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of. the 200 odd patients treated were virtually charitypatients, some few paying a nominal fee for accom-modation, the majority being treated free of all cost.In other words, during the first five years since theinitiation of the treatment Prof. Blair Bell hasreceived remuneration from at most 75 patients--that is, an average of 15 each year. Nor, consideringthe benefit conferred, can the remuneration be regardedas other than most moderate.

Feeling acutely the charges circulated against him-often by men he had regarded as friends-at theend of four years a cheque for the whole amountcharged for treatment was sent by him to the CancerResearch Committee. This cheque the Committeerefused to accept. At the end of last year, on his returnfrom America, when, for the first time, there was alarge influx of patients, Prof. Blair Bell approachedthe Cancer Committee again asking them to receiveall the fees for treatment, at the same time becomingthemselves responsible for all necessary expenses.Knowing how gravely his intense preoccupation withcancer had interfered with his gynaecological practice,the Committee would not consider this offer. Theymade the counter offer, which has been accepted, thatfor his services as Director he should, from Dec. 1st,1925, receive a stipend like the rest of the staff. Inreturn the Committee assume all responsibilities forthe housing and maintenance of the cancer patientsunder Prof. Blair Bell and the clinical staff ; they receiveall the fees and place all the books detailing incomeand expenditure under the weekly supervision of awell-known accountant. They have taken under theircontrol the nursing home previously occupied by Prof.Blair Bell’s gynaecological cases and have, in addition.bought and furnished another. Out of the moneysreceived they are continuing the stipends of those ofthe staff engaged in research, and are enlarging thatstaff, and they have by resolution agreed that allmoneys over and above those expended as aforesaidshall be devoted to the furtherance of medical research.We may add that these arrangements have been

submitted to the President of the General MedicalCouncil and have received his personal approval.Further, to secure their position, the question of incor-poration is being considered by the Committee.

It is felt by all engaged in this work that, if it canbe generally known that Prof. Blair Bell and theclinical staff are not benefiting to any unusual degreeby this work, but are by their labours supporting theentire burden of the laboratories and clinical organisa-tions, there may be greater confidence in, and greatersympathy with, what promises to develop into a verywonderful advance in the treatment of a most terriblestate.We enclose a copy of the circular letter which has

been drawn up and sent by the Director to all doctorswho have written to ask for treatment for theirpatients.

Signed, on behalf of the Liverpool CancerResearch Committee,

Liverpool, Feb. 23rd, 1926.

J. A. SMITH,Chairman.

REX D. COHEN,Treasurer.

J. GEORGE ADAMI.

[ENCLOSURE.]DEAR SiR,-Thank you for your letter. You will under-

stand that we are engaged in a scientific investigation, andhave regarded our clinical work as a test of the findingsobtained in the laboratory. We do not pretend and neverhave pretended that we have a " cure for cancer." Never-theless, the ultimate aim of all such work is that, and we areprepared to take suitable cases that can come for consultationin the first instance, provided they are fully informed :-

1. That consultations are arranged in order that it maybe determined whether the case is suitable for furtherinvestigation. A consultation does not mean that, ipsofacto, the patient will be taken for treatment.

2. That the treatment itself may be dangerous.3. That the treatment is experimental in nature.4. That there is no guarantee whatsoever as to the result.5. That patients must, if they come, place themselves

unreservedly in our hands, and continue the treatment soloag as we think it advisable.

6. That accessory treatment, such as X rays and operation,.may be necessary.

7. That, if an operation has been performed, a sectionmust be sent in advance.

8. That all fees are handed over to the Cancer ResearchCommittee. Yours very truly,

W. BLAIR BELL,Director.

MEDICINE AND THE LAW.

