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which is jealously guarded. The gut is then bleached withsulphurous acid and rubbed vigorously with,chamois leatherto remove dust and sulphur. - The threads are finally sortedaccording to their thickness into five grades, varying from atenth to half a millimetre in thickness. These five gradesare known respectively as " very fine," "nne," "medium,""thick," and "extra thick." The two extreme sizes are

rarely used. The fine threads should resist a mean pull of2’ 5 kilogrammes, the medium threads 4 kilogrammes, andthe thick threads 6 kilogrammes. A length of from 30 to32 centimetres is suitable for surgical use. The gut is

coloured by soaking for an hour or two in a solution offuchsine or methylene blue and subsequently by washingthoroughly to remove excess of dye. In order to render it

supple it is immersed for about six weeks in an antisepticsolution, usually a solution of phenol containing a little

glycerine. Finally, the gut is sterilised in closed flasks I

containing an antiseptic solution in an autoclave at a

temperature of 120° C. for half an hour. Silkworm gut soprepared varies much in quality, according to the thorough-ness of the treatment to which it has been subjected. It

loses its firmness on keeping. The annual production ofsilkworm gut in Spain is about 150,000,000 threads, the

preparation of which provides employment for from 4000 to5000 persons ; the total value amounts to from 2,000,000 to3,000,000 francs.

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MEDITERRANEAN FEVER IN SOUTH AFRICA.

WE have received a reprint of a paper by Lieutenant-Colonel C. Birt, R.A.M.C.,l in which he concludes thatMediterranean fever is now endemic in certain parts of theOrange River Colony and that its further spread is likely tooccur. Attention was drawn to the matter by some observa-tions of Dr. P. D. Strachan of Philippolis, Orange RiverColony, on 72 cases of prolonged pyrexia which cameunder his care during a period of 18 months. The

clinical features of the cases suggested to him the

diagnosis of Mediterranean fever and in order to con-

firm this view he sent blood from 34 of his cases to

the Government laboratories in Cape Town and Grahams-town. Of these, 25 gave an agglutination reaction withcultures of the micrococcus Melitensis in dilutions varyingfrom 1 in 10 to 1 in 50. These results were the more

remarkable since, apart from imported cases of Mediter-ranean fever, none of the cases of prolonged fever in themilitary hospitals at Harrismith, Bloemfontein, and Pretoriahave suggested that disease, and in all the cases in whichagglutination tests have been made with the micrococcus

Melitensis, the results have been negative where trust-

worthy cultures have been used. It is well known thatcultures which have been isolated for some time giveresults which cannot be relied on, since they become muchtoo sensitive to the agglutinins present in normal blood.On the other hand, Colonel Birt and Captain G. Lamb 3 haveshown that with recently isolated cultures a completereaction at a dilution of 1 in 10 or over implied Mediter-ranean fever past or present, and further, that this

agglutinating power persists for months, or even years, afterthe disease has subsided; in one of these cases they obtainedthe reaction seven years after the attack. In order to

subject Dr. Strachan’s cases to a more stringent test ColonelBirt obtained samples of blood from a number of them andtested them with progressive dilutions of recent cultures andin every case he obtained a positive reaction, in some

of them with dilutions of 1 in 1000. He therefore con-

cludes that all these cases were actually Mediterranean fever.Dr. Strachan’s partner, Dr. D. M. Macrae, has informed

1 Journal of the Royal Army Medical Corps. January, 1906.2 South African Medical Record, August 15th, 1904 ; Brit. Med. Jour.

July 15th, 1905.3 THE LANCET, Sept. 9th, 1899, p. 701.

Colonel Birt that he has seen similar cases in Fauresmithand Koffyfontein, and Springfontein and Bethulie have alsopresented cases of the disease. Dr. Strachan is of opinionthat infection has been spread by goat’s milk which is

largely used in these districts. The subject is one which

requires further investigation, since if this disease proves tobe endemic in these districts it will be necessary to takeactive measures to prevent its spread. The actual demon-stration of the organism in the blood of these cases has

apparently not yet been made and Colonel Birt very rightlysuggests that a search for it should be undertaken indoubtful cases of fever in the district.

WHAT IS WHISKY ?

