390 MEDICINE AND THE LAW.

.E s. d.Western Dispensary..................... 62 16 3Western General Dispensary ............... 104 1 3Westminster General Dispensary........, ...... 46 17 6

Whiteuhapel Provident Dispensary ............ 32 16 3Woolwich Provident Dispensary ............... 24 7 6

NURSING ASSOCIATIONS.

Aldgate Freedom ..................... 5 0 0

Aldgate Lordship ..................... 5 0 0Belvedere and Abbey Wood.................. 5 0 0Brixton ........................... 20 0 0Central St. Pancras ..................... 15 0 0

Hackney ........................... 20 0 0Hammersmith and Fulham.................. 35 0 0

Hampstead ........................ 15 0 0

Kensington ........................ 40 0 0Kilburn...................., ...... 15 0 0

Kingston........................... 30 0 0

Metropolitan (Bloomsbury) .................. 50 0 0St. Olave’s (Bermoudsry) .................. 30 0 0

Paddington and Marylebone ............... 35 0 0Plaistow ........................... 85 0 0Rotherhithe ........................ 10 0 0Shoreditch ........................ 55 0 0

South London (Batteroea)... ... ... ... ... ... 45 0 0Tottenham ........................ 5 0 0Southwark ........................ 30 0 0South Wimbledon ..................... 15 0 0Westminster ....................... 25 0 0Woolwich, Plumstead, and Charlton ............ 30 0 0East London ..................... 150 0 0North London ........................ 50 0 0London District ..................... 360 0 0

MEDICINE AND THE LAW.

Infection from Milk.DURING recent years several outbreaks of infectious disease

have been traced to milk which has been shown to be themeans of spreading such diseases among the persons whoconsume it. Scarlet fever is one of the distases mostcommonly spread in this way. It is clear that the germs otthat disease occasionally fiad their way into milk and theyseem to thrive in it. These germs may get in either becausesome person suffering from scarlet fever has been milking thecows or has otherwise been brought into contact with themilk, and it has also been thought that the disease may becaused by the animal being itself the source of infection.In the case of a recent outbreak the source was tracedto the farm from which the milk came, when it was foundthat one of the household was suffering trom scarlet fever, andthe farmer was unaware of the fact until the medical officerof health arrived on the scene from the district in which theinfection had been spread. Besides scarlet fever there areother diseases, the germs of which grow and are conveyedin milk. Of these, typhoid fever, tuberculosis, and diph-theria appear to be the chief. The germs of typhoid feverusually find their way into milk from the water which iseither used to wash the vessels into which the milk is put,or is added for the purpose of dilution. Much, of course,can be done to prevent the spread of infectious disease frommilk by having the dairies and cowshe is kept thoroughlyclean and well ventilated, and this can be effected by thesanitary authorities acting under the orders made pursuantto the Contagious Diseases (Animals) Acf., 1886, Section 9which was not repealed by the consolidating Act of 1894.Experience, however, has shown that even these powers arenot sufficient to check the spread of infection, and there areadditional powers in Saction 4 of the Infections Disease(Prevention) Act, 1890, and also as regards London inSection 71 of the Public Health (London) Act, 1891. It isquestionable, however, whether these powers are sufficientStatutes can afford assistance in two wa s. They can conferon the medical officers of health powers of inspection andof obtaining information, and they can also enable them tostop the supply coming from an infected dairy until thecause of infection has been removed. Section 4 of theInfectious Disease (Prevention) Act, 1830, enacts that incase the medical officer of health is in possession of evidencethat any person in the district is suffering from infectiousdisease attributable to milk supplied within the districtfrom any dairy situate within or without the district, or

that the consumption of milk from such dairy is likely to causeinfectious disease to any person residing in the district, suchmedical officer shall, if authorised in that behalf by an orderof a justice having jurisdiction in the place where such

dairy is situate, have power to inspect such dairy, and itaccompanied by a veterinary inspector or some other properly

qualified veterinary surgeon to inspect the animals therein.If on such inspection the medical officer of health shallbe of opinion that infectious disease is caused from con-

