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ment of the sick. As a result of all these causes, thevoluntary hospitals have acquired a tradition and aprestige which, when combined with the free scopewhich they offer to initiative, have attracted to theirservice men of conspicuous ability, both medical andlay. It has been in the voluntary hospitals that thehighest standard of medical and surgical work hasbeen developed, and it has been with the standard ofthe voluntary hospitals before them, and with the aidof medical men trained in the atmosphere and spiritof those hospitals, that the recent improvements inmany of the poor-law infirmaries have taken place.An efficient and adequate hospital service can becreated, not by converting the voluntary hospitals Iinto official institutions, but by developing municipalhospitals in cooperation with, and under the influenceof, a vigorous voluntary hospital system.

Finance and Accommodation.From the point of view of finance and accommoda-

tion, the contribution of the voluntary hospitals isalso of great importance. Taking Great Britain as awhole, the number of hospitals is 930, with about64,000 beds. The total of voluntary gifts is approxi-mately 9,000,000, including receipts from hundredsof thousands of contributors through weekly workshop Icollections. Of this z9,000,000, over 26,000,000 isfor annual maintenance alone, and more than22,000,000 for capital purposes. But the destructionof the voluntary hospitals would represent the lossof far more than this : these millions would not bethe only charge on public funds, because of the greatamount of voluntary work, both lay and medical,which accompanies them. In the hospital service,therefore, both municipal and voluntary hospitalsshould be essential parts, and should be recognisedas such by the public, both as ratepayers providingthat part of the service which is best provided out ofthe rates, and as voluntary contributors providingthrough the voluntary hospitals those special featureswhich depend on the maintenance of voluntarymanagement and voluntary finance.

The memorandum goes on to make a number ofpractical suggestions for securing the best form ofcoäperation in the future. There should be continuousconsultation between the authorities responsible forthe rate-supported and the voluntary hospitals,respectively. This is now provided for by the newclause, introduced into the Bill in the House of Lords,which runs as follows :-

" The council of every county and county borough shall,when making provision for hospital accommodation indischarge of the functions transferred to them under thispart of this Act, consult such committee or other body,if any, as they consider to represent both the governingbodies and the medical and surgical staffs of the voluntaryhospitals providing services in or for the benefit of thecounty or county borough, as to the accommodation to beprovided and as to the purposes for which it is to be used."The Committee propose that there should be a

Standing Joint Hospitals Conference in each area,composed of equal numbers of representatives of theappropriate committee of the county or countyborough council and of representatives of the volun-tary hospitals, including both laymen and medicalmen. The King’s Fund is considering the best methodof securing this representation in London. As regardsthe rest of the country, the British Hospitals Associa-tion through its regional committees is, at thesuggestion of the King’s Fund, taking the necessarysteps. The functions of these conferences should beadvisory, not executive. One of the principal func-tions of the joint conference would be to consider thehospital needs of the area, and the question which ofthese needs could best be supplied by the voluntaryhospitals and which by the county hospitals.

Staffvng and Equipment. ,The memorandum also discusses the staffing and

equipment of the two kinds of institution. It suggests ‘that, where local circumstances permit, the municipal ]

hospital service should be linked up with the voluntaryhospital service through the appointment on the staffs

of the municipal hospitals of consultants who areexperienced in voluntary hospital work, so that thesame spirit may influence both. On the questionof the classification of patients, it suggests that greatdifficulties would arise if any attempt were madeto lay down definite rules differentiating classes ofpatient, and allocating them to different kinds ofinstitutions, either according to the nature of theailment or according to social status, and that what-ever form and degree of classification is found to bedesirable will be developed in actual practice.

MEDICINE AND THE LAW.

Cockroaches in a Flat.

