188 NEW REGULATIONS FOR THE NOTIFICATION OF INFECTIOUS DISEASE. [

flesh of a roebuck which had struggled violently after having been caught in a snare, gave rise to

symptoms of poisoning, and according to Gautier, pigs have been fatally poisoned through being fedupon the flesh of a horse which had died during itsstruggles when being broken in, and there are alsorecorded by the same writer cases of human poison-ing by the flesh of roebucks which had died in astate of terror or exhaustion. The plea that thequality of milk can be adversely affected by shockis a quite sound one, but a valid defence wouldalso require evidence that the shock had occurred,and that there had been no tampering with the fluid.

THE NEW REGULATIONS FOR THE NOTIFICA-TION OF INFECTIOUS DISEASE.

THE Public Health (Notification of InfectiousDisease) Regulations, 1918, issued by the LocalGovernment Board under date Jan. 19th, will comeinto force on March lst and will affect medical

practitioners in their duty of notifying infectiousdisease throughout England and Wales. The

regulations prescribe new forms for such notifica-tion as set out in two schedules, A and B;Schedule A contains the form for notifying themedical officer of health in the case of municipalboroughs and urban districts, rural districts, andport sanitary authorities other than the Port ofLondon; while Schedule B consists of the form tobe used for the City of London, the Port ofLondon, and the metropolitan boroughs. Thevarious Acts, Orders, and Regulations whichaffect notification are specified, and the provisionswhich are superseded by the new forms are

rescinded. The object aimed at is, no doubt, tosecure uniformity with resulting simplificationof the duties of those who notify and of thosewho record and take action upon the notifi-cations forwarded to them. The use of a

form for the metropolis different from thatprescribed for all places outside it detracts tosome extent from this uniformity, but, unfortu-nately, it is rendered necessary by the require-ments under the Public Health (London) Act, 1891.By this Act certain information, which it is not

necessary to give under the Acts, Orders, and Regu-lations elsewhere, has to be given for metropolitanlocalities, but as the differences are not great itseems likely that the fuller information. deemed

necessary for London will be demanded universally.A form which asks for more details than anotherno doubt gives extra trouble to those who fillit up; but medical practitioners do not grudgeextra trouble where it will assist in the pro-tection of the public, and where the informationasked for is not beyond the scope of reasonableinquiry on their part. What they resent is themultiplication of formalities whose futility isobvious to them, when the work has to be doneby them gratuitously so as to spare other peoplewho may be underpaid or overpaid, either labouror the exercise of intelligence. The difference inthe two schedules is that the metropolitan formin the case of a hospital patient asks for informa-tion as to the place from which the patient wasbrought to the hospital, information which mustbe as desirable when infectious disease hasbeen contracted in a rural district as it is whenthe hospital is in London. The date on which thepatient was brought to the hospital is also asked for.Beyond this the only particulars required in themetropolis, as distinct from other localities, are

whether the case occurred in private practice, or, ifit came under the notifying practitioner’s notice asmedical officer of a public body or institution, thename of the body or institution in question. Everystep taken in the direction of simplification anduniformity in such matters as the above will bewelcomed by medical practitioners who muchresent the increase of the clerical work imposedupon them in recent years. It forms a branch oftheir duties little appreciated by the public forwhose benefit it has been brought into being,and who in their turn should endeavour to renderit as little burdensome as is reasonably possible.A circular of the Local Government Board imposeson sanitary authorities the duty of bringing thenew regulations to the notice of medical practi-tioners in their districts; the Order containingthem will be on sale, so that copies may be obtainedthrough any bookseller or from H.M. StationeryQffice, whose distributing centres are now atImperial House, Kingsway, London, W.C. 2; at37, Peter-street, Manchester ; and at 1, St. Andrew’s-crescent, Cardiff.

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SODIUM PERSULPHATE FOR TETANUS.

THE treatment of developed tetanus has been sodisappointing that the introduction of any remedyalleged to give good results is certainly worthrecording. A solution of sodium persulphate ad-ministered by intravenous injection has been

employed in the American Hospital in Paris; incases treated there by other methods the mortalityfrom tetanus was 75 per cent., while the threepatients on whom this method was employed allrecovered. Details are given by Dr. L. Leyva inthe December number of Surgery, Gynecology, andObstetrics. One of the cases was severe, the othertwo comparatively mild. A 5 per cent. solution ofsodium persulphate is freshly prepared, and keptin a cool and dark place, for it is decomposed byboth light and heat. Dr. Leyva gives at least60 c.cm. of the solution each day, preferably intwo or more intravenous injections. The fluidis introduced slowly, the injection taking somefive minutes. A reaction often appears, the

patient having nausea and vomiting for half anhour, but the relief is so great that the patientsometimes asks for a repetition of the injection.It is important to bear in mind that in each of thethree cases antitetanic serum was employed a,s wellas the persulphate. Three case. are obviously notsufficient to found an opinion upon, for cases oftetanus may recover without any treatment, butthe improvement seemed in these cases to coincidewith the administration of the persulphate. Afurther trial of the method of treatment is certainlydesirable.

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THE ANAEROBIC FLORA OF WAR WOUNDS.

TECHNICAL difficulties in the isolation in pureculture of the anaerobic bacteria of wounds haveresulted in a state of confusion which the specialreport (No. 12) of the Medical Research Committeejust issued goes far to clear up. Dr. James McIntosh

has already described with Staff-Surgeon P. Fildesin our columns 1 the elaborate precautions essentialto success, and in the present monograph he sum-marises some of his results, which suggest that theanaerobic problem is simpler in some respects andmore complex in others than had been supposed.Of the many types of anaerobes examined only two,

1 THE LANCET, 1916, 1., 768.