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The executor resisted the claim on the ground that Mrs.Black’s husband was legally liable to maintain her ; ifthe expenses were recoverable from the husband, theycame within the words " recoverable from any othersource"; being recoverable from another source, theywere not recoverable from the executor. The countycourt judge accepted this view and dismissed the countycouncil’s claim. The Court of Appeal, however, pointsoub’ that the county council has the choice betweenrecovering the expenses from the patient, the personlegally liable to maintain the patient, or (if the patientdies) the patient’s executor. There was, says the court,no defence to the action. The words " not beingexpenses recoverable from any other source " refer tosomething included in a subsequent proviso concerningagreements with the governing bodies of associationsor funds established for providing benefits to members.The words might also relate to sums recovered underthe Road Traffic Act in cases of road accidents.Judgment was given for the appellants (the Middlesex

county council), and the patient’s executor has beenprevented from driving a coach and four through thestatute. Section 184 of the 1936 Act, it may be recalled,gave the local authority an improved position. Ithad been prevented (under the previous law now replaced)from recovering expenses at all where the patient wastreated in an infectious diseases hospital ; it now ob-tained a power (but not a duty) to recover expenses froman infectious disease patient. Ambulance removalexpenses became recoverable, too, whether or no theillness was an infectious disease. The time-limit forrecovering expenses was increased from six to twelvemonths. Finally, recovery out of the patient’s estate isno longer affected by the place of death ; under theprevious law it was barred if the death occurred afterdischarge from the hospital.

Alleged Negligence of Blind MasseurA case reported recently in the Solicitors’ Journal

(Williams’ Executors v. Lush) discussed the legal liabilityof a blind masseur where a burn had been caused duringelectric diathermy treatment administered on medicaladvice. A surgeon with several years’ experience of thetreatment said that burning should not have occurred onthe first occasion. A blind masseur was at a disadvan-tage in not being able to see signs of discomfort in thepatient. The defendant, a qualified masseur with twentyyears of practice, said the patient had been nervous(as was shown by a cold perspiration), but did not com-plain of undue heat. After removal of the pads, theskin did not feel abnormal to the defendant’s touch. Anexpert witness from the physiotherapy department atSt. George’s Hospital gave evidence that burns mighthave been caused even by the low current used. Thisdid not indicate negligence. More burns occurred duringtreatment by masseurs with sight than where blind mas-seurs were employed. Arthritis, from which the patientsuffered, gave rise to an impoverished lymph and bloodsupply ; they might sometimes cause burning duringsuch treatment.The Plymouth county court judge observed that there

was a conflict of medical evidence as to whether theamount of current used was normally sufficient to causethe burn. The burn was the result of the defendant’streatment, but it had not been proved that the burncould only have been caused by some mistake in thecourse of the treatment. The plaintiff in consequencehad not discharged the burden of establishing his case.Judgment, with costs, was given to the defendant.

Blood-group Tests in Nullity ActionThe Law Journal of April 25 describes an interesting

application in the Divorce Court of blood-group tests.In Wilson v Wilson (otherwise Jennings), tried earlierthis year, a husband gave evidence that he cohabitedwith a woman once on June 15, 1940 ; a few days latershe told him that she was pregnant. He married herin the following August and left her shortly afterwards.She bore a full-time child on Jan. 8, 1941. Medicalevidence established that this child could not possiblyhave been conceived in the previous June. The husbandsued for a declaration of nullity of the marriage-undersection 7 (1) (d) of the Herbert Act of 1937-on theground that the respondent was, at the time of themarriage, pregnant by another man.

Dr. G. Roche Lynch, the Law Journal reports, gave’

evidence that he had grouped the blood of the husband,wife and child ; the husband’s was OM, the wife’s BMand the child’s ABN. The factors A and N in thechild’s blood were unaccounted for. The evidence was ..conclusive that the husband was not the father. Mr.Justice Hodson declared the husband’s petition to havebeen clearly and fully proved ; he pronounced a decreeof nullity. As the Law Journal emphasises, in a petitionfor divorce where the husband relies for evidence ofadultery on the birth of a child of which he denies thathe is the father, the rule in the Russell case preventsthe husband from giving evidence that, at the timewhen the child was conceived, he had no access to hiswife. But the law permits evidence of non-access to begiven from some other source. Such evidence as wasproduced by the pathologist in the Wilson case may wellbe sufficient proof of adultery (so that no question ofnon-access would arise). This may be of great valueto petitioners, provided, of course, that the respondentwill allow her blood to be tested, and provided that thecase is one in which the tests establish that the husbandcannot have been the father of the child.

