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but in these cases the site of the injection was apt to Ishow a severe reaction. Most of Dr. Makai’s cases of Ifsuppuration were, however, due to non-tuberculousorganisms such as streptococci, staphylococci, coli-form bacilli, and the like. In none of thesecases did the treatment provoke progressiveinfection, a phlegmon, or sepsis. In about 30 percent. there was no reaction at the site of theinjection, and in another 30 per cent. a slightlypainful infiltration disappeared completely andspontaneously in eight to ten days. In theremaining 40 per cent. a definitely circumscribedabscess formed at the site of injection, healingspontaneously or after aspiration. Although hundredsof such injections were given, it was necessary onlyin two cases to make a 3 mm. long incision. Onlylocalised suppurative processes were, as a rule, thustreated, and among the cases there were some ofsuppuration in the cervical and inguinal glands,empyema, mastitis, periostitis, mastoiditis, andosteomyelitis. There were, however, two cases ofsevere progressive phlegmon of the neck in youngchildren successfully treated in this manner, andone of the illustrative cases recorded in detailwas that of a child, 18 months old, the right lowerlobe of whose lung contained a cavity of the size ofan egg. Puncture of this cavity, which was diagnosedby the X rays, yielded gaseous, greyish-yellow, thickpus containing elastic fibres, the Bacillus fusiformis,streptococci, and coliform bacilli. There was remittentfever reaching 393° C. at times, and the prognosisseemed hopeless. Five injections of 1 c.cm. of thispus were given at five-day intervals. Small abscesseswith the flora of the mother abscess developed at thesites of injection. The temperature fell to 371° C.,the exploratory puncture of the lung no longeryielded pus, the X rays showed an ill-defined shadowin the position of the former abscess cavity, and theappearance of the child was most flourishing, herweight having increased from 7-9 to 9’2 kilos in lessthan two months. Dr. Makai is conducting furtherexperiments with this treatment, and he has alreadyfound that if the aspirated pus is exposed to thequartz lamp for 15 minutes before injection or ischilled for half an hour, the responses of the organismare quite different. Dr. Makai has certainly made outa case for further investigation, but this will haveto be very thorough as well as confirmatory of his

I

findings before his treatment can be accepted at hisown valuation.

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THE MILNE TREATMENT OF SCARLET FEVER.

IN the correspondence columns Dr. A. H. (jr. Burtondraws attention to the great practical significan ce ofan article on the treatment of scarlet fever whichappeared in our columns on Sept. 8th, wherein Dr.G. Gushue-Taylor courageously recanted a theory ofwhich he had been one of the principal advocates.The figures given in proof of recantation were striking,if not absolutely convincing. The fact that seems tous to rob the observations of final proof is that thefigures giving the effect of return to the principle ofisolation (Table A) are derived from a single year only, iand from a year in which the incidence of scarlet fever

was somewhat low. Figures over several years, includ-ing one in which the incidence was considerable, wouldcarry conviction. In the same table it is noticeablethat in 1920, with a total of 50 cases, there were onlyfour return cases, a figure which is remarkably low ifthe eucalyptus treatment is really valueless. Never-theless, it now seems highly probable that the factsreported by the late Dr. R. Milne are explicable onordinary epidemiological principles. Prolonged isola-tion is a serious problem from educational and economicpoints of view, even if our experts are coming to theconclusion that mild uncomplicated cases of scarletfever may be safely discharged at the end of fourweeks ; and we can only regret that Dr. Gushue-Taylorhas been driven to abandon what appeared to be ahopeful alternative treatment. Nor can we feel thathis remarks on the more efficient treatment of naso-pharyneal complications are very helpful, for inhala-

tion of friar’s balsam does not appear of much pre-ventive value in other infections, and he throws nonew light on the difficult choice of which tonsils tocondemn and enucleate. Before resigning ourselvesto the cumbersome protection of prolonged isolation,we may hope that medical officers of health, withDr. Gushue-Taylor’s admirable spirit of inquiry andprogress, will make further trial with other localdisinfectants such as chloramine-T.

THE REGISTRAR-GENERAL’S REPORT FOR 1921.

WE complete this weeh a brief summary of theconcluding volume of the annual report of the

Registrar-General for 1921, a report which calls fordetailed study by all who wish to keep abreast of theprogress of medicine in our own times. We havealready singled out for special notice the section inwhich the writer, presumably Dr. T. H. C. Stevenson,whose name is not mentioned, illuminates the rela-tion of tubercle to infantile mortality. This weekwe reproduce two charts, one of which illustratesrecent remarkable changes in the age-incidenceof mortality from influenza, the other the equallystriking changes in that from cancer. Now thatthe whole " Review " (as it is now called) for 1921has appeared it is the time to return to a con-

sideration of the new format. The present volume is,we freely admit, handy in form and comparativelylight, but further experience has not decreased ourrepugnance to the cramped page and the minutefigures in which the tables of Parts I. and II. are

printed. The change must seriously increase thedifficulties of study except to the myope. It is alsoa hardship to the student of statistics that longmonths have elapsed between the publication of thetables and the text ; possibly in the future a shorterinterval between the three parts will be secured.The substance of the report is so well worth studythat no pains would be wasted in enabling that studyto be made with comfort and efficiency.

A STANDARD FOR MENTAL HOSPITALS.

ANY administrative change which would actuallyenforce a certain standard of treatment in mentalnospitals would probably benefit the insane as a whole.provided that it carried no disadvantages in otherdirections. It is well known that. this standard at

present varies widely, and the Board of Control hasno powers of enforcing changes in an institutionpresenting unsatisfactory features, unless a case ofcruelty to a patient is proved, beyond declining tosanction transfers, a step which would be quiteindifferent to the committee of the average countyhospital. " Nationalisation " of mental hospitals, assuggested by Dr. A. T. W. Forrester in anothercolumn, would achieve a uniform standard of treat-ment, and at the same time enable the existingbuildings so to be utilised as to afford separate andefficient treatment to recoverable cases. But if this" service " were made as efficient as possible, if allthe varied and necessary equipment were provided.and an adequate staff paid at rates which wouldattract the " young, active, progressive, and bestqualified members " of the medical profession (and,correspondingly, qualified recruits to the nursing pro-fession), if, in fact, all that needs to be done were done,.this service would cost not less but far more than thepresent cost of maintenance of the asylums. Moneyis the obstacle to these improvements ; no one hasever suggested before that more could be done withthe present expenditure of eight millions per annum ;.mental hospital committees, who, incidentally, workgratuitously, cannot often be accused of wastefulexpenditure.The main objection which we have to a State service

is one which applies to the State management of anyconcern-namely, that it hampeis originality andenterprise. A keen medical superintendent anxious toadopt a new form of treatment might have his schemeheld up for years either on the score of expense or