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1408 AUSTRALIA dangerously ill, a magistrate may take a voluntary statement from her on oath or affirmation which will be available in criminal proceedings after her death, provided that the accused person had reason- able notice and opportunity of being present and cross-examining. A " dying declaration," made by the patient in the belief that her end is approaching, may be made verbally to the medical practitioner or anybody else and will be admissible in evidence. The recipient should write down the exact words used as accurately and as early as possible. Accessories to Crime A more active kind of intervention between police and criminals has lately been discussed in America. Dillinger and other public enemies, it appears, may have sought the professional aid of doctor or surgeon in order to disguise the tell-tale impressions left by their finger-prints. The practitioner who undertakes such work can hardly be ignorant of its criminal purpose. He is likely to be prosecuted as an accessory after the fact if, knowing a felony to have been committed, he receives, relieves, comforts, or assists the felon. To " receive " a felon covers" any assistance whatever given to one known to be a felon in order to hinder his being apprehended or tried." This is so stated in Hankins’s Pleas of the Crown in a passage quoted with approval in R. v. Levy in 1912. The accused in that case had helped a coiner by removing fragments of coining moulds from the coiner’s room with the idea of preventing them from being evidence against the coiner. To help a criminal to prevent his known finger-prints from being impressed is clearly to attempt to hinder his being apprehended. If a doctor helps a known " public enemy " in this way, then, apart from the prospect of his criminal liability as an accessory before or after the fact, he might possibly be indicted under the vogue and comprehensive accusation, lately discussed in R. v. Manley, of doing an act which is a public mischief. Prisoners Absconding from Hospitals George Rivers, aged 36, serving a sentence in Wandsworth Prison, was sent to the St. James’s Hospital, Wandsworth, for an operation. Though he was described as a dying man who, with the best possible treatment, might live another month, he managed to escape from the hospital on May 26th after scaling a 7 ft. wall. Wearing his blue hospital suit at his departure, he remained at large until he gave himself up last week at the prison. Such incidents are a reminder that civil hospitals are not equipped for the restraint of patients sent from prison. The latest statistics available show that 109 male and 18 female prisoners were removed from prisons to civil hospitals for operation or special treatment during 1933. The statutory authority is Section 17 (b) of the Criminal Justice Administration Act of 1914, which declares that, while absent from prison in this way under Home Office order, the prisoner is still deemed to be in legal custody. The Prisons Commissioners’ report for 1933 contained a statement by the Medical Commissioner that on the whole the prisoners conducted themselves well, " but a few abscond and some hospital authorities are apprehensive when a patient is admitted to a general ward from prison." The apprehension is not entirely surprising and the report explains that steps are being taken to have an operation theatre available in a prison in the London area. Experience has been gained by the satisfactory carrying out of major operations in five provincial prisons. AUSTRALIA (FROM OUR OWN CORRESPONDENT) THE TREATMENT OF INFANTILE PARALYSIS MuCH controversy in which the main issues have been clouded by spirited attack and counter attack in the public press has arisen during the last few months about the merits of a certain method of treating established infantile paralysis. The story began in February last when it was announced in the public press of Australia that a new system of treating infantile paralysis had been presented to the Common- wealth Government, which in the opinion of prominent medical men had achieved success not previously obtained by other methods. In the Sydney Morning Herald of Feb. 16th it was stated that the system had been devised by Sister Elizabeth Kenny and had been approved by the Queensland Department of Health. Dr. J. F. Guinane, who had carried out an investigation for the Queensland Government, was said to have reported that Sister Kenny’s methods had made total and permanent cures in early cases of infantile paralysis and that in spastic cases it was superior to any other method. The origin of the treatment, according to this report, was the work done by Sister Kenny during the war when nursing cases of meningitis on troop-ships ; during that period she is said to have evolved certain ideas on the treatment of paralysis, and after the war she began to apply these ideas in the treatment of victims of infantile paralysis and cases of spastic paralysis. Sir Raphael Cilento, Director of Medical Services in Queensland, had, it was said, been deputed to investigate the matter, and had reported so favourably that the Government of Queensland had opened a clinic in Townsville in March, 1934, to train students in the methods. A silent film was shown to medical men and others, to which Sister Kenny supplied a running com- mentary, in which were shown the results in a number of patients treated by her methods. Three weeks later there appeared in the Sydney Morning Herald of March 9th the report of an interview with Sir Raphael Cilento, in which he was alleged to have said : "The Queensland Government or myself do not approve or disapprove of Sister Kenny’s method." He had investigated her method and acting on his report the Government had opened a clinic at Towns- ville in March, 1934. The clinic with a staff of six nurses was established for a two-year period from funds provided by the Home Department. His report was to the effect that her treatment had improved the health of patients particularly in regard to their general activity. In no case had she restored the functions that had been lost by nerve destruction. The next step in the matter came on March 14th from Canberra where Sister Kenny had gone to place her proposals before the Commonwealth Govern- ment ; she expressed her astonishment at Sir Raphael Cilento’s statements and produced a letter dated Jan. 31st in which, she said, Sir Raphael mentioned his agreement to write a book descriptive of her methods. In his reply to this, in the Brisbane Courier-Mail of March 15th, Sir Raphael said that he saw no cause to alter the opinion expressed in his official report. He had agreed to assist Sister Kenny in the compilation of a book, if and when the method should show itself effective to a degree that justified a book. Of the 16 original cases, for the study of which the Townsville clinic has been instituted, in his opinion 7 were stationary, while 5 had abandoned
Transcript
Page 1: AUSTRALIA

