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simple) because we have no demonstrated example of salu-tary chemical antidotisms which take place in the circula-tory torrent based upon reactions analogous to those of therecognised antidotes. Having premised this, I admit thatthe application to therapeutics of the fact announced byDr. Roux is fully justifiable, and is therefore, in my opinion,to be encouraged, above all because the biological actionof this toxine antidote has been shown expeiimentallyto be innocuous and tolerated-the ne noaeat principlebeing, with me, the primary condition that ought to

be inscribed on the banner of every new remedybefore its introduction into practice." Professor Semmolathinks so far favourably of the serum therapeutics ofdiphtheria that he has been instrumental in sending adistinguished alumnus, Dr. Alfredo Montefusco, to Paristo master at the Pasteur Institute the new method of treat-ment with the object of " checking " it at Naples, and, iffound worthy, of applying it to patients. Dr. Montefusco, itis known, discussed with Dr. Roux at the recent Congressin Budapest the serum therapeutics of diphtheria., and hegoes to the Pasteur Institute with qualifications alreadytested not only in the hygienic administration of Naples, butmore especially in the "Istituto Sperimentale " directed

by Professor Semmola, an institution which has signaliseditself, as reported in THE LANCET, by more than one usefuland creditable achievement in pathology and therapeutics.

DELAY IN THE NOTIFICATION OF INFECTIOUSDISEASE.

DR. ORME DUDFIELD, medical officer of health of

Kensington, while discussing in his last annual report the-subject of notification, refers to the manner in which the

value of a notification certificate is curtailed when a caseis not notified immediately upon the general practitionerbecoming aware of its nature. He points out that the Actrequires the certificate to be sent "forthwith," and he holdsthat a sanitary authority would be justified in takingproceedings when the case is not at once notified. Dr.

Dudfield would only recommend such a course in cases ofrepeated neglect, and after caution ; but he remarks that it ishaidly fair that a sanitary authority should be called uponto pay for a certificate which is not forwarded in accord-ance with the terms of the Public Health (London) Act,1891, and when the delay may have deprived the certificateof much of its value from a preventive standpoint. It seems

from the report we are now referring to that Dr. Dudfieldhas had cases of delayed notification in the district of Ken-

sington ; in fact, he states that in several instances, wherehe has known of the existence of a notifiable disease, he hashad to apply to the medical practitioner for the certificate.We are certainly surprised that the delay exists to the extentreferred to by Dr. Dudfield, and we quite agree with him asto the necessity of rectifying it, more especially when regardis had to the necessity of immediate action being taken ininstances where other inmates of infected houses are attend.

ing public elementary schools, or where food-supplies are inquestion.

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DAILY INSPECTION OF VAGRANTS.

THE guardians of a northern union-which remains un-named-have instituted a daily medical examination of

vagrants. The value of this step must be great, for

vagrants are unquestionably some of the main distributersof infectious diseases, both amongst themselves and the

general public-indeed, the examination of 173 vagrants intwo consecutive fortnights led to the detection of seven

persons who were suffering from infectious disease. The

immediate interest in this method of procedure lies in thefact that when the Local Government Board were informedof the result they simply expressed their satisfaction, and the

guardians in question, having anticipated much more than thisexpression of opinion, have now decided to suspend the newpractice unless the Local Government Board so far identifythemselves with it as to urge on all boards of guardians theadoption of the same system. We cordially endorse the actionof the northern guardians in question, and we trust that somemeasure will be adopted by the Local Government Board tomake this excellent practice universal; but at the same time,we can well see that if this daily inspection is to become a realsuccess it must be carried out in cooperation with the localsanitary authorities. The guardians may properly be calledupon to make the daily inspection and to pay the necessaryfee for that portion of the work ; but when infectious diseaseis discovered they ought not to be expected to retain thepatients in isolation. Workhouses are not proper places forthe reception of outside cases of infectious diseases ; and wecan well understand that any action taken in the directiondesired will be limited to unions where the sanitary autho-rities have undertaken to do their share of the work-

namely, to deal with every case of infectious diseasenotified to them by the medical officer who carries out thesystem of inspection for the guardians. To retain infectious

tramps in workhouses all over the country might be usefulfor the general public, but it would certainly involve dangerto the workhouse inmates who are, after all, the first personswith whose welfare the guardians are concerned.