THE proceedings at the North London police court lastMonday furnished very little evidence that could be said tobe of particular interest or to possess any fresh feature. SirJames Dewar was recalled and gave some figures referringto the effect of age on whisky. He said that experi-ments showed that the longer a whisky was keptin wood the greater the increase in the impurities.(Readers of THE LANCET may remember that this fact hasbeen pointed out in our columns as the result of a numberof analyses made in THE LANCET laboratory.) In cross-examination Sir James Dewar admitted that for drink-

ing purposes whisky was better for being older. Mr.William Saunderson, representing the North British

Distillery Company, Edinburgh, said that to their cus-

tomers they described patent-still spirit as grain spiritand pot-still spirit as whisky only. Asked whether hewould have any objection to stating on the bottle thatwhisky is pot-still or grain, as the case may be, the witnessthought that it might be done but that it ’’ would not alwaysconvey anything." The difficulty would be to exercise

control over the publican who bought the whisky in bulk.This witness agreed with another distiller that the publicknew very little as to how or from what materials whiskywas made. The hearing was again adjourned.

HYGIENE AT THE MILAN INTERNATIONALEXHIBITION.

THE International Exhibition by which it is intended to

celebrate the opening of the Simplon Tunnel was first meantto illustrate the past history and the modern developmentof the means of transport. Even this restricted programmeincluded several questions of great interest from the point ofview of health. The most obvious of these is the warmingand ventilation of railway carriages. Then there is the

great problem of food-supply-that is, the transport of livecattle and the railway cold storage cars for fish, meat,vegetables, beer, and other alimentary substances; medicalexamination, quarantine, disinfection of passengers and

cattle vans and wagons-all these and many other publichealth problems form part of the general question of trans-port and travelling. But the programme has been enlarged.The exhibition will be held at Milan. An area of 840,000square metres is secured and about a quarter of this space willbe built upon. Here visitors will find what promises to be anattractive fine art section. Then there are sections on decora-tive arts and a working hall for industrial arts. There willbe sections for agriculture, fishery exhibits, meteorology,aeronautic exhibits, social reform organisations, publichygiene, and, finally, a special exhibition of all that

relates to the multifarious endeavours made to reduce the

prevalence of pulmonary tuberculosis. The Italian executive

committee, we are informed, is especially anxious to givegreat prominence to all questions connected with tubercu-losis and to secure international cooperation in bringingforward all that bears upon the subject. The sanitary

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appliances in the production of which British manufac-turers have held the first place would serve as useful

object lessons, particularly as in Italy there is a growingmarket for these health-protecting products. This willbe the first international exhibition of hygiene ever

held in Italy and it should prove an excellent oppor-tunity for showing how hospitals, sanatoriums, factories,workshops, private dwellings, and public buildings can

be equipped with appliances for draining, warming, or

ventilating such places in a satisfactory manner. The

exhibition will be open from April to November this year andalready more than a hundred national and international

congresses are announced as about to meet at Milan duringthis period ; one of these congresses will be devoted to thequestion of tuberculosis. -

UNIVERSITY COLLEGE, LONDON.

A COURSE of eight lectures on Physiological Optics is

being given in the physiological department of UniversityCollege by Mr. J. Herbert Parsons on Fridays, at 5 P.M.,the first lecture having been delivered on Friday, Jan. 26th.The syllabus is as follows. Lecture I. : Elementary optics-reflection, mirrors, refraction, prisms, and lenses. Lecture II. :The eye as an optical instrument-the homocentric systemand the dioptric system of the eye. Lecture III. : Ophthalmo-metry. Lecture IV. : Ametropia-myopia, hypermetropia,astigmatism, and aphakia. Lecture V. : Ophthalmoscopy andretinoscopy. Lecture VI. : Visual perceptions—*light sense,colour sense, and form sense. Lecture VII. : Accommoda-tion and binocular vision. Lecture VIII. : Muscle balanceand strabismus. The lectures are open to all students inLondon medical schools and also to qualified medical menon presentation of their cards. Professor E. A. Minchin willcommence on Monday, Feb. 5th, a course of lectures onParasitic Protozoa. Professor Minchin has recently returnedfrom Uganda, where he has been engaged, as one of thespecial commissioners of the Tropical Diseases Society ofthe Royal Society, in research on the life-history of thetrypanosome of sleeping sickness.

MEDICAL PRACTITIONERS AND THE NOTIFICA-TION OF INFECTIOUS DISEASES.

