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MEDICINE AND THE LAW.

Death from Unnatural Cause Common Law Duty toNotify.

DURING the debate on Mr. Tinne’s Births and DeathsNotification Bill, Sir Richard Luce moved an amend-ment that where the cause of death was unknownto the medical practitioner, or where death appeareddue to violence, neglect, poison or other unnaturalcause, or seemed to be the result of an anaesthetic,he should not grant a certificate, but should forth-with report the circumstances to the coroner. ThisSir Kingsley Wood resisted on the ground that theamendment would impose as a statutory duty whatwas already the duty of the medical practitioner atcommon law, apart from statute. This objectionwas legally correct, but so little is this common lawduty known that there would have been no harm inembodying it in statutory form. At common lawthere is a duty upon any person about the deceasedto give notice in such a case if Parliament has notalready thrown upon any particular person theburden of informing the coroner of the death. It isnot a duty of the doctor as doctor, but of any personwho is in a position to give the information. Thiscommon law duty is complied with either by informingthe coroner’s officer or by telling the nearest police-man. Its origin is very ancient. It goes back to the ’,twelfth and thirteenth centuries, when the finder ofa person feloniously slain was expected to raise thehue and when townships might be amerced for failingto send for the coroner. Exactly what is the purportof the word " hue " it is hard to say ; we know itbest in the form " hue and cry " (hutesium et clamor).Possibly, said the late Prof. Maitland, the propercry was " Out! Out ! " and therefore the word isuthesium or hutesium. At any rate, out the neighbourswould come with their bows and arrows and theirknives and there would be shouting and horn-blowing,and the hue would be " horned " from vill to vill.But we no longer live in the age of bows and arrows ;we no longer raise the hue and follow the cry. SirRichard Luce’s amendment would have laid downsome definite guide for the medical practitioner indoubtful cases, and it is perhaps a pity that he wasinduced to withdraw it on the ground that it mighthave infringed the obscure and almost obsoleteprocedure under the common law.

Dangerous Drugs Act Prosecution: Failure to EnterPurchase in Register.

Dr. Samuel Grahame Connor, of Dryden Chambers,Oxford-street, was summoned at Marlborough-streetpolice-court at the end of last month for failing onthree occasions to enter, in a register kept for the solepurpose, a certain quantity (50 gr.) of morphinepurchased by him. A fourth summons charged himwith failing, in a prescription of morphine, to specifythe address of the person for whom the prescriptionwas given. Dr. Connor pleaded guilty to the fourcharges, and was sentenced by Mr. Cancellor to twomonths’ imprisonment in the second division on eachof the first three, and to a fine of 250 on each’summons,making six months’ imprisonment in all and 2200 fine.Notice of appeal was given.

. Dr. Connor was stated by the police to be a drugspecialist and to have as patients several addictsknown to the police. One of these, a MissYoung, had been convicted of forging a prescrip-tion in Glasgow, and Dr. Connor was found to besending her morphine from London. When toldthat she was being treated by another doctor, Dr.Connor said he would discontinue treating her him-self. A year later she was again interviewed by thepolice, and in the sequel an inspector called to seeDr. Connor’s register. Dr. Connor kept no register,but produced a day-book showing dates on whichprescriptions had been given. Between Jan. 25th andDec. 27th of last year, it was stated, he had prescribed575 gr. of morphine on 13 occasions and had onlyseen the patient six times. A firm of chemists

produced their register showing in all 850 gr.ordered ; only one prescription was for Miss Young ;there were many orders signed by Dr. Connor andheaded " for surgery use only." These orders, theprosecution contended, were not " prescribing "but " supplying " within the meaning of the DangerousDrugs Acts. On behalf of Dr. Connor it was urgedthat his day-book was open to inspection and that noattempt was made to mislead anyone or concealanything. The magistrate, however, refused to treatthe case as a merely nominal breach of regulations,and, apparently influenced by the suggestion thatthe accused had been amply warned by the policeand that his drug practice was on a substantial scale,inflicted what certainly seems a remarkably severepenalty.

IRELAND.

(FROM OUR OWN CORRESPONDENT.)

