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,the Grape Juice Co., 7, Great Tower-street, London, E.C., I’had very interesting exhibits, as did also Messrs. Schweppes, I,Limited, 64, Hammersmith-road, London, W., Bendles MeatIPort Syndicate, 41, Seething-lane, London, E.C., and theAngier Chemical Company, 32, Snow-hill, London, E.C.Messrs. Scott and Bowne, 10, Stonecutter-street, London,1E.C., showed their well-known Scott’s Emulsion. Mellin’s.Food Company were represented and the Aylesbury Dairy Co.,Limited, St. Petersburgh-place, Bayswater, London, W., had,a large exhibit, including various kinds of Koumiss. Driedmilk was represented by the Glaxo Company, St. John’s.House, Minories, London, E.C.

Messrs. Down Brothers, Limited, 21, St. Thomas’s-street,.London, S. E., showed a fine collection of surgical instruments. and apparatus for diagnosis and general operative surgery,more especially for tuberculous lesions. An exhibit which,attracted some attention was the "Patent Zymotic FaceiProtector," a shield made of aluminium with a transparent,window designed to protect the face of the medical.attendant or nurse from infectious matter or involuntary. expectoration in diphtheria, fever, and other cases. Thiswas shown by Messrs. Garrould, 150, Edgwareroad,il,ondon, W.

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MEDICINE AND THE LAW.

Accident Ins1wance and Pneumonia Res1Ûting from a H1mtin,qAccident.

A CASE of considerable medical and legal interest recentlyoccupied the attention of the Court of Appeal. The personalrepresentative of a deceased gentleman named Etherington- claimed against the Lancashire and Yorkshire Accidentinsurance Company under a policy insuring the holderagainst accidental death only. Difficulty arose as

Fto the interpretation and application of the phrasesused in the policy with the intention of limiting its’benefits to death by accident, and the arbitrators towhom the dispute was referred stated a case upon which

- argument took place before Mr. Justice Channell, who- decided in favour of the claimant under the policy, a deci-sion which has now been upheld. The terms of the policysecured payment of 1000 if the deceased "should sustainany bodily injury caused by violent, accidental, external, and’visible means," if it should within three calendar months,from the occurrence of the accident causing such injurydirectly cause the death of the insured." The policy also- contained this stipulation : " Provided always and it is herebyas the essence of the contract agreed as follows : That this.policy only insures against death where accident within themeaning of the policy is the direct or proximate cause thereof,’but not where the direct or proximate cause thereof is diseaseor other intervening cause, even although the disease orother intervening cause may itself have been aggravated bysuch accident, or have been due to weakness or exhaustionconsequent thereon, or the death accelerated thereby." The

’history of the case as set out by the arbitrators was that thedeceased suffered from influenza late in January butrecovered, and on Feb. 13th went hunting, as to which theyfound as facts that neither the influenza nor the ordinaryexposure of driving to the meet and riding to hounds causedhim to suffer any ill effects, but that about 12.30 P. M. hewas thrown when jumping a fence in which was a hiddenstrand of wire. He fell heavily on his ’left shoulderand side, getting wet to the skin at the -same time, butsuffered no "trauma or wound to the body or lung." Heafterwards rode home, meeting his second horse in thecourse of the ride and proceeding homewards upon it at atrot, so that he arrived about 2 P.M. The arbitrators foundthat he thus took the best course and one rendered inevitable

by the accident, but. that the effect of the shock was tolower his general vitality, and that the ride home lowered itstill further. They proceeded to find further that "thecumulative effect of both these causes, but not the effect cfeither exclusively of the other, was to lower the generalvitality of his body to an extent which made the onset ofthe pneumococcus possible and that onset thereupon ko’"place one and a half hours after the accident. The pneumo-coccus is the germ which causes the disease known as

pneumonia." The arbitrators further sketched in accordancewith the medical evidence before them the course of develop-

i ment taken by pneumonia in terms which will be found in

the Tirnes of Feb. 5th, whence the above extracts have beenquoted, and went on to state that "on Feb. 14th the assured,against the opinion of his medical attendant, being still ingreat pain, took a journey occupying one hour and a half bytrain to London. He then transacted his business until 6 P.M.when he developed the first physical signs of pneumonia."The arbitrators further " found as facts " that the deceasedat 6 P.M. on Feb. 14th was suffering from fully developedpneumonia, frum which he died on Feb. 20th, and that "thejourney to London and a day’s work in the condition inwhich he then was tended to, and as a fact did, impair hisvitality still further and diminish his resistance to thepneumococci, so increasing the severity of the attack." Thequestion for the court was whether the above findingsentitled the plaintiff to recover under the terms of thepolicy. Mr. Justice Channell, before whom, as has beenstated, the matter was first argued, held, though not withoutdoubt, that the findings had brought the facts of the casewithin the terms of the policy, and that the death was causedby an accident within the meaning of the policy, and gavejudgment accordingly for the plaintiff. Against this judg.ment the company appealed and after argument on bothsides it was affirmed by the Court of Appeal. Lord JusticeVaughan Williams in delivering judgment was of opinionthat the policy was not easy to construe, but helaid emphasis on the principle that in interpretingany really ambiguous clause in a policy of insur-ance of any kind the construction should be againstrather than in favour of the insurance company. Hepointed out that to uphold the contentions of the companywould tend to limit accidental death under such a policyto what he termed " death on the spot," and he upheld theview of Mr. Justice Channell that the " disease or other inter-vening cause " meant something new and independent of theaccident. Be did not agree with the contention that the

