756 MALARIA CONTROL IN INDIA.

their elected representatives, make the by-laws,would consent to the imposition on themselves of

heavy burdens, even though they feel, as they couldfeel, that the funds of the Society would be used forthe advancement of pharmacy on a scale even moregenerous than in the past.Turning to the administration of the law affecting the

sale of poisons, the pharmacist will note that, whereasin the past the Society has been its own policeman, itis now proposed that the functions of prosecutingoffenders should be handed over to the properauthority for dealing with infringements of the law.Such a proposal was inevitable as soon as an inquirystarted, for although the Society has performed thefunctions of prosecution, judge, and jury for all these ’,years with vigilance and justice, the system is out iof tune with modern methods. Moreover, under

existing conditions, the penalty for the offence in themajority of cases is an unalterable fine, and theoffender is able to pay the penalty without incurringthe more effective correction provided by publicity.The difference between the existing state and thatproposed is the difference between a caning at homeand sitting in the stocks, and while offenders wouldprefer to receive a demand by post for ;E5 rather thana summons from the hand of a policeman, it is franklyimpossible to raise any logical objection to theproposed change. Some of the older members ofthe Pharmaceutical Society may regret the suggestedintrusion of representatives of the Government intothe domestic circle of the elected council. It is truethat the Society’s council and that august body, thePrivy Council, have rubbed shoulders from the verybeginning, but one may be friendly with a man

without asking him home to dinner. The proposal,however, is in keeping with modern developments,and as it is impossible by any known method for aminority to outvote a majority, it is difficult toforesee that the presence of three nominees of thePrivy Council will have any baneful influence onthe 21 councillors elected by the members of thePharmaceutical Society. In quite a different categoryis the contemplated constitution of the " PoisonsBoard," which is something entirely new in pharmacylegislation. It is to consist of 14 or more members,of whom only five are to be appointed by the Society,and its duties will include the drafting of two listsof poisons ; the sale of those in the first list will berestricted to registered chemists, but those in thesecond list may be sold not only by chemists, but byany person licensed for that purpose by a local

authority. Chemists will claim a larger representationon this Board, notwithstanding that the nomineesof the Pharmaceutical Society, together with those ofmedical bodies, will have a majority of two over theother members, unless the Home Secretary exercisesthe priviloge of appointing four additional members.Hitherto the initiative in deciding what is a poisonwithin the meaning of the Acts has been vested inthe Society, and the change projected-namely, togive them only five-fourteenths of a voice, is so

fundamental that it cannot go unchallenged. That,however, is an almost trivial matter compared withthe encouragement which the recommendations,and Clause 16 of the Bill itself, holds out to potentialvendors of poisonous preparations used for sanitary,industrial, horticultural, or agricultural purposes,or as sheep dips or vermin killers. As Mr. GAMBLE,whose association with a firm bearing the names oftwo of the founders of the Pharmaceutical Societyis not without interest, says in his Minority Report:"

any person will be able still more freely to purchasesufficient arsenical weed-killer to exterminate a

village " if Clause 16 is enacted. To us it

appears inconceivable that it will become law inthe form laid down in the Draft Bill. Alreadymore than ample provision for the sale of industrialand agricultural poisons is available under an

existing law, and it would be an act of follyto compel local authorities to grant licences for thesale of such poisons to all applicants, exceptingimbeciles or criminals. The shops of trained andeducated chemists are to be subject to a regularsystem of inspection, one of the objects of which isto ensure that poisons are properly

" stored." Isit not far more important in the interests of publicsafety that purchasers of sufficient poison "toexterminate a village " should be required by lawto store their purchases with extreme care, and toallow an inspection of the premises in which thepoisons are stored, whether in an outhouse or in thelarder ?

MALARIA CONTROL IN INDIA.