Census of the Irish Free State.ARRANGEMENTS are now complete for taking a

census of the Irish Free State, and " Census night "is fixed for April 18th. Forms have been distributed bythe Civic Guard, and their collection will begin onMonday. The form, which is in English and Irish,contains 13 columns, in which information is requiredconcerning occupation, nationality, birthplace, race,language, religious beliefs, conditions of marriage,relation to head of family, issue born in marriage, andhouses and buildings inhabited or uninhabited or incourse of erection.

Women’s National Health Association.The annual meeting of the Women’s National

Health Association was held last week under thepresidency of the Marchioness of Aberdeen andTemair. Dr. Alice Barry, in a report on the workingof the babies’ clubs, mentioned that the membershipof the clubs was 3451 ; attendance of mothers at clubs,27,166 ; infants, 17,998; and children, 20,082. Therehad been 10,946 medical consultations and 237 caseshad been sent to fresh air and convalescent homes.Drugs and food had been distributed by the clubs ata reduced rate, or free to necessitous cases. Prof.J. W. Bigger moved a resolution urging publicauthorities to provide for the protection of milk, toensure a free supply for children of from 1 to 5 yearsof age, and to make the public understand the valueof milk as a food and the importance of having ithygienically treated. Dublin milk was very bad, butthe increased demand for bottled milk showed thatpeople were taking an interest in having better milk.Bottled milk, however, might be as dirty as any other.The public health authorities should, he suggested,protect the terms " Certified," or " Grade A," inrelation to milk. There was at present no milkreaching Dublin under " Grade A " conditions. Otherarticles of food as well as milk required care in

production and sale.

Queen’s University of Belfast.The late Right Hon. J. C. White, formerly Lord

Mayor of Belfast, left a bequest of .860,000 to Queen’sUniversity to endow a chair of biochemistry andlectureships in that subject and in bacteriology. Thenew biochemical laboratory was inaugurated on

March 26th. The Vice-Chancellor of the University,who presided, pointed out the great and growingimportance of biochemistry; it seemed to be thedepartment in which most progress was to be hoped forin the immediate future. The Lord Mayor of Belfast,Sir W. P. Turner, in proposing a vote of thanks toMrs. White for unveiling the memorial tablet, dwelton the public services of her late husband, and on theprosperity and progress of the Belfast Medical School.Prof. J. A. Lindsay, in seconding the motion, pointedout that universities were largely dependent on privatebenevolence, for experience had shown that theycould not expect to derive more than a third of their

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income from students’ fees. The contributions of theState and of municipalities to university education hadin the past been somewhat meagre, but recently therehad been some advance. America gave a splendidexample of private beneficence in support of univer-sities, and the proportion of university students to thepopulation in that country-1 to 300-was the highestin the world, Scotland being a good second with1 to 400, and Germany third with 1 to 600. He hopedthat the White bequest would be a stimulus to furtherbenevolence in Northern Ireland.The chair of biochemistry is held by Dr. J. A.

Milroy.

Public Health Services.THE INFLUENZA EPIDEMIC IN GLASGOW.

ALTHOUGH reports in the daily press have exaggeratedthe position, there has undoubtedly been an epidemicof influenza in Glasgow during the last few weeks.Dr. W. G. Clark, assistant medical officer of healthfor the city, has kindly supplied us with the actualfigures of deaths from certain causes during the fiveweeks ended April 10th. These are as follow :-

The normal number of deaths from pneumonia inGlasgow at this season is round about 30 perweek, while those from influenza are usually under 10.In January of 1922 and March of 1924 there was adefinite prevalence of both these diseases, that of1922 being heavier than the present. Contrary tocurrent popular statement there has been no signifi-cant increase in the number of cases notified as

encephalitis lethargica during this period.

INFECTIOUS DISEASE IN ENGLAND AND WALESDURING THE WEEK ENDED APRIL 3RD, 1926.

