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effects caused by the passage of these currents through,electrolytes and the human body. The theory of .1’ions is explained, and the migration of ions and themovements of colloids and particles in suspensionunder the influence of the electric current are described. IAn account is given of the physiological action of thevarious currents on motor, sensory, and sympatheticnerves, on the central nervous system, on sense organsand the circulation, and on metabolism. The thirdpart concludes with a section on electro-diagnosis.The fourth part (106 pages) deals with disease andits treatment by electrical methods. The generaltherapeutic properties of the different currents aredescribed in the first section of this part. In thefollowing 11 sections the diseases suitable forelectrical treatment are reviewed, each system of thebody being considered in a separate section.The book is a useful introduction to the principles

and practice of medical electricity. The authorrightly devotes much space to a. consideration of theaction of electricity on the body in health, for aknowledge of the physiological effects brought aboutby electrical currents not only enables us to applyelectricity intelligently, but also indicates the linesalong which investigation can be most hopefullyconducted. Dr. Kowarschik discusses the vexedquestion of the method of action of the galvaniccurrent when used to treat disease of parts lyingbeyond the range of entry of ions introduced from theexterior. He acknowledges that the current can

generate heat in the tissues, but maintains that theheat is too slight to have any therapeutic value. Hethinks the power of the current to cause movement ofcolloidal particles plays some part, not yet known, inthe treatment of disease, although these particlescannot be made to migrate through animal membranes.The therapeutic value of the sinusoidal current is notsufficiently emphasised. The author appears to becautious in the recommendation of these currents,perhaps in view of fatal results which have followedthe application in full-length baths in certain partsof Germany. Static electricity is very briefly con-sidered, and the author does not think much of itstherapeutic value. It must be mentioned, however,that the machine installed in his department is

extremely small.The work can be recommended. A noteworthy

feature is the number of clear and helpful diagrams.

ELEMENTS OF WATER BACTERIOLOGY.Fourth edition. By S. C. PRESCOTT, Professor ofIndustrial Microbiology in the MassachusettsInstitute of Technology; and C-E. A. WINSLOW,Professor of Public Health in the Yale School ofMedicine. London: Chapman and Hall; NewYork : John Wiley and Sons, Inc. 1924. Pp. 211.lls. 6d.

THIS sound and admirably balanced monograph onWater Bacteriology is now in its twentieth year and,for the present edition, has been largely rewritten.In spite of its long enduring popularity the book isstill of a size not beyond the compass of the D.P.H.student, and not too bulky to give the beginner inwater examinations an excellent review of the whole I

subject within a reasonable space of time. A certainnumber of errors have crept into this edition.For example, Houston’s table, quoted on p. 19,lacks column headings, and is, in its present- form,absolutely meaningless, and the table on p. 36 isout of place and should be between pages 26 and 27 towhich it has reference. The characters of theorganisms of the typhoid-colon group, as stated onp. 56, are somewhat inaccurate ; B. lactis aerogenes,B. acidi lactici, and B. dysenterice (Flexner) all beingshown as fermenting dulcitol, which none of them do,and B. dysenter-icc (Shiga) being shown as turningmilk alkaline, which is a property of an allied andoften confused organism which Andrewes has calledB. ambiguus. In connexion with the differentiationof the coli and aerogenes groups by sugar reactions,the methyl-red and the carbinol tests, there are several

contradictions on pp. 57-59. It is a pity that suchinaccuracies have been permitted to occur, since thebook is one likely to be read as a dogmatic guidanceto salvation by the beginner in water bacteriology,rather than as a contribution to the subject fromauthors of great experience for those whose life’soccupation lies in this type of work. But thebeginner should read it with much profit, if he carriesaway with him nothing more than the recogniticnthat " In sanitary water examination... the factor sinvolved are so complex, and the evidence necessarilyso indirect, that the process of reasoning much moreresembles a doctor’s diagnosis than an engineeringtest."

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ANNALS OF MEDICAL HISTORY.

Vol. VI. No. 2. June, 1924. Philadelphia :Paul B. Hoeber.$2.50.THE principal articles in this number are bio-

graphical-namely, papers upon Sir William Bowman,Carl Weigert, Spallanzani, and Sir William Buttes,who was physician to Henry VIII. We think thatthe author of this paper, Dr. T. N. Toomey, is inerror when he translates the commencement ofHenry VIII.’s grant to Buttes by the words,

"

