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the size of a sixpence. The result, according to theplaintiff, was dermatitis of the scalp, inflammation ofthe left ear and of the neck and chest, swelling of theeyelid, insomnia, shock, and nervousness. Mr. JusticeHorridge left it to the jury to say whether, in all thecircumstances of the case, the plaintiff had received.adequate warning of the risk she ran in having thetest applied ; if she had had such a warning, theyshould find a verdict for the defendant. This theyproceeded to do forthwith, without leaving the box,.and judgment was entered for the hairdresser withcosts. TI_lH, - T..+;^? ITT-- 741, 2, .",. z

Heaun V7- J’LGJL’LGG

The learned Recorder of Chichester, at a lecturegiven to the Royal Institute of Public Health whichwas reported in THE LANCET last week, gave hisopinion that no change should be made in the legalrule which requires a doctor to disclose confidentialdetails concerning his patients. Lord Justice Atkin,however, expressed a different view at the close of thelecture ; he frankly stated that in some cases-notablythose connected with venereal disease-the claims ofpublic health far outweighed those of justice, and hefavoured a change in the law. The Lord Justiceprovided a fresh argument in this controversy byreferring to the secrecy with which-certain evidence ofofficial matters is treated. The solicitor’s privilege isdefended because it is in the interests of the adminis-tration of justice ; the doctor’s privilege is refusedbecause it conflicts with the administration of justice ;and yet the courts allow facts to be withheld-if,for instance, they concern the technical details of theequipment of our fighting services-without anyreference to the administration of justice whatsoever.In the past few weeks there has been a prosecutionunder the Official Secrets Act of two spies, who havereceived severe sentences ; part of the evidence wasgiven behind locked doors. There has also been anapplication in the police-court concerning the owner-ship of certain naval documents, and again theproceedings were partly carried on in camera. Mayit not be just as much to the interest of the Stateto withhold facts dealing with a man’s healthas to withhold facts dealing with the constructionof a submarine ? ?

SOUTH AFRICA.

(FROM A CORRESPONDENT.)

Dengue in Durban.DURING the first half of 1927 Durban suffered from

a remarkable epidemic of dengue fever, the numberof cases in the town and its vicinity being estimated atabout 50,000. At the request of the town councilDr. A. J. Orenstein, of Johannesburg, has submitteda report on the measures that should be taken toeliminate mosquito-breeding and thus prevent thedisease. In this report he says that it is now estab-lished with reasonable certitude that dengue istransmitted by Aedes egypti, more commonly known asStegomyia fasciata. This mosquito invariably breedsin collections of water near human habitations, itsflight is very limited, and it may safely be said thatunder ordinary circumstances it does not travelmore than 100 yards. The larvae are most commonlyfound in artificial receptacles, both indoors andoutdoors, and will develop in very small collections ofwater—e.g., in tin cans or broken bottles, in ewers ofwater in unused guest rooms, in water-tanks, water-barrels, and holes in trees. The larvae can remainsubmerged for several hours, and consequently maybe difficult to detect in fairly large collections of water,such as rain-water tanks. The eggs are very resistantto unfavourable conditions and may remain dry formonths and yet, when placed in water, hatch outhealthy mosquitoes. The adult mosquito will, underfavourable circumstances, survive for several weeks.

It used to be considered, says Dr. Orenstein, thatCulex fatigurts transmitted dengue, but experimentalwork seems to have disposed of this theory. Stegomyia

is almost certainly the sole danger, and its habits ofbreeding are consequently of great importance inconsidering the preventive measures. As it appearsthat a very large portion of the European populationof Durban and its vicinity were attacked by dengueduring the first half of 1927 there is good reason tobelieve that an outbreak on a large scale is improbablein the near future among the European population,inasmuch as it has been shown by Siler, Hall, andHitchens that the disease conferred immunity in58 per cent. of cases, and modified towards mildnesssubsequent attacks in the remainder. An outbreakmight, however, occur among the native and colouredpopulation, who apparently were not affected as muchas the European population by the last epidemic, andan outbreak of minor magnitude might occur amongthe European population not attacked in the lastepidemic.

Dr. Orenstein does not think that dengue should bemade a notifiable disease, but he suggests that themedical officer of health should circularise the medical

! practitioners of Durban to ensure (a) that all casesshould, for the first three to five days of their illness,be carefully protected by mosquito nets; and (b) thatthe houses of such cases be searched for adultmosquitoes and for mosquito-breeding, with a view toits elimination. He recommends that the municipalityshould offer to provide on loan mosquito nets forpatients and for the personnel of the mosquito search,for " Protection of the sporadic cases against mosquitobites ... is the best and most promising measure ofpreventing an epidemic of dengue."