MORE ACTIONS AGAINST DOCTORS.IN addition to the action for negligence brought by

Mrs. Venn against Dr. Todesco and Dr. Elder (dis-cussed in a leading article on p. 560) two other actionsagainst doctors were heard recently in the law-courts.In one of them Mrs. Norris claimed damages againstDr. W. A. MacWilliam, of Norbury, for allegedbreach of contract and for personal injury, said to be-due to his negligence in treating her at childbirth.She also claimed :E430 special damage. The defendantdenied the negligence and counterclaimed for hisunpaid fees. The case presented no new point ofgeneral principle. After a careful hearing before theLord Chief Justice it fortunately reached a finaldecision, Dr. MacWilliam succeeding at all points.The second case was one of greater difficulty and less.

finality. The facts, as stated in the Times report,were these. An ex-officer, Captain F. Hume-Spry,late R.F.A., was invalided out of the Army in 1917.Suffering from neurasthenia he was examined on behalfof the Ministry of Pensions in 1920, and entered one-of the Ministry’s hospitals. He passed through otherhospitals and in 1923 went to Latchmere. Twomonths later a medical certificate was signed for areception order under the Lunacy Act, and he wasremoved to the Old Manor Asylum, where he remainedunder a second certificate. Later he left the asylum,a doctor having certified that there was sufficient cause-to release him. He then began two actions, oneagainst the doctors who had certified him for removaland retention, the other against his wife and other-persons for conspiracy. Prima facie these proceedingsagainst the doctors were blocked by Section 330 of theLunacy Act of 1890, if they had acted in good faithand with reasonable care. Under the usual legalmachinery in chambers the action was stayed. Theplaintiff appealed to Mr. Justice Bateson, who con-firmed the order staying the proceedings, but grantedleave to appeal further. The Court of Appeal reversed

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the order and directed that the action should proceed.Under the statute the sole question for the judges atthis stage was whether or not they were " satisfiedthat there is no reasonable ground for alleging want ofgood faith or reasonable care." It was perfectly clearthat the judges could not be thus satisfied, for theplaintiff was able to produce affidavits sworn bymedical practitioners testifying to the contrary. " Itmight be said," observed Lord Justice Bankes,

" thatit was rather surprising to find a body of medicalmen who could come forward and say of others thatthey had not only acted without reasonable care, butalso with want of good faith ; but in this case therewere two medical men who had come and pledgedtheir oath upon both points." The court could notdisregard such testimony ; the case must go to a jury.The learned judge was careful to say that he expressedno view on the merits of the case, nor whether theaffidavits contained opinions which a jury was likelyto accept.

PROFESSIONAL SECRECY AND THE DANGEROUSDRUGS ACT.

The recent prosecution of Dr. George C. Kingsbury,for supplying morphine contrary to the DangerousDrugs Act, raised important professional issues.Counsel for the prosecution made it clear that not theslightest reflection was made upon the defendant’spersonal honour ; the case was one, however, of muchmore than personal interest. The facts seem to havebeen undisputed. Dr. Kingsbury, having moved fromthe North of England to London, and having become

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a barrister-at-law, no longer carried on a generalmedical practice, but occasionally saw some of his oldpatients in a friendly way. Amongst these were twomorphine addicts. One of them, a woman, hesucceeded in curing. The other, a man of 70, he wastreating, by the method of gradual withdrawal, withgood prospect of success. Dr. Kingsbury purchaseda supply of morphine from a chemist for a period ofa year or more and personally handed the tablets tothe patient whom he was treating gratuitously. Theprosecution said that the doctor must keep a registerin the prescribed form or else a day-book containingthe patient’s name and address. Dr. Kingsburyrefused to disclose this information. He contended that

a consulting physician in personal charge of a caseis not obliged to keep any record ; he added thatthousands of doctors were never asked to keep theseregisters and never would. The magistrate treatedthe prosecution as a test case, convicted the defendant,and imposed what was euphemistically called the

nominal penalty of 25 guineas. Dr. Kingsburyintimated that he would ask for a case to be statedwith a view to appeal.The Home Office, it appears, is seeking to ascertain

how far it can go under its present powers. Afterstudying the report of the recent DepartmentalCommittee on Morphine and Heroin Addiction, onecertainly retains an impression that the circumstancesof Dr. Kingsbury’s case were therein recognised as notwholly covered by existing legislation. If this be so,it seems undesirable that so big an issue should bedealt with by pressing prosecutions under the presentlaw rather than by asking Parliament to pronounceafresh.On the all-important question of the confidential

relations between doctor and client the recent reporthad something to say. It recognised the disadvantagesof impairing those relations. It observed that publicopinion and the legislature have in some instancesregarded the interests of the community and of thepatients themselves as outweighing the interests ofprofessional secrecy ; but the report added that" each proposal for extension of this principle to a newgroup of cases must be considered on its merits." Withthis recommendation the medical profession wouldprobably be prepared to agree, provided that theproposals are to be considered by public opinion andParliament rather than by the police-court.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

