A. W. McAlester, M. D., Kansas City, Missouri: I move that that be referred to the Council.

Motion carried, and so ordered.

President McCleave: The matter is really in the discretion of the individual Commissions, however, it is referred to the Council to make its recommendations at the next meeting.

Secretary Geier: I would like to request of the real President of this meeting,-Dr. Thomas.

President McCleave: No, he is not President yet.

Secretary Geier: Mr. President, if I am in order, I want to move that the incoming President appoint a Committee of three who shall have power to formulate resolutions such as were in our minds in yesterday's discussion, appealing to the American Medical Association for assistance in carrying forward pure milk propaganda.

President McCleave: I might say that Dr. Geier did not express that very well. I do want to tell you that we have been endeavoring for some years to get Certified Milk put in a better attitude before the American Medical Association. Three years ago, as you remember, there was a rigid editorial on the subject of Certified Milk in the American Medical Association publication, and we caused the editor a little disagreeable experience in reference to that and the attitude has been getting better since then. However, last year in the House of Delegates, a resolution was introduced by the then delegate from the Pediatric Section, Dr. Sedgwick, endeavoring to secure the endorsement of the Certified Milk movement officially by the House of Delegates of the American Medical Association. That went into a Committee who dropped it and nothing was ever heard of it.

This year we are going to do the same thing again, and it is not going to be dropped again. Dr. Geier is Secretary of the Section on Preventive Medicine and Public Health of the American Medical Association, Dr. Kerr is Chairman of the Committee on Public Health of the American Medical Association, and I am the delegate of the Pediatric Section of the House of Delegates, so that we three together ought to be able to make the House of Delegates accept

our resolution. We are going there to try it, and it will be rather strange if when this resolution is introduced in Dr. Geier's Section and in our Section, I will, of course, introduce it in the House of Delegates, and it will be referred to Dr. Kerr's Committee, of which he is Chairman,—and it will be strange if Dr. Kerr's Committee does not report it back favorably.

A Voice: It looks like a vicious circle!

Dr. Adelaide Brown, San Francisco, California: This looks like progressive politics.

President McCleave: I will appoint on that Committee Doctors Kerr, Geier and myself. All those in favor of the appointment of this Committee will please say "Aye," contrary "No." The motion was carried.

How to Meet the Fact and Estimate the Danger of Bovine Tuberculosis

By Henry L. Coit, M. D., Newark, New Jersey

Tuberculosis of known bovine type in children is a disease with which few have had experience or experimental knowledge. The best authorities estimate that in children it constitutes not less than ten per cent. of all cases and in adults it is not often seen.

The clinical features of these cases cannot be studied until after the bovine type of the tubercle bacillus has been demonstrated. Because of the difficulties in identifying bovine tuberculosis in man and of the greater difficulties of employing inoculation experiments on lower animals in order to determine the type of bacillus in tuberculosis, most of the cases are undetermined.

Many physicians have made and are making diagnoses of bovine tuberculosis in children in a loose and unwarranted manner. If it is a lymph-adenitis or an exudative peritonitis or a bone it is assumed to be bovine. These conclusions are unwise, are conjectural and are usually without any positive evidence whatever.

That there is such a disease as bovine tuberculosis, all are aware and no one was ever more forcibly or with a more cruel jolt impressed with the fact than the writer.

Our scientific knowledge in relation to bovine tuberculosis in man is almost entirely confined to the fact of its entity as a type. Its distinctive clinical features in human subjects have not yet been completely worked out, are largely inferential and the opinions of medical authorities are not yet in agreement.

We do not overlook the well known theory of Von Behring that all tuberculosis was originally bovine and is transmuted into the human type while passing through the human host. While this view is supported by eminent men, it is still hypothetical and may not prove to be true.

Thus far, in localities where animal tuberculosis has been prevalent among cattle and the milk presumably a greater menace, the bovine type of infection among children who are more susceptible to this form of infection than adults has not shown an unusually high percentage when the human and bovine cases have been differentiated.

The human type of tuberculosis still preponderates in children to the extent of from seventy-five to ninety per cent. even though all children are exposed to milk as a possible cause; whereas, while few children comparatively are associated with the human type of the disease, these constitute the great majority of the infections. This proves the mild and non-virulent character of the bovine bacillus. Park believes that even with mild tuberculosis of the udder, where good dairy hygiene applied to the milk collections is practised to exclude dust and feces and when reasonable attention is given to the health of the animals, the probability of infection through the milk is slight.

The tuberculin test as applied to milking herds is not the last word as generally supposed in protecting our milk supplies from tuberculosis. "Tuberculin tested milk" is a charmed phrase used by milk concerns and Boards of Health and the credulous and uninformed public is led into a false sense of security.

The public should know who did the testing, whether the veterinarian knew more than to shoe a horse or de-horn a cow and whether he left his thirty-four hour task which must be continuous with no opportunity for sleep and turned it over to irresponsible farm hands or whether he personally took all temperatures following the injections of tuberculin. Furthermore, whether the tuberculin employed was reliable, was properly applied or was not rendered inert by age or neglect. The difficulties of getting tuberculosis free milking herds are admitted by all to be very great.

Tuberculosis and its prevention, its types and its means of transmission are questions, the knowledge of which has been confined to a period within the memory of most of those present. As a student at Columbia, I remember when Prof. Alonzo Clark announced that Robert Koch had discovered the tubercle bacillus. It is not strange that many of the problems arising out of tuberculosis as a menace to human life have not yet been solved, their several aspects comprehended, nor an accurate knowledge of prophylaxis attained.

It would seem that all activities for human welfare are still in their infancy and far from being perfectly organized and effective. This is true in the field of health and disease which includes the approach through many channels of many infections.

The tuberculin reacting cow, possibly potential for danger, always has been and still is in the herds giving our milk supply but to what extent she is a menace to the health of our children or whether this danger is negligible we are only just beginning to determine.

During its entire history the Medical Milk Commission, which led the movement for procuring clean and safe milk, has not met so grave a problem as that of finding in a well guarded herd under Commission control, a large number of tuberculin reactors. This has accentuated interest in the medical control of milk intended for clinical purposes and not only the profession but the public has been awakened to its importance. Heretofore, the real significance of this system and its value has been chiefly recognized by the medical men actually engaged in the work. In all probability, the wide publicity given to this occurrence will be transformed into a fortunate result.

No one could be more anxious that this plan for clinical milk should be rigorously carried out than the writer who laid down its principles twenty-five years ago. One collateral reason for this is that eighty-one Commissions are credited to the initial effort.

This specific revelation in the course of a Commission's work showing a large number of reactors on a retest of a supervised herd has seemed to disturb the confidence of many people in the system. This is not just, because all milk herds when tested and retested at some time show a percentage either large or small of tuberculin reactors. The custom of this Commission to place the responsibility for the tuberculinization in a veterinarian of recognized ability and standing, did not in this instance protect the Commission nor the herd under its control from the presence of an unusual invasion of tuberculous infection.

The Milk Commission, through its system of safeguarding the milk by contract control of dairy hygiene, veterinary supervision, biological investigations and medical inspections of employees, has imposed sixty-five requirements upon the dairyman only one of which in this instance was called in question. In respect to the one, it was not that the tuberculin test was not applied but that its technique and the vigilant application of retests, following segregation of the animals after the initial test, was possibly defective.