Kingby all, &c.," for though he only gives the two firstwords of the preamble-namely, " Rex omnibus,&c.," the beginning was probably Rex omnibus adquos presentes litere pervenerint...." Also, in thelast line of Buttes’s epitaph Dr. Toomey transcribes" Mors mihi nunc lucum vitaque Christus erit," andtranslates, " Now that I am dead, Christ will be tome refreshment and life " ; it is surely obvious that" lucum " should read " lucrum," and equally obviousthat the line is simply a poetical rendering of St. Paul’sremark (Phil. i. 21) as given in the Vulgate, " Mihienim vivere Christus est, et mori lucrum." Apartfrom these little oversights the paper is good, and Dr.Toomey has been at much trouble to consult originalsources of information. Dr. Francis Packard, theeditor, gives his readers an interesting paper uponReferences to Venereal Diseases, in which, with theart of a practised writer, he arrests attention at theoutset by a quotation which has nothing to do withsyphilis. The best paper in the number, however,is that by Dr. John Ruhrah, entitled James Atkinsonand his Medical Bibliography, a scarce and amusingbook and a great favourite of Osler. We shareDr. Ruhrah’s wonder that it has never been reprinted.but are sincerely grateful to h:m for having givenus a generous number of quotations from it. Biblio-graphy pure and simple is an arid form of literature ;as annotated by such men as Atkinson it is mostsimulating.

BRITISH WINES AND CORDIALS.

THE Ministry of Health has recently publishedNo. 24 of its " Reports on Public Health and MedicalSubjects " (Is. 6d.), dealing with the composition ofcommoner British wines and cordials (alcoholic andnon-alcoholic). Dr. G. C. Hancock, one of the

Ministry’s medical officers, is responsible for Part I.,which deals with the historical and technical side ofthe industry, while the much larger Part II., con-tributed by the Government Chemist, consists of aclassified summary of the results of the analyses ofsome 360 samples. The composition of these beveragesformed the subject of a special inquiry by the LocalGovernment Board, which was begun in 1913, butowing to interruption by the war it has only justbeen completed.Many of these beverages, although not specifically

described as temperance drinks, are not uncommonlyregarded as such, and, roughly speaking, they may bedivided into two classes-namely, those which containalcohol and those which really are temperance drinks.Strictly speaking, the term " wine " should be appliedonly to the former, since wine in its broadest sense

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is the fermented expressed juice of any fruit, though Ithe term is generally understood to apply to thejuiee of the grape. The term " British wine " has,however, been applied to a number of beveragesmanufactured in the British Isles, some of whichcontain alcohol produced in part by the fermentationof fresh and dried fruits, whilst others consist for themost part of sugar solutions flavoured with fruitjuices, fruit essences, and other flavouring agents,and contain no alcohol or only an amount not exceeding2 per cent. of proof spirit, as permitted by the Exciseauthorities. Fermented wines are usually sold withoutany special indication that they contain alcohol, buttemperance drinks are almost invariably described as" non-alcoholic," " non-excisable," or " unfermented."The yearly consumption of British wines and cordialsis difficult to estimate. The annual output offermented British wines probably does not exceed2 million gallons. The manufacturers of these wines,with few exceptions, use preservatives in some form,those most commonly used in fermented beveragesbeing sulphurous acid and sulphites. Salicylic acid,although the most favoured preservative for tem-,perance wines and cordials, does not appear to be

Bextensively used in alcoholic beverages. For thesake of convenience, the preservatives and alcoholic Icontent of both unfermented and fermented wineshave been tabulated, and the analyses are shown inthe following table :—

Alcohol, either in the form of grain or wine spirit,is an ingredient occasionally added to fermentedwines, but its use for the most part appears to belimited to certain manufacturers of ginger wine whoexport to the British colonies. British fermentedwines may contain from 20-28 per cent. of proofspirit and therefore do not need to be fortified. Ofthe vegetable acids, tartaric and citric are sometimesadded, usually before fermentation or in the prepara-tion of the syrup.

Unfermented British wines are sold under similarnames to those given to fermented wines but in largervariety. They are manufactured in much the sameway and contain similar ingredients, the chiefdifference between a wine and a cordial being thedensity of the syrup which forms the basis of both ;in the case of wines, the syrup usually contains from

1’5 to 3 lb. of sugar to the gallon, while in cordials itruns from 3 to 6lb. to the gallon.

