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that a finger was amputated. Virulent diphtheriabacilli were obtained from the amputated finger ofthis milker and from a sore on the hand of another

milker, the specimens being taken by differentobservers on separate occasions and being examinedin different laboratories. The sores on the handsof the third milker were healed at the time he

came under observation. As Dr. MACEWEN observes,it was difficult, if not impossible, to dissociate thecows from the milkers in considering how the milkbecame infected; the milkers had been free fromdiphtheria or sore-throat infection at their homesand they could hardly have been infected one afteranother on the fingers apart from the agency ofinfection on the cows’ teats which they handled.It was found that in five of the cows at the farm

irregularly shaped sores had been present on theudder and teats, situated usually on the upperportion of the teats, which resembled the sores onthe milkers’ hands. No great attention had beenpaid to these sores, and it could not be ascertainedhow long they had been present; it appearedtolerably certain that they had been observedbefore the first milker’s finger was affected. At

the time the farm was visited the sores were prac-tically healed, and only a dry surface remainedfrom which no swabs could be obtained. Samplesof the milk were examined for the presence of

diphtheria bacilli with negative result, but as thesesamples were not taken until Feb. 2nd, when allthe external lesions were healed, no inferencecould safelv be drawn as to the bacterial conditionof the milk of these cows during the infective

period in the previous December.The unusual features of this outbreak deserve

n,otice, and may usefully be borne in mind in

similar cases where milk is suspected, and its

prolonged daily infectiousness cannot be explainedby a diphtheria case or carrier having access to themilk. The suggestion that cow infection may playa part in milk epidemics of diphtheria is not new,though well authenticated cases are rare. SirWILLIAM POWER, to whom we owe the demonstra-tion, in 1878, that diphtheria can be spread by milk,himself suggested the possibility of cow infectionwhen reporting in 1886 on the facts of a remarkablysevere outbreak of diphtheria in York Town andCamberley. Here, although he succeeded in tracingthe infection to the milk of a large dairy, inquiriesfailed to produce any evidence of diphtheria amongthe milkers, and it was pointed out that a hypo-thesis of continued or intermittent infection of themilk as obtained from the cow could not be dis-

regarded. In 1906 Dr. A. ASHBY reported in detailon a condition of the udders and teats of cows,similar to that now described at Horsham, in a dairyherd the milk of which had caused a considerableoutbreak of diphtheria at Twyford. In this case themilkers’ hands appear to have been unaffected,but diphtheria bacilli were demonstrated in thesores on the teats of the suspected cows. It is -to

lbe regretted that in ’the present instance thecircumstances did not suggest or permit earlier

‘

examination of the cows at the Horsham farm andso complete on the bacteriological side the interest-ing chain of evidence which we have summarised.In such cases it is evidently desirable to lose notime in introducing the bacteriologist to the cow.

Annotations."Ne quid nimis."

THE BORDERLAND OF NEUROLOGY ANDPSYCHIATRY.

AT the recent quarterly meeting of the Medico-Psychological Association of Great Britain andIreland, which was reported in our last issue, Dr.Helen Boyle, of the Lady Chichester Mental Hos-pital, read a paper on the question of how to

improve treatment in the matter of early nervousand mental cases. The subject is undoubtedly onethat is surrounded by both theoretical and practicaldifficulties, as several of the speakers in the subse-quent discussion fully recognised. The generaltenor of Dr. Boyle’s paper was that neurology andpsychiatry were as a rule practised separately, withnot infrequently unfortunate consequences to thepatient. Cases of mental disease in an early stagewere diagnosed as neurasthenia and subjected torest-cure treatment, which often was not merely

useless but positively harmful. It was remarkedwith truth that the last person to see an earlymental case was usually the alienist, who is never-theless the specialist in that class of disease.There is, of course, no hard-and-fast line to bedrawn between nervous and mental diseases. Fromwhichever side they are approached border-line casesare constantly occurring. If the neurologist makesthe erroneous diagnosis of neurasthenia in a caseof exhaustion psychosis, the alienist may fail to

recognise a cerebral tumour running perhaps anatypical course in a case with obvious disorders ofconduct. We must admit that, broadly speaking,neurology and psychiatry have each a wide field,and that many cases are easily and readily placedas belonging to one or other category. But noone denies that leakage from one group to theother is a matter of everyday occurrence. Toobviate mistakes, and, indeed, to avoid the un-

satisfactory transference of cases where no mistakeis made, the neurologist should be sufficientlyfamiliar with the early forms of insanity, just asno psychiatrist can afford to dispense with a

neurological training. No antagonism existsbetween the two sister sciences, and we believethat the whole tendency of modern developmentsin the study of disease of the nervous system isto bring them closer together than ever before.This is just as it should be. At the same

time it must be said that asylum officerswill often be found frankly to admit that theyare conscious of having begun at the wrong end,so to speak, and that they feel that a workingknowledge of the main facts of neurology should betheirs before ever they start on what is the highexstudy of the two-the study of the mind diseased.Comparatively few asylum officers have had sucha training. In this connexion the newly instituteddiplomas in psychological medicine are proving asplendid incentive to the psychiatrist to make him-self as strong, on the neurological side as he is onself as strong, on the neurological side as he is onhis own. Nor should the neurologist feel that

