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public health department over which he presides. The Bill

in its main lines seems to have met with approval, thoughsome of its clauses have received considerable criticism

from medical officers of health and the different local

authorities which will be concerned in giving it effect.

The principle of relegating to future departmental regula-tions important matters such as the control over the sanitaryarrangements of cowsheds and the cleanliness of milking,the system of registration of dairies (which in the

Bill include not only dairy farms and cow-byres, butalso milk shops and other premises where milk is obtained

or stored), and the details of their inspection, has, we are

glad to note, received general acceptance. Departmentalregulations can be varied if they are found unsatisfactoryin experience, and no new measures of reform in connexionwith such a complex and important industry as the milktrade can be so perfect as not to call for fairly frequentadjustments in practice. The principal objections whichhave been urged to the Bill relate to the choice of the

executive authorities that has been made. The Bill placesmost of the administrative duties on district councils and

county councils concurrently, the latter authority havingsupervisory powers, but in "rural" districts the countycouncil is to act to the exclusion of the district council for

certain purposes, such as making investigations into com-

plaints that infectious disease has been caused by milk sentout of the district, and making orders to stop the sale ofinfected milk. County medical officers of health, if we mayjudge by a recent contribution to Pu,blic Health by Dr. W. G.SAVAGE, see many difficulties in taking responsibility in asort of patchwork over their counties. On the other hand,whole-time district medical officers of health, especiallythose who act for combined areas, have pointed out that

they could themselves exercise the necessary supervision andcontrol more efficiently than is practicable at a countycentre. This contention has been forcibly expressed in thecase of the eastern portions of Surrey by Dr. A. E. PORTERin his annual report for the Reigate district. It must be

realised, however, that when the new Order of the Board of

Agriculture relating to the slaughter of tuberculous cattle,with a view to compensation, has taken effect next month a

strong reason will be furnished for control being exercisedin health matters by the same authorities which carry outthe veterinarv work.

Criticism has also been expressed of the proposed repeal ofthe "milk clauses " in several local Acts which gave the

health authorities power to trace infected milk back to the

farm in the country and stop its supply to the city. It has

been contended that these powers should remain at any rate

for a few years after the passing of the Act, until these citiesare satisfied that the county supervision is adequate. At a

recent discussion at the Royal Sanitary Institute Mr.

HERBERT JONES drew attention to the invidious position inwhich medical officers of health may be placed in carryingout their duties under the Bill, and it is suggested thatclauses should be added to provide for security of tenureof district medical officers of health, analogous to those

relating to county officers which were introduced a few years iago into the Housing and Town Planning Act. We trust that I,the Bill will be given its second reading as soon as possible, ’

so that these and similar matters of administrative detail

may be fully dealt with in committee. As we before have

pointed out, it is in favour of the prospects of the Bill thatin several points it already represents a working compromisebetween the more extreme demands of public health adminis-tration and the opposition which was at first made in theinterests of the milk industry, and critics on both sides maynow do well to remember that the best is sometimes the

enemy of the good.

Unexpected Recoveries from

Insanity.THE cases which Dr. LEWIS C. BRUCE, of Murthly Asylum,

records in another column of THE LANCET present featuresto which it may be well to direct attention. In one case a

confirmed epileptic of many years’ standing was apparentlycured-in so far as an interval of eight years of freedom

from seizures may be said to constitute a cure "-by thewithdrawal of 40 c. c. of blood from the median basilic vein

once a week for six consecutive weeks. In the second case,a patient with cyclical insanity of manic-depressive type,it was discovered that her blood contained a specific

agglutinin to a variety of streptococcus obtained byDr. BRUCE from the blood of another patient who

suffered from acute mania. By feeding the former on

living cultures of this streptococcus a striking improve-ment set in, and whereas prior to the date of treat-

ment-October, 1905-her attacks of insanity occurred

every year, and sometimes frequently in the year, from thattime to the present there has been no relapse. A third case

is that of a patient with what appeared to be chronic

delusional insanity, who contracted scarlet fever, and inwhom convalescence from the fever was accompanied bycomplete disappearance of the delusional symptoms. For

three years she has been quite well. The fourth case is that

of a patient with delusions of identity, a morose, impulsive,absolutely intractable woman, to quote Dr. BRUCE’s own

words, who after four years of this condition suddenlybecame unconscious one day, developed a right hemiplegiawith aphasia, followed by high irregular fever, and when,some five weeks later, she had recovered to a greatextent from the effects of the "stroke," it was found

that her mental condition was entirely normal, apart from acomplete retrograde amnesia for the events of the precedingfour years. She was discharged recovered, went into service,and has apparently kept in good health since-i.e., for

almost five years.

Each of these four cases presents points of interest, andthree of them have this in common, that an alteration

in the psychical state was effected through the agencyof another form of disease. The case of recovery of a

maniacal patient after being fed by streptococci presentsdifficulties ; the technique here must be above reproach, andother experiments with every precaution against error

would be advisable before any conclusions are drawn from

it. Further, it is possible that in the last case narrated theintercurrent disease was not cerebral haemorrhage, as Dr.BRUCE is inclined to think, but encephalitis; in other words,a toxi-infective condition. The fever, which was one of the

