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Popular lectures are also given by the provincial surgeons ontheir tours of inspection. The attendance on these lectureshas been, on the whole, satisfactory, but the natives show acertain amount of scepticism, and especially do not under-stand why they should take medicine when they are well.3. Quinine distribution. In 1906 paid distributers were

employed to carry the remedy to the remote villages andsmall towns. This method did not answer the purpose verywell: it was very expensive and unsatisfactory, therewas no check over the amount of the drug distributed, andthe distributers were suspected of selling the remedy topeople actually suffering from fever, and in many cases ofstaying at home and filling up false lists of people who hadbeen given quinine. Hence in 1907 these paid distributerswere discontinued, and headmen and others holding respect-able positions were supplied with quinine for distributionfree to any persons applying for it. The arrangementsdescribed in the report for 1906 for the distributionof quinine amongst school children were continued in1907 with gratifying results. The total amount of quinineissued from the civil medical stores was 76,206 ounces,which cost Rs.50,295.96.

Cholera gave 105 cases in 1907 with 62 deaths, one-seventhless than the numbers for 1906. The infection of most of theoutbreaks was traced to India. Small-pox caused outbreaks inall the provinces except three. In the Western Province allthe cases were traced to infection from Calcutta, Singa-pore, and Shanghai. The death-rates per cent. for theunvaccinated were 50, and for the vaccinated 15 1. Entericfever from the statistics is on the increase, and the officialfigures shown ought to stimulate the carrying out of im-proved water- and milk-supplies and sanitation throughoutthe island. The death-rate is given as 22’ 55 per 100 casestreated. Regarding dysentery, there were 3474 cases treatedat the various government hospitals, with 1264 deaths. Inthe jails for the whole island there were 328 cases, with 20deaths, a death-rate of 6 - 06 per cent. Cholera belts orBannel shirts were issued to prisoners exposed to rain andcold. Dr. A. Castellani had good results following the admi-nistration of dysentery vaccine in chronic cases of bacterialdysentery. In the more acute forms of bacterial dysenteryhe has had success with the anti-dysenteric serum preparedat the Lister Institute.Leprosy gave a total of 465 cases treated during the

year; of these 79 were discharged and 66 died. SirAllan Perry is strongly in favour of the establishmentof a leper colony in the Eastern Province, where the

patients could live the home-village life and cultivatethe land, for, as he rightly says, the afflicted class isnever happy in an "institution " like a hospital or asylum.The main things required would be a large area of groundand a fair water-supply ; the buildings should be made ofcadjans on wooden frames; there should not be more thanfour patients in a hut, and everybody who is able shouldw6rk on the soil. The only permanent buildings wouldbe the hospital, kitchens, and latrines. As regards thetreatment of this disease, the director of the Bacterio-

logical Institute made experiments during the year toobtain a leprosy vaccine, but having prepared such a vaccineits practical utility was not demonstrated. The most recentform of treatment, that of Professor Deycke of Constan-tinople, is about to be tried.Respecting ankylostomiasis, there was an increased number

of cases, which totalled 3831, the disease being constantlyintroduced by coolies from India. It is reported by themedical officers to be spreading amongst the natives, andthis spread appears inevitable under the present con-

servancy arrangements regarding the disposal of sewage andin many cases as regards the water-supply. The death-ratein 1907 was 23 17, which is probably lower than the realdeath-rate, many cases being returned under the heading ofmalarial cachexia. The disease is most certainly increasing,as shown by the admissions into hospital, for in 1898 therewere 1201 admission with 21 °2 deaths. Each succeedingyear the admissions and deaths have increased until, as

has been noted above, there were 3831 cases, with 888deaths. The disease is prevalent on the island whereverthe immigrant Tamil coolie lives, whilst a large pro-portion of the coolies who arrive from India are alreadyinfected with this worm. If Ceylon is divided intothe dry " and "wet" " zones they represent respec-tively those portions of the island slightly and markedly i

infected with ankylostomiasis. There are no sanitarymeasures in Ceylon for dealing with the disease ; thus there-is no sanitary accommodation on estates. In the treatmentof the disease thymol is considered in Ceylon the best drug,although on Sir Patrick Manson’s recommendation eucalyptus-oil was given an extensive trial. Beta naphthol is preferredby some medical officers. All are agreed that a long courseof iron tonics is necessary after the worms have been got ridof. Sir Allan Perry insists on the use of proper latrines and,a pure water-supply : he holds that the hospital accommoda-tion must be considerably increased and the staff c

strengthened, the people must be educated to observecleanliness and taught the dangers of becoming infected,with the disease. The public latrine accommodation mustbe increased, the drainage improved, and a pure water--

supply be instituted. A conservancy scheme on sanitarylines should be introduced on all estates, whilst

lastly Sir Allan Perry wisely points out that it wouldbe possible to rid every immigrant of his worms

on arrival if the planting community would bear the

expense of his stay in the coolie camp, and the extra medicalstaff that would be required. It is earnestly to be hopedthat the authorities concerned will fall in with these excellentrecommendations.