A LADY who was tenant of a flat at the MarbleArch succeeded in obtaining ;S481 damages from herneighbours on the ground of their encouragement ofcockroaches on a lower floor and the consequentinvasion of her premises by swarms of these unwelcomeinsects. She claimed that she had been unable to sleepat night, that her health had been affected, that herrooms and curtains had been damaged, that she hadlost the amenities of her flat, and had suffered fromthe work done in the attempt to exterminate theinsects and from the smell of disinfectants. Her claimincluded an item of 2110 special damage for repairs,materials, cleaning, and medical attendance. Hermedical attendant, Dr. Philip Dennis Scott, describedher condition a few days before Easter, 1928. She wasexcited and nervous and she complained of sleepless-ness owing to the presence of tne cockroaches. Laterhe found marks on her neck which resembled bites ;in the autumn she developed dermatitis and was sentto the 8t. John’s Hospital for Diseases of the Skin.It was put to him in cross-examination that dermatitismight have been caused by the use of sulphur ointment,but this ointment, he said, was not used till thedermatitis had appeared for some weeks. Dr. WilliamGriffith, who had attended the plaintiff at the hospital,attributed the dermatitis to tne nervous upset whichshe had suffered. Expert evidence was given on thesubject of cockroaches. The plaintiff’s claim allegedthat the insects were of the species known as Blattaorientalis. Mr. Ernest Crabbe, Fellow of the Ento-mological Society of London, called on behalf of thedefendants, said he had been to the premises anddiscovered specimens of Blatta orientalis ; he handedthe judge a box of them. He did not think theseinsects could bite and pierce the human skin, but theyate bed-bugs. Both cockroach and bed-bug came tothis country in 1583. Cockroaches, he said, werepractically omnivorous ; they would eat each other,organic refuse, or, preferably, sweet things. Heregarded this as an " ordinary case of cockroachinfestation."The plaintiff’s claim was for damages for nuisance or

alternatively for negligence-nuisance in that thedefendants had so used their property as to cause hersubstantial discomfort, negligence in that they hadfailed to take reasonable precautions of care andcleanliness or to appreciate the consequences of theaccumulation of refuse in the cafe below her flat. Shesaid the defendants were owners of the cafe premiseswhile used as a cafe and were occupiers of thosepremises after they ceased to be so used. The jury’sdetailed answers to a series of questions framed bythe judge will indicate the steps by which the plaintiff’sclaim was established. Did a quantity of animal orvegetable refuse remain on the cafe premises betweencertain specified dates ?-Yes. Was such refuseunusual in quantity ?-Yes. Did it constitute a

nuisance in the circumstances ?-Yes. Did the refusecause or substantially contribute to the invasion of theflat by cockroaches ?-Yes. There were other findingson the aspect of negligence, the alternative to,nuisance. But the findings as to nuisance were suffi-cient. The question whether the refuse was unusual inquantity is significant. There was an interesting

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decision in 1914 on proceedings against a marketgardener from whose manure heaps came smells andflies to the detriment of his neighbours. An injunctionwas granted against him because, though it is usualfor manure to be used in market gardening, what thisparticular market gardener had done was regarded bythe court as something quite beyond ordinary marketgardening. Similarly, it is natural that there should besome accumulation of animal and vegetable refuse inpremises where the business of a cafe is carried on.It is the excessive or unusual accumulation which gavethe plaintiff the right to damages. The cafe, it wasexplained, has now been demolished, the RegalCinema having been erected on the site.

Appeal against a Death Sentence. I (Dr. Benjamin Knowles, who until last October

practised as a medical practitioner in the Bekwai 1district of the Gold Coast and was employed as medicalofficer in charge of that district, was arrested on (Oct. 21st on a charge of shooting his wife with arevolver. A month later he was found guilty of ’murder by the Acting Circuit Judge (who tried the Icase without a jury) and was sentenced to death, but ’the sentence was commuted by the Governor of theGold Coast. Dr. Knowles has petitioned the JudicialCommittee of the Privy Council for leave to appealagainst the judgment of the local court, and theJudicial Committee has granted him leave to appeal.The next stage therefore is that he will appear beforethe court in Downing-street in the submission of theappeal itself. The facts as stated on the recentproceedings were that Dr. and Mrs. Knowles gave aluncheon party at their bungalow on Oct. 20th atwhich various Government officials were present, thatlater (about two hours after the guests had left) Mrs.Knowles, being then in the bedroom with her husband,received a revolver wound of which she died two daysafterwards in Kumasi Hospital, and that in a dyingdeposition she declared that the shot had been acci-dentally caused by her getting up out of a chair onwhich the revolver had been placed. The ActingCircuit Judge said he had to decide whether the firingwas an accident or whether Mrs. Knowles’s dying state-ment was a generous woman’s falsehood ; he describedthe evidence as confusing, but overwhelming, andsaid there could be no doubt of the guilt of theaccused. Dr. Knowles’s petition for leave to appeal c

was based on the grounds that the local court had no tjurisdiction to try him without a jury, that there wasno reliable evidence on which a capital conviction (

