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Fig. 4-The consulting-room, with the workroom beyond.

Patients’ comments were sometimes illuminating.One of them observed : " The Government have built

you a nice place here. It’s marvellous, this HealthService." And a farmer remarked : " You get a bit ofincome-tax rebate on this, don’t you I do on my new

piggeries." (Good piggeries, it seems, are encouraged,

1. See Lancet. 1951, i, 468.

Medicine and the Law

A Hospital’s LiabilityEVEN a layman understands that Scots law and

Scots procedure are different from the English. Therecent case of Macdonald v. Glasgow Western Hospitalsand Brown, heard earlier in the month in Edinburgh,provides an illustration. It was an action for damagesfor alleged negligence on the part of the hospital manage-ment and the house-surgeon. It was not a final hearing,uor was it a trial on the merits. In Scotland questionsof the competency and relevancy of an action are decidedby way of preliminary argument before the merits ofthe claim are examined. In Scotland, moreover, thecourts still apply (notwithstanding the National HealthService Act and certain English decisions such aa Cassidy

Minister of Health 1) the rule that, since a hospitalboard is not in a position, or not competent, to controlthe treatment or prescribe the operations undertaken byphysician or surgeon, it is not to be held legally responsiblefor malpraxis.

-Air. Macdonald, a bank accountant, had been admittedto Killearn Hospital for a minor operation, successfullycarried out, to his foot. He became very ill, sufferingabdominal pains and continual sickness, a few dayslatter: he was transferred to the Western Infirmary,where an operation was performed for removal of anintestinal obstruction, and died soon afterwards. Hiswidow contended that the hospital board was vicariouslyresponsible for the negligence of the house-surgeon who,she said, had failed to diagnose her husband’s symptomsand to call in a senior doctor to examine his condition.She also maintained that the board was itself at faultin having made no provision at the Killearn Hospitalfor necessary and urgent operative treatment there, sothat the patient had to be transferred to the WesternInfirmary for operation though immediate operation wasnecessary.Lord Strachan found himself obliged to follow the

previous Scottish decisions which make it clear that inScotland, if the governors of a public hospital engage

but there is no similar incentive to build good quartersfor patients and doctors.)The unit is in a village of about 2000 people and serves

a population of between 2000 and 3000. For four yearsnow it has proved a satisfactory place to work in. Asurgery session has been set aside for antenatal examina-tions, and this is followed by an infant-welfare clinic.This new building has given me a feeling of confidence,of being able to do the work for which I was trained.It is possible to deal with any emergency in fairly goodconditions ; and the scope of my work is limited largelyby the unfortunate economic pressure of time. If adoctor does more than a certain amount for his patients,his list must be smaller, and so he is poorer. Much worktherefore goes to hospital, for the enlightenment of

registrars and the frustration of consultants, which couldwell be done by the family practitioner working in suchsurroundings.There should be no difficulty of principle in removing

this discouragement to better work. For instance, extrafees are paid to general practitioners for obstetric workunder the N.H.S. ; and fees are paid to consultants whenthey use an electrocardiograph in domiciliary con-

sultation. The G.r. experienced in midwifery gets higherpay for the use of his skill, but if he has any other

specialised experience and training—whether in E.N.T.work, pathology, psychiatry, or some other subject-he incurs a financial penalty by using it. The College ofGeneral Practitioners will not be a real success unlessit tackles this anomaly.

competent doctors and nurses, they are not responsiblefor any negligent discharge by the doctors and nursesof their professional duties. He therefore dismissedthe claim so far as it concerned the Glasgow WesternHospitals,2 but allowed the case to proceed against thehouse-surgeon, who has already outlined his defence.The latter avers that two other surgeons examined thepatient four days after the operation to the foot andfound no sign of abdominal abnormality ; he contendsthat he exercised reasonable care in his treatment of thedeceased.Not many days ago the House of Lords, in a case about

the definition of a "

charity," spoke of the, " painfuldilemma " presented where Scots and English law

diverges. On that occasion there was a problem whichlegislation may be needed to solve. It will be interestingto see whether the liability of hospitals is to be left inso different a position in the two countries, or, if not,how harmony is to be restored.