Lastly, with regard to plague, we are glad to notethat owing to the excellent precautions that have been invogue for many years past against the introduction of thedisease no case of plague was brought to Ceylon during1907. The remainder of this report deals with the generalsanitary condition of the colony and of the chief towns andthe various provincial reports. From the above brief 7’esM?MCit is evident that the sanitary supervision of the island is inmost capable hands, and Ceylon is to be congratulated thatthe arrangements of its health are under the wise régime outSir Allan Perry.

MEDICINE AND THE LAW.

The Responsibility of Medical Men in Examinations for Life,Assqlrance.

AT the recent Glamorgan assizes, held on April 5th, two-medical men appeared to answer to indictments preferredby the Colonial Mutual Life Assurance Society, Limited,-

charging them with obtaining from the society by false pre-tences certain sums of money, and with conspiring to obtainvarious policies of assurance. The money referred to con-i sisted of fees of 10s. 6d. for examining and reporting upon

persons to be insured, and the other charge implied that thedefendants had combined with an agent of the society to,! defraud the society by helping to bring about the issue ofL policies which would have been refused if the society had hadI full information with regard to them. In both cases thel magistrates had decline to commit for trial, the bench being’ equally divided in one, and the society had applied to be. bound over under the Vexatious Indictments Act to prosecute.I at the assizes. When, however, the case was called on,, counsel for the prosecution asked Mr. Justice Bray’s per--mission to withdraw the prosecution, and this was accorded,. his lordship intimating that from a perusal of the deposi-

tions he was satisfied that there had been no criminal intentr on the part of the defendants, although there had been verygreat negligence. The evidence given before the magistratesshowed that both defendants, when asked to do so by thel local agent of the insurance company, had signed reports-- relating to the physical fitness for insurance of certainl proposed lives without making any physical examination ofthe persons named in their reports. In the cases whichl formed the subject of inquiry the persons to be insured weref not aware that policies upon their lives were being taken, out, and one of them had died before the case came beforei the magistrates. The medical men had not intended to

; defraud ; they were acquainted with the persons as to whoses bodily health they deposed, and one of them, when he wasI before the magistrates, pointed out that if a woman as to whom he had signed a report and who had been his patient. on past occasions, had been asked to allow an examinationand had refused, he could have marked the papers "refused

"

and would then have been entitled to his fee of 10s. 6d.

just the same. The prosecutions referred to have no-

r doubt attracted the attention of life assurance companies.-

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and of medical men who work for them in localitieswhere policies for comparatively small amounts are taken out.On the one side, it may be pointed out to the companies thata thorough and careful examination, such as should be madewhere important pecuniary interests are involved, is not

adequately rewarded by a fee of half a guinea, and thatalthough they are entitled to expect a medical man to carryout what he undertakes, as a matter of business it cannot beto their interests to underpay him. On the other hand, amedical man should remember that a document to which he

appends his signature is a statement to which that signatureattests his full and unreserved assent. If he signs a docu-ment which declares that he has this day carefullyexamined the proposed person," when in fact he has notdone so, he places on record a statement which isuntrue and for which he may at any time be made answer-able. The fact that the fee which he is to be paid is not anadequate one is no excuse in such circumstances, though sucha fee may be, and, in the interest of the medical profession,should be, refused.

Liability for Medical Pees.A case of some interest to medical men as to their right

to recover their fees from third parties came recently beforethe county court at Newport in the Isle of Wight. Mrs.Woodhall, of Roland-gardens, South Kensington, describedas a lady of considerable means, was sued by a medical manfor £ 37 for attendance on the defendant’s sister. Whilststaying at Yarmouth, Isle of Wight, in September last, thedefendant’s sister (Miss Langton) was thrown out of a motor-car and sustained a broken leg. A medical man attendedthe lady, paying over 50 visits. From time to time de-fendant was consulted about the case. When the plaintiffsent in his bill the claim was repudiated. On behalf of the

plaintiff it was argued that the defendant not only approvedRoentgen ray treatment when it was recommended by theplaintiff, but paid for it. Counsel for the defendant sug-gested that the host of the young lady should pay, but hishonour held that that was a very strong proposition. If hostswere to be held responsible in such circumstances it woulddo much to upset week-end visits, now so much in vogue.His honour gave judgment for the full amount claimed,with costs, holding that defendant had held herself outas responsible for the payment for her sister’s medicalattendance. Medicines and medical aid are necessariesfor which an infant may contract and render himself liable,but a parent is not liable to pay for such necessaries furnishedto an infant child without some proof of a contract on hispart, either express or implied, and no such contract will beimplied where the infant has been allowed a sufficientlyreasonable sum for his expenses (Crantz v. Gill, 4 Esp. 471).Where a father of a family had several of his children livingat a distance from his own house, under the protection ofservants, it was held that if an accident happened to one ofthe children he was liable to pay for the medical attendanceon such child, although he might not know the surgeoncalled in, and although the accident might have arisen fromthe carelessness of the servant (Cooper v. Phillips, 4 C. & P.