1408 AUSTRALIA

dangerously ill, a magistrate may take a voluntarystatement from her on oath or affirmation whichwill be available in criminal proceedings after herdeath, provided that the accused person had reason-able notice and opportunity of being present andcross-examining. A " dying declaration," made bythe patient in the belief that her end is approaching,may be made verbally to the medical practitioner oranybody else and will be admissible in evidence. The

recipient should write down the exact words used asaccurately and as early as possible.

Accessories to Crime

A more active kind of intervention between policeand criminals has lately been discussed in America.Dillinger and other public enemies, it appears,may have sought the professional aid of doctor orsurgeon in order to disguise the tell-tale impressionsleft by their finger-prints. The practitioner whoundertakes such work can hardly be ignorant of itscriminal purpose. He is likely to be prosecutedas an accessory after the fact if, knowing a felonyto have been committed, he receives, relieves,comforts, or assists the felon. To " receive " a feloncovers" any assistance whatever given to one knownto be a felon in order to hinder his being apprehendedor tried." This is so stated in Hankins’s Pleas ofthe Crown in a passage quoted with approval inR. v. Levy in 1912. The accused in that case had

helped a coiner by removing fragments of coiningmoulds from the coiner’s room with the idea of

preventing them from being evidence against thecoiner. To help a criminal to prevent his known

finger-prints from being impressed is clearly to attemptto hinder his being apprehended. If a doctor helpsa known " public enemy " in this way, then, apartfrom the prospect of his criminal liability as an

accessory before or after the fact, he might possiblybe indicted under the vogue and comprehensiveaccusation, lately discussed in R. v. Manley, of

doing an act which is a public mischief.

Prisoners Absconding from HospitalsGeorge Rivers, aged 36, serving a sentence in

Wandsworth Prison, was sent to the St. James’sHospital, Wandsworth, for an operation. Thoughhe was described as a dying man who, with thebest possible treatment, might live another month,he managed to escape from the hospital on May 26thafter scaling a 7 ft. wall. Wearing his blue hospitalsuit at his departure, he remained at large until hegave himself up last week at the prison. Suchincidents are a reminder that civil hospitals are notequipped for the restraint of patients sent from prison.The latest statistics available show that 109 male and18 female prisoners were removed from prisons to civilhospitals for operation or special treatment during1933. The statutory authority is Section 17 (b) of theCriminal Justice Administration Act of 1914, whichdeclares that, while absent from prison in this wayunder Home Office order, the prisoner is still deemedto be in legal custody. The Prisons Commissioners’report for 1933 contained a statement by the MedicalCommissioner that on the whole the prisonersconducted themselves well, " but a few abscond andsome hospital authorities are apprehensive when apatient is admitted to a general ward from prison."The apprehension is not entirely surprising and thereport explains that steps are being taken to have anoperation theatre available in a prison in the Londonarea. Experience has been gained by the satisfactorycarrying out of major operations in five provincialprisons.