AN action recently brought against Dr. Louis Stamm,practising at Streatham, for negligence illustrates the ex-

treme hardship imposed upon medical men by the law whichlays them open to prosecution if they delay in notifying, orfail to notify, cases of dangerous infectious disease, while itaffords them no protection against patients who considerthemselves aggrieved by the notification should the diagnosisnot be confirmed at the isolation hospital. In the case of

Dr. Stamm a female patient, who had eaten shell-fish at

Margate, became unwell, and after he had attended her forten days he notified her case as one of typhoid fever. Shewas detained at the South-Western Fever Hospital for 17 daysand there at some period subsequent to her admission theopinion was arrived at that her condition was due to

influenza and not to typhoid fever, of which she became awarebefore, or at the time of, her discharge, with the result thatshe brought an action against Dr. Stamm founded upon hisalleged mistake. There was no evidence whatever that hehad been negligent and the medical officers of the hospitalcalled on behalf of the plaintiff naturally and properlyexpressed their opinion that the defendant’s conduct in

notifying the case as one of typhoid fever had been perfectlycorrect. Dr. F. F. Caiger, the medical superintendent of thehospital, who had been absent and had not himself madethe diagnosis of influenza, was a witness and said that,having heard the story of the shell-fish and of the symptomswhich the plaintiff was stated to have exhibited, he con-sidered Dr. Stamm to have acted rightly in notifying that she

was suffering from typhoid fever. It was, in fact, a doubtfulcase and quite possibly was one of typhoid fever after all.The damage suffered by the plaintiff was apparently describedas nervous shock due to her detention in the hospital andinjury to her property occasioned by the disinfection of herflat. In these circumstances it is not surprising that thecounty court judge, the Hon. Arthur Russell, stopped thecase without the defendant being called upon to make goodhis defence, and he is to be congratulated upon havingdone so firmly and decisively in such terms as left nodoubt as to his view of the plaintiff’s conduct. He alsomarked his sense of this by ordering the costs to be paidon what is known as the C Scale, so that so far as possiblethe defendant will be indemnified for his necessary ex-

’

penditure in resisting the claim against him. Perhaps Dr.Stamm would have preferred the opportunity of justifyinghis diagnosis in the witness-box but, be this as it may,the real lesson of the case lies in the fact that he hadto undergo all the anxiety and expense of preparing hisdefence, however shadowy or non-existent the case of theother side might be. It is submitted to the good sense ofthe communitv that in its own interests and in those of

justice actions such as this should not be permitted and thatthe medical man should be absolutely protected until a strongprinad facie case can be made out against him, pointing notto erroneous diagnosis but to negligent and unskilful con-duct resulting in a mistake which the exercise of ordinaryprofessional skill and care would have prevented.

FEEBLE-MINDEDNESS IN CHILDREN.

THE growing literature upon the subject of the feeble-minded is indicative of the increasing interest which is beingtaken in this matter by medical men and educationists.There is abundant scope for the collection of scientific datain respect to the history and diagnosis of cases of feeble-mindedness in children upon which to found a rational

system of education and care. To this subject Dr.C. Paget Lapage makes a contribution in the Medical

Chronicle, 1905, based upon the examination of 258 feeble-minded children of Manchester who were pupils or would-be pupils of special schools, inmates of the homeof the Lancashire and Cheshire Society for the Per-

manent Care of the Feeble-minded, or patients at

the Children’s Hospital, Manchester. The following werethe etiological factors most commonly noted in these

cases : a history of non-epileptic convulsions or one of

epileptiform convulsions in the child ; a family history oftuberculosis, of feeble-mindedness, of insanity, or of epilepsy;a parental history of alcoholism ; and a maternal historyof some abnormality during pregnancy. The various factors

were usually found in combination. In regard to physicalanomalies in the feeble-minded child Dr. Lapage found thatout of 200 children examined 181, or 90. 5 per cent., ex-hibited various " stigmata of degeneration." These are

stated to occur much more frequently in the feeble-mindedthan in ordinary children and usually in combination,whereas in the ordinary school child single defects are

more common. The question of the frequency of occur-

rence of such stigmata in the insane and mentallydefective, as compared with normal individuals, andof the relative significance of the various stigmata isin need of elucidation. There is here a wide field for

inquiry. In the cases recorded the head appears to havebeen examined more especially and attention is drawn to

the frequency of occurrence of the following conditions:smallness of the maximum circumference, asymmetry,deficiency of the posterior part of the skull as comparedwith the anterior, defects of the external ear, and defectsof speech and of facial expression. " Featural " defects are

stated to be hard to classify or to describe but are regarded