620 increase the red calls and haemoglobin or between the carbon dioxide tensions in the tissues and powers of acclimatisation, so that breathing cannot play the main part in the process. The heart seems to be the chief organ concerned ; with insufficient oxygen its muscle degenerates. The underlying principle advanced by Dr. Campbell is that the body is unable to prevent a large rise of internal oxygen tensions under exposure to high oxygen pressure in the air, just as it is unable to prevent a large fall of oxygen tension in the tissues under exposure to low oxygen pressure in the air. Mr. P. Eggleton has continued his study of phosphagen," a constituent of muscle, which has been isolated as a barium salt from rabbit muscle and shown to contain creatine and phosphoric acid in equimolecular amounts. It breaks down in a muscle in contraction producing inorganic phosphate and is resynthesised during recovery in the presence of oxygen. This work clears up uncertainties about the relative places, in the chemical machinery of muscle contraction and relaxation, of carbohydrate and phosphate, and adds a new link between the functions of muscle and the presence of creatine. Phosphagen is apparently related to the velocity of contraction. Intestinal Flora. Mr. C. Dobell and Dr. P. Laidlaw have obtained every stage in the development of the Entamceba histolytica in artificial culture. It has been shown that the amoebae cannot survive at ordinary temperatures for more than three days, but the cysts can live and remain infective to man for 37 days Emetine has been shown to have a specific toxic action in cultures on both human and simian strains. The entamoeba can be transmitted from man to the monkey. One strain has been propagated in the department for three years, and has lost its original infectivity for kittens though not for monkeys, and has also lost its power of engulfing red corpuscles. Miss Bishop has shown that-neither increase nor decrease in oxygen pressure, within the limits tolerable by a monkey, has any lethal effect upon intestinal protozoa. Dr. L. S. Davidson, of Edinburgh, has devised a method for quantitative estimation of the chief groups of intestinal bacteria by which the differences of intestinal flora in health and disease can be tabulated. He believes that in the most chronic infections the cause is no new organism, but an increase in numbers or a change in site of the organisms normally present. In pernicious anaemia all organisms are enormously increased in number and there is a huge count of B, welchii. The toxaemia of intestinal obstruction I seems to be probably due to this organism. MEDICINE AND THE LAW Dr. Alcock’s Unsuccessful Appeal. " A JURY," said Lord Justice Scrutton last week, is rarely a good tribunal to decide actions which depend on professional skill." This important dictum was delivered during the judgment dismissing Dr. Alcock’s appeal from the verdict of heavy damages awarded against him at Gloucester Assizes last December. The facts of the case will be remembered. A little girl, 8 years of age, fell off a donkey and broke her left arm above the elbow. She was conveyed ten miles in a motor-car to Gloucester where the limb was set in the doctor’s surgery and she then went into a nursing home in Gloucester. The case alleged against Dr. Alcock was that he bound up the arm in a bent position without having got the fractured bone into complete alignment, thus producing a condition in which the arm muscles deteriorated. As Dr. Alcock was able to show, he had adopted the most approved surgical practice. An X ray photograph was taken before he began treatment ; while he was manipulating the arm the X ray apparatus was used to throw the reflection of the bone upon the screen so that he could see exactly what he was doing. When he had finished the manipulation and bound up the arm, the radiologist reported that the X ray photograph showed a perfect reduction of the fracture. In these circumstances Dr. Alcock watched the arm subsequently to see that the circulation was not impaired ; as soon as he detected that this had occurred, he loosened the bandages and endeavoured. though without success, to ward off worse symptoms. For the plaintiff it was said that faulty setting and subsequent negligence established Volkman’s con- tracture ; as this resulted in permanent deformity the child, who was stated to be a particularly promising musician, would be unable to follow the profession of music. Impressed by this fact, presumably, the jury awarded the large sum of 22150 damages. Dr. Alcock went to the Court of Appeal and asked for a new trial, complaining that Mr. Justice Shearman’s summing-up was not adequate and that he had overlooked the fact that the doctor had followed the most approved surgical practice ; the judge, it was contended on Dr. Alcock’s behalf, had never told the jury that Dr. Alcock was entitled to rely on what the radiologist told him. Lord Justice Scrutton’s observations