In England NowA Running Commentary by Peripatetic CorrespondentsIT was a bit tough to get a hair-raisingpamphlet about

the dangers of vaccination when our George was a monthold and his vaccination had just taken nicely. Fortun-ately for our peace of mind, though no doubt a good caseagainst the universal compulsory vaccination of infantscould be made out, this pamphlet did not carry convic-tion. Of its three sheets the first was a useful accountof the procedure to be adopted in order to contract out ofvaccination. The second was a reasonable-soundingsummary of the story of postvaccinal encephalitis. If ithad stopped at that the pamphlet might have given us asleepless night or two. But the third sheet containedsome quotations from the sayings of medical men bothhere and abroad-mostly consisting of one sentence withno hint of its context-which were so grotesque as to beentirely reassuring. After all, most of us have beenvaccinated ourselves, or at least some of our friends have,and survived, so it is hard to follow the bloke who isalleged to have called vaccination " an infamous crimeand a beastly outrage," or the ones who called it ‘$aghastly risk," " a blunder in poisons," or even " thesupreme folly of the Medical Profession " (a folly wouldhave to be pretty high up to be our supreme one). Andwhen a doctor was quoted as saying " I have seenhundreds of children killed by vaccination " we knew thatall was well. Either these remarks were so old that theyreferred to arm-to-arm days, or they were but the echoof the hum of bees in the bonnet. We slept in peace-and so did George. * * *

.

It is one of the more likeable characteristics of theaverage Englishman that, just as he has a somewhatdumb and unaesthetic appreciation of the wild flowersof the countryside, so he has a rather more overt admira-tion for the birds that either as residents or as migrantsare familiar in the intimate setting of his native land.This love of birds is often carried to the extreme thatcauses the enthusiast who annually announces that hehas heard the first notes of the chiff-chaff to be regardedby ordinary people with a benevolent tolerance extendedto the misguided but harmless. I am inclined to agreewith the ordinary person, and I approve of the ornitholo-gist who heard the cuckoo on a fine day in February-he heard it give its familiar note twelve times in awell-known street in Oxford exactly at noon. Butapart from this enthusiasm there are several classes ofpeople who consider themselves entitled to be regardedas bird lovers. There is the genuine field ornithologistwho is prepared to spend uncomfortable days in orderto study and if possible photograph the intimacies ofthe family lives of birds. This man will cheerfully liein an uncomfortable hide amidst bramble and nettles,or conceal himself in the dampness of sand dunes insome grey estuary to learn about the habits of ourwarblers or our waders. Strangely enough there arethose whose interests lead only to the destruction of birdlife and who yet claim to be classed as bird lovers. The

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egg collector and the man who shoots every strange andrare bird he meets we will rule out from any claim tothe title. To only one class whose preoccupation iswith the killing of birds will I ever extend any sympathy.In this class is the real wildfowler : the man who with

some hardihood waits long hours of twilight and duskin lonely places on deserted marshes or on shore flats toget a shot at flighting ducks and geese. This man takeshis limited toll of flighting birds by pitting his patienceand cunning against that of birds born and bred in thewild. He endures hardships in his calling, his successesare no real threat to the survival of the flocks of whichhe takes his toll and the products of his enterprise arean addition to the nation’s food-supplies.

There is, however, another class in England that has,with a supreme disregard for the ordinary connotationof the words, arrogated to itself the title of bird loversince it "

preserves "

game birds. There could benothing more un-English than to decry this traditionalEnglish business of breeding certain birds wholesale inorder that they may, during the interval permitted bylaw, be slaughtered for " sport." It would be as uselessto raise objections to this traditional and typicallyEnglish business as to question the oft-repeated assertionthat were horse-racing restricted, or put an end to, thethoroughbred would deteriorate and ultimately becomeextinct. We are so accustomed to this argument thatmany of us, even in war-time, have come to accept it asbeing valid. But fifty years ago I never heard anyoneclaim that were dog races to be prohibited the breed ofgreyhounds would die out; I believe neither the onenor the other of these stupid assumptions. Nor do Ibelieve now, since I have resumed my railway journeysthrough England after an interval of thirty years, thatthere is anything to be said in favour of the traditionalBritish custom of alienating wide tracts of productiveland for the idle business of rearing game birds to beslaughtered wholesale in the name of sport. I will gofurther than that. Those evils that I have seen in theway of overgrown hedgerows, in the wide disseminationof weeds and in the conspicuous and to an outsideralarming increase in the rabbit population are, I believe,the direct outcome of this alienation of so large aproportion of our potentially food-producing land forthe purpose of preserving game. I am by no meansalone in this opinion. I quote from an article publishedbefore the outbreak of war : " The land and what it canproduce may make the difference between life and deathto us. The land can no longer be treated as a playground.Farming for sport at the land’s expense must stop."

