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stomach and poor efficiency. The speaker referredto the greater vitality of white people, the result oftheir higher protein consumption. Dr. WILSON pointedout that ordinary bean curd, which is an importantitem of Chinese dietary and regarded as akin to cheese,has 86 per cent. water and 14 per cent. solids (whichcontain 21 per cent. fat, 60 per cent. protein, and 6 percent. ash) as against our European cheese, which has38 per cent. water and 62 per cent. solids. In manyschools he found scarcely any protein or fat given, thediet consisting mainly of a little cabbage, white Chinesebread, white rice, and some salt and radishes.At the next session Dr. Wu LIEN TEH gave an
address on the Latest Phase of the Narcotic Problem,in which he showed figures representing the enormousincrease of morphine injection in China, brought aboutby unscrupulous Japanese traders and British andAmerican manufacturers. The amount had increasedfrom 5 tons in 1911,14 tons in 1914, to nearly 28 tons in1919. Both Edinburgh and London firms of highstanding were implicated, as was proved by samplesof covers which were shown. The Conference passeda resolution urging that immediate action should betaken for the better control of the production of opiumand for the limitation of the manufacture of morphiaand other derivatives to a quantity not exceeding thatnecessary for legitimate medical purposes.
The Rise of Scientific illedicine in China.On the last day of the Conference the members with
their wives attended a reception in the palace ofPresident Hsu Shihchang. The President addressedthem in a speech referring to the great humane workwhich they had done throughout China, and spoke withemphasis on the progress of Western medicine and thebenefit it could bring to the people. This was followedin the evening by a banquet at the Army MedicalCollege, where further complimentary speeches weremade.The Chinese Government has shown much apprecia,-
tion of the work which is being done, and a new era hasbeen entered in which scientific medicine and surgeryare no longer regarded with suspicion and animosity.The founding of the China Medical Board (the Rocke-feller Endowment), Hong-Kong University, Chinanfu,and other medical colleges, has brought about a realawakening. It is a movement which has come to stay,as evidenced by the numbers of Chinese students nowentering the medical profession. This Biennial Con-ference has brought to notice the part being played allover China by medical missionaries, British and
American, in the cause of medical education. It hasalso stimulated the delegates to further observation andresearch in a field which opens boundless opportunitiesfor useful contributions to present-day medicine.
MEDICINE AND THE LAW.
Sentence on a P1’ofessional bo.tionist.AT the Central Criminal Court recently, Mr. Justice
Shearman passed a sentence of ten years’ penalservitude on Devi Dayal Sasun, L.R.C.P. Edin., 1902, anative of India, practising medicine in the East End,for manslaughter. The indictment was for the murderof a woman whose body was found in an archway atnight near the prisoner’s house. The case for theprosecution was that the woman had asked Sasun toprocure her miscarriage, and that immediately after hehad operated on her with that intent, had died fromshock in his surgery. In order to conceal the crimehe had carried the body to the place where it was
found, and called the attention of the police toit, as though he had observed it casually in passing.The evidence of Dr. B. H. Spilsbury was to the effectthat the woman died from the shock of the operationas stated above, and that though such an occurrencewas rare, he had had experience of five similar cases.For the defence Dr. H. R. Andrews, Mr. ComynsBerkeley, and Dr. J. S. Fairbairn expressed opinionsadverse to that of Dr. Spilsbury, to the effect thatdeath from shock in such circumstances was so rare
that it must be accounted as out of the question that itshould have been caused by the operation in the casebefore the court.More might have been heard of this view if the con-
viction had been one of murder and not of man-slaughter. The latter verdict is not one strictly legalor logical, in that to cause death in the commission ofa felony constitutes the crime not of manslaughter butof murder. It is, however, sometimes found, and itgave occasion for the police to go into the prisoner’srecord and antecedents, which were of such a characterthat the question whether in this particular instance hisconviction was justified by the scientific evidence mustto him, at any rate, have become unimportant. Notonly was there another indictment on the file which wasnot gone into, but the police had found on Sasun’spremises documents which showed, when followed up,that he had procured, or had attempted to procure,abortion in a number of women. It need only bepointed out that a single conviction in one of these caseswould have rendered him liable to penal servitude forlife, and, as a matter of fact, conviction in all of them,with cumulative sentences averaging ten years in each,would have involved condemnation to penal servitudefor 1160 years!
