Chapter XLII: Anthrax

_Hides and Horsehair._

The disease to which the term anthrax is at the present time usually applied, in this country, is fortunately of rare occurrence in man, mainly affecting, as it does, cattle, sheep, swine, and horses. In 1891, it may be noted, there was an outbreak among deer, and in certain foreign countries attacks among goats and camels appear to be not uncommon. The disease may be transmitted by direct inoculation of a scratch or wound of the skin, by inhalation into the lungs, or by being introduced into the alimentary canal with the food. The last-named mode of infection is that which appears to be most common in the lower animals, and the disease produced in them, accompanied as it is, as a rule, by marked enlargement of the spleen, is sometimes referred to as splenic fever. The infective property clings pertinaciously to certain fields and pastures, so that in America, and on the continent of Europe, the risk incurred by allowing animals to graze in particular localities is definitely recognised, while a similar phenomenon has also been observed in this country. The risk in question appears to be greater at certain times of the year. In the Western States of America it is said to be inseparably connected with the highest temperatures of summer, and to occur only when the surface soil has been thoroughly warmed; a certain degree of moisture is also believed to be necessary. Power of transmitting infection is maintained in these particular localities, and conveyed to others, by allowing the discharges from infected animals, and the blood of such animals, if they are slaughtered or cut up after death, to obtain access to the soil. Hides, skins, hair, and wool, which have become smeared with such blood or discharges, retain the property of conveying infection after drying, and exposure to light and air for prolonged periods; even after transportation for thousands of miles the manipulation of such infected products is attended with serious danger.

In man the disease assumes generally what is known as the _external form_, the poison obtaining access to the body through some abrasion of the skin. At the site of inoculation a small vesicle may be detected at the outset: this vesicle speedily develops into a _malignant pustule_, _i.e._, an inflamed area presenting a dark centre, surrounded by a ring of vesicles with a crenated margin. At this stage, which is that in which attention is usually first drawn to the disease, the appearances are generally quite characteristic, and if skilled advice is obtained, and the nature of the mischief realised, the pustule can be excised and there is comparatively little risk of a fatal issue. The term pustule, it may be noted, is a misnomer, as pus (_i.e._ matter) is not formed in the local manifestation of anthrax as in the case of an ordinary boil or carbuncle. A variety of external anthrax occasionally met with (erysipelatous or œdematous anthrax) is referred to elsewhere. Again, in some instances, usually in connection with the manipulation of wool, anthrax in man assumes the _internal form_ (_vide_ Anthrax in relation to the wool industry). This last-named form of the malady is also met with among workers in horsehair, but is very uncommon in persons who manipulate hides and skins.

_History of the Disease._--Little is known as regards the prevalence of anthrax in man and in animals in past times. It has been suggested that the grievous murrain which destroyed the cattle of the Egyptians, and which was succeeded by a “breaking forth with blains” upon men, and upon horses, asses, camels, oxen, and sheep, was anthrax. Again, numerous instances of the concurrence of murrain in cattle with pestilence in man have been recorded from time to time, and some of these may conceivably admit of similar interpretation. At the present day the name _anthrax_ is commonly given, in some parts of the world, to what in England is known as carbuncle, and there is room for difference of opinion as to the meaning of the word when it occurs in old records. It may be sufficient to note in this connection that it has been contended that in ancient Greece the term was applied to smallpox. Towards the end of the last century, however, the occurrence of what would now be termed in this country “anthrax” seems to have been observed in the human subject, in association with the manipulation of raw animal products. Thus Fournier of Dijon in 1769 referred to the transmission of disease to men engaged in handling hair and wool. Similar cases were recorded by Montfils in 1776; moreover, the subject of anthrax in animals was, it may be noted, discussed by Chabert in a work published in Paris in 1780. It was not, however, until the latter part of the nineteenth century that any considerable amount of attention was attracted by the malady.

In 1847 cases of “malignant pustule” were described by Lawrence in connection with a hair factory; a series of cases was collected and published in 1852 by Mr Harvey Ludlow; and in 1862 the history of some 30 cases, one of which occurred in a tanner, and one in a person who had been employed in loading hides, was given by Dr William Budd.