intervening cause might be dependent or independent. "Theappellants contended that it meant some new cause, but thatit mattered not whether it was dependent or independent.He did not agree with that. When it was a dependent causeone had a right to say that the direct or proximate causedid not consist merely of the immediate results of the acci-dent but included all those things which could fairly be con-sidered as the usual attendant results of the partioularacei-dent in question ........ "He thought that it was impossibleto limit the proximate cause of death to one fact of theaccident. The truth was that an accident ordinarily accord-ing to its nature produced certain consequences, and if deathresulted as the final step in those consequences the wholetrain of events was the proximate cause of the death which

! resulted. In his opinion intervening cause’ in the policymeant a cause independent of the accident and its ordinarycon-

! sequences. Notwithstanding the fact that it would be natural. to construe the words ’ weakness or exhaustion consequentthereon’ as covering a case where weakness or exhaustion wasibrought about by the accident itself, he was of opinion that in; the policy those words ought not to be so construed." Lord; Justice Farwell and Lord Justice Kennedy delivered judg-t ments to a like effect and the appeal was dismissed. The

importance of the case to the medical profession lies in the

full recognition accorded by it to the evidence of medical

1 experts and to statements as of fact founded upon the recentdiscoveries of medical science rather than upon specifici observation of the phenomena described in the subject of ther inquiry. 20 years ago in the case of Isitt and Others v. Thet Railway Passengers Assurance Company (22 Q. B. D. 504) ae claim was made under a policy providing against "deathe from the effects of injury caused by accident," where a mana had suffered from an accident which dislocated his shoulderd and had died from pneumonia. According to the descriptione of his case then laid before the court he had been made weako and susceptible to cold and had caught cold."

" It was held.t that the executors could recover because the policy drew ae distinction between the accident and its effects, that itf implied that the injury must be caused immediately" byfl the accident, but that the death need not be " imme-)f diately " caused by the accident. This decision, as was’< suggested in argument in Mr. Etherington’s case, was

)- probably responsible for the wording of the policy granted toits him, and it very nearly lost to his representative the benefit;e which he intended to secure. Perhaps if he had fully3- understood the possibility of death following a huntingn accident in the manner in which, it afterwards occurred to

643

himself and the interpretation which the company wouldendeavour to put upon the clause in question he would haverefused to take the policy.

The Ed1wation of the Mentally Defective.An interesting test case with regard to the education of

mentally defective children was tried in Birmingham theother day. The parent objected to his child being forced togo to one of the council’s special schools for mentallydefective children. He urged that the child was not mentallydefective and was receiving proper education at a privateschool. It was proved that the child was mentally defectiveand suffered from word-blindness, and it was shown that thefather was not in a position to provide the child with a tutor.On the evidence it was decided that the child must attend aschool selected by the parent and approved by the authori-ties, or failing such selection by the parent the child mustattend a school selected by the authorities.

Public Health.ANNUAL REPORTS OF MEDICAL OFFICERS OF HEALTH.

Maldon Ritral Di8t’l’ict.-Dr. J. C. Thresh, in his recentannual report, furnishes a sort of retrospect of the progressmade in this district during the 20 years for which he hasbeen medical officer of health, and especially in the matterof water-supply there is every reason for congratulation.This rural district council is one of the very few districtcouncils which have attempted to deal with the housing ofagricultural labourers by erecting cottages under the Housingof the Working Classes Act. Six cottages were, Dr. Threshstates, erected as cheaply as the requirements of the LocalGovernment Board would allow. The rents amount to54 12s., and the repayment of the loans and expenses to&pound;96 15s. 9d., leaving a balance which calls for a rate of2 3/4d. in the E. In another 26 years this loan will be repaidand the rents may, it is thought, relieve the rates by 2d. in the E. Notwithstanding this, Dr. Thresh thinks that the

experiment is not sufficiently satisfactory to justify the erec-tion of further houses unless it can be done with greaterfacility and the repayment of the loan extended over