sumption of the milk supplied therefrom, he shall reportthereon to the local authority and his report shall be accom-panied by any report furnished to him by the said veterinaryinspector or veterinary surgeon, and the local authority maythereupon give notice to the dairyman to appear before itwithm such times not less than 24 hours as may be specifiedin the notice to show cause why an order should not be maderequiring him not to supply any milk therefrom within thedistrict until such order has been withdrawn by the localauthority. If in the opinion of the local authority he failsto show such cause then the local authority may make suchorder as aforesaid ; and the local authority shall forthwithgive notice of the facts to the sanitary authority and countycouncil (if any) of the district or county in which such dairyis situate and also to the Local Government Board. Anyperson refusing to permit the medical officer of health on hisproduction of such order to inspect any dairy, or if so accom-panied to inspect the animals kept there, or if after anysuch order not to supply milk has been given supplying anymilk within the district in contravention of such order, shall bedeemed guilty of an offence against this Act. The order is tobe withdrawn immediately the cause of infection is removed.The word "dairy" includes any farm, farmhouse, cowshed,milkstore, milkshop, or other places from which milk issupplied or in which milk is kept for purposes of sale, and"dairyman" includes any cowkeeper, purveyor of milk, oroccupier of a dairy. A medical officer of health, if hesuspects that milk is the cause of the disease, will act on bis.own initiative without waiting for a justice’s order. Itwould be an advantage if local authorities had the power toobtain a list of customers from a dairyman whose milk issuspected ; they would then be able more easily to tellwhether or not the milk was the actual cause of the disease..It will be noticed that in the section above quoted the localauthority can only stop the dairyman from sending milk intoits own district. There is nothing whatever to preventhim from sending it into any other urban or rural district inthe country. No doubt the proper remedy is to stop the saleof the infe,-ted milk entirely. This might be done either bythe sanitary authority of the district or by the Local Govern-ment Board. It woulrl seem, therefore, that if anyamend-ment of the law is required it should be in the direc.tion of giving the medical officers of health greaterpowers to discover the source of infection, so that ifit is due to milk they should learn the fact at once

and immediately inform the purveyor. Urban and ruraldistrict councils are the local authorities charged with

carrying out and enforcing the Dairies, Cowsheds, and Milk-shops Order of 1888 made by the Privy Council, the powers ofwhich in this respect have since bet n tran-ferred to the LocalGovernment Board. Under these orders the council is

required to keep a register of persons carrying on the tradeof cowkeepers, dairymen, or purveyors of milk, and personscarry ing on those trades without being registered are liableto penalties. A person, however, who only keeps cows or adairy for the purpose of making and selling butter or

cheese and not for selling milk is not treated as a cowkeeperor dairyman for this purpose. If disease exists among the:cattle in a dairy or cowshed or other place the milk of adiseased cow is not to be mixed with other milk, or sold orused for human food or (unless it has been boiled) sold orused for the food of swine.

Actions against Medical Aren by their Patients andVice Versd.

From time to time medical men struck by the obvioushardship ot an action brought against a member of their

profes-don by a former patient suggest in the public press-that the case should sometimes be reversed and that anaction should be brought by a medical man on account ofsuffering resulting to him in the pursuit of his practice.We have ourselves received letters to this effect andone recently a,ppeared in the Pall Mall Gazette,signed "M.D.," which contained the following passage: --" In a case in which a medical man has undoubtedlycaught, say, scarlet fever, from a patient, conld that patientbe sued for damages by the medical attendant under theEmployers’ Liability Act? It seems to me-not being versedin the law-that this suing game can be played by bothsides, doctor and patient." To many the answer will beobvious, but to others wholike "M.D." are not as "versed

391BRITISH MEDICAL BENEVOLENT FUND.-ASYLUM REPORTS.

in the law as every man by law is assumed to be, we maypoint out that the liability of the medical man towardshis patient, upon which actions are brought such as thatof Crierv. Hope and Currie, commented upon in THE LAKCETof July 28th, is based upon allegations of " negligence." Inother words, it is as necessary that negligence should beproved to the satisfaction of a jury in an action of thiskind against a medical man in order to constitute a " causeof action as it is when one man sues another for runningover him in the street. If the running over is a pure acci-dent-due, for example, to a horse bolting through beingfrightened by lightning-there is no liability, and justly so.The Employers’ Liability Act is referred to in the passagequoted, so we may add that the Employers’ Liability Actand the Workmen’s Compensation Acts provide in certainclasses of employment and in certain defined circum-stances that an employer shall be liable for injuries sus-

tained by his servant in the course of his employment,when under the common law no such liability would exist.For example, these Acts, where they apply, may enable aservant to sue his employer on account of injuries caused bythe negligence of a fellow servant. An employer is liable tostrangers at common law for injuries caused to them by hisservant’s negligence in the course of his employment, aseverybody knows, or should know, but not when one

servant injures another in the same employment. Weneed hardly point out that the relations of a patientto his medical man are not those of master and servant.Injury arising to a medical man from attending upona patient can rarely arise through negligence on thepart of the latter only, without any intention of runninga risk on the part of the former, and there wouldbe plenty of occasion at the trial of such an actionfor the airing of the well-worn legal saying, "Volentinon fit injuria," which might be applied generally by sayingthat those who enter of their free will into a dangerous pro.fession must accept the perils which arise out of it. Theymust endure without complaining such personal sufferingas may be the natural result of what they have undertakerto do.