A Remarkable ln?,postoi,.At Liverpool Assizes recently Mr. Justice McCardie
passed a richly deserved sentence of five years’ penalservitude upon a man named Richard Thomas Cubbin,who for many years and in various places has preyedupon the public with singular effrontery and equallyremarkable success. Cubbin was stated to have beenthe son of a collier and to have worked as such himself,losing a leg by an accident. Since 1895 he had livedmuch abroad and had practised as a medical man.He is a married man who, having deserted his wife,has gone through the ceremony of marriage withother women in order to rob them. In one instance hepersuaded the widow of a medical man who had diedat sea that he was her lost husband returned to herafter three years’ interval. His past sentences includedone of penal servitude for bigamy and another forposing as a medical man and giving certificatesof death. In the present instance the sentence wasfor forgery and giving death certificates, offencescommitted at Blackpool and Wigan. The epithetremarkable has been applied above to the success ofthis rascal’s operations, because he was stated at histrial to have obtained posts as an assistant to medicalmen not only under an assumed name, Sir AlexanderThomas Munro, not in the Medical Register, but underthe guise, unusual in such candidates, of a baronet, a"colonel-surgeon," a brigadier-general, and a K.B.E. ;combinations of these titles appearing upon cards usedby him. He even exhibited a coronet upon his
stationery. This last peculiarity on the part of an
alleged baronet may have helped to bring aboutCubbin’s undoing, but it is suggested that the otherimpostures, or any one of them, should have been
enough. Medical directories, medical registers, armylists, and books of reference containing the names ofbaronets, with other particulars about them, are fairlyaccessible everywhere, and can be consulted without anypossibility of hurting the feelings of a genuine candidatefor a vacant post.
Witnesses Under S1Lbpaena and Expe1’t Evidence.In an action tried recently in the High Court Mr. and
Mrs. A. Leuw sued Mr. W. A. Bulleid for damages foran injury occasioned by the drill used by him in pre-paring one of her teeth coming in contact with the fioorof her mouth. Severe haemorrhage took place, andquestions arose at the trial, not only with regard to themanner in which the accident was brought about, butalso with regard to the subsequent treatment of thewound. In the end Mr. Justice Bailhache awardeddamages to the plaintiff, with regard to the questionof negligence, on the ground that either the defendantallowed the carborundum wheel to slip, in which casehe would be liable, or that, assuming that the patientcaused the accident by swallowing while the wheel wasbeing used, the defendant ought to have Warned her notto do so, or requested her to notify him before doing so
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unless he could control her tongue in any case with the ’,mirror. The accident, it may be observed, is one to ’,which any dentist might at some time or other beliable, and the judge said expressly, in giving judgment,that although the evidence constrained him to findthat there was " negligence," it implied nothing againstthe defendant’s professional skill, or that there wasmore than a momentary lapse from caution on hispart. Dr. Hugh Woods has since written, as secretaryof the London and Counties Medical Protection Society,to point out, with justice, that extreme rarity in theoccurrence of an accident is no proof that when it doesoccur it was the result of negligence.A point of some interest with regard to medical
witnesses was raised, however, in the course of the caseby Sir Herbert Waterhouse, who was called on behalfof the plaintiffs, having been consulted by Mrs. Leuwfour days after the accident took place. Sir HerbertWaterhouse explained to the judge that he had beensummoned to give evidence under a subpoena, and sub-mitted that in the circumstances he had the rightto restrict his evidence to facts observed by him andto refuse to answer any questions intended to elicitfrom him an expert opinion as to the treatment ofthe plaintiff by the defendant. The judge expressedhis appreciation of the point raised, but it is to beobserved from the report of his evidence that SirHerbert Waterhouse did, in fact, express certain
opinions as to the probable nature of the wound andas to what was said to have been done to arrest the
haemorrhage. The question suggested would appear tobe,
" Can a witness, a medical man who has observedcertain conditions in a patient and has been subpoenaedto attend at a trial and to give evidence with regard tothem, be compelled further to express opinions as anexpert upon matters not within his actual experienceaffecting his patient’s condition?" In other words, in acase such as the one under discussion, having entered thewitness-box in obedience to a subpoena, can he be obligedto criticise the treatment given by another practitioner ?He might, no doubt, be very glad to refuse, and itwould be convenient if it were recognised by the courtthat he was at liberty to do so. We doubt, however,whether the witness in the circumstances indicatedcan do more than Sir Herbert Waterhouse did-namely,protest, leaving the judge to make any comment that theoccasion, in his lordship’s opinion, may demand. Wedo not find any precedent for a witness on subpoenabeing regarded as distinct from other witnesses. Thequestion whether a witness is one who can rightly beasked to express an opinion is always one for the judge.A witness in the position in which Sir Herbert Water-house was placed can explain, if he feels that he oughtto do so, that he has not had such an opportunityto become acquainted with the facts as would
qualify him to express an authoritative opinion uponthem. The judge would, no doubt, give weight toan objection so raised; but we doubt if such a witnesscan have any right or privilege of refusing his evidenceat his own option. It may, however, be pointed outthat the occasion is not likely often to arise. With
expert witnesses of other kinds it is likely to do sovery seldom. With them and with medical men anobvious observation would apply. Expert witnesses arecalled to support the side which calls them, and areusually prepared to do so, having carefully studied thefacts which others will prove. Counsel do not askquestions, particularly of their own witnesses, by whoseanswers they are bound, unless they are pretty sure ofthe nature of the answer that will follow. A prudentman, to use an advocate’s phrase, does not fire off hisgun unless he knows how it is loaded. Consequently, amedical practitioner who has kept strictly to himselfhis opinions on a given subject is not likely to be askedfor them in the witness-box or to be pressed to givethem if he shows himself reluctant in doing so. Itmust be remembered that we are here speaking of awitness who has attended unwillingly in obedience to asubpoena, and of his evidence in chief. In cross-examina- !,tion he would be liable to be asked for opinions if itwere believed that the replies would be favourable tothe side putting the questions.