deserve close attention. The Court of Appeal was obliged to dismiss the application .for a new trial because the law of the land has placed juries in the position of deciding these issues of professional skill or negligence -- and, unless it could be said that there was no evidence whatever to support the jury’s verdict (which was not suggested), it was impossible for the Court of Appeal to interfere. " I do not profess for one moment,’’ said the Lord Justice, " that this case is a satisfactory one." The action was one for professional negligence. " The consideration of the margin between what would be an error of judgment (which is not actionable and a departure from the degree of professional skill which a professional man practising for reward holds himself out to exercise is very difficult to explain to the jury and very difficult for them to follow.... It might very often happen that the judge would. not feel very happy about the verdict of the jury, and the Court of Appeal also might not be very happy about a verdict against a professional man, but, if we were to grant a new trial, the case would have to go back again to the same tribunal "-i.e., a jury, In this case, said Lord Justice Scrutton, there was evidence before the jury on which they, properly directed, were entitled to decide either way ; it was impossible for the Court of Appeal to interfere with the verdict although the members of that Court might have come to a different conclusion. If the natural sympathies of a jury towards a little girl of 8, whose potential prospects as a professional musician are unhappily marred by an accident to her arm, are to be translated into the award of heavy damages against a medical practitioner who has followed the most approved surgical practice, then we really seem to be approaching the position in which a surgeon must be taken to guarantee the success of every operation he undertakes. Lord Justice Scrutton’s judgment makes it clear that the verdict against Dr. Alcock is far from commanding his whole- hearted assent. There is something wrong with the system when such a verdict can be enforced against a professional man. The medical profession has often had occasion to protest against questions of pro- fessional skill being left to the arbitrament of a jury entirely devoid of technical knowledge. Lord Justice Scrutton’s opinion of the unsuitability of a jury as the tribunal in such matters will strongly reinforce the view of the profession that the present position is intolerable. Patent Rights in Therapeutic 1YIanufactures: The Need of Novelty. The claim of Sharp and Djhme (an American company, incorporated in New Jersey) against Boots Pure Drug Company, raised highly technical issues but also illustrated valuable principles of patent law. The plaintiffs brought their action originally before Mr. Justice Astbury, claiming that they were entitled
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increase the red calls and haemoglobin or between thecarbon dioxide tensions in the tissues and powers ofacclimatisation, so that breathing cannot play themain part in the process. The heart seems to be thechief organ concerned ; with insufficient oxygen itsmuscle degenerates. The underlying principleadvanced by Dr. Campbell is that the body is unableto prevent a large rise of internal oxygen tensionsunder exposure to high oxygen pressure in the air,just as it is unable to prevent a large fall of oxygentension in the tissues under exposure to low oxygenpressure in the air.
Mr. P. Eggleton has continued his study ofphosphagen," a constituent of muscle, which hasbeen isolated as a barium salt from rabbit muscle andshown to contain creatine and phosphoric acid inequimolecular amounts. It breaks down in a muscle incontraction producing inorganic phosphate and isresynthesised during recovery in the presence ofoxygen. This work clears up uncertainties about therelative places, in the chemical machinery of musclecontraction and relaxation, of carbohydrate andphosphate, and adds a new link between the functionsof muscle and the presence of creatine. Phosphagen isapparently related to the velocity of contraction.
Intestinal Flora.Mr. C. Dobell and Dr. P. Laidlaw have obtained
every stage in the development of the Entamcebahistolytica in artificial culture. It has been shown thatthe amoebae cannot survive at ordinary temperaturesfor more than three days, but the cysts can live andremain infective to man for 37 days Emetine hasbeen shown to have a specific toxic action in cultureson both human and simian strains. The entamoebacan be transmitted from man to the monkey. Onestrain has been propagated in the department forthree years, and has lost its original infectivity forkittens though not for monkeys, and has also lost itspower of engulfing red corpuscles. Miss Bishop hasshown that-neither increase nor decrease in oxygenpressure, within the limits tolerable by a monkey, hasany lethal effect upon intestinal protozoa.