AUSTRALIA

(FROM OUR OWN CORRESPONDENT)

THE TREATMENT OF INFANTILE PARALYSIS

MuCH controversy in which the main issues havebeen clouded by spirited attack and counter attackin the public press has arisen during the last fewmonths about the merits of a certain method of

treating established infantile paralysis. The storybegan in February last when it was announced in thepublic press of Australia that a new system of treatinginfantile paralysis had been presented to the Common-wealth Government, which in the opinion of prominentmedical men had achieved success not previouslyobtained by other methods. In the Sydney MorningHerald of Feb. 16th it was stated that the systemhad been devised by Sister Elizabeth Kenny and hadbeen approved by the Queensland Department ofHealth. Dr. J. F. Guinane, who had carried out aninvestigation for the Queensland Government, wassaid to have reported that Sister Kenny’s methodshad made total and permanent cures in early casesof infantile paralysis and that in spastic cases it was

superior to any other method. The origin ofthe treatment, according to this report, was thework done by Sister Kenny during the war when

nursing cases of meningitis on troop-ships ; duringthat period she is said to have evolved certainideas on the treatment of paralysis, and after thewar she began to apply these ideas in the treatment ofvictims of infantile paralysis and cases of spasticparalysis. Sir Raphael Cilento, Director of MedicalServices in Queensland, had, it was said, been deputedto investigate the matter, and had reported so

favourably that the Government of Queensland hadopened a clinic in Townsville in March, 1934, totrain students in the methods.A silent film was shown to medical men and others,

to which Sister Kenny supplied a running com-

mentary, in which were shown the results in a numberof patients treated by her methods. Three weekslater there appeared in the Sydney Morning Heraldof March 9th the report of an interview with SirRaphael Cilento, in which he was alleged to have said :"The Queensland Government or myself do not

approve or disapprove of Sister Kenny’s method."He had investigated her method and acting on hisreport the Government had opened a clinic at Towns-ville in March, 1934. The clinic with a staff of sixnurses was established for a two-year period fromfunds provided by the Home Department. Hisreport was to the effect that her treatment hadimproved the health of patients particularly in regardto their general activity. In no case had she restoredthe functions that had been lost by nerve destruction.The next step in the matter came on March 14th

from Canberra where Sister Kenny had gone to placeher proposals before the Commonwealth Govern-ment ; she expressed her astonishment at Sir RaphaelCilento’s statements and produced a letter datedJan. 31st in which, she said, Sir Raphael mentionedhis agreement to write a book descriptive of hermethods. In his reply to this, in the BrisbaneCourier-Mail of March 15th, Sir Raphael said that hesaw no cause to alter the opinion expressed in hisofficial report. He had agreed to assist Sister Kennyin the compilation of a book, if and when the methodshould show itself effective to a degree that justifieda book. Of the 16 original cases, for the study ofwhich the Townsville clinic has been instituted, inhis opinion 7 were stationary, while 5 had abandoned

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treatment. These were the only cases of this serieswhich had been under observation long enoughto justify even a tentative opinion.As a result of the publicity there arose a

demand from parents having children suffering frominfantile and other forms of paralysis to be ableto obtain the treatment. Townsville is situated in thenorth of Queensland and many miles from the largercentres of population. As this is the only clinicavailable for the treatment, crippled children havebeen sent by train and aeroplane to Townsville andpublic subscriptions have been organised in countrytowns to send children there. A demand also arosefor the creation of clinics at Brisbane and other

capital cities.On April 2nd the Commonwealth Government

announced the result of its investigations and theFederal Minister for Health and Repatriation(Mr. William Hughes) read a report which had beenmade to him by the medical superintendent of theFrankston Orthopaedic Hospital, Victoria (Dr.Galbraith), and a Melbourne orthopaedic surgeon,Mr. Whittaker, on an inquiry they had made into thetreatment. Their report was as follows :-

" It is our opinion that the only way of demonstratingthe value of Sister Kenny’s work, and of comparing itwith orthodox methods, would be to give her facilitiesto treat cases, both recent and chronic, in one, or preferablytwo, capital cities. Such work should be carried out bySister Kenny in person, or by her trainees. It would bewise, and with this Sister Kenny agrees, that the locationof such facilities be at a public hospital, and preferablya children’s hospital. Sister Kenny has always workedwith the medical profession, and it is hoped that a cleavagewill not be enforced by establishing clinics apart from suchhospitals. Under the Hospitals Commission, certain safe-guards would be necessary, but we are definitely of theopinion that if the Government requests the committeesof management of the hospitals to provide such facilities,some mutually satisfactory arrangement could be reached."