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because a patient begins to show so-called mentalsymptoms the case is passing beyond his ken. He,too, should have had at least some asylum training,and he cannot afford to ignore the importance ofan adequate acquaintance with the main facts andprinciples of so-called mental disease. We agreewith Dr. Boyle that neurology and psychiatry areparts of the medical curriculum of which as a

rule the student is somewhat shy; they are notbrought prominently before him, and unless thephysician in the hospital wards has him-self shown interest in that class of case thestudent may have seen very little to help him when at length he joins the ranks of the

general practitioner. For this reason we welcomethe advances that are unquestionably being made.Several of the large general hospitals have neuro-logical departments; most have at least one memberon their staff who is alive to the importance ofthese specialties, and who chooses to teach on suchcases in preference to others drawn from the othersections of internal medicine. It is rather on theside of psychiatry, on the whole, that the student isstill not so well catered for as he might be, butalready more than one general hospital has an out-patient clinique for mental cases, and ere longLondon will be still better off in this connexion.We see no reason why there should not be bothneurological and psychiatrical cliniques at generalhospitals, and it is possible that some day the

physician at the head of such cliniques willbe neither neurologist nor alienist, but a teacherwith full experience of both nervous and mentaldisease. It is our impression that on thecontinent there is more cooperation in the twobranches than in England; at least, more neuro-logists are members of psychiatrical societies, andvice versa, than at home. In any case, it seemsclear that in order to keep abreast of advances inknowledge of the functions of the nervous systemboth alienist and neurologist must continue tolearn each from the other. We know that pre-judices die hard, and that the stigma supposed inthe mind of a considerable section of the public tobe attached to the word asylum is a potent factorin the continuance of the present unsatisfactorysituation. But this stigma is gradually dis-appearing ; and were the public to become morefamiliar, by means of hospital cliniques and other-wise, with the view that mental disease is nervousdisease, it would in time vanish altogether. All ]endeavours to achieve that end are worthy of thestrongest support. ____ c

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ACUTE PANCREATITIS.

, PROBABLY one of the latest abdominal lesions tobe recognised was acute pancreatitis, and yet it isone of the most important and most serious ofthe many acute affections involving the abdominalviscera. It is not, however, so important on accountof its frequency, for acute pancreatitis is one of therarer abdominal lesions, as on account of the diffi-culty in recognising it, at least in most cases. The

rarity of the condition renders it unlikely that mostsurgeons will see many cases of the disease, and, infact, it falls to the lot of few surgeons to see morethan one or two examples. In the present issueof THE LANCET we publish an interesting andimportant paper by Mr. A. E. Barker, who hascollected the notes of six cases which have beenunder his own care or that of his colleagues atUniversity College Hospital. It is of interest tonote the conclusions at which Mr. Barker has

arrived. He points out that in several of the casesthere had been previous attacks evidently of thesame nature. The sudden onset and the severity ofthe pain were very marked. In no case was anytumour discoverable in the epigastrium without ananaesthetic, and even after the administration of ananaesthetic in only one case could a swelling be felt.With regard to treatment, drainage of the omentalsac is not sufficient in most cases, and Mr. Barkerinsists on the need for retroperitoneal drainage. Asto the results, of the five cases in which an opera-tion was performed four recovered. With earlier

operations the danger of the condition will probablybe greatly diminished.

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FERRO-CHROME DANGERS.

IT appears that ferro-chrome is liable, like ferro-silicon, to give off poisonous phosphoretted hydrogengas, and the attention of the Local GovernmentBoard having been drawn to the subject, threeofficers were appointed to institute an inquiry.The results obtained now appear in a reportpublished last week, signed by Dr. S. MoncktonCopeman, F.R.S., medical inspector of the LocalGovernment Board; Mr. Samuel R. Bennett, M.A.,one of H.M. inspectors of factories; and Mr. H.Wilson Hake, Ph.D. Chromium as a constituent ofsteel confers important physical properties, butchiefly it hardens the material and as the proportionof chromium increases the alloy exhibits a highresistance to rupture and a high elastic limit.Chrome steels are mainly used for armour

plate, armour-piercing projectiles, some high-speed steels, steels for stamps and crushers,and also for files, tyres, and springs. Accordingto Dr. Monckton’s summary of Dr. Hake’s investi-gations there would seem to be no doubt thatan excess of aluminium in chrome steel alloys iscoincident with a tendency to spontaneous dis-

integration, accompanied by evolution of phos-phoretted hydrogen. It may be remembered thatferro-silicon is prone to disintegration, especiallyin presence of moisture, poisonous gases beinggiven off in such quantity as to bring about fatalresults in human beings subjected to such emana-tions. Consignments, however, of ferro-chromehad been found to evolve " acetylene smelling gasmore strongly than the worst ferro-silicon." Sampleswere found to fall to powder very readily on ex-

posure to air and moisture, and paper impregnatedwith silver nitrate assumed an intense black colouralmost immediately on exposure to the gases givenoff from this material, while lead paper was un-

affected, thus indicating the evolution of phos-phoretted hydrogen in large quantity. The ex-

planation offered was that this must have beendue to an abnormally high percentage of silicon,whereas ordinary ferro-chrome is almost as hard ascast iron. It now seems fairly established, accordingto this report, that the disintegrating quality offerro-chrome is not due to silicon but to an

excess of aluminium present. It certainly appearsto be the case with the related material ferro-silicon. A sample of this latter with pure alumi-nium introduced proved to be specially liableto disintegration, giving off at the same timelarge quantities of phosphoretted hydrogen, whileanother sample freed from aluminium did notdisintegrate, although otherwise of practicallythe same composition and exposed to similarconditions in all respects. By previous methods.f manufacture apparently aluminium was practic-ally excluded, but by a later method, in which