Appendicitis not DiagnosedThe converse principle in England may be seen in

Edler v. Greenwich and Deptford Hospital ManagementCommittee and Another,3 where a father recovered

damages against the hospital and the doctor on a verdictof negligence. His child, aged 11, had been ill withabdominal pains and vomiting throughout a Saturdaynight and on a Sunday morning. His own doctor did notattend surgery on Sunday morning ; he therefore tookthe child to the hospital. There the casualty officerasked where the pain was. The child put her hand toher stomach and moved it to and fro. She wincedwhen the abdomen was touched. The hospital doctorthought there was nothing more seriously wrong thangastric trouble. He sent her home, saying that, if shegot worse that day, the father should bring her backto the hospital ; if she got worse next day, she should betaken to her panel doctor. She became much worseon the Tuesday and was hurried to hospital, where anoperation was performed. There was advanced peri-tonitis and a ruptured and gangrenous appendix. Deathoccurred after the operation. Mr. Justice Finnemore

2. Glasgow Herald, March 6, 1953.3. Times, March 7, 1953.

594

held that the child had indicated pain on the right side ;the hospital doctor should have detected signs of acuteappendicitis, and the child should not have been senthome. The hospital was liable for his negligence.

A Transfusion AccidentThe death of a 54-year-old man after a postoperative

blood-transfusion was the subject of an inquest atPreston on Feb. 27.1 Two pints of blood were given with-out mishap, and during the transfusion of the secondpint the registrar in charge of the case gave instructionsto the nursing staff that a third pint should be givenlater on if necessary. A staff nurse wrote in the ward

report that there was a third pint of blood in the labora-tory. At the inquest she explained that she did so

because there was no blood in the ward refrigerator, andshe concluded that it must be in the laboratory. Duringthe night, a nursing sister was called to see the patient,and she decided to give him the third pint. She had readthe ward report, and when she went to the laboratoryshe found a bottle of blood bearing the patient’s name,Moon. The bottle did not have the usual compatibilitylabel, but she did not notice this. The blood was given,but it proved to be incompatible, and the patient died.It was stated at the inquest that the name on the bottlewas in fact that of the donor. Recording a verdict ofdeath by misadventure, the coroner said that it wouldbe unfortunate if the case should shake anybody’s con-fidence in the hospital, which was doing first-class work.

1. Manchester Guardian, Feb. 28, 1953.

Parliament

QUESTION TIME

Supplies of AureomycinDr. SANTO JEGER asked the Minister of Health whether,

now that aureomycin was manufactured in this country andthe limitations on its efficacy were so well known among generalpractitioners, he would make it more freely available to doctorsso that delay was avoided when its use was indicated.-Miss M. P. HORNSBY-SMITH replied : The manufacture of

aureomycin in this country still involves bulk importationof the crude drug at considerable dollar cost and the Ministerthinks that its issue ought still to be subject to the presentsafeguards. He is not aware that, under these arrangements,there is any undue delay in supplying this drug to generalpractitioners in cases where its use is indicated.

Replying to a further question by Dr. JEGER, Miss HORNSBY-SMITH said that 896 applications by general practitioners foraureomycin had been granted. It was estimated that about5 % of the applications were refused.

Tuberculosis Among ImmigrantsMr. KENNETH ROBINSON asked the Minister how long his

Standing Tuberculosis Advisory Committee had been consider-ing the problem of tuberculosis among persons taking up residencehere from abroad ; and what recommendations the committeehad made on the subject.—Mr. lAIN MACLEOD replied :The actual reference to the committee was made in December.I understand it is to be discussed in a few days. Mr. ROBINSON:Is the Minister aware that there are at least indications thattuberculosis is being imported into this country to a disturb-ing extent, and that the problem is not confined to aliensbut extends to British subjects from parts of the Common-wealth and Ireland ? ’.’ Will he introduce some measure of

urgency into this matter ? Mr. MACi-EOD : I do not quarrelwith what the hon. member has said. The wider questionshe raised are under discussion with the Ministry of Labourand the Aliens Department of the Home Office.

