REVIEW — TROPICAL MEDICINE, ETC. 125 



A more recent delivery on the subject is that of Buchan,' who thinks that the more Measles- 

 recent method of excluding only the infants and susceptible older children seems that cmUim 

 which is most gaining ground. In epidemic times, daily medical inspection of those 

 cliildren attending the infant departments is indicated, but too much must not be expected 

 from this measure, and in the future the school teacher, properly trained, is likely to be of 

 the greatest service. Lastly, the question of disinfection after measles falls to be considered. 

 M'Vail contents himself with thorough washing and cleansing, scrubbing of floors and 

 furniture, scouring of bed and body clothing, and the free admission of fresh air. 



Brown- sums up the advantages and disadvantages of disinfection as a prophylactic 

 measure in measles in the following terms. The advantages appear to be : — 



1. The prevention of the spread of the disease by infected articles in a very small and problematical 

 percentage of cases. 



2. Its educational effect, i.e. inculcating on parents the serious nature of measles. 

 Among the disadvantages may be mentioned : — 



1. The very small part it play.s in preventing the spread of the disease. 



2. The small return for the labour and expense of carrying it out. 



3. The piecemeal method in which it can be done at the best. 



4. The annoyance which this latter causes. 

 6. The difficulty of diagnosis ; and lastly, 

 6. Its leading to concealment of cases. 



As regards its educational advantage, it seems to me a very expensive and ineffective method of education, 

 and this can be much better done by our method of forwarding in every case precautions to be taken in the 

 disease, as well as an extract from the Public Health Acts bearing on the prevention of infectious diseases, 

 followed by a visit from the Sanitary Inspector. 



On the whole, the disadvantages appear to me to outweigh the advantages, and probably the best method 

 would he to do it on request by the medical man in attendance and in those special cases where circumstances 

 point to its utility. 



In a later paper, ^ he recommends : — 



That general disinfection after measles be discontinued, and that it only be done on 

 the request of medical men in attendance, the parents and guardians, or in special cases 

 where circumstances point to its utility. 



Milk. One has reference to a very large number of papers on milk and milk supply, 

 but most of those considered here will be found to have a bearing on the question as 

 it affects tropical countries. 



Blackham'' quotes Giles, who, in his book on " Climate and Health in Hot Countries," 

 says : — 



Qoats are extremely hardy and, being naturally clean feeders, require far less attention than cows, while 

 the flavour of their milk in tea is preferred by many to that of cows' milk. Thej' stand marching well, too, 

 and are therefore better suited for use in camp ; and as their favourite food is the leaves of bushes, they may be 

 trusted to find their living to a great extent as they trot along on their way from camp to camp. Usually their 

 milk agrees excellently with infants, but there can be little doubt that asses' milk is superior for this purpose. 



Goats' milk requires somewhat less dilution than that of the cow, and may agree in cases where cows' milk fails. 



Asses' milk is probably the best substitute for an infant's natural food, and, failing this, the goats' milk is to 

 be prefeiTed to that from the cow. 



Blackham himself confirms Giles' opinion that the milk of a "clean feeder" is 

 much more desirable than that of an animal which occasionally finds its nutriment in 

 village rubbish heaps. He says : — 



If Indian mothers realised that when pressed by hunger there is no fouler feeder than a cow, and it is 

 dismal fact that in the polity of an Indian village, the cattle rival the pigs in their efficiency as scavengers, they 

 would, when travelling about and unable to keep a cow of their own, prefer the milk of the goat to that of the 

 cow as food for their infants. 



Most of the Khartoum milk supply is derived from goats and in itself is of good 

 quality and flavour, but it is only fair to state that I have seen herds of goats browsing 

 on rubbish heaps containing mostly straw and paper, while the conditions of supply leave 

 much to be desired and will not be improved until the scheme indicated under " Sanitary 

 Notes " (Third Eeport) can be carried into effect. 



' Buchan, .J. J. (April, 1908), "Preventive Measures in Measles." Journal of the Royal Institute of Public 

 Health, Vol. XVI. 



^ Brown, B. K. (January, 1907), "Disinfection after Measles as a Preventive Measure against its Spread." 

 Public Health, Vol. XIX. 



" Brown, R. K. (January, 1908), {loc. cit.) 



* Blackham, R. J. (September 29th, 190G), "Goats' Milk for Infants." Lancet, Vol. II. 



