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world by legal or illegal channels, and part of which is absorbed, simply and easily, by the licensed drug shops and smoking rooms established by Governments in the Far East, which make temptation

easy and revenue certain. The time has come when on this issue the moral forces of the world must call a halt.

THE RED CROSS AND DISEASE PREVENTION by Professor RoCCO SANTOLIQUIDO, Councillor of State to the Kingdom of Italy.

Although the Red Cross was conceived in wartime and for purposes of war, it was not long before it became a moral as well as a material force, and its activities soon spread to those innumerable peace time conflicts the battles against the diseases which surround us. After having firmly established itself in almost every country throughout the world, the Red Cross has settled down to its task, intervening promptly wherever disasters, epidemics and other great calamities occur. Nevertheless, if one compares what it has accomplished with what it ought to be able to accomplish, one must admit that its activities hardly amount to more than beau geste.

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The radical changes in our manner of living and in our conception of life, which we call moder progress, have assigned a higher mission to the Red Cross. Unless its organization is given a definite place in preventive medicine, its rôle clearly defined and its work co-ordinated with that of other public health organizations, the results achieved will be negligeable, and confidence will give way to disappointment. All those working in the same cause should reflect upon this, especially those engaged in public health administration. The first step to be taken is to see that national Red Cross Societies possess sufficient technical staff and equipment to enable them to undertake in a competent manner the mandate which lies at their door.

Let us not be misled by vague formulas and idealistic phrases. The more we find out about the factors which cause disease, the more we learn how deep and hidden they are. The elementary text-book

formula: "Isolate the first cases " has been proved utterly inadequate. In actual practice the problems of public health are very different from those which they are popularly supposed to be, even to-day. Even statistics no longer have the importance which was formerly attributed to them; unknown and unforeseen factors too often outweigh known facts.

What, for instance, can we expect to gain by the most careful notification of cases of human plague, when it is a known fact that the human factor counts for nothing, as compared with the hidden rat, in the spread of infection? What can even the most reliable cholera statistics teach us when medical science tells us that every recognized clinical case is only a serious individual manifestation of a phenomenon embracing a wide demographical area, and that in this area germ-carriers are spreading the virus wherever they go, whereas the "clinical case " is already isolated by force of circumstances. The same may be said of dysentery, of typhus, of malaria and of diphtheria. The struggle is unequal, because, when it comes to applying our knowledge, we have no levers at our disposal sufficiently powerful to raise practice to the level of science. Our plan of campaign against disease needs revision as regards the quality as well as the quantity of the weapons employed.

We are lacking neither in perception nor in scientific training but in the means of applying our knowledge. No help can be expected from progress in civilization. It is true that a more rational regime, especially from the point of view of diet, at present prevails, resulting in better organic defence. This is

probably one of the factors in the relative immunity against epidemics enjoyed by the majority of people to-day compared with epochs when famine and deprivation opened the door to devastating scourges. On the other hand, by a cruel law of compensation, centres of infection are increasing and becoming more active. Every man, in his capacity of world citizen, leads a sort of whirlwind existence owing to the new interests which he has made for himself and the larger measure in which he satisfies his desires. National and international communications have become feverish, sometimes one might say convulsive. Incessant changes uproot men and things, and all this, from the point of view of health, makes man the worst enemy of mankind. His contact with his fellowmen increases a thousandfold and the risk of infection becomes more frequent and more dangerous.

The inroads made by disease constitute a veritable disaster which can only be remedied by a realization of the present situation, by preventive measures, and finally, by prompt and effective aid.

Let us take an example from the field of plague prevention. The United States of America is already applying to rat epizooties the same strict system of technical investigation and of compulsory notification as in epidemics, and the people submit willingly to this discipline." They understand ", and if they understand for one disease, why not for another? To bring disease prevention up to the standard of modern requirements is not only a public health task but also a civic duty, for it is impossible to lag behind in the general advance.

One of the last acts of the late Dr. Metchnikoff was to investigate the cause of the invasion by tuberculosis of the Russian steppe, which had formerly been free. He discovered that the phenomenon coincided with the migratory movement among the younger generations, who, after having become infected with tuberculosis in the large European social centres where they went to be educated, subsequently transmitted the infection to their families who were not immune. At first sight there would appear to be only two alternatives: either to remain ignor

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Each national Red Cross society, should, therefore, in close co-operation with the public health authorities on the one hand and with scientific institutions on the other, apply itself to the task of venting disease. It should study the question from the epidemiological, the technical and the practical point of view, and should issue instructions that the necessary precautions be taken, even when such precautions may appear superfluous to the untrained mind. Such an extensive programme would necessarily require experimental work in the unknown field. With this object in view, health demonstrations should be organized which, while constituting in themselves an effective weapon against disease, would at the same time educate the people by propaganda.

An organization already exists which may be regarded as a model of what is needed, on a larger scale, for the protection of the populations of the world. I refer to the Rockefeller Foundation. This organization, as is well known, intervenes wherever it finds gaps in the public health service, offers financial support, encourages all serious efforts and establishs model educational and training centres.

But the Rockefeller Foundation, remarkable as it is as a generous philanthropic conception, is smal compared with the enormous need which exists on

every side. The task of the national Red Cross societies is to extend the work of the Rockefelle: Foundation and to guarantee it a solid basis of action by means of a universal relief fund, which would enable them to extend their programme and to increase their activities. An agreement with this end in view between national Red Cross societies and the Rockefeller Foundation might lead to the establishment of a preliminary centre of information and organization for the future development of the work.