Fluorine Gas Inhalation

Dr. BARNETT STROSS asked the Minister of Health whatinformation he had of the ill effect on health from the inhala-tion of fluorine gas as a by-product of industrial processes.—Mr. MACLEOD replied : I have no evidence that such illeffects are occurring. Dr. STROSS: Is the Minister awarethat, in my constituency, in the neighbourhood of at leasttwo factories the glass of the factories is etched and renderedopaque, as is also the glass of many of the houses round about,

as a result of fluorides which come from the industrial

processes ? W’ould he consider going further into this matterand seeing that some research work is done so that we knowwhat is happening to human beings as well as to cattle’-Mr. MACLEOD: I am aware of the recent incident in whichfour or five cattle were poisoned in the constituency of thehon. gentleman, but that seemed to me to confirm the

investigation in 1949 by the Medical Research Council intoan incident in Inverness, which showed that though theremay be, and indeed is, danger to animals, there is no danger,so the M.R.C. advised the Minister then, to human life.

Dr. STROSS: But may I ask the Minister to go further intothe matter because there is a good deal of circumstantialevidence, which we cannot term strictly scientific, that harmcomes to human beings ? The right hon. gentleman has acouncil, will he ask them to look at it again ?

Mr. MACLEOD : As I have said, the M.R.C. have lookedat it, but I will draw their attention to what the hon.

gentleman has said.Smokeless Zones

Replying to a question Mr. HAROLD MACMILLAN, Ministerof Housing and Local Government, said that 12 localauthorities had obtained powers by local Acts for establishingsmokeless zones, but so far only 2 zones were in operation-at Coventry and Manchester. The 2 zones were limited inextent and sufficient time had not elapsed to enable the fulleffects to be assessed.

Dentists BillDr. STROSS asked the Minister of Health when he proposed

to reintroduce the Dentists Bill.-Miss HORNSBY-SMITHreplied: As soon as Parliamentary time permits, but Iam afraid that will certainly not be this session.

Spastic ChildrenIn answer to a question Miss FLORENCE HORSBRUGH,

the Minister of Education, said that there was no generalregister of spastic children, and she did not collect separatefigures for spastic as distinct from other physically handi-capped children. Educable spastic children might be sentby local education authorities to ordinary schools or to

special schools for the physically handicapped. There werefour special schools in England, of which three were main-tained by voluntary organisations and one by a local educa-tion authority, specifically for children suffering from cerebralpalsy, and a number of others made special arrangementsfor them.

Juvenile CrimeIn answer to a question Sir DAVID MAXWELL FYFE, the

Home Secretary, stated that provisional figures for 1952showed that at all courts in England and Wales 26,212children under the age of fourteen and 18,866 young personsaged fourteen and under seventeen were found guilty ofindictable offences. The comparable figures for 1951 were

28,578 and 18,895.

Voluntary Help for HospitalsSir GuY LLOYD asked the Minister what success was being

achieved by the encouragement he was giving to the greateruse of voluntary help for the hospitals.-Mr. MACLEOD

replied : It is too early to attempt to assess results, but signsof development are most encouraging, and I am confidentthat the hospitals and voluntary workers will continue to

cooperate further to the great advantage of the patients.Dental Estimates

Mr. EDWARD WAKEFIELD asked the Minister how manyestimates per week were received on the average from dentists

by the Dental Estimates Board ; and what was the numberof staff employed by the board to deal with these estimates.-Miss HORNSBY-SMITH replied : On the average 160,000 newestimates are received each week together with 40,000estimates submitted for a second time. The staff numbers926, some of whom are employed part-time. Mr. WAKEFIELD:Does the Minister agree that these figures indicate an excessivedegree of centralisation ?-Miss HORNSBY-SMITH: There is a

large sum of public money involved and the Minister feels that,the service is better controlled under one organisation.

Deaths from Coal-gas PoisoningReplying to a question -Air. MACLEOD said that during the

twelve months ended Sept. 30, 1952, 2356 deaths were regis-tered as due to poisoning by gas in domestic use. The trendin post-war years has been upwards ; but an enormous

proportion of the figures given—namely 1900-were suicidedeaths.