JVotcaMoMS.—The following cases of infectious diseaseswere notified during the week :-Small-pox, 130 (last week178) ; scarlet fever, 1564 ; diphtheria, 979 ; enteric fever,42 ; pneumonia, 1376 ; puerperal fever, 38 ; cerebro-spinalfever, 5 ; acute poliomyelitis, 4 ; encephalitis lethargica, 38 ;continued fever, 1 ; dysentery, 7 ; ophthalmia neonatorum,93. There were no cases of cholera or plague notified duringthe week. There was no further case of typhus fever notifiedduring the week, although the return omits to state so.Deaths.-In the aggregate of great towns, including

London, there were 3 (1) deaths from enteric fever, 107 (44)from measles, 8 (2) from scarlet fever, 66 (8) from whooping-cough, 50 (16) from diphtheria, 46 (10) from diarrhaea andenteritis under 2 years of age, and 223 (48) from influenza.The figures in parentheses are those for London itself.The notified deaths from influenza are 87 in excess of theprevious week. The measles deaths have now exceeded100 for seven weeks in succession.

THE LATE DR. T. A. GuTHBiB.—Dr. James AshtonGuthrie, who died at his home at Halifax on April 3rd inhis 85th year, was the son of Mr. Daniel Guthrie, of BrierleyHill, Staffordshire, and was educated at Queen’s College,Birmingham. As a young man he went to Halifax as anassistant, and seven or eight years later moved to Edinburgh,where he remained for five years until in 1885 he took hisdegree as M.B., C.M. Returning to Halifax he remained ingeneral practice until 1914. He was keenly interested inscientific developments and was an active member of theHalifax Scientific Society.

Correspondence.

THE PROBLEM OF MALIGNANT DISEASE :A VIEW.

"Audi alteram partem."

To the Editor of THE LANCET.

SiR,—In the Registrar-General’s Statistical Reviewof England and Wales for the year 1924 it is statedthat the mortality from cancer has been steadily risingsince 1884, and during 1924 there were more deathsfrom this cause than in any previous year for whichofficial records had been kept.

In the face of such an official statement, is it nottime we began to question the wisdom of our presentmethods and seek something better if it can befound ? Surgery has failed to meet the situation,and we have the testimony of one of the most eminentmembers of this branch of the profession that nofurther elaboration of surgical technique can make anydifference ; so that it may fairly be said that we havearrived at a "dead end." The mortality steadilyincreases-this in spite of the fact that surgicalmethods and technique have been steadily improvingyear by year. Also it is to be remembered thatthe surgeon has the best possible chance to make good.All cases come to him in the first instance. He keepsthe early and operable ones to himself, passing theinoperable and hopelessly incurable on to others. Hisstatistics are naturally based on the former and yetthe results are scarcely satisfactory, as most surgeonsare quite ready to admit. Such, very briefly, is thepresent situation, and however much we may wish tochange it the alteration is not going to be an easy one.An important reason for this is the present tendency

for patients to be taken directly to the specialist in aparticular method of treatment, and on the principlethat " there’s nothing like leather," his own methodsare used. For this reason, among others, I deplore theelimination of the pure consultant from our medicalservice. From him at least we could count on gettingsome sort of independent opinion-more than canbe said of our present system, which is not onlyantagonistic to the best interests of the patient, but isa formidable barrier to progress in the healing art.

It is a cardinal principle of medical service thatwhen we are called upon to deal with some disabilitywe should exhaust the possibilities of such curativeagents as are at our disposal before resorting tosurgical interference. The most important exceptionto this rule is malignant disease, and however correctthis may have been at one time it is very doubtful ifit can be considered so now.

Of the multitude of things that from time to timehave been suggested as a possible cure for malignantdisease, the gamma ray as derived from the X ray tubeor from radium is the only one that has shown itselfto have any real value. (It is true that lead is showingsome promise, but while hoping for the best we mustbe patient for the present.) The fact that the rayhas a more than ordinarily prejudicial influence on thedevelopment of the malignant cell has been known tous for nearly 25 years, and the question naturallyarises : What have we done to establish the real andfull value of radiation in malignant disease ?

Personally I am of the opinion we have done verylittle, but I hope I may not be misunderstood. I knowthat an enormous amount of work has been and iscarried on, and it is far from my wish to disparageit in any way, but almost all of it is concerned withadvanced cases, many hopelessly incurable, and alsothose that have been through the hands of the surgeon,which seriously impairs any chance of success fromradiological methods. Experience gained under suchconditions has its value, especially if it serves to giverelief to the patient and prolong life under comfortableconditions. It teaches us no more, however, than we