THE AMENDMENT OF THE AGE-RETIRING REGU-LATIONS FOR THE ARMY MEDICAL SERVICE.

IT has been notified by the Secretary for War thatHer Majesty has approved of the Royal Warrant concerningofficers of the Medical Service being amended as regardsArticle 347. The amended wording of the regulation doesnot apparently amount to much, but in its application it

may really amount to a good deal. It is ruled that the

age for the retirement of a surgeon-major-general maybe extended for a period not exceeding two years if itshould in any particular case be considered desirable in theinterest of the public service. It must be borne in mind

that, however desirable or convenient this provision may befor the State, medical officers generally cannot regard it as

desirable for them, seeing that promotion in the medicalservice is retarded by every such extension in the upper rank;and the question naturally arises whether its application willbe severely restricted to those particular cases where it is

clearly desirable on public grounds that an exception shouldbe made and the officer retained in the service for two yearslonger. It seems possible that the interests of an officer,and especially the interest which he can bring to bear on theauthorities, rather than the interests of the public service,may exercise an important influence in the matter.

THE DIFFUSION OF SMALL-POX.

THERE is not much news to hand concerning the diffusionof small-pox during last week, and such as there is tendsto show that the disease is becoming more restricted in itssphere of action at present. In the metropolis but little

change has been manifested during the past month, therecords for the past five weeks having in respect of freshcases never shown a difference greater than 7, the total forthat period having been 83, of which only 13 occurred lastweek. On Saturday last the patients under treatmentin the hospitals of London were only, in all, 84 in number,against 109, 100, and 98 on the three preceding Satur-

days. The cases admitted during the week were 11 in

number, against 19, 23, and 14 respectively. There was butone death registered—namely, that of a patient from

Marylebone. In the provinces the hospital records at

Birmingham last week showed a rise in the number of

inmates suffering from small-pox ; but, on the other hand,

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the number of fresh cases arising fell from nearly 40 to twodozen, and the deaths registered from the disease were, as ineach of the two preceding weeks, 2 in number. There were6 attacks notified in Manchester, but Salford was againfree from the malady. At Liverpool 4 deaths were regis-tered and a dozen cases were heard of, a decrease on

recent records. A few cases have been reported in

different parts of the country, in addition to those above

chronicled, but in England no other localised outbreaks seemto be now prevailing. In Dublin the progress of the small-

pox epidemic during September was as follows. In the weekended the 8th the cases admitted to hospital numbered 16 ;there were two deaths, and the patients remaining in

hospital totalled 85. In the next week the admitted caseswere 12, with one death, and the patients remaining undertreatment 80. These latter fell to 68 at the close of thethird week, with 13 admissions and 1 death ; and in thelast week of the month as many as 19 patients were admitted,1 case proved fatal, and 64 patients were left in hospital.

LIFE-SAVING AT SEA.

NOT the least useful of the functions discharged by theBoard of Trade is that which is directly concerned with thesaving of life upon our coasts. We are apt at times to forgetthis, and to assign even more than its due of reputation, if thatwere possible, to another national and world-famous organi-sation. An official series of life-salvage tables recently issuedby the Department is, therefore, the more interesting. Weare reminded by these that, although but two lifeboats arewithin the Board’s control, other and equally valued mEansto the same end are subject to it. Among these are

to be numbered some 3C0 life-saving stations, with rocketapparatus, cliff ladders, heaving-lines, and lifebuoys. Unlessit be on a comparison in the number of boats and thetotal result in life saved by their invaluable aid, not even theNational Lifeboat Institution can show a better record.

During the year ended on June 30th ro fewer than 402persons owed their lives to the Board’s live-saving apparatus.There is not, indeed, nor can there be, any essentialdifference or semblance of disagreement between these twoassociations. One is doubtless official, the other voluntary,but both are alike so far in their purpose. Each is, more-over, a counterpart of the other, shaiirg in one work, one,affect, and one reward of honour and gratitude. Thisleads us to consider a project which has already beendiscussed at some length-namely, the necessity of con-

necting by telegraphic wires our coastguard stations and

lighthouses. It is clear that success in life-saving at

sea must be greatly aided by such communications. Wehave on shore the fire-alarm bell, and the great facilitiesfor rescue which it provides are obvious to every one. Thesecoast telegraphs are the alarm bells of shipwreck. Doubtless

they might also subserve other purposes. They constitutein any case a more than desirable part of our coast equip-ment, and we trust therefore that they will before long beadced to the accomplished facts of our national policy.