1037

notable symptoms, is in favour of such a diagnosis, while the

age of the patient (27) is somewhat against the likelihood of

haemorrhage. However, be this as it may, the case is of

great interest. It is fairly well recognised that the incidenceof an intercurrent affection may have a curiously ameliora-

ting action on the course of a pre-existing disease,and instances will no doubt occur to the reader. We

know of a patient suffering from a well-established

delusional insanity who, in suicidal mood, threw herself

out of a window, sustained a fracture-dislocation of

the lumbar vertebrse, and from that date her mental

symptoms vanished and have not returned. It is diffi-

cult to appreciate the real meaning of such a course of

events ; the difficulty is not, perhaps, so great in cases

where the morbid process that supervenes is definitely toxicor toxi-infective, as in various recorded examples, and inone or two of those given by Dr. BRUCE. Nor need there

be any insuperable difficulty in explaining the interestingamnesia of the fourth case of Dr. BRUCE, for if an ictus,such as a blow on the head, can occasion a retrogradeamnesia, there seems to be no valid reason why the ictus of asudden haemorrhage or encephalitis should not be capable of

producing a similar result in a particular case. We have

heard of an old gentleman noted for his devoutness and

religious nature who, ever since an attack of right hemi-

plegia without aphasia, has had the greatest difficulty in

retaining or expressing his conceptions of the Deity, andadmits that to his distress he seems to be unable to recall

the familiar truths of his religion.It is well that the profession should hear of such instances

as Dr. BRUCE records, for they serve to show how alterationsin what were once thought the intangible and inaccessiblerealms of the insane mind can be brought about by definite

encephalic processes. We cannot agree with those who

would limit the possibilities of cerebral localisation ; after

all, if a cerebral tumour can effect changes in a man’s

disposition, character, and temperament, then these

features of his psychical" make-up "-to employ a usefulif colloquial Americanism-must have some anatomical

substratum, and we welcome all evidence that will aid

in the elucidation of the interrelations of the two. To

lay too great stress on scanty data would be injudicious;nevertheless, it is equally a mistake to ignore them- Dr.

BRUCE’S cases further illustrate the startling nature of somerecoveries from a condition of insanity-recoveries not

merely unexpected, but previously regarded as quite im-

probable. And the same may be said for the remarkable

recovery described in a letter this week by Dr. J. BATTYTUKE. Such cases indicate, it must be confessed, our com-

parative ignorance of the nature of not a few pathologicalmental states, but their suggestiveness will be noted by thealienist and physician.

ROYAL INSTITUTION. - On Tuesday next

(April 15th) at 3 o’clock, Professor W. Bateson delivers thefirst of two lectures at the Royal Institution on the Heredityof Sex and Some Cognate Problems, in continuation of thosedelivered before Easter. The Friday evening discourse onApril 18th will be delivered by Dr. T. M. Lowry on Applica-tions of Polarised Light ; and on May 2nd by Mr. H. G.Plimmer on Blood Parasites.

Annotations.

THE CONTROL OF PETROL.

11 Ne quid nimis."

IN 1908 a Departmental Committee was appointed to inquireinto the sufficiency of the existing regulations relating to thestorage, use, and conveyance of petroleum spirit, and toreport what further precautions, if any, were in their opiniondesirable as tending to diminish the dangers attendantthereon. In 1910 the committee presented their first report,but certain evidence was not forthcoming ; this, however,has since been obtained, and has enabled them to presenttheir final report which was issued last week. In this reportprovisions are recommended in regard to the conveyanceof petroleum spirit by road, and further powers, it is

suggested, are to be conferred upon harbour authoritiesin connexion with making by-laws under the PetroleumActs. It is also recommended that, generally speaking,the provisions of existing Acts-to wit, the Petroleum

Act of 1871 and the Explosives Act of 1875-should be morestrictly enforced by local authorities. In regard to theconveyance of petroleum spirit in the river Thames, inparticular (to the dangers of which considerable attentionhas been drawn), the committee uphold the views of the Portof London Authority that tank steamers shall not be allowed

above Thameshaven, although they have decided to allowgreater facilities for the conveyance of petroleum spirit upthe river in licensed tank barges, by increasing the capacityof the barges and by allowing self-propelled barges havingengines of a certain type. Recommendations are also madewith respect to the safe storage of petroleum for trade

purposes and to the domestic use of petrol. The use of

petroleum spirit hair - washes in hairdressing establish-

ments should, in the opinion of the committee, be

prohibited, and it should be made illegal, they add,to use petroleum spirit or mixtures containing it °°on

the hair of the living subject." It should be made

illegal, they also think, to allow any petroleum spiritto escape into any inlet or drain communicating with

a sewer. As regards the keeping of petroleum spirit for usein motor vehicles, no great change appears to the committeeto be necessary. It is suggested, however, that a certainregulation should be amended allowing of two spare tinsbeing carried on a motor-car without notification to the localauthority, and that a regulation should be added making itcompulsory to keep a supply of dry sand or some suitablesubstitute in every storehouse or garage. As a whole, thereport seems to present useful, temperate suggestions, inflict-ing no hardships, while at the same time offering better

protection both of person and property from a highlyinflammable material, the increasing use of which is afeature of modern times.

MEDICAL EXAMINATIONS IN SWITZERLAND.

THE regulations for the Swiss medical examinations of

1877 and 1886 have been completely revised. The new

regulations, dated Nov. 29th, 1912, come into force for thefirst time this spring. The examinations still take place atthe principal university towns-Basel, Berne, Geneva,Lausanne, and Zurich—and are conducted in German or

French (Lausanne and Geneva). (The innovations in the newregulations are marked in italics.) Only persons who havepassed the Swiss Matriculation Examination are admitted

to the three medical examinations-first, second, and final.The successful passing of the final examination provides thecandidate with a Swiss Federal diploma and admits him to