CONTROL ()F VENEREAL DISEASE.
The Increase in Ophthalmia Neonat01’ll1n and itsSigni ficance.
THE significance of the increase in the notificationsfor ophthalmia neonatorum cannot be overlooked. In1918 the total number of cases notified was 6532, in 1919it was 8548. Taking the figures for successive quartersof the year- 1919-namely, first quarter 1413, second2036, third 2353, fourth 2746-we note a steady increaseduring the year. We may well ask whether maternalgonorrhoea has increased in this proportion. It wouldbe enlightening to discover how many of these motherswere under treatment for gonorrhoea before the birthof their children and whether they were known to beinfected or not. When these facts are known, it stillremains to inquire if the simple precautions necessaryto safeguard the infant’s eyes at the time of birth weretaken, and if not why not.
The Manchester Early Treatment Cent1’e.The report of Dr. W. A. Young, assistant M.O.H. for
Manchester, on the result of the first three months’ workof the Venereal Disease Early Treatment Centre formales in that city is of considerable interest. Duringthat period 1016 attendances were registered, 708 personsreceived treatment and 117 were referred to differentclinics in the city. At first, treatment was given toevery individual who applied for it within two days afterexposure to risk, but those applying late were warnedthat treatment could not be relied upon to prevent,after so long a period had elapsed. From Jan. 5thonwards no treatment was administered when morethan 24 hours had elapsed from the risk of infection.Later it was laid down that no treatment would be givenafter an interval of 12 hours. One point already broughtout is this: there seems no reason for believing thatindividuals have, to any marked extent, been instigatedto take fresh risks, inasmuch as there have only beentwo instances of habitual frequenters of the centre. Wehope that the Ministry of Health will consent to therequest for this centre to continue its work, and willgive the desired permission for another to be opened.The cost per head has worked out at 2s. 0. Trulythis is a small sum when it is realised what the averagepatient suffering from venereal disease costs the com-munity through loss of work, apart from maintenancein hospitals, asylums, or infirmaries. We reiterate our
plea for the establishment of a similar experimentalearly treatment centre in London.
Report for 1919 on the T1’eatment of Venereal Di3eases inBi1"1ningharn.
A report prepared by Dr. J. Robertson, M.O.H. forBirmingham, shows a considerable increase during theyear 1919 in the number of venereal cases coming fortreatment. It is difficult to say whether the maximumhas now been reached, but there is some suggestionthat it was reached during the third quarter. Asregards gonorrhoea, there were during the year 1399new male cases and 187 female cases, as compared with685 and 118 during 1918. The total number of attend-ances were 11,925 for males and 1531 for females. For
syphilis the new cases were 782 males and 459 females,as compared with 603 and 41 for 1918. The totalattendances were 10,433 for males and 6881 for females;8373 doses of salvarsan substitutes were given. The
figures for gonorrhoea suggest that the number of casescoming for treatment are not as numerous as theyshould be, especially in the cases of females. Anunsatisfactory feature is that nearly one-half thepatients cease attendance before the completion oftreatment. The present facilities provided are: (a) formales, five clinics weekly, staffed by nine medicalofficers at the General Hospital, and two evening clinicsat the Skin and Urinary Hospital, staffed by two medicalofficers. In addition, attendances are made at othertimes for injections and irrigations. A whole-timeorderly is present at each centre. (b) ’For females, theGeneral Hospital provides three clinics weekly, staffedby two medical officers, the Skin and Urinary Hospital