In this scheme for the reorganization of the weapons of preventive medicine, the League of Red Cross Societies has an important rôle to fill. It should stimulate and help the development of national societies so that, in every country, even the least advanced, the public health service would adopt the

most practical lines, as revealed by science and experience. It should lead the many health activities which have sprung up towards the degree of development which modern progress requires of them, finally, it should study internationally how it may best help national Red Cross societies. In order to carry out this programme, the League should obtain the collaboration of selected specialists in every branch, without however, taking them away from their scientific and practical work. By getting into touch with these specialists, by providing them with the necessary information and by bringing them together for exchange of views and mutual agreement, it would prepare the way, in national and international public health work, for the "armed nation which constitutes the only sure guarantee of protection against the deadly attacks of disease.

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The Italian Red Cross is one of the oldest of the national Red Cross societies. Founded at Milan in 1864, it has taken part in all the changing scenes through which Italy has passed. From the war of 1866 to the world war which has just ended it has cared for millions of wounded, sick and convalescents, has re-educated thousands of the disabled. and has given assistance to thousands of prisoners of war.

Other great national disasters came to add their burden to that of the war. During the influenza epidemic of 1918 and the earthquakes of 1915, 1917, 1919 and 1920, the Red Cross furnished most generous help and gave proof of profund solicitude for the sufferering.

PEACETIME ACTIVITIES AT HOME

Not less important is the peacetime work of the Italian Red Cross. It was one of the first societies to undertake campaigns against malaria and tuberculosis, which are Italy's two worst enemies. As far back as 1900 the first anti-malaria units were formed in the Campagna, in the Pontine marshes, in Sicily, in Apulia and in other districts ravaged by malaria. These units, which were organized by Professor Paolo Postempski of Rome, were admired and imitated by other countries and were cited at the International Red Cross conferences as a noteworthy example of what the Red Cross can accomplish in peacetime, to help the civil population. The work of these units is being continued and developed for the welfare of our country.

An anti-malaria campaign was organized in agreement with the Army Medical Corps and in cooperation with it as far as technical details were concerned, in the course of which a great many antimalaria dispensaries and sanatoriums were established. Following on the initiative of the Cagliari

chapter, the Italian Red Cross set up an interprovincial service of motor ambulances in Sardinia. This service, which has already yielded most encouraging results, is an interesting exeriment in bringing aid to distant and inaccessible districts.

The Red Cross is no less active in the antituberculosis campaign. Led by the Central Committee and by various local committees, it has founded numerous dispensaries and sanatoriums; from 1916 onwards it has established and conducted, with the support of the public health services, eleven institutions containing in all 2,500 beds for tuberculous soldiers. About 30,000 patients have received treatment, which represents half a million days of hospitalization.

The anti-tuberculosis work of the Red Cross is not, however, limited to the care of the tuberculous. It also undertakes preventive work, and, since the germs of the disease enter the body in childhood, the Italian Red Cross devotes special attention to the protection of children. It has started anti-tuberculosis dispensaries, a children's home, open-air schools, permanent prophylactic colonies and temporary summer camps at the seaside, in the country or in the mountains. Every year a growing number of children benefit by these institutions, and this branch of child welfare is continually being developed and improved.

The Red Cross permanent climatic establishmerts such as the Camerata institution at Fiesole for boys and those at Fara Sabina for girls needing treatment at a certain altitude, or that of Valdotra near Trieste for sea cures, are universally admired both on account of the modern methods which have been adopted there and the originality displayed in their organization, to which the most recent ideas on special schools have been applied.

This year another institution, the Maraini Pre

ventorium in Rome, (1) directed by Profesor Valgussa, has been added to the technical resources of the Red Cross for use in the anti-tuberculosis campaign. The babies of tuberculous mothers are admitted to it from birth and the results of this preventive work have proved et inestimable value.

The Junior Red Cross has been organized on a very large scale with the support of the government. This organization already has 70,000 members in the schools and publishes two bulletins, one for children in the lower classes

and one for older children.

was carried out entirely by the Red Cross throughout the long struggle which took place in that city, was

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SEASIDE COLONY FOR DELICATE CHILDREN AT SAN BENEDETTO DEL TRENTO.

The Red Cross has not been inactive in industrial hygiene. It has studied a programme of aid in factories to be carried out by specially-trained nurses and has established first aid posts, such as that in the workmen's premises of the Garden City on the Aniene near Rome. The number of these posts is likely to be increased in the future, especially if the cordial relations established between the working classes and the Red Cross, as an independent and non-political body, continue to develop.

PEACETIME ACTIVITIES ABROAD

The conditions resulting from the war led the Red Cross to undertake peacetime activities in other countries where it has given help to famine victims. to refugees and to the destitute. The relief work amongst the Viennese children, the children of our former enemies, which was undertaken with the same care as for our own children, awakened universal admiration.

The feeding of the inhabitants of Fiume, which

(1) See Bulletin of the League of Red Cross Societies, Vol. II. No 12, p. 487.

no less remarkable. The Italian Red Cross has also rendered valuable assistance to Russian refugees in Constantinople, and to the people of Georgia, Poland and the Ukraine. At the present time the Red Cross, in answer to the Russion famine victims' of distress, has, in accordance with an agreecry ment made with the Italian government, sent a relief mission to feed the unfortunate inhabitants of the lower Volga district. Eighteen kitchens make a daily distribution of 15,000 adult rations and 3,600 child rations. These kitchens are divided into three groups, to each of which is attached a dispensary with a medical staff and supplies.

The Italian government has allocated a gift of 6 million lire for Russian relief and the Red Cross has furnished medical supplies to the value of a million lire.

WHAT THE RED CROSS IS GOING TO DO

The Italian Red Cross is one of the founder members of the League of Red Cross Societies. whose aim is to carry on peacetime work: to prevent di

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