It is suggested that the following amendments bemade in the public health regulations :-

(a) No tanks, wells, barrels or receptacles of any kind forthe collection or storage of water shall be permitted exceptin those districts which are without a public water-supply.When such tanks, wells, barrels, or other receptacles for thecollection or storage of water are permitted, they shall bemade mosquito-proof to the satisfaction of the medicalofficer of health. Wells, where permitted, must be fittedwith an approved pump.

(b) The throwing or keeping of tins, bottles, brokencrockery, or any other object that may hold water andthereby become a breeding-place for mosquitoes, in anystreet, yard, alleyway, or any premises or property, whetheroccupied or unoccupied, constitutes an oftence.

(c) All premises, whether occupied or unoccupied, must bekept in such a condition as to prevent mosquito-breeding,and the medical officer of health may give notice to theowner or occupier of such premises requiring him to correct,within a definite time-limit, the conditions as specified inthe notice. Failure to carry out the instructions containedin the notice shall constitute an offence.

(d) Roof gutters shall be so planned and constructed as tobe self-draining and remain dry between rainfalls. Upondue notice from the medical officer of health, which shallspecify a time-limit, the owner or occupier of the premisesshall remove or repair roof gutters which hold water andmight give rise to mosquito-breeding.

(e) If any owner or occupier refuses to carry out themeasures specified in any notice under these regulations, orfails to do so within the time-limit imposed, the localauthority may, by persons duly authorised thereto, carryout such measures. The costs incurred in so doing shall berecoverable by the local authority from the person uponwhom the notice was served.

Dr. Orenstein recommends that special inspectorsbe detailed for work against stegomyia ; it would betheir duty systematically to inspect premises forbreeding-places, especially during the warm season.The large swampy areas in the vicinity of Durbanpresent difficult problems of mosquito control.Without more data Dr. Orenstein is not prepared tosuggest definite methods of permanent control, butproposes an experiment on a small scale in two areaswhere cattle could be kept out by fencing, sunflowerscould be planted, and collecting pools could be arrangedat the lowest point, with clear banks, for any excessivewater. This might, he thinks, lower the surface watersufficiently to diminish mosquito-breeding veryconsiderably. At present larvae are controlled inswamps and ditches by means of crude oil, but inseveral instances he found larvae where oil had beenrecently applied, this being due either to the oil

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being blown away by the wind or to the film being broken by vegetation or dry twigs. A great manymosquito-breeding areas could, he thinks, be moreeconomically treated by the application of some cheapemulsifying larvicide.

Retirement of Port Natal Health Officer.Dr. H. E. Fernandez has retired from the post of

port health officer at Durban, Natal, after a service of32 years. He has seen Durban develop from the dayswhen there was only a depth of 17 feet of water onthe bar at the top of high tide to what it is to-day-when vessels of the deepest draught come inside tothe wharf.

Bilharzia in the Transvaal.Remarkable success has been achieved by the

pioneer camp established at Rustenburg School forchildren suffering from bilharzia. Sixty patients drawnfrom 25 different schools in the district-which isparticularly pestered by the disease-have been under-going treatment at the camp, and are reported to havebeen completely cured in less than a month after theirarrival. The Director of Sanitation for the Rand Minessubmits that it is imperative for the authorities of theProvincial Council and the Union Government tocooperate in establishing similar camps throughout theTransvaal.

’

The Carnegie Corporation of New York has drawnup a five-year programme of grants in aid of scientificresearch in the Union of South Africa. The sum of£1500 is to be used in investigating the Bantumentality, whilst £4000 will be set apart for a study ofthe " poor white " problem. The total amount to beexpended will be £100,000, and £18,000 is to be usedfor encouraging the exchange of visits between SouthAfrican and American scientific and educationalauthorities. Some of the funds will be devoted tosocial and medical work in East Africa.