In addition to its sweetening power, some manufac-turers are aware of the antiseptic value of saccharin,and, since for equal sweetening power, this substanceis in normal times about half the price of sugar,advantage in a commercial sense is effected by itsuse. The use of artificial colouring matter is practisedto a greater degree in the colouring of temperancedrinks than in the colouring of alcoholic drinks,and 30 per cent. of the samples analysed by theGovernment chemist were found to contain coal-tar(aniline dyes) in very minute amounts. As regards theuse of saccharin, it should, of course, be rememberedthat this substance has no relation chemically tosugar and is not a food, and its use in food is prohibitedin the United States save in respect of certain drugsand classified foods containing this substance whichmay be required for the mitigation or cure of disease(Food Decision No. 142, United States Department ofAgriculture). Its use in British wines and cordialshas been shown to be limited for the most part tosome of the non-alcoholic wines and cordials. Thisstatement does not apply to the manufacture ofsweet mineral waters in which saccharin appears tobe much more commonly employed. Most manufac-turers are, however, able to do without saccharin,and it is clearly not necessary in the preparation ofthese beverages. An expert American committee whoreported on the use of saccharin summarised theirconclusions as follows : (1) Saccharin in smallquantities (4’6 gr. per day or less) added to food iswithout deleterious or poisonous action, (2) in largerquantities (over 4’6 gr. per day and especially above15’5 gr. daily) if taken for considerable periods oftime, especially after months, is liable to inducedisturbances of digestion.Coming now to the use of salicylic acid, which is

the most commonly employed preserving agent intemperance drinks, the author states it is a powerfuldrug, and, like sulphurous acid, has the quality ofinhibiting especially the growth of moulds and thoseorganisms which cause fermentation in fruit prepara-tions. Williams and Starling have found that itretards gastric digestion but has practically no effecton pancreatic juices ; on the heart it exercises adepressing effect. Within recent years feeding experi-ments with this preservative on human beings havebeen conducted by the U.S. Bureau’of Chemistry(Bulletin No. 84, Part 2, 758-9). The conclusionswhich were drawn from the study of the clinical andmedical history of the men under observation aresummarised as follows :-

" The final conclusion in this matter is that the unenviableposition which salicylic acid has heretofore held amongpreservatives, in being regarded as the most injurious ofall, is to a certain extent undeserved. Like other ordinarypreservatives, it is not one which can be classed as a poisonin the usual sense of the word. When used as a medicine inmany cases of derangement of health it is, like the otherchemical preservatives, often highly beneficial when properlyprescribed by a competent physician. It is when used inthe food at first an apparent stimulant, increasing theabsorption and solubility of the common food elementsz

from the alimentary canal. It soon, however, loses itsstimulating properties and becomes a depressant, tendingto break down the tissues of the body more rapidly thanthey are built up. It disturbs the metabolic processes, inmost cases producing conditions which are not normal andwhich, apparently, are not beneficial. It has a tendencyto diminish the weight of the body and to produce a feelingof discomfort and malaise,’ which, while not marked, isdistinctly indicative of injury. In some cases these symptomsof ’malaise’ approach illness, and, while not alwaysdiagnostic, are sufficiently common to point unmistakablyto the salicylic acid as their origin. It places upon theexcretory organs, especially the kidneys, an additionalburden which they are not able to bear, and which cannotpossibly result in any good, but, on the contrary, mustnecessarily finally result in injury, though perhaps with theuse of very small quantities of the preservative these organswould continue to perform their function for many yearsbefore finally breaking down."

The Departmental Committee, appointed in 1899 toinquire into the use of preservatives and colouring

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matters in food, recommended that the quantity ofsalicylic acid permissible in liquids should not exceed1 gr. per pint. Of the temperance wines and cordialsexamined by the Government Chemist 50 per cent.contained salicylic acid. The table below shows thenumber of samples which exceeded the 1 gr. limitrecommended by the Departmental Committee.

No. ofSalicylic acid. samples.

Exceeding 1 gr. but not exceeding 3 gr... 28» 3 gr. , , , , 7 gr... 21" 7 gr. " 12 or. 9

Total .... 58

As the question of preservatives and colouringmatters in foods is again under consideration by aDepartmental Committee appointed by the Minister,Dr. Hancock states that he has refrained from makingany specific recommendations in the matter.

The Conduct of Medical Practice.A Series of Articles by Experts dealing with the

Difficulties Encountered in ProfessionalLife and How to Meet Them.

XVIII.—LIBEL AND SLANDER.

BY HUGH WOODS, M.D.,GENERAL SECRETARY, LONDON AND COUNTIES MEDICAL

PROTECTION SOCIETY.

"Where it concerns himself, who’s angry at a slandermakes it true."-BEN JoNsoN, Catiline, Act III., Scene i.

EVERY medical practitioner ought to have a soundelementary knowledge of the law of libel and slander,for not only is he, by the nature of his profession,much exposed to libel and slander and very liableto serious damage from them, but he also runs seriousrisk, in the course of his professional duties, of himselflibelling or slandering others, or of giving opportunitiesfor accusations and claims for damages against himon the ground of alleged libel or slander. Beforediscussing the subject in its special reference tomedical practice, I will therefore briefly set out afew elementary principles with which every prac-titioner ought to be familiar.