THERE is a tendency to associate roving commissionswith pleasant little excursions under the most comfort-able conditions at the right time of year, punctuatedat convenient intervals with complimentary dinners.But that this is not always a true picture is shown inan account of an Indian tour made by the MalariaCommission of the League of Nations last October, inthe Singhbhum district of Bengal; the story is told byLieut.-Colonel R. KNOWLES, the Editor of the IndianMedical Gazette, who accompanied the Commission,in the January issue of the journal. The Commissionstarted work at the height of the malaria season, andtheir tour was evidently a very strenuous one. Therewere representatives from the United States ofAmerica, France, Spain, Holland, and Roumania.The members adopted a common-sense working kit;a photograph shows them all dressed in shorts, withopen-necked shirts, no coats, and of course theuniversal solar topi for head covering. Starting fromCalcutta they were taken, in a special train as head.quarters, through some of the most malarious regionsin India, varying between the rice fields which are socharacteristic of Bengal, and picturesque hill andforest scenery. Close to Calcutta they were shownnumbers of good-class Bengali houses lying deserted,the causes of abandonment, apart from the naturaldrift towards the city, being largely malaria and kala-azar. Graphic accounts are given of the wretchedcondition of the inhabitants of small villages in theworst-infected areas, and of the sufferings of the

engineering staff at the time of the construction of therailway, due to malignant malaria and blackwaterfever, but it is admitted that in most of these ruralareas control on anything like a wholesale scale wouldbe out of the question on the score of expense. Onesite fixed on for an important railway station had tobe abandoned. Infection of running crews in themining district of Noamundi is avoided by keeping thetrains up at the mine heads in protected areas untilthey can get a clear run through by day.

Colonel KrrowLES’s paper deals mainly with controlmeasures at the Noamundi Mine, and, by contrast, atDangoaposi railway station, through which passes anenormous amount of traffic connected with the miningarea. The ground in the Noamundi region consistsalmost entirely of pure iron ore, which is worked fromopen quarries in the hillside. The chief source ofmalaria lay in innumerable seepages, and the bed ofthe river which they fed. This boulder-strewn stream

757REFLECTIONS ON CROTCH V. MILES.

has been drained throughout the entire area, and everyone of the seepages subsoiled-i.e., channels five feetdeep and three feet wide are constructed, filled withboulders and covered with graded stones and earth.Neighbouring trees are dug out, and in that rockyground it was necessary to use dynamite freely.Protective masonry walls were also built, whennecessary, and everywhere seepage water has been ledunderground and delivered into the main stream

through protected outlets. In short the entirehillside has been drained dry of water, thus consti-tuting (with the addition of oiling where necessary,and the screening of all residential bungalows) themalariologist’s ideal of a malaria-free enclave withina malaria-ridden district. A diligent morning’ssearch for mosquitoes by one of the Commissionyielded only a single chironomid. It is stated thatNoamundi Mine is now free both from larval and adultanophelines, and that the only cases which occur arerelapses. These measures have, of course, beenimmensely expensive, and could only have been carriedout where wealthy bodies such as the large steeland iron companies were concerned. The expenseincurred must, however, have been repaid over andover again in the diminution of the sick-rate, whichmight otherwise well have rendered work impossible,as in the early stages of construction of the PanamaCanal. Just outside the enclave is a village of

aboriginals, where anophelines still breed freely, andthere is an intense malaria incidence. The problemsinvolved in mosquito prevention in the mine area areso largely of an engineering nature that the work hasbeen put in charge of an engineering officer. He hasunlimited labour at his command, and as muchdynamite as he requires.Malaria at Dangoaposi station is a different problem

altogether. There, as Colonel KNOWLES says, it is

man-made, as in so many other cases in India. Themain trouble was a lengthy storm water channel,which was badly constructed, and an incessant sourceof mosquito breeding, and numerous borrow-pits bythe side of the line. Malaria was so prevalent in 1925that the incidence of attacks amongst the runningemployees in September was 287 per cent. for thatmonth, which meant that each employee had approxi-mately three attacks. Engines lay idle, and themineral traffic was almost at a standstill. Controlwas commenced in November, 1925. Only two mainmeasures were possible-the filling in of swamps andborrow-pits and the creation of proper storm waterchannels, with regular oiling. These procedures havebeen very successful, and Dangoaposi is now said topresent a malaria control almost as perfect as