BRITISH MEDICAL BENEVOLENT FUND.

AT the July meeting of the committee 22 applicationswere considered and grants amounting to S161 were votedin relief, one case being postponed for further inquiries.Appended is a short abstract of the cases assisted :-Daughter, aged 54 years, of late M.R.C.S. Eng., L.S.A., who prac

tised in Bucks. Used to be a governess but is now unable to teach onaccount of deafness and can only earn a few shillings a week by needle-work. Relieved five times, B56. Recommended by Lady Milbank.Voted £10 in ten instalments.Widow, aged 50 years, of M.R.C.S.Eng., L.S.A., who practised in

London. No income; indifferent health; no children. Quite un-provided for at husband’s death a few years ago. Relieved twice, ,E24.Recommended by his Grace the Archbishop of York. Voted ,E12 in 12instalmeuts.Widow, aged 62 years, of L.R.C.P. Lond., L.R.C.S. Edin., who prac-

tised iu London. No income; only son, aged 42 years, is barely able tosupport himself on account of mental weakness. Earns a few shillingsa week by needlework. Husband’s means exhausted by six years’ ill-ness before death. Recommended by Mr. Percy Warner. Voted £10in ten instalments.Daughters, aged 68 and 65 years respectively, of late L.R.C.P.,

L.H.C.S. Edin., who practised in Scotland. At father’s death, 22 yearsago, the younger sister obtained a certificate for teaching and for 22years has been head mistress in a State-aided episcopal school but isnow obliged to retire (on account of age) with a pension of -E20 perannum. The elder sister is living with her, attending to the house-hold duties, and has assisted for many years in the charge of a residentpatient. Recommended by Sir Hector Cameron. Voted ;E18 in 12instalments.Daughter, aged 48 years, of late M.R.C.S.Eng., who practised in

Oxfordshire. Income less than C8 a year and since her father’s deathsome years ago has supported herself by taking situations as servant,&c., but has now had an accident by which she is temporarily in-capacitated. Recommended by Miss Kingslake. Voted 25.Widow, aged 54 years, of L.K.Q.C P. Irel., who practised in Bucks.

Practically unprovided for at husband’s death. Has endeavoured toestablish a nursing home and is now trying to obtain situation as acompanion. Recommended by Dr. William Travers. Voted £5.Daughter, aged 21 years, of late L.R.C.P., L.R.C S. Edin., who prac-

tised in Jamaica. Has been obliged to give up a situation as draper’sassistant on account of severe dyspepsia and nervous exhaustion fromcarious teeth. Is advised to have 23 teeth extracted and replaced byartificial ones and asks for help to get this done. Recommended by Mr.Edward East and Mrs. Evelyn Martin. Voted .B6.Widow, aged 46 years, of L.S.A., who practised in London. Quite

unprovided for at husband’s death two years ago. Small earnings tromneedlework; ill-health and bad sight. Two sons, aged 19 and 14 years

respectively, barely self-supporting. Itelieved once, -E12. Recont-mended by Dr. J. A. Ormerod. Voted B14 in 13 instalments, JE2 beingan emergency grant.Widow, aged 52 years, of M.B. Cantab., when practised in London.

No provision at husband’s death five years ago and has supportedherself with a little help from this Fund and from friends and bywashing and other work. Five children, of whom three are in domesticservice, one a boy, earning 6s a week is an apprentice, and the iitth,a daughter, aged five years. Relieved three times, -E41. Itecommendedby Mr. J. Roche Lynch. Voted £12 in two instalments.Widow, aged 55 Bears, of L.R.C.P. Lond., L.R.C.S IreI., who

practised in South Wales. At husbaud’s death a few years ago had;E50u iusurance money but has spent a considerable portion of this tomaintain and educate a daughter, who is studying cookery andlaundry work, with a view to teaching these subjects under a countycouncil. Ekes out small income from the remainder of her capital by

letting lodgings and the help received from a Masonic fund. Relievedonce £5. Recommended by Dr. A. Sheen, vice-president. Voted E5.

