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enlarged, or if frequently the site of acute inflam-matory attacks, should be removed. As infective

organisms are frequently to be found in the

deepest portions of the gland the method of

removal should be complete and by enucleation.

BORIC ACID IN CREAM.

THE amending Order in regard to milk and creamregulations issued last week by the Local Govern-ment Board places the question of the use of boricacid as a preservative of cream on a definite basis.The regulations hitherto permitted the use of boricacid in cream so long as the presence of this pre-servative was declared, but there was no limit laiddown as to the quantity of boric acid added.The amending Order, while still requiring a

"declaratorv label," does not permit the use ofmore than 0’4 per cent. boric acid by weight of thepreserved cream. The Order also requires that thelabel on the cream so preserved shall bear the words" not suitable for infants or invalids." In the case

of hydrogen peroxide being used as the preserva-tive, the label is required to be drawn up in thesame terms, but then no statement is demanded as to the quantity of the peroxide present.

THE OUTBREAK OF ACUTE POLIOMYELITIS INNEW YORK.

Up to the last available date of record therehave been in New York City and the adjacentStates of New York, Connecticut, Massachusetts,New Jersey, and Pennsylvania the followingnumber of cases and deaths :-

Cases. Deaths.New York City (Sept. 30th) ...... 9,029 ...... 2286New York State, exclusive of NewYork City (Sept. 14th) ......... 2,785 ...... 318

Connecticut (Sept. 18th) ......... 677 Not reported.Massachusetts (Sept. 19th) ...... 671 ...... 95New Jersey (Sept. 19th) ......... 3,495 ...... 775Pennsylvania (Sept. 20th)......... 1,278 ...... 313

17,935 3787

Amid all the ignorance as to the means of distribu-tion of the virus, and the inconsistence of expe-rience in different epidemics, climates, and conti-nents, two facts in relation to medical experiencein New York City stand out with strikingclearness. They have been pointed out to us byDr. Haven Emerson, Commissioner for the Depart-ment of Health in New York, who writes as

follows :1. We have had no case among the 30,000 children in

institutions for orphans, &c., in New York City. By insti-tutions I do not mean hospitals or such places as day-nurseries, but the permanent homes of children outside offamilies. These institutions are under the supervision ofthe Department of Health, and we excluded all visitors atthe beginning of the epidemic and maintained as usual thetwo weeks’ quarantine for all children on admission-i.e.,two weeks for isolation and observation before admission tothe general living rooms, dormitories, and dining rooms.These institutions have the same water, pasteurised milk,and the same food as other children. They are no more pro-tected against flies and mosquitoes, but are probably lessafflicted with fleas and bed-bugs than many poor homes.Not a single case up to date, and the children are of all themost susceptible ages.

2. No case has been found on Barren Island, an island inJamaica Bay, Borough of Brooklyn, where 1300 people live,and upward of 350 children. All city garbage is rendered onthe island, also all dead animals are reduced to their com-mercial elements. There is no general water-supply ; thewater is from shallow wells. No sewerage, no roads, no localgarbage removal, little good sanitation in or out of homes,abundant flies and mosquitoes, and an ignorant populationof low-grade Poles, Italians, and coloured people working in

and about the rendering plants. They are geographicallyand socially isolated from all but the rarest contact with therest of the city.It is obvious from the experience in New Yorkand elsewhere that many of the facts upon whichan intelligent and logical sanitary control of acutepoliomyelitis can be based are still to seek.

PETECHIAL ERUPTIONS IN CAMP FEVERS.

DURING the present campaign attention hasbeen drawn to the frequency with which signs ofcutaneous haemorrhage are met with in troops atthe front during various infectious diseases, espe-cially typhoid fever, giving rise at first to seriousdoubt as to the differential diagnosis from cases oftyphus. Last August, while inspecting a sanitarystation where troops from various sectors wereconcentrated, Dr. G. d’ Ormea and Dr. M. Segale 1found five cases with symptoms of severe typhoidand a diffuse petechial eruption which appearedbetween the fourth and fifth day from the apparentonset of the disease. These subjects had beeninoculated against typhoid. Blood-cultures weremade in three of these patients: in one the organismof paratyphoid B was isolated, in another typicalcolonies of B. typhosus; the third culture gave anegative result, probably owing to lack of sufficientmaterial. In two of these cases positive evidenceof typhoid enteritis at the middle of the secondweek was found. The same observers, workingin another part of the front, noticed, in a largenumber of necropsies, frequent manifestations ofcutaneous haemorrhages more or less extensive inpatients dying not later than between the tenth andfifteenth day of a disease which clinically ran thecourse of a continuous or subcontinuous fever.The necropsies and bacteriological investigationsin these cases confirmed the presence of typhoid,in a large number with typical forms of Eberth’sbacillus and sometimes with that of paratyphoid B.These cases, although not very numerous, weresufficiently striking, since they led to the suspicion ofpetechial typhus, and were, on the contrary, ordinarytyphoid, often severe, in both inoculated and non-inoculated or cases of paratyphoid B. Petechialeruptions in typhoid are of extreme rarity in ordinarycivil practice, and their occurrence with relativefrequency in camps leads to the supposition thatthere are certain conditions inherent to the sur-roundings which favour their occurrence, the mostprobable explanation being that they are connectedwith haemovascular instability consequent on a

defective regime to which soldiers are exposed,without excluding as contributory causes over-

exertion and nervous exhaustion. Widal in 1915insisted on the absolute necessity of serologicalexamination before diagnosing petechial typhus in

order to exclude error with regard to typhoid, andDr. d’ Ormea and Dr. Segale emphasise the samepoint. They also draw attention to the analogybetween these petechial forms of typhoid and thecases of diarrhoea and trench nephritis as havingsome probable relation to the diet of soldiers at thefront, which contains an excess of animal food inproportion to cooked or raw vegetables.

THE autumn session of the General Council ofMedical Education and Registration will commenceat 2 P.M. on Tuesday, Nov. 28th next, when thePresident, Sir Donald MacAlister, K.C.B., M.D., willtake the chair.

1 Giornale di Medicina Militare, May, 1916. Tipografia EnricoVoghera, Rome.