Unfortunately there is more than the loss of the landand the deterioration of lands adjacent to these areasfarmed only for sport. If game is to be preserved untilit is ripe for wholesale slaughter there must be custodiansof the game and of the broad acres on which game ispreserved. Now gamekeepers, as a class, rank amongthe most admirable of mankind.. They are steeped innature lore, good observers of wild life, lovers of thecountryside and are, as a rule, keen students of the waysof men either as masters or as poachers. RichardJefferies, in his " Gamekeeper at Home," has endearedthe typical race of these men to his readers for all time.But in the economic consideration of the land of Britainthe gamekeeper is not only an anachronism but anunmitigated curse. During the last war many game-keepers were called on to undertake duties more directlyutilitarian than those they were accustomed to inpeace-time. The result was that many of their tradi-tional enemies succeeded in multiplying. Owls, hawksand birds of prey increased once the gamekeeper’s gunwas deflected from them. The owls and hawks hadclose season in which they could carry on their beneficialwork of ridding the fields and barns of mice and volesand sparrows. The kestrel hovered in peace, a beautifulthing to see and a preserver of our crops from the lesserfry of the army of destruction. The sparrow hawk wasfree to sneak along the hedgerows at harvest time ; freeto snatch a sparrow from the thousands lurking in theovergrown hedges waiting to take their toll of theripening grain. Native vermin-hunting mammals hadtheir chance to increase : polecats and stoats were nolonger nailed to the doors of barns but were left to dealwith the rabbit and the rat. Weasels were free to taketheir toll of the vast and destructive armies of mice.

But all this was changed when the gamekeeperreturned to his duties. England once more was farmed" for sport." As I look from the windows of my railwaycarriage I see more and more of England " farmed withthe main eye on the shooting rights," more and moreof England gone out of useful cultivation. The panicploughing of poor land in order to earn a bonus is noreal remedy. It is the " preserver " of game, theshooting syndicates and the gamekeeper and not theagriculturist who farm so much of our fair land. Inone European country the people have been offered thechoice of guns or butter : we have been given no choice,but the alternatives facing us for the future of Englandare bread or battues, grain or game.

* * *

After the clinic on Tuesdays we two, a bit tired andsnappy, have a late supper. What have we got tonight-cottage-pie ? Shall I turn the wireless on, it’s theBrains Trust ? Any meat in it, it’s we who have to dothe trusting. No, just the same as usual, that’s Joad.I say, what nonsense he talked the other night aboutthe expression of the emotions, d’you remember ? I’vefound a bit of tripe, yes, but with complete assurance.Oh absolutely, he must have realised it himself, for hedevoted a "second thoughts" to it, just a verbalsmoke-screen. They’ve put a lot of condiment into this,sort of disguise. Of course, he’s a word-thinker. Visualor auditory ? Greens and potatoes, fifty fifty. Oh,there’s Campbell; I say do you think he has really hadall those wonderful experiences ? Pass the salt, please.No, that bit’s not meat, only ersatz rabbit, what thealienists call " confabulation." And the psychic experi-ences ? I don’t know why these wineglasses are here,there’s nothing to put in them ; psychic experiencesare 1, a form of snobbery (I met a duke or a spirit) ;2, an over-reaction from flesh and mammon ; 3,"atavisticcredulity. Sorry, old boy, but that sounds awfully likeJoad. What about those repetitions and parrot phrases : s" It seems to me, in my opinion, what I mean to say is,I do most certainly think " These rolls are hollow ;that’s just to fill up thought vacuoles; old lad. Ah,roly-poly, but he does come out with plain horse-sensesometimes. Here’s a currant. Wonder they don’t getKing-Hall again, have some real cheese. Like a characterfrom Marryat, wasn’t he ? Yes, but this old biscuitcomes from W. W. Jacobs. Will you say grace. 0Gad, we’ve had of pie and dough enough, of Joad a loadof Campbell ample. Amen. Definitely.