As the result of this report, it was decided that theCommonwealth Government should take steps tohave the method tested in public hospitals inMelbourne and Sydney with the cooperation of theVictorian and New South Wales Governments.On April llth the New South Wales Minister forHealth announced that his Government had beenapproached by the Commonwealth Government andwas anxious to provide Sister Kenny with all facilitiesto make an early start with her treatment. Laterit was announced that it was proposed to open aclinic at the Royal North Shore Hospital, Sydney.On May 13th it became apparent that an open

break had occurred between Sister Kenny and theQueensland Government over the establishment ofthe Brisbane clinic. She announced that she did notintend to comply with the request by the HomeSecretary to conduct a clinic in Brisbane while anydoubt of the efficiency of her method existed, and thatshe had been unable to arrange for a clinic to beestablished under conditions satisfactory to her or thepatients. Sir Raphael Cilento, she contended, hadattempted in his report to the Home Secretaryto discredit her methods, had raised doubts about itsoriginality, and had inferred a similarity between hermethods and those published by Dr. WilhelminaWright in the United States in 1927. (Actually SirRaphael’s conclusion had been that her work wassoundly based, was effective within certain limits, andwas similar in general principles to those advocatedby most modern doctors and specialists.) Everyone,she added, would appreciate her unwillingness tohave her work extended in Queensland in view of

the unsympathetic attitude of the Governmentmedical adviser.The Queensland Government announced that it

intended to proceed with the clinic, and on May 25thSister Kenny in the Brisbane Courier-Mail statedthat she had not given her permission for the use ofher methods at this clinic, one reason being that thedescription of her method had not been officiallypresented to the Home Secretary. The only copyof the description of her method was in her possession.Sir Raphael Cilento had possession of an incompleteand discarded draft copy, in which one essential featurewas not mentioned. She had asked the Home

Secretary, in the interests of the public, to have thatcopy destroyed. She resented, she said, Sir Raphael’shalf-hearted approval of her work and his implicationthat her method was not original. She proposedthat a committee be appointed to determine the

originality of her work. Years before she hadvisited America she had effected cures in Australia.A reply to this was made by Sir Raphael Cilento

in which he said that the Government intended toopen the Brisbane clinic and place in charge of it thenurse who was first appointed and longest trainedat the Townsville clinic. He regretted that he hadbeen made " the villain of the piece " and suggestedthat the real reason for her not opening the Brisbaneclinic was that she had received a better offer toestablish a larger clinic in Sydney. He repeatedhis opinion " that her work was soundly based andwas effective within certain limits. To suggest thatthere should be no qualifications as to the effectivenessof her method was to suggest that it should bedescribed as miraculous."The Government also announced that it intended

to make a register of all sufferers from infantile

paralysis in Queensland. An effort would be made totrace every possible case and in view of the successthat had attended the work so far, the Governmentwas of the opinion that every paralysis sufferershould be given a course of after-treatment at clinicswhich would be established at various centres through-out the State. It was also announced that theGovernment had taken over the control of theTownsville clinic as a Government activity. Resent-ment at this action by the Government has beenexpressed at a meeting of the parents of patients at theclinic and a public meeting of protest is being arranged.

Sister Kenny on May 17th made a further announce-ment. Her attitude throughout had been that shewould not extend the work at Townsville to any othercentre unless she had the complete confidence of thepeople and Governments concerned. So that therewould be no repetition of the trouble which hadoccurred in Brisbane, she must have an assurance,before she would accept the invitation to establisha clinic in Sydney, that the authorities in New SouthWales were convinced of the originality of her method,its scientific basis, and its value to the medicalprofession. For this purpose a Sydney doctor wouldvisit her in Brisbane within a week, and when theQueensland Government was prepared to complywith her conditions for the protection of all concerned,she was ready to serve the people of that State.The medical profession in Australia and the public

generally are very much in the dark concerning thewhole matter, and no public disclosure of the methodhas been made. The first announcement was some-what modified by the medical authorities in Queens-land, who state that the results obtained have beensatisfactory, but discount anything miraculous.On the other hand, a letter has appeared in the

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1410 SCOTLAND

Courier-Mail, May 14th, signed by five of SisterKenny’s patients, in which they state that all butone of them had had many years’ experience withorthodox methods of treatment, and that results wereobtained by Sister Kenny’s methods which appearedimpossible of accomplishment by the ordinary treat-ment ; the improvements had been of a permanentnature and no relapse had occurred in five months.What the exact nature of the treatment consists in

is difficult to ascertain. Undoubtedly re-educationplays a large part in it. By some the treatment isregarded as being of the nature of psychic cure by awoman of outstanding personality. It is consideredthat her personal service and supervision in carryingout the treatment plays a large part in its success.The method is reputed to differ from those ordinarilyadopted in the following respects :-

1. No splinting or plaster is used at any stage oftreatment.

2. Movements are carried out where possible underwatcr, to which some salt is added.

3. Treatments are given frequently during the day,with rest periods between.

4. Hydrotherapy in the form of sprays and showersis used.

5. Attempts at active and passive movements are madeat the earliest possible moment.

As Sister Kenny has nowhere set out the detailsof her method, there is no way of checking these

impressions which are based on reports and on remarksmade by her whilst demonstrating her film.