Growth of knowledge concerning anthrax was much stimulated by the discovery of the anthrax bacillus. This organism had been observed by Pollender in 1849; it was shown to be the actual cause of the disease, however, by the researches of Davaine, and knowledge of its life-history was subsequently greatly extended by Koch. The discovery of the comparatively easily destructible bacillus, and its ability to produce highly resistant spores, afforded explanation of the pertinacity with which raw animal products retain the power of transmitting infection, and led to appreciation of the difficulty of dealing with contaminated material. The researches of Pasteur, concerning attenuation of the anthrax organism and protective inoculation, moreover, opened up a most interesting and important field of inquiry.

_Anthrax Statistics._--It was not until 1863 that “malignant pustule” began to appear as a cause of death in the Registrar-General’s returns. During the fourteen years 1863–1876, three or four deaths on an average were registered annually. Then, for a time, in addition to the heading “Malignant Pustule,” the headings “Charbon” and “Wool-sorters’ Disease” were officially recognised, and the number of deaths registered under the three headings had, in the year 1880, increased to eighteen. From 1881 onwards, all anthrax deaths have been included by the Registrar-General under the heading “Splenic Fever,” and the number registered was, it may be noted, as small as three in the year 1891, as high as eighteen in 1884, 1897, and 1898, and twenty-one in 1899.

Brief as has been the period in which records of the disease in man have accumulated, and imperfect as these records doubtless still are, anthrax statistics relating to other animals are, as might be expected, still more imperfect. Returns for Great Britain, which are only available from 1887 onwards, are given in the annexed table, taken from the annual report on proceedings under the Diseases of Animals Acts, compiled for the Board of Agriculture.

Number of Counties in Great Britain in which Anthrax was
reported by the Inspectors of the Local Authorities, with the
Number of Outbreaks reported, and the Number of each kind of
Animal returned as attacked in each year.

+------+---------+---------+-----------------------------------+
| | | | Animals attacked. |
|Years.|Counties.|Outbreaks+-------+------+------+-------+-----+
| | |reported.|Cattle.|Sheep.|Swine.|Horses.|Deer.|
+------+---------+---------+-------+------+------+-------+-----+
| 1887 | 51 | 236 | 415 | 37 | 184 | [147]| |
| 1888 | 49 | 180 | 280 | 45 | 76 | [147]| |
| 1889 | 45 | 167 | 236 | 4 | 69 | [147]| 461 |
| 1890 | 48 | 152 | 253 | 72 | 210 | [147]| |
| 1891 | 50 | 226 | 300 | 15 | 156 | [147]| |
| 1892 | 60 | 289 | 445 | 11 | 190 | [147]| |
| 1893 | 68 | 563 | 833 | 108 | 313 | 46 | |
| 1894 | 64 | 494 | 625 | 125 | 188 | 62 | |
| 1895 | 66 | 434 | 604 | 158 | 140 | 32 | |
| 1896 | 64 | 488 | 632 | 34 | 200 | 38 | |
| 1897 | 67 | 433 | 521 | 39 | 284 | 38 | |
| 1898 | 73 | 556 | 634 | 22 | 161 | 39 | |
| 1899 | 67 | 534 | 634 | 69 | 253 | 30 | |
+------+---------+---------+-------+------+------+-------+-----+

As time goes on the value of these returns will no doubt be enhanced. At present veterinary opinion rather suggests that too absolute reliance must not be placed upon the figures given. It may be taken for granted, however, that the system of reporting outbreaks has led to increased attention being devoted to anthrax in animals, and to an appreciation of the fact that the disease is more prevalent in Great Britain than had been supposed. The particulars collected, moreover, show that those counties in which foreign animal products, hides, hair, wool, etc., are manipulated, are specially prone to suffer from outbreaks of anthrax in animals. It may be mentioned that an inquiry was made a few years ago by Dr Ravenal of Pennsylvania as to the influence of tanneries in spreading anthrax among cattle feeding on pastures watered by streams contaminated by tannery refuse. The result of this inquiry is given by Dr Legge in a report, which appears in the Annual Report for 1899 (p. 325) of the Chief Inspector of Factories. It seems that in 1897, 12 men and 60 head of cattle died of anthrax near tanneries in the State of Pennsylvania.

Of the prevalence of anthrax in other parts of the world, it is difficult at the present time to obtain precise knowledge. In some parts of Europe (France, Germany, Russia, and Italy) the malady appears to be more prevalent than it is in this country; the same remark may perhaps be said to hold good for Persia, India, Siberia, China, and parts of Africa, and North and South America. It is stated that in the district of Novgorod, Russia, in the four years 1867–70, 56,000 horses, cattle, and sheep perished from anthrax.