"COMMON DISEASES MISTAKEN OR MIS-TREATED."

AN address under the above title, by Dr. James F. Goodhart,appears in this week’s issue, and draws attention to mattersupon which every member of the profession will do well toponder. Dr. Goodhavt does not consider the difficulties of

diagnosing a case of actinomycosis attacking the pleura fromone of empyema, or the latest application of the antitoxinprinciple—avast subject only just in its infancy,-but he dis-cusses the diagnosis and treatment of everyday practice,cases which practitioners must Eea daily, and yet whichare frequently mistaken and mistreated. For instance, he

mentions infantile scurvy, a very common complaint, and yethow often not recognised, and allowed to "pass as rickets,or rheumatism, or injury, or temper, or ’pure cussednes,’ andso on." Another disease, which, although very common, yetvaries very much in severity and in the mode in whichthe pain manifests itself, is angina pectoris, and thisis often mistaken for indigestion, neuralgia, rheumatism,flatulence, &c.; and instances must occur to all medical men

when, owing to suitable treatment not having been adopted,fatal results have followed. One of the most interesting por-tions of Dr. Goodhart’s address is cccupied with the considera-tion of the uric acid diathesis. He utters a warning againstthe popular fallacy of confusing the passage of urates withthat of uric acid, and also against treating all the subjectsof the complaint in the same way-namely, by a rigid formof dieting to get the uric acid out of the system. " It is all

very well," he observes, "for a man to make experimentsupon himself and then go and preach a universal rule." He

maintains that a cardinal medical rule is that disease is in

all cases individualised, and that we have to treat the

individual, and his malady through him. After reference tocases of renal colic and chlorosis, Dr. Goodhart concludes

by emphasising the fact that not a few of the methods andaims of medicine are faulty by reason of the ready assump-tion that their bases are unassailable, that men are con-

stantly driven back upon their own experience, and compellednot to accept it, but to question it.

THE SALE OF LAUDANUM TO A CHILD.

IN the course of a recent prosecution of an unqualifiedassistant in a druggist’s shop at Glasgow some curious factsconnected with the sale of poisons were elicited. It appearedthat four pennyworth of laudanum had been sold to a childeight years of age, and that the laudanum had been takenby the boy’s father and had caused his death. The only pre-cautions taken by the vendor had been to ask for what pur-pose. the laudanum was required, and to place two labels onthe bottle, one marked "poison" in red letters. As theaccused pleaded guilty there was no dispute about thefacts of the case, and, being charged under the PharmacyAct, the full penalty of E5 was inflicted. The point of specialinterest, however, lies in the fact that there appears to beno clause in the Act relating to the sale of poisons to

children. In the course of argument this point was raised,and the counsel acting for the Pharmaceutical Society saidthat, although it was the practice of registered druggists neverto sell poisons to children, there was no provision prohibitingthem from EO doing. The custom was for them to sendchildren home and say that they must have an older personwith them. So far as we are aware this is the first case in

which this curious omission has been referred to. The non-

observance of "custom" opans up such terrible possibilitiesthat we trust the omission will be rectified at an early date.However strictly the rules relating to the sale of poisons maybe drawn up, means of evading them will constantly be found ;but this loophole-the employment of children to effect thepurchase-is certainly one which should not be left un-

guarded. -

DIPHTHERIA IN LONDON.

DIPHTHERIA showed an increase in its fatal form in the

metropolis last week over any of the twelve preceding weeks,the deaths registered having been 66 in number. For the fiveweeks of August the total was 252, yielding a weeklyaverage of 50 ; and in the four weeks of Septemberthe total was 213, giving a weekly average of 53. Thecorrected average for the week corresponding to last weekfor the ten years 1884-93 is 36 9, so that the deathsof last week were 29 in excess of that average. As

showing the wide diffusion of diphtheria in London, we