a longer period. He does not, however, tell us much aboutthe construction of these cottages or the period over whichrepayment has been spread-probably it is 60 years.Apparently houses were erected at a less cost at Tiptree,the cost per cottage ranging from &pound;162 on light land to &pound;180on heavy land (the cost of land excluded in each instance).If the cost of land were included Dr. Thresh estimates thecosts at .&182 and .B200 respectively, and after comparingtotal costs, rental and rates, he concludes that 12 cottagescould be erected on the Tiptree lines for the same annualcost to the parish as six cottages on the Bradwell type. Itwould have been useful had Dr. Thresh specified the differ-ences between the two cottages and told us how, if at all,the local by-laws, if any, affected the situation. As it is, itis difficult to determine whether the data are strictly com-parable or whether cost of land, materials, and labourdiffered. However, Dr. Thresh thinks that the action of thedistrict council in erecting the Bradwell cottages exercised agood effect in that it stimulated private enterprise andthe provision of 12 cottages. A similar stimulus appearsto have been given in the Chelmsford rural district by athreat made to erect cottages under the Housing of theWorking-Classes Act. Dr. Thresh again returns to the questionof isolation hospitals, reiterating some of the comments con-tained in his last annual report. The existing isolation hos-pital had, he states, cost between E400 and E500 per annum,an expenditure which would, he says, enable the districtcouncil to build 60 to 120 excellent cottages. This district isin the proper season visited by pea-pickers who apparentlygive rise to some trouble. Dr. Thresh does not think thatby-laws would be of any avail in helping to control thesewanderers, although he is of opinion that the contractorsshould be compelled to provide some little accommodationfor the workpeople. We do not quite follow Dr. Thresh’scontention in this matter, as our experience suggests thatby-laws may be of some value. The utility of the LondonCounty Council (General Powers) Act, 1907, was illustratedin this district during 1908 by the detection of suspiciouscases of tuberculosis in one of the cowsheds.

Chchnafnrd Rural Distract.--In the annual report relativeto this district Dr. Thresh draws attention to the difficultywhich sometimes exists im providing cow’s milk for theinhabitants of rural districts, and this notwithstanding thefact that milk is sent to London therefrom. He points outthat milk may be sent to London from a farm and yet thepeople living near may be using tinned milk producedabroad. This difficulty is not confined to the Chelmsfordrural district and it is one which is worthy of general con-sideration. Pea-pickers are also a trouble in this district andthey are found sleeping in granaries, open sheds, andmangers, while in one instance married quarters were pro-vided in a cleaned-out pig-sty.

Short Heath Urban -District.-Mr. John T. Hartill reportsthat the education committee of the county council, which isthe education authority for this district, has issued regula-tions for the guidance of managers and teachers under itscontrol, and it would appear that certain of its regula-tions are not in harmony with the views held by Mr. Hartillrelative to the control of measles and whooping-cough. Mr.Hartill points out that the statute which brought about themedical inspection of school children does not conferpowers in supersession of those heretofore exercised generallyin a public health sense by sanitary authorities under pre-vious enactments," and he proposes, we gather, to get the-regulation with which he is not in agreement altered, sincehe regards it as unworkable. We are afraid that differencesof opinion such as the one here in question are hard to avoidwhere one person regards disease from the point of view ofthe whole community, and the other from that of the schoolor scholars only, but they may be largely avoided by friendlyconference between the local and county medical officers ofhealth.Buckingham, Rural District.-Buckinghamshire is an im--

portant milk-producing county and consequently all legisla-tion directed towards the greater purity of this importantcommodity has interest for the medical officers of health ofthe county. Dr. P. L. Benson, in referring to the powerspossessed by the London County Council of taking samples ofmilk at the metropolitan railway stations, expresses the

opinion that the price of milk must be raised by allrestrictions which tend to augment the cost of productionand that if the public demands a perfectly clean milk itmust be prepared to pay an enhanced price. This is

theoretically sound, but as a matter of fact competitionwill result in keeping prices very much where they are, asthe cost of elementary cleanliness is, after a proper routinehas been firmly established, not very great. Dr. Benson hashimself brought about a marked improvement in certain ofthe cowsheds in his district, as is shown by the photographswhich accompany his report. Attention is drawn in the

report before us to a matter which certainly requires atten-tion. According to Dr. Benson the milk producers are notallowed to fasten or to seal their churns or vessels in whichmilk is sent to London, and if this is so the milk may betampered with and polluted after it has left the producer.Whether Dr. Benson is correct or not in this estimation ofthe attitude of the railway companies there is no doubt as tothe necessity for better control of milk churns during passage-by rail. It is a common event to see the milk splashed overthe lids during movements on the platform and it is rare tosee the covers properly sealed. We were under the impres-sion that some of the railway companies raised no objectionto sealing provided the tare" " of the cans is duly marked on-them so that the contents can be ascertained by weighingand possibly Dr. Benson may be able to effect some improve-ment in this direction.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8921 births and 5709deaths were registered during the week ending Feb. 20th.The annual rate of mortality in these towns, which hadbeen equal to 18 &deg;’7 and 17 - 5 per 1000 in the two pre-ceding weeks, rose again to 18. in the week undernotice. During the first seven weeks of the current quarterthe annual death-rate in these towns averaged 17 ’ 4 per 1000,and in London the mean rate during the same period wasequal to 17 - 8. The lowest recorded annual death-rates inthese towns during last week were 8 - 4 in Walthamstow, 9 - 3