Dr. L. S. Davidson, of Edinburgh, has devised amethod for quantitative estimation of the chief groupsof intestinal bacteria by which the differences ofintestinal flora in health and disease can be tabulated.He believes that in the most chronic infections thecause is no new organism, but an increase in numbersor a change in site of the organisms normally present.In pernicious anaemia all organisms are enormouslyincreased in number and there is a huge count ofB, welchii. The toxaemia of intestinal obstruction Iseems to be probably due to this organism.
MEDICINE AND THE LAW
Dr. Alcock’s Unsuccessful Appeal." A JURY," said Lord Justice Scrutton last week,
is rarely a good tribunal to decide actions whichdepend on professional skill." This important dictumwas delivered during the judgment dismissing Dr.Alcock’s appeal from the verdict of heavy damagesawarded against him at Gloucester Assizes lastDecember. The facts of the case will be remembered.A little girl, 8 years of age, fell off a donkey andbroke her left arm above the elbow. She was conveyedten miles in a motor-car to Gloucester where the limbwas set in the doctor’s surgery and she then wentinto a nursing home in Gloucester. The case allegedagainst Dr. Alcock was that he bound up the arm
in a bent position without having got the fracturedbone into complete alignment, thus producing acondition in which the arm muscles deteriorated.As Dr. Alcock was able to show, he had adoptedthe most approved surgical practice. An X rayphotograph was taken before he began treatment ;while he was manipulating the arm the X ray apparatuswas used to throw the reflection of the bone uponthe screen so that he could see exactly what he was
doing. When he had finished the manipulation andbound up the arm, the radiologist reported that theX ray photograph showed a perfect reduction of thefracture. In these circumstances Dr. Alcock watchedthe arm subsequently to see that the circulation wasnot impaired ; as soon as he detected that this hadoccurred, he loosened the bandages and endeavoured.though without success, to ward off worse symptoms.For the plaintiff it was said that faulty setting andsubsequent negligence established Volkman’s con-
tracture ; as this resulted in permanent deformitythe child, who was stated to be a particularly promisingmusician, would be unable to follow the professionof music. Impressed by this fact, presumably, thejury awarded the large sum of 22150 damages. Dr.Alcock went to the Court of Appeal and asked fora new trial, complaining that Mr. Justice Shearman’ssumming-up was not adequate and that he hadoverlooked the fact that the doctor had followed themost approved surgical practice ; the judge, it wascontended on Dr. Alcock’s behalf, had never told thejury that Dr. Alcock was entitled to rely on what theradiologist told him.Lord Justice Scrutton’s observations deserve close
attention. The Court of Appeal was obliged todismiss the application .for a new trial because thelaw of the land has placed juries in the position ofdeciding these issues of professional skill or negligence --and, unless it could be said that there was no evidencewhatever to support the jury’s verdict (which wasnot suggested), it was impossible for the Court ofAppeal to interfere. " I do not profess for one moment,’’said the Lord Justice, " that this case is a satisfactoryone." The action was one for professional negligence." The consideration of the margin between whatwould be an error of judgment (which is not actionableand a departure from the degree of professional skillwhich a professional man practising for reward holdshimself out to exercise is very difficult to explain tothe jury and very difficult for them to follow....It might very often happen that the judge would.not feel very happy about the verdict of the jury,and the Court of Appeal also might not be very happyabout a verdict against a professional man, but, ifwe were to grant a new trial, the case would have togo back again to the same tribunal "-i.e., a jury,In this case, said Lord Justice Scrutton, therewas evidence before the jury on which they, properlydirected, were entitled to decide either way ; it wasimpossible for the Court of Appeal to interfere withthe verdict although the members of that Courtmight have come to a different conclusion.