In view of the public interest in this matter, it isto be hoped that a public disclosure of the methodwill soon be made. Amongst medical men who haveexamined patients treated by the method, thereappears to be considerable divergence of opinionas to its value.

AN UNUSUAL MEDICO-LEGAL PROBLEM

About the middle of April some fishermen caughta large tiger shark on the Coogee Beach for the

purposes of exhibition at the Coogee Aquarium. Theshark refused to eat and for a week swam lazily upand down the pool, brushing its body against the sides.On April 25th it began to flay the water to foam,dashed up to one end of the aquarium, and threshingwildly with its tail, disgorged several objects. Theseincluded some vertebrae of a large fish and a humanarm. A piece of rope was tied tightly around thewrist and the arm was in a good state of preservation.There was a large gash in the front of the arm justabove the elbow and some small irregular andsuperficial incisions, which may have been causedby the teeth of the shark, on the back of the forearm.The arm was cleanly cut through just beyond theacromion and cleanly dissected off at the shoulder-joint. On close examination it was thought by theauthorities to be unlikely that a bite of a shark couldhave so nearly removed the arm through the joint,and that removal was probably by human agency.It was clear from the flaps that the method adoptedwas not surgical, and the arm showed no evidenceof being a discarded dissecting-room specimen. Onthe front of the forearm was a tattoo mark of twomen boxing. The police continued their investiga-tions ; they obtained the fingerprints with some

difficulty and later the arm was identified by itstattoo marks and fingerprints as belonging to a man

who had disappeared from his home on April 8thand had since then not been heard of. As nobodywas forthcoming, the city coroner could hold noinquest and there was not sufficient of the body topermit him to hold a magisterial inquiry. It is

thought that the police will attempt to overcometheir difficulty by bringing medical evidence to certifythat the owner of the arm could not have lived withoutmedical attention. A man has been arrested and

charged with murder. The incident is not altogetherwithout precedent, as according to a story in H. S.Mazet’s book " Shark ! Shark ! " the crew of the

brig Nancy were sentenced for piracy in 1771 on theevidence of a log book found in the stomach of ashark.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

NEUROPATHOLOGY

THE Scottish mental hospitals have a joint schemefor pathological research, and an account of itsthirty-seventh year’s work has just appeared. Two

years ago the board secured the services of Dr. J. H.Biggart as pathologist, and he has been able toform a highly efficient laboratory for the study ofneuropathology. Specimens are sent to him frommany of the mental hospitals in Scotland, and fromgeneral hospitals in Edinburgh, particularly theRoyal Infirmary where the laboratory is situated.His services are already much appreciated by allwho are interested in neuropathology, and it is tobe hoped that his laboratory will be increasinglyused both for routine examination and for researchwork. A specialised laboratory such as this isessential for the proper study of the pathology of thenervous system, owing to the complicated natureof the modern staining technique.

A CHILDREN’S HOSPITAL

The annual report of the Royal Edinburgh Hospitalfor Sick Children shows that its work is steadilyincreasing. A total of 3144 cases were treated in thewards during the year, and the number of attendancesat the out-patient department, including the massageand sunlight departments, was nearly 40,000. Theordinary income amounted to £14,264 ; the incomefrom legacies and the like was £10,280 ; and the

expenditure for the year was £19,019. During theyear 190 patients were treated in the convalescenthome at Gullane. Through the generosity of LordForteviot and members of the Dewar family a newconvalescent home for children under two years ofage is to be opened. The medical staff intend tostart a campaign against rheumatism in childhood,which they compare to cancer in the adult. Nodisease is more tragic and they are to be congratulatedon this intention.

PIONEERS IN MENTAL DISEASE

Bronze plaques in memory of six pioneers in the .

humane treatment of mental disease were unveiledlast week by Sir Arthur Rose, chairman of theGeneral Board of Control for Scotland, in the groundsof West House, Royal Edinburgh Hospital forMental and Nervous Disorders. They are arrangedaround the bust of Philippe Pinel, and commemoratethe work of William Tuke, Andrew Duncan, FlorenceNightingale, Dorothea Dix, Gardiner Hill, andCampbell Clark. Tuke was the founder of theRetreat in York, and Duncan of the Royal EdinburghAsylum. Dorothea Dix, an American, after visitingthe asylum, was so impressed by the work done there,that she made a report which resulted in the LunacyAct of 1857 coming into being. Gardiner Hill hadmuch to do with the abolition of restraint and locking-up in mental cases; Florence Nightingale had


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