a curve representing the normal haemoglobin-concentration during the first 12 months of life..

Shortly after birth this concentration falls from itshigh level of 120-140 per cent. and reaches an

average of 99 per cent. in the third or fourthweek; by the second or third month it has fallen to69 per cent., but then rises until at five or six months;it reaches 80 per cent., where it remains until the.

end of the first year. The frequency of anaemia inthe East End of London has been measured by the-. examination of more than 1000 infants. Only 10; per cent. of artificially fed infants and 16 per cent., of breast-fed infants showed a haemoglobin con--

3centration of 80 per cent. or more after the age of15 months. The fact that appropriate treatmentcaused 69 per cent. of the infants to reach this

, haemoglobin level is taken as evidence that lowerE levels of haemoglobin concentration do, in fact,. represent a true state of anaemia, and this conclusionis almost certainly justifiable.1 That the main cause of this anaemia is a deficiency31 of iron, and possibly also of other metals such as. copper, is suggested from the results both of animal_experiments and of prophylactic trials in clinicalI practice. The production of nutritional anaemia in.young animals by feeding them after weaning, exclusively on milk has been recently reporteds from several laboratories, and it has been shown

1 Nutritional Anæmia in Infancy, with Special Reference toIron Deficiency. By Helen M. Mackay. Assisted by LorelGoodfellow. With a Statistical Appendix by A. Bradford Hill.Medical Research Council Special Report Series, No. 157.London : H.M. Stationery Office. 1931. Pp. 125. 2s.

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that this type of ansemia can be cured by theaddition of iron together with traces of copper.The iron content of cow’s milk is known to be lowerthan that of human milk, and is not, in fact,sufficient to supply the infant’s needs after he hasexhausted the reserves normally stored in his liverat birth. Dr. MACKAY has shown that the regularaddition to a milk diet of a soluble iron preparationis remarkably successful in raising an infant’shaemoglobin concentration to the " normal " level.Iron and ammonium citrate was the preparationused, and it was either given in a mixture or wasincorporated with the dried milk given to the infantsin such proportions that from 4i to 9 grains aday were taken. This preparation was shown tocontain traces of copper, so that part of its effectmay have been due to this metal. Although thissimple or nutritional anaemia has been shown to beextremely common, at least in the East End ofLondon, and to be readily amenable to treatment,it often appears to be associated with little or no

general disturbance of health and might thereforebe considered of no great practical importance.But evidence is presented in this report which

shows that this view is untenable. Among Dr.MAcKAY’s cases the morbidity-rate of infantsreceiving prophylactic doses of iron was onlyabout half that of control cases not receiving iron.Certain types of infection are known to predisposeto anaemia, and this anaemia itself appears toreduce resistance to infection ; the vicious circlecan be broken by the administration of iron, and,in fact, many infants with chronic infections wereobservej who had an associated anaemia and whoimproved dramatically as soon as iron treatmentwas instituted. Moreover, the infants receivingiron gained in weight at a greater rate than thecontrols.The evidence presented in this report, which has

been subjected to statistical analysis by Mr.A. BRADFORD HILL, D.Sc., points conclusively tothe existence and the importance of the conditionof iron deficiency, or nutritional anaemia, amonginfants in this country. The simplicity of thetreatment recommended for its prophylaxis or cureshould ensure its wide adoption and the disappear-ance of a deficiency disease with its unfavourableeffects on the health of the infant community.

ANNOTATIONS

NARCOTIC DRUGS: A NEW CONVENTION.

THE conference on the limitation of the manufactureof morphine, heroin, cocaine, and other narcoticdrugs, to which reference was made in our issue ofJune 27th (p. 1407), was in session at Geneva fromMay 27th to July 13th. It has prepared anotherconvention, which in some particulars is supplementaryto the Opium Conventions of 1912 and 1925. Asintimated in our annotation, the " quota scheme,"whereby due proportions of the world’s requirementsof the drugs referred to were to be produced respectivelyby the eight countries which are at present engagedin their manufacture, did not commend itself to theconference. That scheme, espoused by the Britishdelegate and backed by the advisory committee ofthe League, as well as by the London conference ofmanufacturing countries, found few supporters. Themore complicated scheme, whereby annual estimatesof the products of each manufacturing country arenot to be exceeded, whether for export, conversion,government stocks, or home consumption, was

adopted. Codeine, dionin, and peronin are to be

brought within the convention, while heroin is onlyto be exported to governments. New preparationsderived from opium or coca leaves are not to bemanufactured unless the government of the countryof origin is satisfied as to their medical or scientificvalue ; nor shall such be exported until the opinionof the Health Committee of the League of Nations asto their capability of causing addiction has beendeclared. It is noteworthy that this new conventionwill not be applied unless and until 25 nations,including four of the eight manufacturing countries,shall have ratified it. The effectuation of an inter-national treaty has to proceed by way of signature,ratification, putting the convention into force,legislation, and enforcement of legislation. TheGeneva Convention of 1925 required ratification byten Powers, including seven represented on theCentral Board, of which two were to be permanentmembers of the Council of the League. It will be

recalled that it was several years before that con-vention came into operation and that some of themore important opium- and coca-producing countriesare still outside its scope. Statistics recently issuedby the League of Nations show how much can beachieved by effective legislation based on the existingconventions, as in the case of the Dangerous DrugsAct, 1920-1925 of Great Britain. By such means itappears that the appalling illicit traffic in narcoticdrugs can be successfully reduced, while their medicaland legitimate uses are not unduly restricted.

THE CARE OF THE DEAF.

WE have on many occasions called attention tothe neglect by the State of deaf persons who, if

properly trained, could be made into useful and self-supporting citizens, and the matter has been constantlyput before the public by the National Institute forthe Deaf. Ministers of State, whose departmentscould do much to ameliorate the lot of these afflictedand handicapped persons, have expressed officialsympathy under two administrations, while last year,at the annual meeting of the Institute, Mr. Baldwingave an eloquent and thoughtful address on the

subject. Apathy, however, has not been overcome,as was indicated by Lord Charnwood, the Presidentat the annual meeting at Church House, Westminster,recently. He said that the average man and womanwholly failed to appreciate the character of theaffliction, while, owing to lack of general knowledge,the necessary money for carrying out the beneficentwork of relieving it was not forthcoming. Yet, hesaid, the sum needed was very small as comparedwith the response given to appeals for other charitableobjects. The report of the executive committee ofthe Institute, which has reached us, emphasises LordCharnwood’s words. This shows that the debt onRichardson House, which now provides a home for asmall group of deaf women, amounts to 1237, and thatduring the past year, apart from a legacy of 500, the