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

Diabetes in Germany.IN the course of a recent address to the Society for

Insurance Medicine Dr. Ullman drew attention tothe increase in diabetes throughout the world, anincrease most obvious, he said, in the United States.The late war caused a general diminution in the disease;thus in Berlin the mortality per 1000 rose from1-0 in 1900 to 2-3 in 1913, but in 1919 had fallen againto 1-0. Since that time there has been another steadyrise, bringing the death-rate to 1-8 per 1000. Theage-period at which diabetes most commonly showsitself is from 40 to 45, and it attacks especially thoseclasses whose work involves much mental strain.In America there is a saying that if prices on thestock exchange fall the amount of diabetes rises.The mortality is higher in towns than in the country,and Dr. Ullman considers that no race is especiallyliable to be affected, the apparent racial differencesbeing actually dependent on varying habits of life.Up to 35 years of age both sexes are equally prone tothe disease, but afterwards the mortality among malesincreases owing to the exertion and excitement of theirwork. Now that women are working more thanformerly the difference between the rates for the twosexes is diminishing. It has not yet been ascertained whether diabetes is growing more severe in type.

Infectious Diseases in Berlin.The last two years have seen a considerable increase

of diphtheria in Germany, and especially in Berlin,where the number of cases is three times as great asin 1925. But, as Prof. Seligmann, head of the BerlinMunicipal Laboratory, points out, the record of thelast five years is on the whole a good one ; diphtheria,indeed, reached its minimal incidence in 1924, and itmay be hoped that the increase is only transient.500 cases were notified in Berlin during September andOctober, 1927, as compared with 200 in the previous

year, most of them being in the east and north-eastparts of the city, which are thickly populated by poorpeople. School-closure is sometimes adopted by themunicipal educational authorities, but they do notapprove of this measure as a rule as it does not seemto be very effective and may lead to infection beingspread more widely. The clinical course of thedisease has grown worse, and the case-mortality hasbeen higher in Germany than elsewhere. The preva-lent organism seems to be of a specially malignanttype ; possibly, too, the resistance of the populationhas been lowered by the privations of the war and ofthe period which came after it. To combat its conse-quences antitoxin is given gratis to indigent families,and pamphlets warning parents against negligence aredistributed in the schools.Last year’s figures show that the incidence of scarlet

fever and measles in Berlin was much as usual.Notifications of infantile paralysis, of which an

epidemic occurred at Leipzig and elsewhere inGermany, are seen to have increased but little.Dysentery and typhoid fever have been kept undercontrol by regulation of the water and milk-supply,but meat-poisoning and paratyphoid have been onthe increase. If the people of Berlin would refrain fromeating raw meat in the form of "beefsteak a latartare," the amount of poisoning would diminish.

The Soft Palate in Diagnosis.In a paper read before the Berlin Medical Society

Dr. Neuda pointed out that examination of the softpalate will often give useful information about generalas well as local diseases. The colour of the palate maybe altered, showing either hyperaemia or anaemia ; itmay look oedematous, and the junction with the hardpalate may disappear or else become more obvious.Increase of fat in the soft palate suggests metabolicdisorder, and also occurs in cancer of the stomach.In duodenal ulcer the soft palate is hypersemic ; largespots of hypersemia indicate recent syphilis, whilstsmall spots show congenital syphilis. The palate isyellow, of course, in diseases of the gall-bladder.

SCOTLAND.(FROM OUR OWN CORRESPONDENT.)

Edinburgh Health Week.THE Edinburgh Health Week has included a full

programme of medical and hygienic conferences anddemonstrations. The Society of Medical Officers ofHealth, the school medical officers, and those lay andmedical men and women associated with child welfareand maternity service, have all found a convenientplatform and good audiences. But the outstandingfeature of the week has been the health and hygieneexhibition in the Waverley Market. Edinburgh is veryfortunate in having so fine an exhibition hall in aposition so central. The daily average of visitors evenin the first few days approached 10,000, and theexhibition deserves their patronage. It includes mostof the leading departments of civic activitv affectinghealth and the prevention of disease. The tuberculosissections under Dr. John Guy, the children’s sectionsunder Dr. Leonard Findlay, and many of the othersattracted continuous crowds. The cookery exhibitsand demonstrations under the Atholl Crescent Schoolof Cookery were among the best of the relatively"

lay " sections. Dr. William Robertson, the medicalofficer of health, and his very active collaborators areto be complimented on the success of a first-classexhibition. It is the largest demonstration of civichygiene that the Edinburgh Corporation has, in itsofficial capacity, organised within the last 30 years.

Industrial Health Education Society.This society took advantage of the Health Week to

organise a meeting in the Usher Hall. In numbersthe meeting was not large, but all those present wereindividually interested. The Secretary of State forScotland made a telling appeal for support andencouragement. Men of all parties, creeds, and classes