Noamundi, at the comparatively slight cost of sixrupees per head per annum of the population.Mention is made of a very remarkable phenomenonin this neighbourhood : a pool formed by an oldmanganese quarry, the water of which is absolutelyinhibitory to the breeding of mosquito larvse. Notonly do mosquitoes not breed in the pool itself, butthe water when turned into an adjoining streamapparently sterilises it of larvae, while experimentscarried out with the same water in shallow pools haveshown that it retains its larvacidal properties for threeweeks. The water has been analysed, and there isnothing unusual in its chemical composition. ColonelKNOWLES comments on the invaluable opportunitieswhich tours of this description provide for workers indifferent countries to compare notes with each other,and remarks that this visit has afforded a most useful stimulus for the local observers. He considers theNoamundi scheme of control one of the most completeand perfect in the world. I

REFLECTIONS ON CROTCH v. MILES.

ON mere academic grounds the case of Crotch v.

Miles (fully reported in the last two issues of THELANCET) may be deemed regrettably inconclusive.Two serious legal issues were raised but not decided.To begin with, was not the claim barred by theStatute of Limitations ? The plaintiff began pro-ceedings just eight years after the surgical operationof which she complained ; the statute says proceedingsmust be begun within six years. Here there was aningenious rejoinder. The surgeon, it was argued,committed an act of trespass by leaving the forcepsin the plaintiff’s body (if the jury should decide that hedid) ; this trespass continued till the removal of theforceps in 1928, so that the six-year period did notbegin to run until this recent date. The defence of a

statutory time-limit (important in the Harnett

litigation and crucial in cases where the PublicAuthorities’ Protection Act is invoked) is not a meretechnical plea. The Statute of Limitations was passedto check the abuse of raking up staie claims, it beingunfair that a defendant should be attacked at a datewhen, by reason of lapse of time, his power of defenceis prejudiced. Crotch v. Miles illustrated the unfairness;a witness on whose evidence the defendant would havestrongly relied had died in the eight years interval.How can a surgeon, physician, or dentist be otherwisethan at a grave disadvantage if suddenly called uponto meet an attack based on something which happenedeight years ago ? ‘1The other important issue in the case-the question

of the respective liability of surgeon and theatresister for the counting of forceps and swabs-is alsoleft in the air. A definite ruling, given by the Court ofAppeal of South Africa in 1924, was cited to showthat it is a reasonable and proper practice to leavethe duty of checking swabs to the theatre sister. Inthe South African case the surgeon had made acareful search at the conclusion of the operation andhad relied upon the sister to count and check inaccordance with the usual hospital practice ; theCourt held that, though the operating surgeon wasbound to exercise all reasonable and proper care, hewas in these circumstances not guilty of negligence inrespect of one swab which was overlooked. If that isthe law in South Africa, is it also the law in England ’?We do not know. The second question which thejury was invited to answer in Crotch v. Miles raised theissue of the surgeon’s responsibility for the taskentrusted to the sister, but the answer to the firstquestion made further answers unnecessary. Some-

thing like the same issue arose in a hot-water bottlecase not long ago. Are the legal relations of surgeonand sister those of principal and agent or of masterand servant, or either The legal theory, broadly, isthat if A has only the right to direct what work B isto do, the relation is that of principal and agent ; if Ahas the further right to direct how B shall do the work,the relation is that of master and servant. B may bethe servant of A though C pays the wages and has thepower to dismiss ; and B may be simultaneously theservant of A and C for different purposes. The LordChief Justice seems to have advised the jury thatthe theatre sister is not a servant but " one of a team."The legal implications of this status remain obscure.The relationship is presumably a question of fact forthe jury ; if so, the decision may differ with the facts ofeach case.The public will have noted Lord HEWART’s remark

that, if a forceps is left inside a patient, somebodymust be liable. Intolerant of subtle divisions of