Daughter, aged 37 years, of late M.K.C S.I:ug., L.S.A., who prac-tised in Staffordshire. Endeavours to support herself by literarywork. Indifferent health. Relieved once, £12. Recommended byDr. J. Pickett. Voted 25.Daughter, aged 58 years, of late M.R.C.S. Eng., L.S.A., who prac-

tised in Warwickshire. Supported herself for many years as a

dispenser but now finds it impossible to get work on account of herage. Only income about B15 a year, being the interest on savings.Relieved once, -E1O. Recommended by Dr H. F. Haynes. Voted £10in ten instalments.Widow, aged 35 years, of M.R.C.S Eng., L R.C.P., who practised

in London but was incapacitated for some years before death.Applicant maintains herseif as a working housekeeper but has beenrecommended to have a short rest. Two children, aged 15 and 11years respectively. Relieved twice, .E20. Recommended by Mr. S. H.Byam. Voted £5. ’

Daughter, aged 56 years, of late M.R.C.S. Eng., L.S.A., who prac-tised in Hants. Income B15 a year and receives a little help frombrothers. Endeavours to earn a few shillings a week by needleworkbut finds her eyesight is failing. Relieved once, £6. Recommendedby Dr. W. R. Grove. Voted k6 in two instalments.Daughter, aged 2b years, of late M.D., who practised in Middlesex.

Unable to earn her living on account of ill-health and dependent on amother with a very small income. Relieved once, £10. Recommendedby Dr. H. A. Sansom. Voted £5.Daughter, aged 59 years, of late M.R.C.S.Eng., L.S.A., who prac-

tised in Hampshire. Used to be a governess but unable to obtainpupils any longer. Tries to supplement a pension of £20 per annumfrom a charity by letting rooms. Relieved nine times, e78 Recom-mended by Sir Constantine Holman, vice-president. Voted £3.Widow, aged 50 years, of L.S.A., who practised in Notts. At

husband’s death, nearly 20 years ago. applicant trained as a maternitynurse with the aid ot a grant given by this fund and has supportedherself ever since, but two years ago invested her savings in a registryoffice, which has not been a success. Two daughters, aged 21 and 17ears respectively, barely self-supporting. Relieved once, 212.Recommended by Mr. Edmund Owen, vice-president. Voted £ 6.Widow, aged 66 years, of M.D. St. And., M R C.S. Eng., who prac-

tised in London. No income and dependent on children. Relievedfive times, E66. Recommended by Mr. E. Parker Young and by Mr.H. W. Kiallmark. Voted £12 in 12 instalments.Widow, aged 60 years, of L.It.C.P. Edin., L.F.P.S. Glasg. Dependent

on a pension of -E20 a year from a charity and occasional help from a.son earning a small weekly wage Relieved nine times, .E96. Recom-mended by Dr. F. W. Tatham. Voted £10 in ten instalments.

Daughter, aged 50 years, of late M.R.C.S. Eng., L.S.A., who practisedin London. Has supported herself for 30 years by nursing but is nowincapacitated by ill-health and dependent on a niece who lets lodgingsto maintain herself and a consumptive brother. Relieved twice, £15.Voted k2 as an emergency grant, the case to be considered again at thenext meeting.

ASYLUM REPORTS.

Asylum for the Counties of Salop and Montgomery andfor the Borowgh of Wenlock (Sixty-first Annual Reportfor the Year 1905) -The reports ot the visiting committeeof this asylum deal largely with the question of pro-viding increased accommodation. At the close of 1905 theasylum contained 801 patients, or 50 more than the numbersprovided for ; at the same date 65 patients were boarded outelsewhere. The committee is of opinion that it is advisableto enlarge the present institution to accommodate 200 morepatients and has notified the county councils to thiseffect. It likewise recommends the latter to unite withseveral other local authorities in adapting a residencein the neighbourhood of Birmingham for the purposeof an asylum for idiot and imbecile children-avery wise proposal. The report of the medicalsuperintendent, Dr. Daniel F. Rambaut, states that theadmissions numbered 230, the largest annual admission-ratein the history of this asylum. The recoveries were in the pro-portion of 33 91 per cent. (males) and 38 46 per cent.

(females) of the admissions. 86 per cent. of those dischargedrecovered had been resident less than 12 months. The

average daily number resident was 785 The causation of

insanity in, ai.d the character of, the admissions are notreferred to in the report, but from the statistical tables it.

appears that only 29 of the total admissions had the " insane