could safely and justly be founded, that the judge failed (

to give effect to the paramount rule of law that the 1onus of proof was on the prosecution, and finally that athe case should have been referred to the local SupremeCourt for trial with a jury. The tribunal before which iDr. Knowles was tried was the Chief Commissioner’s 1

court. Its procedure is governed by the AshantiAdministration Ordinance (No. 1 of 1902) whereofone clause says that no accused person may have theservices of a barrister and solicitor. Another clausesays that the court is to follow the procedure of theSupreme Court of the Gold Coast so far as practicableand so far as local circumstances permit. It does notappear that the judge made any statement that trialby jury was impracticable or impossible owing to localcircumstances. It will be a matter for argument onthe appeal whether any circumstances could bar anEnglishman’s right to trial by jury when accused ona capital charge and whether, if the trial was legal inview of the Ordinance, the Ordinance itself is valid.No reference was made during the recent proceedingsto a subsequent Ordinance which is understood tohave modified (by way of statute law revision) thewording of the Ordinance of 1902. The PrivyCouncil was inclined to regard as meagre the informa-tion before the court. One might add, perhaps,that service in an out-district in the Gold Coast seemsto be exposed to’risks which strike an Englishmanas strange, and that the Government does not seemto have been at any pains to assist the defence ofone of its servants. !

Correspondence.

THE USES OF ULTRA-VIOLET LIGHT,

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,-As your leading article points out, it is amatter of medical history that though ascertainedscientific facts may be the truth, they are not neces-sarily the whole truth. When the Medical ResearchCouncil state that " their prolonged researches...give no scientific reason at all to suppose that thetreatment of rickets is better effected by ultra-violetrays falling on the skin than by the direct provisionof the necessary food values," they are doubtlessstating the truth according to their lights. But thoseof us who have worked at light clinics in industrialdistricts and who know so well the practical workingconditions will be profoundly unconvinced. Weremember the wretched specimens of infants withdigestion impaired, unable to tolerate cod-liver oil,and the ignorant, careless, or harassed mothers whocould not be depended upon to give it. We rememberhow often cod-liver oil failed us under those conditions,and how, on the other hand, ultra-violet light effectednot only a rapid cure of rickets, but a wonderfuluplift in general health. I, personally, tried dieteticand hygienic measures under these conditions in thetreatment of hundreds of cases of rickets at Mother-well Child Welfare Centres from 1919 to 1924, andI freely confess that the adverse conditions proved toomuch for me. Success was comparatively negligible.From 1924 to 1925 I had a series of cases which hadpractically failed under this treatment respondrapidly to ultra-violet light. In 1925 and 1926 whenthe light clinic was organised I treated 121 cases toa conclusion and easily and rapidly achieved satis-factory radiographic cure in 95 per cent., as well asastonishing improvement in general health in thevast majority. Of course, I know that all this is not" scientific." But it was all that I had time andopportunity to do in that unfortunate area, and thedegree or success acnievecl was sumcienLly remarKaDleto satisfy all concerned.

I believe I am not by any means alone in thisexperience. Indeed, my observations, which mightotherwise have been published in much greater detailthan they have been, were anticipated by the appear-ance of Dr. Katherine Gamgee’s book on " ArtificialLight Treatment of Children " in which case-historiesin rickets are given, showing precisely similar resultsto mine. The Medical Research Council state thatreports submitted from artificial light centres" exhibit much variation of opinion," but if these

reports are studied with discrimination, I believe thatno appreciable difference of opinion will be found asregards (1) the rapid cure, even under adverse con-ditions, of the bony lesions in active rickets, and(2) the remarkable improvement obtained in generalhealth in such cases, including such factors as

improvement in muscle tone and associated activityin waking hours, the disappearance of apathy, fret-fulness and sleeplessness, and the appearance ofhappiness and well-being.The reports on the London children quoted by the

Council deal, of course, with a different class of casealtogether, but there is no clear indication of thisdistinction in the Council’s statement. On the basisof these two limited investigations and of currentlaboratory findings, the Council seem prepared tocondemn artificial light centres for rickets as unneces-sary and about 50 times more expensive thanalternative methods of treatment. In their estimateof cost they appear to have entirely overlooked thefact that many children can be treated togetherround the lamps, thereby making the cost per casevery low. Huldschinsky, who made the great dis-