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injure milk by interfering with its keeping, by makingit unpalatable, and by reducing its food value. Onthe other hand, the satisfactory cartons that wereexamined had much lower bacteriological counts thanglass bottles, the average being less than ten coloniesper container, and the bacteria recovered were of nosanitary significance. It appears that the process of

making paper-board can yield an almost sterileproduct and water-proofing with hot paraffin furtherreduces the viable bacteria. If the bottles are sealedin the factory where they are made, and not openeduntil they are about to be filled, the parts that comein contact with the milk need not be exposed tocontamination. From a health point of view non-returnable containers have obvious advantages overreturnable bottles, and it is therefore gratifying tolearn that they can be. supplied commercially in analmost sterile condition.

Anthrax from Artificial Manure

At the inquest on June 4th on a market gardenerof 30 who died of anthrax in Manchester RoyalInfirmary, the jury returned a verdict of death bymisadventure, adding a rider that death had beencaused by handling artificial manure. The man

bought manure from a local manufacturer andscattered some of it on his land with his bare hands.A few days before his death he complained to hiswife of severe headaches and she noticed a pimple onhis neck. Later his neck swelled and the swellingspread to his chest, and, in spite of treatment inhospital, he died of anthrax septicsemia. The doctorwho gave evidence said that the man might havebecome infected by scratching his neck while spread-ing the manure, and asked whether anthrax bacilliwould not be destroyed in the preparation of manure,pointing out that they were very resistant to heat.Evidence was given that horses, cattle, and occa-sionally sheep are used to make manure, diseasedanimals being examined by veterinary surgeons.A representative of the makers of the manure statedthat this was made from horses which they slaughteredthemselves and the hides and hair were not used.The horses were old and sometimes diseased, and anyanimal which died suddenly was examined by a

veterinary surgeon for anthrax. He agreed thatit was possible for an animal to go through themanufacturer’s hands without examination.

THE LANCET 100 YEARS AGO

June 16th, 1838, p. 393.From a lecture an cathartics delivered by Dr. G. G.

Sigmond, at the Windmilhstreet School of Medicine.IT is often in this that the scientific man demonstrates

the superiority of his knowledge ; the superficial andinattentive practitioner thinks all purgation alike ; hehas not that discriminating judgment which enables himto adapt his means to his ends, and here it is that realknowledge is shown, and that the ignorance of the quack,or the foolish love of domestic remedy giving, isdisplayed....

I do not object to your allowing your patients to payproper attention to the state of the bowels, and of theirown accord occasionally taking a favourite domesticremedy ; but it is your duty to point out to them, thatwhat is commonly considered a most innocent medicinemay be the source of the utmost harm, if it be taken atan improper moment, or under unfavourable circumstances.You ought to make them aware that the medicines we mostgenerally and apparently unhesitatingly prescribe, are

only given by us with safety, because we are intimatelyacquainted with their modus operandi.

Panel and Contract PracticeCriticisms of the Insurance Service

THE LANCET 100 YEARS AGO

AT the congress of the Royal Institute of PublicHealth and Hygiene lately held at Blackpool someoutspoken criticisms of insurance practitioners andthe insurance service were made by Dr. H. B.Trumper of Imperial Chemical Industries, whoseaddress is reported in the llfanchester Guardian ofJune 4th. Every medical man in industrial practice,he said, knows how anxious the sick worker is toreceive the best treatment, and how well he cooperateswith the medical profession to this end, but thoughhe can have the doctor of his choice he has no

guarantee that he is receiving appropriate treatment,for many panel practitioners are " lazy and incom-petent." A patient cannot always get specialist treat-ment without paying a heavy fee, and, although hecannot be certain of a hospital bed in an emergency,yet by paying the fee of a consultant he can beadmitted without regard to the urgency of the case.Dr. Trumper thought that the only logical solutionlies in a State medical service which could certainlybe moulded to provide good and complete treatmentwithout removing the patient’s right to free choice ofdoctor. In his opinion most medical men wouldwelcome the introduction of a scheme which allowedthem to practise their craft without fear or favourand where the prospects of promotion depended onpersonal merit. At present no man of abilityentering panel practice could hope to obtain a goodincome without exploiting the service.

INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

JUNE 4TH, 1938Notifications.-The following cases of infectious

disease were notified during the week : Small-pox, 0 ;scarlet fever, 1967 ; diphtheria, 986 ; enteric fever,31 (39 " expected ") ; pneumonia (primary or

influenzal), 919 ; puerperal pyrexia, 179 ; cerebro-spinal fever, 29 ; acute poliomyelitis, 5 ; encephalitislethargica, 1 ; dysentery, 52 ; ophthalmia neo-

natorum, 117. No case of cholera, plague, or typhusfever was notified during the week.The number of cases in the Infectious Hospitals of the London

County Council on June 10th was 4108, which included : Scarletfever, 800 ; diphtheria, 1014 (carriers 41) ; measles, 1108 ;whooping-cough, 268 ; puerperal fever, 15 mothers (plus 8babies) ; encephalitis lethargica, 280 ; poliomyelitis, 2.At St. Margaret’s Hospital there were 26 babies (plus 15 mothers)with ophthalmia neonatorum.

Deaths.-In 126 great towns, including London,there was no death from small-pox, 1 (0) from entericfever, 20 (7) from measles, 6 (1) from scarlet fever,13 (2) from whooping-cough, 24 (2) from diphtheria,42 (15) from diarrhoea and enteritis under two years,and 38 (8) from influenza. The figures in parenthesesare those for London itself.The fatal case of enteric fever was reported from West

Hartlepool. In thirteen great towns there was one fatal caseof measles, and there were four deaths from diphtheria eachat Liverpool and South Shields. Birmingham had five deathsfrom influenza and Liverpool and Manchester each 3.

The number of stillbirths notified during the weekwas 310 (corresponding to a rate of 42 per 1000 totalbirths), including 51 in London.

SERVICE AwARDS.-Dr. Edgar Cochrane, medicalofficer (health), Gold Coast, has been awarded the NorthPersian Forces memorial medal for 1937 for his paper ontuberculosis in the tropics published in the Tropical DiseasesBulletin last year.-Major C. V. Macnamara has beenawarded the Alexander memorial prize for 1937. It is

given annually to an officer of the Royal Army MedicalCorps for professional work of outstanding merit.