581). In dealings between medical men and the guardiansof an infant it must be borne in mind that although theexpenses of an extraordinary illness do not form part of themaintenance of an infant strictly speaking, yet where therehas been no extraordinary illness physic and doctors’ feesmust be included in the general allowance for past mainten-ance, and the court will not allow the guardians to claim anextra sum for the same. A master is not bound to providemedical assistance for his servant, but the obligation (if any)must arise from contract; nor will such a contract beimplied simply because the servant is living under themaster’s roof. In all cases where a servant falls ill and isunable to pay for medical assistance, the parish is bound tosupply such assistance, although the servant may not

have, previously to his illness, received or stood inneed of parish relief (Newby v. Wiltshire, 2 Esp.739). Where a servant, who hurt her foot in gettingover a gate, called in a surgeon who was not the regularmedical attendant of the family without being desired to doso by her master or mistress, it was held that her master wasnot liable to pay the surgeon’s bill (Cooper v. Phillips,4 C. & P. 581). A master is bound to provide an apprenticewith proper medicines and medical attendance (R. v. Smith,8 C. & P. 153). While a husband and wife are livingtogether it is a presumption of fact that the wife is agent

for, and has the authority of, her husband to pledge hiscredit for goods supplied to their establishment which aresuited to her station. A wife has implied authority to bindher husband for reasonable expenses for medicines andmedical attendances incurred during illness, but this impliedauthority is put an end to if the husband has given sufficientnotice that he will no longer be responsible for any debtswhich she may incur. A medical man can recover pro.fessional charges according to a scale varying with the classof patients visited, provided that the same be fair andreasonable. In all professional dealings between medicalmen and their patients the customs of the profession will beconsidered as imported into the contract unless excluded

expressly or by implication. ,

Proseezttions itnder the Factory and Workshop Act, 1901, inthe City.

At the Guildhall recently summonses were heard byAlderman Sir Henry Knight against Messrs. Laurence andCo., blouse manufacturers in the City, for having employedfour young persons under the age of 16 years for more thanseven days without having obtained certificates in the pre.scribed form of their fitness for their employment. As amatter of fact, two of the girls had been employed for threemonths and the others for four and 11 months respectivelywithout being examined by the certifying surgeon, so thatthe offence was hardly to be described as a technical oneonly, in spite of the fact that since attention had been calledto the matter they had been examined and had been grantedcertificates. Sir Henry Knight, however, seems to havethought otherwise, for he is reported as having said that thematter was not very important and he inflicted a fine of ls.only in each case, with costs. The following dialogue at theconclusion of the hearing is taken from the report in the-Daily Telegrccp3 :-

Sir H. Knight: What are the costs ? I really cannot hear theseladies, they will not speak up. That one (indicating Miss A. M. Newton,the inspector of factories who appeared in support of the summonses),has been better since I cautioned her. (Laughter.) The Chief Clerk:The actual out-of-pocket expenses are 27s. Sir H. Knight: I shall notgive her a half-penny more. (Laughter.) This is one of those harass.ing Acts of Parliament which are driving business out of the Cityaltogether. Still that is no reason why these people should not dowhat the law requires.

It is to be regretted that such an expression of opinionshould have been uttered by a magistrate in enforcing asection the effect of which is to prevent young persons-i.e.,children under 16 years of age-from being employed atwork for which they are physically unfit. The Act of Parlia-ment to which he referred as driving business out of theCity applies to the whole of the United Kingdom. Theattitude adopted by the learned alderman towards the womenfactory inspectors who, in the course of their official duties,conduct prosecutions, may point to the desirability of em.ploying solicitors or barristers to appear in court, but nodoubt it is not thought desirable to incur unnecessary expensewhere the law and facts are not in dispute.

Looking Back.FROM

THE LANCET, SATURDAY, April 30th, 1831.

CHRONIC BRONCHITIS-PARAGORIC ELIXIR.l

From William’s Ward a case of chronic bronchitis waspresented, which had existed many years. There wassonorous and sibilous rattle in various parts of the chest,and copious frothy expectoration, with cough and dyspnoea.There was from time to time a great increase of the difficultyof breathing,-spasmodic dyspnoea. He was relieved, hesaid, very much by taking the compound tincture of aloessaturated with bruised aniseed. There is a sort of elixir, asecret medicine, which evidently contains a great deal ofaniseed, and certainly in many cases of spasmodic difficultyof breathing, affords very great relief. I endeavoured toimitate it at the suggestion of Dr. Prout, who found in it

1 Dr. Elliotson on Peritonitis and Bronchitis at St. Thomas’sHospital.