_Outbreaks Recorded during Recent Years._--During the last twenty-five years several detailed reports on outbreaks of anthrax in man, attributed to the handling of particular raw animal products, have been made. Thus Dr Russell, in 1878, published the history of an outbreak of this kind, which was attributed to the manipulation of “raw Russian manes” in certain horsehair factories in Glasgow. In his report (appended to the Annual Report of the Medical Officer of the Local Government Board for 1878) Dr Russell discusses certain previously recorded instances of anthrax in association with horsehair manipulation in Paris, Metz, Leipzig, and Massachusetts. From 1878 to 1899 no further cases of the disease were noted in workers in the horsehair industry in Glasgow; in 1900, however, three such cases were reported, and similar cases have been observed in several instances in London (_vide_ Annual Reports of the Medical Officer of Health of the County of London and of H.M. Chief Inspector of Factories). Outbreaks on a more extensive scale have been reported in Germany (_vide_ Report of Dr Kubler in _Arbeiten a. d. Kaiserlichen Gesundheitsamte_, 15 Band, 3 Heft, 1899). It may be noted that raw Russian and China manes have fallen especially under suspicion in connection with several of the recorded outbreaks, and these kinds of raw material seem particularly prone to be contaminated with dirt, and when combed or “willeyed,” to give rise to dust, which it is presumed is the medium by which infection is conveyed to workers in horsehair.

At about the time when the publication of Dr Russell’s report drew attention to horsehair, the question of wool-sorters’ disease (_vide_ Anthrax--its relation to the Wool Industry) also came to the fore. Again, in 1882–83, Mr Spear, on behalf of the Local Government Board, carefully investigated the circumstances of an outbreak of anthrax in connection with the hide and skin industry in London, affecting persons who had manipulated certain bales of hides from China, either at the warehouse in which they were in the first instance stored, or subsequently at the tannery to which they were conveyed and in which they underwent the process of conversion into leather. Mr Spear published, in an appendix to his report, a table giving particulars as to cases of anthrax which he had traced as having occurred in London between 1873 and 1883. This table was subsequently extended, and further cases have been recorded from time to time in the Annual Reports of the Medical Officer of Health of the County of London. These reports show that between 1873 and 1896 there were recognised, in the metropolis and its neighbourhood, in all 148 cases of the disease. Of these:--

108 occurred among persons engaged in the hide and skin trade;
5 occurred among persons engaged in slaughtering animals; 18
occurred among persons engaged in the manipulation of horsehair,
or in the manufacture of brushes; 1 occurred in a person
employed in a bacteriological laboratory; finally, 16 occurred
under circumstances in which the source of infection was not
traceable.

_Anthrax Notification._--Sect. 29 of the Factory and Workshop Act of 1895 made notification of a case of anthrax occurring in a factory or workshop compulsory, and under this section there have, during recent years, been notified the following cases:--

In 1896, 13 cases.

In 1897, 23 cases, including 14 in connection with hides and
skins and 9 in connection with wool.

In 1898, 28 cases, including 8 in connection with hides and
skins; 16 in connection with wool; 3 in connection with
horsehair; and 1 in connection with other industries.

In 1899, 55 cases, including 16 in connection with hides and
skins; 18 in connection with wool; 17 in connection with
horsehair; and 4 in connection with other industries.

In 1900, 37 cases, including 9 in connection with hides and
skins; 9 in connection with wool; 12 in connection with
horsehair; and 7 in connection with other industries.

In 1897 an important report by a Departmental Committee appointed by the Home Office to inquire into the “Conditions of Work in Wool-sorting and other Kindred Trades” was issued. In this report existing knowledge concerning the subject was summarised and special consideration was devoted to the discussion of possible preventive measures. Dr Whitelegge, now H.M. Chief Inspector of Factories, was one of the members of this Committee, and since his appointment to his present office he has, in his annual reports, published a summary of the facts ascertained with regard to anthrax in each year since 1897. Dr Whitelegge’s more recent reports contain also the results of the inquiries made by Dr Legge, the Medical Inspector of Factories. This series of Home Office reports is from year to year, adding materially to our knowledge of the disease and the methods which may be advantageously used in checking its prevalence. In Germany, moreover, the reports of the Imperial Health Office have of late years contained frequent references to the subject, and a new era may thus be said to have commenced as regards the study of the malady in its relation to industry.