* * *

In normal times, when the smoker has not developedsuch awful habits as blowing his foetid expired smoke intomy face in the middle of a conversation or even of ameal, tapping the ash over my shoulder if not down myneck, burning holes in the tablecloth, leaving a smokingcigarette-end in an ash-tray under my nose, or simplyburning a hole in the seat of my trousers, I do not objectto smoking. But nowadays, when so many people arerendered bad tempered through lack of a cigarette whenthe itch to smoke is on them surely it is plan what aslave man has become to this habit. Let us look into thecauses. The first desire to smoke comes from the smallboy’s eagerness to copy his elders, stimulated by thetaboo on smoking at that age. In adolescence embarrass-ment in company is dispelled if the hands can beemployed, and smoking a cigarette or a pipe is theaccepted way of doing this in society. Whittling a stickwould be equally effective, but might make more of amess of the carpet. The drug is said to have a calminginfluence on the nerves, but I have yet to see a non-smoker who is not as calm as a smoker in a crisis.Whether the habit has an injurious effect on the healthis a point on which opinions differ enough to bewilderthe Minister of Health who is now Chancellor. Butit certainly causes such minor maladies as sore throatand dry cough, and it certainly irritates a pepticulcer. Besides which a smoker gets a far worse hang-over than a non-smoker after the same celebration.According to the budget 233 million is spent annuallyon tobacco, which gives a startling idea of the amount ofshipping space that might have been used for food. Yetsmokers do not seem to bother about saving tobacco, letalone reducing the number of matches they waste.Pipe-smokers may pass on the first score but certainlynot on the second, while cigarette-smokers must waste

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on the average a quarter of all the tobacco they smoke.Why have they even yet, after nearly three years of war, notproduced a cigarette with a t in. paper tube on one end, asthey have always had in Russia and also in Germany afterthe last war ? And what about double-ended matches ?The immediate reason for this diatribe against the

smoker is that I have just had the back of my hand burntby a cigarette in a crowded mess, and before I couldturn round to indulge in a little justifiable abuse theowner of the cigarette, already craving for anotherinhalation, was registering indignation at his cigarettehaving been extinguished.

* * *

What do they do with umbilical cords these days ? A friend of mine was doing his midwifery when heobserved a beauty, fifty-five inches long, coiled thriceround the neck and once round the chest. He wantedto keep the thing, but before he could say so a nurse hadwrung the blood out of it and dropped it into a bottle ofacetone. It was going to be sent, she said, to Bushey.He has an idea it may be made into munitions.

DENTAL DILEMMASPOSTWAR reconstruction is now the vogue, and Mr.

Edward Samson has given much travail and thought tothe future of dentistry (Facing the Facts. London: T. S.Cottrell. Pp. 99. 10s. 6d.) Ha exposes the abuses ofdental benefit under the NHI scheme and probes theweaknesses of our school dental and infant welfare services,and the lack of care for adolescents. But can he reallythink that mechanical dentistry is more remunerativethan conservative or operative dentistry ? If, after thewar, the task of providing dentures and appliances isplaced in the hands of a separate branch of the pro-fession, then the operative dentist will surely prosper ;but private practice may dwindle in any case. Dentists,however, are relatively so scarce that a large access totheir numbers will be needed before reconstruction canbegin. It has been estimated that nearly half a millionwas spent by the Dental Board, since it was created in1921, in education grants to help boys to become dentists.But these have been discontinued, at least for "theduration." If the NHI scale of fees for dentistryprovided a better living (Mr. Samson puts existingremuneration at JB400 a year gross, on the average,earned byexcessive hours of labour) sufficient boys would probablybe forthcoming and the money offered to attract entrants,if it again becomes available, could be spent on betterequipment for dental hospitals, on special dental depart-ments for general hospitals, on enlarged teaching staffand research. Mr. Samson notes that an assurance com-pany with a membership of 3,000,000 has blamed neglectof dental trouble for half the ill health found in industrialclasses, and this despite vast sums spent on dentalbenefit. Profits from the sale of his book-which everythoughtful dentist will want to read-are to go to theBritish Red Cross Society.