If the natural sympathies of a jury towards a littlegirl of 8, whose potential prospects as a professionalmusician are unhappily marred by an accident to herarm, are to be translated into the award of heavydamages against a medical practitioner who has
followed the most approved surgical practice, thenwe really seem to be approaching the position inwhich a surgeon must be taken to guarantee the successof every operation he undertakes. Lord JusticeScrutton’s judgment makes it clear that the verdictagainst Dr. Alcock is far from commanding his whole-hearted assent. There is something wrong with thesystem when such a verdict can be enforced againsta professional man. The medical profession has oftenhad occasion to protest against questions of pro-fessional skill being left to the arbitrament of a juryentirely devoid of technical knowledge. Lord JusticeScrutton’s opinion of the unsuitability of a jury asthe tribunal in such matters will strongly reinforce theview of the profession that the present position isintolerable.
Patent Rights in Therapeutic 1YIanufactures: The Needof Novelty.
The claim of Sharp and Djhme (an Americancompany, incorporated in New Jersey) against BootsPure Drug Company, raised highly technical issuesbut also illustrated valuable principles of patent law.The plaintiffs brought their action originally beforeMr. Justice Astbury, claiming that they were entitled
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to Letters Patent (No. 219,922) for a method of makingnew alkyl resorcinols of high therapeutic value,particularly valuable as a non-toxic germicide ; theyclaimed that the defendant company had infringedtheir patent. The defendant company answered thatthe patent was invalid for want of novelty and subjectmatter ; that the methods described in the plaintiff’sspecification had been published before the date ofthe patent ; or that the prior publication had indicatedmethods to be adopted for obtaining homologousalkyl resorcinols higher than those hitherto obtained.It was a question to some extent of how wide theplaintiff’s specification might be. Their process wasbased on information contained in two previouslypublished papers-those of Johnson and Lane (inthe American Chemical Society’s Journal of 1921)and of Clemmensen in 1913. Evidence by Sir WilliamPope and Mr. Ballantyne indicated that the reductionsdisclosed by Clemmensen were of such general valuethat, if used, they would probably result in the productfor which the plaintiffs claimed a patent. It seemedclear that, if the plaintiffs had a valid patent, thedefendants could not deny infringement,. They hadmade and sold n-hexyl resorcinol made by a methodindicated in Johnson and Lane’s paper. Mr. JusticeAstbury held there was no subject matter in thepatent; he also held that the patent was invalidbecause of anticipation. In his judgment it appearedthat the foundation of the process was laid in 1913 ;the only thing left to be done was to verify theanticipation of the earlier chemists. Verification ofan earlier statement is not a ground for a patent grant.The plaintiffs took the case to the Court of Appeal,but their appeal was unanimously dismissed by aC’ourt consisting of the Master of the Rolls and LordJustices Sargant and Lawrence.The subject matter of the privilege granted by a
patent must involve, as is observed in Halsbury’s"’ Laws of England," discovery and a new art. " Aninvention," said Lord Justice Lindley in 1892, " isnot the same thing as a discovery; when Voltadiscovered the effect of an electric current from hisbattery upon a frog’s leg, he made a great discovery,but no patentable invention; again, a man whodiscovers that a known machine can produce effectswhich no one before him knew could be producedby it, may make a great and useful discovery, but,if he does no more, his discovery is not a patentableinvention." The subject matter of a patent is some-thing for the sole working or making of a manufacture,but the manufacture must be something new and,further, it must not have been used by others at thEtime when the patent is granted. The reason is clearThe inventor must be encouraged but the justificatiorfor his monopoly is the benefit of the public. If hÜinvention is not new, the public gets no benefitFamous men like Lord Kelvin have been heard to,express the view that our system of protectingdiscoveries by monopoly has done as much harm afgood. If medical research were to be commercialisedthe public benefit would be diminished. Judiciainsistence that the element of newness should bpresent if patent grants are to be valid is well foundecnot only in law but in public advantage. LoreHanworth in the case under discussion confirmed MrJustice Astbury’s view that no inventive step ha(been taken; there had been only verification o
previous researches, coupled with the ordinary skilthat a chemist could be expected to provide and supplyIt is matter for general congratulation that th,Rnglish bench can produce judges capable of masteringthe extremely technical details of patent cases
Specialists like the late Lord Moulton may be rarebut such judgments as that of Mr. Justice Astburyor the more frequent judgments of Mr. Justice Tomlioin patent matters are supremely competent.