Having regard to the recent introduction of compulsory notification, and to the larger measure of importance which is attached to anthrax, it is now unlikely that cases of the disease will escape notice, as they have doubtless in some instances done in the past, and as more and more complete records of the circumstances of anthrax outbreaks are obtained, there seems reason for hoping that it may be possible to obtain fuller knowledge concerning the history and antecedents of the material which has conveyed infection. If this proves to be the case, preventive measures may be thus greatly facilitated.

_Grouping of Anthrax Cases._--That investigation of this kind may prove of importance seems clear from the evidence of grouping of cases which has been forthcoming, even from such inquiry as it was possible to make in past years, and in the absence of the more precise information which compulsory notification may, in future, be expected to afford. The following instances observed in the metropolis and its neighbourhood may be referred to in illustration of this point.

(1) In the year 1895 a number of cases of anthrax occurred among persons employed in manipulating horsehair and in brushmaking. Thus three cases occurred in Southwark, and in each instance the persons attacked had manipulated horsehair, in connection, however, with the establishments of three different brushmakers. A fourth case occurred in a dresser of horsehair employed in St Luke’s. Two cases in Shoreditch appeared to be traceable to a brushmaker’s at Tottenham, and it was found, on making inquiry there, that two other cases had occurred among employés at this particular workplace. Two further cases occurred in East London affecting men who worked with horsehair at a bass and fibre dresser’s in Mile End Old Town. In all, ten cases occurred between May and December 1895, in association with the manipulation of horsehair. The facts as to the distribution of horsehair to the various establishments concerned could not be fully ascertained; so far as the question could be followed up, it appeared quite possible that some particular consignment of horsehair had been handled by all the affected workers, and that this consignment had done all the mischief. Having regard to the distribution of the cases in time such an hypothesis seemed a likely one.

(2) On the last day of January and the first four days of February 1896, six men were admitted to Guy’s Hospital suffering from malignant pustule. Five of the men had recently been engaged in manipulating goatskins at a leather-dressing establishment, and the sixth man was employed at a warehouse from which goatskins had been supplied to this establishment. Every facility was given by the firm employing the five men with a view to enabling the particular consignment of skins implicated to be traced, but it was not found possible to ascertain all the facts with regard to these skins. There was, however, evidence pointing to two conclusions respecting them. In the first place, some of them were “sea damaged,” and secondly, they were brought to England by a vessel which had touched at certain Mediterranean ports.

On investigation of previous occurrences of anthrax in London it was found that a case had occurred in December 1895, the patient being a man employed in a tanyard. This man had on 29th November and succeeding days handled goatskins, which, inasmuch as they were a salvage lot from a ship on which a fire had broken out, had “been sold cheap.” Some of these goatskins which were described as “sea damaged,” were regarded as unfit for treatment, and were sent away; the others were converted into leather. The ship by which they were brought to this country had come from the Mediterranean. Again, a dock labourer who had unloaded goods, among which were goatskins, in St Katherine’s Dock during the first week of December, developed on 7th December a malignant pustule. The skins concerned possibly came from the Mediterranean.

Thus within a period of a few weeks three distinct occurrences of anthrax had been observed in London, apparently attributable to one common cause, the manipulation of goatskins. On the information to hand, the three consignments of goatskins could not be traced to one and the same source--indeed a distinct ship was apparently implicated in each instance, the only feature in common being that two of these vessels were definitely stated to have come, and the third may have come, from the Mediterranean. It was further noteworthy that several cases of anthrax had occurred in recent years at the wharf from which one of the consignments referred to above had been supplied. Thus a case occurred at this wharf in September 1893, another in March 1894, and in each of these cases the man who was attacked had manipulated goatskins. In September 1894 another man working at this wharf was attacked; there was, however, no information as to goatskins in this instance. Again, in October 1895, two cases occurred in men who had manipulated goatskins at the same wharf.

This series of events is suggestive of one or other of two explanations. Either the wharf may have been supplied from time to time with infected goatskins, and in that case the possibility of some particular anthrax-infected locality being the source of supply and the cause of all the trouble naturally suggests itself; or the wharf premises, having themselves become infected, may have served as a means of re-infecting from time to time batches of skins. The former hypothesis seems to best fit in with the facts. That premises may, however, at times become infected and again convey infection at a later period seems not improbable. Such was indeed proved to be the case by Professor Boyce (_vide_ Annual Report of the Medical Officer of Health of Liverpool for 1899). It may be noted in this connection with regard to the five cases of anthrax mentioned above, as having occurred in January and February of 1896, that three further cases developed which may possibly have been attributable to the same source of infection. Two of the cases occurred in persons who may have been brought in contact with the skins implicated in January and February; a third case was that of a man who had worked at the leather-dressing establishment, and on a part of the premises in which the skins implicated in the earlier part of the year had been placed.

