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hygiene. Dr. Xoel Davis’s report calls particularattention to the epidemics during the year of cerebro-spinal fever, which was reported in Shanghai inMarch, and cholera which appeared in Septemberin a severe form, though with a lower mortality thanhad characterised previous outbreaks. In this con-nexion he makes reference to the visit paid at theend of the year by Dr. Rajchman, Director of theHealth Section of the League of Nations, finding it" impossible to estimate too highly the achievementsof the League in the cause of international science."Dr. Rajchman was accompanied by Dr. Boudreau, andthey took part in an interesting discussion with a- number of Chinese and foreign officials, having forits object the prevention of cholera and other com-municable diseases in Shanghai. The statisticalsummary, derived from an interesting report, justifiesDr. Davis’s optimistic outlook.

UNDULANT FEVER IN MALTA.

THE paper by Sir Themistokles Zammit and Dr. J. E.Debono, which we publish on another page, comes as arude reminder of the fact that although the labours ofthe Mediterranean Fever Commission of 1904-05removed, for all practical purposes, the dreadedundulant fever from the medical history sheets of theServices, the civil population of Malta, left to work outits own salvation, still suffers as heavily as ever.From the most recent report on the health of theMaltese islands we learn that in 1928 undulant feverheaded the list of notifiable infectious diseases, with atotal of 962 cases and 42 deaths among the total popula-tion of 230,618. As the bulk of the cases involveyoung adults, the problem is a serious one forindustry as well as for the public health authorities.It is now generally accepted that in at least 70 per cent.of the cases the disease is conveyed by milk derivedfrom goats infected with Bacillus melitensis, and it isequally clearly established that the infectivity of themilk can be readily destroyed by boiling or even byefficient pasteurisation. It is difficult, therefore, tounderstand why the disease has not been stamped outfrom the Maltese islands during the interval (now aquarter of a century) that has elapsed since thefindings of the commission were made known, and whyno attempt has been made to cope with the situationeither by the adoption of palliative measures such ascompulsory sterilisation of the milk, or measures

based upon the Bang process for the eradication of theinfected animal-practical proposals which were

made by Dr. John Eyre in a report upon the work ofhimself and his colleagues in 1906. The answer to thesequestions undoubtedly is that local conditions, onlytoo familiar to those who have worked in Malta,coupled with lack of financial support, have stultifiedthe efforts of the public health department in dealingwith the infected milch goat. It is true that Zammit,who has never allowed his ardour in the study ofmelitensis infection to lessen, has from time to timearoused the sympathetic attention of various authori-ties, but in the past lack of funds has operated adverselytoward his endeavours. His present investigation,however, appears to have received material supportfrom the Legislature of the island, and the results herecords, though by no means conclusive, suggest thathe has achieved a measure of success. His attemptsat cuti-immunisation form a logical corollary toBesredka’s claims, and if these latter are based onsolid foundations, it may well be that modifications intechnique will enable Zammit to confer a lastingbenefit upon his fellow-countrymen. Incidentally hisobservations bring out a disquieting but veryimportant point-namely, that certain animals, thoughproved by post-mortem examination to be heavilyinfected, fail during life to show what has hithertobeen regarded as the cardinal sign of infection—i.e.,specific agglutinins in the blood serum. This observa-tion is one that demands further and fuller investiga-tion, because if it holds good to any marked extent itmust greatly increase the difficulties of prevention.

STREET ACCIDENTS.

THE note on street accidents in Bremen (see p. 1362)by Major P. G. Edge, of the London School of Hygieneand Tropical Medicine, raises an interesting question.Major Edge points out that the allocation of respon-sibility for traffic accidents made by the Bremenauthorities contrasts glaringly with that establishedhere with respect to fatal accidents, and suggests thata concentration of attention upon the latter maygive us an incorrect view of the aetiology of a diseasewhich claims thousands of victims. Some of themost fruitful work of the Industrial Health ResearchBoard has been based on the study of trivial accidents,has established the importance of individual psycho-logical factors, and has gone some way towards thedifferentiation of the temperamental types prone toaccident. It is probable that these results may begeneralised and that there are. now in legal controlof masses of steel capable of being hurled through ourstreets at high velocity many persons not only unfitto shoulder such a responsibility, but not capable ofdiscipline by legal sanctions. Evidently the firststep towards real knowledge is a more precise analysisof a sample of the facts than has yet been published.Major Edge makes some valuable suggestions. Inaddition to these we think some use might be madeof car insurance data. The companies presumablynow possess extensive particulars of accidents of alldegrees of gravity. Is it too much to hope that thisexperience will be used ? An analysis of such data bya scientific committee containing medical, psycho-logical, statistical, and engineering experts shouldbe illuminating. It may be true that a mere test ofproficiency, even if administratively practicable,would be but a poor safeguard ; yet the contrastbetween the stringent conditions imposed uponwould-be amateur aeronauts and the free trade interrestrial locomotion is curious. That the onlyguarantee of fitness our laws demand of a raw lad,before he is allowed to bring out upon a crowdedhighway a ton and a half of machinery, capable ofpassing from rest to a velocity of 60 miles per hourwithin a few seconds, is his ability to write his name.and pay a sum of 5s., may seem to a future generationat least as monstrous as any of the savage customsof our ancestors.

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VARIABLE RESPONSE TO INSULIN.

IT is a common observation that some diabeticpatients vary from time to time in their reaction tosimilar doses of insulin, even in the absence ofcomplications, such as infections, which tend toaggravate the disease. Karelitz and co-workers 1have recently investigated the suggestion that thisvariability in response to insulin is due to the presencein the diabetic patient’s blood of some substancewhich neutralises or inactivates insulin. They findthat insulin, after incubation with blood plasmaobtained from a diabetic patient, loses its power toproduce hypoglycaemia in rabbits. Intact corpusclesgive indefinite results, but laked corpuscles possess thesame property of inactivating insulin to an evengreater extent than plasma. Control experiments inwhich saline solution, agar-agar, and egg albumin aresubstituted for blood yield negative e results, andsuch changes as occur in the pH of the incubatedmixture are insufficient to explain the phenomenon.It is, however, a significant fact that normal bloodpossesses this same inhibiting action on insulin,although in much smaller degree. It is difficult toassess the importance of these results, since eightyears of research following the isolation of insulinhave failed to reveal either the structure of thehormone or the way in which it exerts its profoundaction on carbohydrate metabolism. Further controlexperiments seem desirable, for such a mixture ofsubstances foreign to the rabbit as human blood

1 Karelitz, S., Cohen, P., and Leader, S. D.: Arch. Int.Med., April, 1930, p. 546.