Mr. A. Cornford Bowden, writing on the same theme(Medicine Today and Tomorrow, 1942, 3, 4) pictures afuture of socialised dentistry. He would’like dentalstudents to be given a good general grounding and thenthe opportunity of specialising. Thus some would attainmedical standard in anatomy, physiology, pathology andbacteriology, and study surgery of the head and neck ;others would follow pure dentistry specialising in pros-thetics, orthodontics, or crown and bridge work. Buthe is strongly opposed to the idea of two grades of dentist,insisting that skilled prosthetics requires not only deftnessbut sound knowledge of anatomy and physiology. Hewould like to see dentists working as a group at healthcentres under the eye of a director who would see thatthe standard of work was maintained. These generalpractitioner clinics would send difficult surgical cases andthose needing advanced technical procedures in ortho-dontics or restoration work to a special centre in or nearthe local hospital. This would be staffed by expertswho would cooperate with the medical and surgical staffof the hospital, undertaking with them the treatment ofjaw fractures, maxillofacial injuries and cleft palate,carrying out minor dental and oral surgery, and makingradium boxes for the treatment of cancer of the mouth.This industrious picture, however, is clouded by the lackof personnel to carry it out. Like Mr. Samson, Mr.Bowden asks first for more dentists.

Letters to the Editor

WHY NOT AN ADOLESCENTS HOSPITAL ?

SIR,-Children’s hospitals are special hospitals. Soare urological, ophthalmological, dental, mental and half --a score beside. Some people of importance and influencein the hospital world are saying that there is no need for" special departments " in the teaching hospitals.Consolidate, strengthen, expand, amalgamate the specialhospitals in their groups, send the students thither, andhow much the financial burden on the governors of thegeneral hospitals will be eased tThe professor of medicine has already been robbed of

mental disease, infectious disease, a great part of pulmon-ary disease, some part of endocrine disease, the care ofthe child up to the age of (say) five, ten, or fifteen, thecare of the aged, and infirm. Why not go a step or twofurther and deprive him of everything except hislaboratory and his chair ? If it be logical to take fromthe professor of surgery his neurology, urology, injury,repair, and half a dozen other snippets such as fistula(for which there is a hospital designate) why not se-quester another age-group, the adolescent, and makeit a specialty ? There are problems, physical andpsychological, peculiar to that decade ; surely somedoctors can be found to restrict their interests andresearch to it. -

Of course, once the hospital is established the adoles-cent specialists will find they need an ophthalmologist,a laryngologist, an obstetrician, a general surgeon (if suchthere be), just as the children’s hospital, the, mentalhospital and all the other special hospitals need, at leaston occasion, representatives of all the other specialdepartments.Why not ? ’Why not change with the changing timesand have nothing but special hospitals, allowing theprofessors of medicine, surgery and obstetrics, in theirhumble and unimportant capacities, to figure at thebottom’of the list of staff as a tribute to an outmodedpast ? A LOOKER ON.

CALCIUM IN BREAD

SIR,-In a recent letter to the Times Sir EdwardMellanby defends the adulteration of bread with chalk,and makes several statements which should not beallowed to pass ’unchallenged, but which are more

suitable for discussion in a, professional than in a layjournal. He raises once again what Sir Frederick Keeblehas called the phytic-acid bogy, which has made sporadicappearances during the last year or two. Bread of highextraction contains more phytic acid than white bread,but it also contains more calcium ; and the fixation ofcalcium by the phytic acid is, according to one investiga-tion, reduced by association with fat. The chief sourceof calcium is dairy produce. If, on account of shortage,it is necessary to attempt to augment the intake ofcalcium, natural substitutes should as far as possible beutilised. Is there satisfactory evidence that much orany of the chalk added to bread actually reaches thetissues ? Clinical experience indicates that it does not.

Sir Edward states that the consumption of the 85%flour, without additional calcium, would probably makethe people’s teeth even worse. Structure is no doubt animportant element in the resistance to dental decay, butthe label, deficiency disease, now often attached to it,connotes a simple and complete explanation of the causa-tion. This implication is incorrect : the pathology iscomplex. Cereals, the staff of life, must inevitably be animportant factor in a balanced diet. They need notproduce decay. There is reason to believe that peoplein other countries living under simple conditions on adiet consisting largely of rye bread suffer little from decay.A sufficiency of calcium, in conjunction with phosphorusand the necessary vitamins, is of course of paramountimportance in the first decade of life, and before. Inchildren and adults the ravages of decay can be checkedby a change of diet, and there may even be a kind ofreparative process induced. I do not know any evidenceto show that mere addition of calcium to the diet willeffect this. Decay always begins on the surface of atooth. No proof that the calcium content of the externalenamel can be increased or reduced after it has been

fully formed has been given ; the implication that the