The Problem of the Expatriated Practitioner.EVER since the end of the war there has been serious

trouble over the nationality of people born in thenon-Austrian States of the old Empire, who havetaken up their abode in what is now called the AustrianRepublic. The right to practise medicine here islimited to Austrian subjects, but the various peacetreaties have assigned many practitioners to othercountries-countries whose language they may noteven know. Being unfamiliar with its customs andpeople they have no desire to get to their native land,although-mainly for military reasons-their countriesclaim them. Out of about 5900 practitioners fully27 per cent. are not Austrian born, whilst in Viennaitself the proportion of doctors technically not Austriansreaches about 39 per cent. It would be utter ruin forthem to be uprooted and to leave Austria, or to losethe right to practise here. The Ministry of HomeAffairs has accordingly decided to nationalise uncon-ditionally all persons born in the former AustrianEmpire who were in practice here before 1920. Other" aliens " must apply for nationalisation, and theirapplications will be considered in a most liberal sense.’The Government has also begun negotiations, nownearly complete, for obtaining full reciprocity in thisrespect with all the seceding States, especially asregards the frontier cities and health resorts.

Fees between Medical Men..The Vienna Medical Council has repeatedly con.

sidered the relations between medical men whorender one another medical assistance. It was

understood, of course, in older, better times that suchservices were gratuitous, but now, with changedconditions, the views of the majority of doctors havechanged also. It must be said that under the oldsystem the doctor and his family were for the mostpart worse off than private individuals, who in case

of illness could summon the family physician as oftenas they thought fit. The medical man, on thecontrary, could not bother his doctor too muchbecause the service was gratuitous, and many a

necessary call was never made because of thesescruples. More than two years ago suggestions weremade in the German (Austrian) medical papers bya number of practitioners who wanted a ruling onthese questions, and at a recent meeting of the

Medical Council a resolution was presented and

adopted, to the effect that every service requiresadequate payment and that medical men and theirfamilies should be treated on the same principles asother private patients. It was suggested that, for thetime being, the profession should accept the followingproposals : (1) Every medical man who is offered afee for the treatment of a medical man or the family(wife, children) dependent on him for their upkeepis bound to accept it and to hand it over in a tactfulway to the funds of a medical or other charitableinstitution or to the Medical Organisation. (2) Suchfees shall be offered at a scale not exceeding thatarranged between the Organisation and the sicknessclub of the Civil Service men. These provisions, itis hoped, will remove the qualms of patient andpractitioner. They will also suit the patient’s pocket,for the fees are only about one-third of those paid byprivate patients, and though the doctor is bound toaccept an offered fee, he does not ask one. Thesearrangements are, as stated above, only temporary.There is some question whether it would not ulti-mately be more convenient to have a central clearingoffice, so to say, for the payments, so as to do awaywith the awkwardness-to some coctors, at least-of offering fees to a colleague. It is intended thatfunds from this source shall be used to ensure bctternursing for medical men requiring treatment inhospitals or nursing homes. Definite regulations willbe suggested after the present scheme has been triedfor one or two years.

The Title of " Specialist."

In conformity with the views held by the largemajority of medical men, it has been decided by theOrganisation that a doctor may not style himself

specialist and become a member of the officiallyrecognised Association of Specialists until he hasfulfilled certain requirements. These are : Qualifica-tion as M.D. ; three years’ study in a hospital or clinicdevoted only to the specialty selected (which mustinclude at least one year’s service as house surgeon orhouse physician) ; and another year as resident or juniorsurgeon or physician in a general hospital. This meansthat a specialist has seen four years’ hospital workbefore he becomes a fully-fledged member of theAssociation and gains the right to settle down inpractice. Difficulties have now arisen over doctorswho are in practice already or are in the act of takingit up, but have not had that kind of elaborate prepara-tion. In order to regularise their position it has beendecided that doctors who graduated before Jan. lst,1923, and have had at least two years’ specialisttraining may apply for membership of the Associationof Specialists. Those who have been in specialistpractice for two years or more are exempt from allrestriction.

Fewer School-children and Fewer Males.The census of school-children in December, 1925,

has shown that the total number of pupils in allschools from 6 to 18 years of age is 61,060 less thanlast year. Statistics of the Board of Health of Vienna