_Grouping of Cases considered in Relation to Preventive Measures._--The occurrence of such groups of cases as those above referred to merely repeats the experience of Glasgow in 1878, when Russian manes were at fault, and that of Bermondsey in 1882, when certain Shanghai hides fell under suspicion. If careful inquiry were made concerning every case of anthrax, it appears not improbable that all the cases occurring during a series of years could be referred to a very limited number of consignments of raw material, and if the origin of the goods were followed up in each instance, it might be found that a considerable check could be placed upon the introduction of infected raw products into this country. In some cases workmen have been led to suspect that they were incurring special risk from something unusual in the appearance of the hides, skins, or horsehair, with which they were dealing. It has been already said that the hides suspected in the historic outbreak in Bermondsey in 1882 came from Shanghai; a considerable number of these were ascertained to have been “light,” “dirty,” “stale,” and “much tainted,” “many were in fact ‘dead’ hides,” _i.e._ those of animals that had not been slaughtered, but had died, possibly, of course, of anthrax. In a particular instance, in connection with a more recent occurrence of a case of the disease in question in London, it was found that a small quantity of suspected material had been retained at the broker’s warehouse, the bulk of the consignment, of which the said material formed a portion, being sent abroad. The small quantity in question, which consisted of scabbed and worthless skins, was handed over, at the request of the Medical Officer of Health in whose district the warehouse was situated, to be destroyed; but that officer had no opportunity afforded him of examining the bales which were not disposed of in London. There can be no doubt that there would be less likelihood of suspected material being placed upon the market, if it were definitely realised that the source of infection would be traced in all cases of anthrax which occur. Veterinary experts in this country have long insisted that “no attempt should be made to utilise any part of the carcase of an animal which has died of anthrax”; and M. Chauveau, in a paper read before the seventh International Congress of Hygiene and Demography in 1891, argued that only by convincing those concerned with the disposal of raw material, to which suspicion attaches, that to destroy it is the only course open to them in order to safeguard their own interests, will it be practicable to exercise any really efficacious check upon production of disease. M. Chauveau urged that effort should be made to cause this fact to be generally appreciated, and he added, “L’effet de cette propagande devrait être renforcé par une bonne organisation des services de surveillance sanitaire, et par une application sévère des pénalités contre les délinquants.”

Mr Spear, in his report in 1883, referred to the possibility of “the establishment of an organisation by which this country may be warned of the existence of the disease among cattle,” with a view to prohibiting the import of suspected hides. He pointed out, moreover, that if the practice of dealing separately with “dead” hides, from their first shipment at the port of export, were to become established, such a system would “result in the limitation of dangerous material mainly to one class of goods, instead of its distribution throughout the entire bulk.” These suggestions seemed, perhaps, when they were made, to be “counsels of perfection,” but if the material conveying infection is in the future traced in a growing proportion of cases, and if, armed with knowledge of all cases of anthrax which occur, inquiry as to the antecedents of implicated material is more and more sedulously prosecuted, it seems probable that it will increasingly become the practice of owners of diseased animals to destroy infected hides, skins, hair, etc., instead of attempting to dispose of them.

Against the prospect of diminution of risk from the growth of a desire on the part of dealers in raw animal products to safeguard their own interests, it may be urged that anthrax is so common a disease that the wholesale destruction of the skins, hides, hair, etc., of infected animals would mean great loss; that in many instances the existence of diseased conditions cannot be detected; that even with the best intentions on the part of the dealer much dangerous material must necessarily be placed on the market; and that in any event all that is needful in the case of suspected raw products is that they should be adequately disinfected. Further experience will no doubt throw more light on these questions, but the history of cases in London and elsewhere, so far as it is known, suggests that the amount of dangerous material exported to this country is very small in proportion to the total bulk, and that, with the devotion of an increasing amount of attention to the matter, it will become more and more usual for the origin of consignments of such dangerous material to be traced. If this should prove to be the case, it may be that the prevention of anthrax infection will be worked out very much upon the lines indicated by M. Chauveau.