Dangero1Js Drugs Register.One object of the Acts and regulations dealing wit]
dangerous drugs is to make it possible to trace.purchase. For this purpose the medical practitioneis obliged to keep a register and to enter his purchase
therein. At the West London Police-court on March16th a doctor was charged with failing to enter inthe register required to be kept for that purposecertain purchases of dangerous drugs-namely-morphine sulphate and diamorphine hydrochlorate.It was stated that a detective-inspector had occasionto interview the defendant doctor about prescriptionscontaining heroin and cocaine supplied to two womenpatients. Purchases had been made from wholesalechemists in October and January last, but thepurchases had not been entered in a register as
required, though the defendant was able to producea book showing a list of prescriptions. On behalfof the medical practitioner it was mentioned that hehad practised for 14 years in Jersey and was unawareof the details of the Dangerous Drugs Regulationsoperating in this country. It was not suggested thathe had been guilty of any illicit traffic in drugs.The magistrate, Mr. Marshall, imposed fines amountingto ;S21 with 23 3s. costs.
THE HARVEY TERCENTENARY :CELEBRATION BY THE ROYAL COLLEGE OF PHYSICIANS
OF LONDON.
FROM the Royal College of Physicians of Londonthere has been issued a provisional programme of theseveral functions and entertainments arranged bythe College in the course of the celebration of theHarvey Tercentenary ; this is issued in advance, soas to give delegates and others early information of ageneral character. A full and detailed programme willbe published in May, and may be obtained then onapplication at the College. Delegates and guestsshould send information as early as possible of thenumber of ladies, if any, accompanying them, inorder that the Ladies’ Committee may make suitablearrangements for the entertainment of ladies atcertain ceremonies where their presence may beimpracticable owing to limitations of space. Visitorsattending the celebration may give the Royal Collegeof Physicians, Pall Mall East, London, S.W. 1, as theirpostal address, and letters will be handed to them whenthey call. They should, on arrival, leave their Londonaddresses with the Secretary of the College.
Provisional Diary.Monday, May 14th: 11 A.M., Reception of delegates by
H.M. the King at Buckingham Palace. 3 P.M., Receptionof delegates and distinguished guests by the President of theRoyal College of Physicians at the College ; presentation ofaddresses by delegates ; admission of honorary Fellows ;eulogy of Harvey by selected speakers. 6.30 P.M. for 7 P.M.,dinner to delegates and guests given by the WorshipfulCompany of Grocers at Grocers’ Hall, Prince’s-street, E.C.
Tuesday, the 15th: 10.30 A.M.-12.30 P.M., demonstrationsof recent additions to our knowledge of the circulation bythe Royal College of Physicians at University College. A
reproduction of Harvey’s original experiments will be dis-played cinematographically. 1.15 P.M., luncheon to delegatesand guests at St. Bartholomew’s Hospital (Harvey’s hospital),given by the governors of the hospital. 4 P.m.,* tea to dele-gates, guests, and their ladies at the College, with exhibitionof books, manuscripts, pictures, silver, and other objects ofinterest. 9 P.M.,* conversazione of delegates, guests, Fellows,and their ladies at the Hall of the Worshipful Company ofMerchant Taylors, 30, Threadneedle-street, E.C., by per-mission of the court of the company. The Prince of Waleshas graciously consented to be present.Wednesday, the 16th : In the morning there will be a
continuation of the demonstrations at University College,London. 6.30 P.M. for 7 P.M., dinner to delegates and guestsgiven by the President and Fellows of the Royal College ofPhysicians in the Guildhall of the City of London.
Thursday, the 17th :* In the morning and afternoon therewill be a visit of delegates, guests, and their ladies to Oxford,by invitation of the Warden and Fellows of Merton College,of which Harvey was Warden.
Friday, the 18th :* In the morning and afternoon therewill be a visit of delegates, guests, and their ladies to Cani-bridge, by invitation of the Master and Fellows of CaiusCollege, whence Harvey graduated.Ladies are invited to those functions merked with an asterisk.
Morning dress will be worn at daytime and eveningdress, with orders and decorations, at evening events.