‘

Flementary Principles.Defamatory Words.-vVords which produce, in any

given case, appreciable injury to the reputation ofanother are called defamatory, and defamatory words,if false, are actionable. False defamatory words, ifwritten and published, constitute a libel ; if spoken, aslander. False words which by their nature evidentlymust damage the reputation are actionable withoutproof that any particular damage has followed,otherwise it must be proved that some appreciableinjury has in fact followed from the words spoken orwritten. Such evidence of " special damage " is notrequired when the words complained of were spokenof the plaintiff in the way of his profession or tradeor an office of public trust, as it is assumed thatdisparaging words will under these circumstancescause injury even if specific instances of damageare not in evidence. In order to judge whether certainwords are defamatory or not it must be consideredwhether the nature of the words is such that it mustbe presumed that they would seriously injure thereputation of the person referred to as being disparag-ing or tending to bring into ridicule and contempt,when written ; or when spoken, as charging withthe commission of a crime, with having a contagiousdisorder, with unchastity or adultery in the case ofa woman, or as disparaging the person in his or hertrade or profession. When it cannot be presumed thatthe words must cause appreciable injury it is necessaryto prove that they have in fact produced injuryto the patient’s reputation. The presumption thatwords are defamatory arises much more readily in

cases of libel than in cases of slander, since for severalreasons they are more likely to cause injury whenwritten than when merely spoken.

Malice.-It is not necessary to prove that therewas any wrong intention or motive in the use ofdefamatory words unless the words are privileged byreason of the occasion on which they were employed.Words, if false and defamatory, are actionable (whennot privileged) even though published with an honestbelief in their truth or accidentally or inadvertently.Absence of malice may, however, be pleaded inmitigation of damages. When the judge has ruledthat the occasion was privileged in an action fordefamation, the plaintiff has to prove malice. Thequestion whether there was malice or not is for thejury, unless the judge rules that there is no evidenceof malice to go to the jury. Malice in law is anyindirect motive other than a sense of duty, and notonly feeling against the plaintiff. If malice is proved,the privilege attaching to the occasion, unless it beabsolute, is lost. The fact that the defendant at thetime of the publication of the defamatory wordsknew that they were false is clear evidence of malice,but even if the defendant honestly believed in thetruth of what he said, and was acting under a senseof duty on a privileged occasion, still the words usedand the manner and mode of their publication mayafford evidence of malice. Where the language usedis much too violent for the occasion and circumstancesto which it is applied, or utterly beyond and dis-proportionate to the facts, or where improper motivesare unnecessarily imputed, there is evidence of maliceto go to the jury.

Privileged Occasions.-An occasion is privilegedwhen the circumstances under which defamatorywords were written, or spoken, were such as to makeit right that the writer or speaker should honestlystate what he honestly believes of the characterof another, and to speak his mind fully and freelyabout him. Privileged occasions are of two kinds :those absolutely privileged, and those in which theprivilege is qualified. Privilege is absolute in thecase of words spoken by a judge on the bench, by awitness in the witness-box, words spoken in Parlia-ment, &c., and even if the words were spoken falsely,knowingly, and with express malice, they are notactionable. Where the interests of the public donot demand that the speaker should be freed from allresponsibility, the privilege is qualified, and notabsolute, and damages can be recovered in spite ofprivilege if it can be proved that the words were notused in good faith, but that the privileged occasionwas made use of for the purpose of wilfully andknowingly defaming another. It is for the judgealone to decide whether or not a communicationis, or is not, privileged by reason of the occasion. Ifthe occasion is absolutely privileged judgment willat once be given for the defendant. If the judgedecides that the occasion is one of qualified privilegeonly, and the plaintiff puts forward any evidenceof malice sufficient to go to the jury, it is then a ques-tion for the jury whether or not the defendant wasactuated by malicious motives in writing or speakingthe defamatory words, and if the jury find that hewas so actuated the protection of privilege is lost.

- PM&KccHoM.—Publication is the communication ofthe defamatory words to some person or personsother than the person defamed. In civil proceedingscommunication of the words to the person defamedonly is not publication. It cannot damage his repu-tation. When the words are such as obviously wouldprovoke to a breach of the peace, criminal proceedingscan be successfully taken when they are communicatedonly to the person defamed, provided the words arewritten and not merely spoken. Criminal proceedingscannot be taken for slander.

Justification.—It is a complete defence to any actionfor libel or slander if the truth of the defamatorywords, on which the action is founded, is proved.In a criminal trial for libel this defence is not sufficient.The defendant must, however, prove that the words