_Disinfection and Other Measures of Precaution._--As regards disinfection it has been, until quite recently, assumed that exposure to steam, or to reliable chemical disinfectants, was quite out of the question. So far as the leather trade is concerned this doctrine is still generally accepted, but, as regards the horsehair industry, experiments have shown that disinfection is practicable under certain conditions. It appears from a recent Report of the Medical Inspector of Factories (Dr Legge), that in this country a steam disinfector is in use in a particular establishment for dealing with mane hair from Russia and China, and that in other establishments all mane hair is boiled or dyed before being used for curling purposes. In Germany careful experiments have been made with a view to determining how disinfection can be carried out with a minimum of damage to raw material, and an account of the results obtained is contained in the _Arbeiten a. d. Kaiserlichen Gesundheitsamte_, 15 Band, 5 Heft, 1899. The principal conclusion would appear to be that the pressure under which the steam is allowed to enter the disinfecting chamber should not exceed 0.15 atmosphere (2 to 3 lbs. to the square inch). Higher pressures, such as are commonly in use in steam disinfectors in this country, tend to make the ends of the hair (especially of long tail hair used for weaving purposes) brittle. A further objection to steam is the yellow colour which it imparts to white hair. As the outcome of these experiments, special rules dealing with the disinfection of foreign horsehair and pigs’ bristles were formulated, and came into force throughout Germany in 1899. A report as to their operation appeared in 1901 (_loc. cit._, 18 Band, 1 Heft).

The use of steam disinfection in the horsehair industry may, therefore, become considerably extended. Dr Legge points out, however, that reliance must not be placed upon such disinfection as at present practised for dealing with “unopened bales, especially when hydraulically pressed.” The fact noted by Dr Legge that, in September 1899, “the principal horsehair manufacturers, at a meeting held in London, passed unanimously a resolution binding themselves from that date to buy no Russian, Siberian, or Chinese undyed mane hair, until satisfactory guarantees had been given by the sellers that the hair has been thoroughly disinfected,” is a significant one. Further, reference may be made to a circular letter, addressed to occupiers of horsehair works by H.M. Chief inspector of Factories, which deals with means of diminishing risk of anthrax in the industry in question (_vide_ Annual Report of the Chief Inspector for 1900).

In connection with hides, Mr Spear first pointed out the desirability of studying, in relation to the process of curing, the question of the possibility of favouring the destruction of morbific germs. “It might,” he said, “be possible so to treat the skins by a preliminary process, as to cause any attached spores to germinate into the easily destructible rods.”

Anthrax appears to be rarely, if ever, conveyed by wet hides, and there is, therefore, some prospect that the increasing adoption of the “wet,” as opposed to the “dry,” cure may prove an important means of obviating the spread of infection. The dry cure is said to stand condemned from the point of view of producing good leather, but, in places where difficulty of transport makes weight an important consideration, it is still largely adopted. As long ago as 1894, a writer in the _Leather Trades Circular and Review_ urged the merchants engaged in the China trade to “establish saladeros (as has been done in South America), where all green hides shall, after slaughtering, go through a proper system of brining, or arsenic curing, or salting, by which the pelt will be preserved.” Arsenic curing, it may, however, be noted, might become a source of danger. Experiments made with a view to determining whether chemical disinfection of hides can be effected in a practicable manner are being carried out in this country at the present time.

Pending the growth of knowledge as to sources of anthrax infection, and increase in appreciation of the desirability of destroying infected goods, something can be done by advocating cleanliness and enforcing the provision of washing appliances, and by urging the great importance of alertness as regards detecting the disease at the outset, with a view to obtaining proper advice during the earliest stages of the malady. In the Annual Report of the Chief Inspector of Factories for 1899 the special rules issued in 1899, and established in eighty-eight works, are published _in extenso_. These rules define both the duties of the occupier and the duties of persons employed. In 1899, too, it was decided by the Home Office authorities to give facilities for bacteriological examination, with a view to the verification of doubtful cases of anthrax, and medical practitioners, on making application to the Medical Inspector of Factories at the Home Office, are now enabled to satisfactorily clear up the diagnosis in doubtful cases. This in itself constitutes an important step in advance, and is an indication of the growing amount of attention that is likely to be accorded to anthrax prevention in the near future.

W. H. HAMER.