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to the following qualifications as regards medicalmen :-

Subsection (2). The provisions of the foregoing sub-section shall not operate to prohibit-

(a) the practice of dentistry or dental surgery by a regis-tered medical practitioner who is at the date of the passingof this Act a registered medical practitioner, or

(b) the performance of any surgical operation in con-nexion with the tissues of the mouth or jaws, or the givingof any dental treatment, advice or attendance in urgentdental cases by any registered medical practitioner.

It will be seen that the Bill proposes, in effect, tomake dentistry in future a separate profession insteadof regarding it, as hitherto, as a branch of surgery.It may be assumed that the universities and medicalcorporations will make representations to preventthe limitation proposed to be put to the functions ofthe medical profession. As the section stands, it

appears that it depends on the interpretation of thesignificance of a comma whether in the future a surgeonmay operate on the mouth or not, except in case ofurgency.

SCOTLAND.(FROM OUR OWN CORRESPONDENT.)

C’ertifierl Milk.THE report of the Scottish Board of Health, noticed

in your columns last week, shows in detail the progressof the movement towards the popularisation of ahigher grade milk. The response to official initiativein this campaign was at first given only’by a fewenthusiastic pioneers in production. Now the com-mercial demand is stiffening everywhere, and isdemonstrated in the efforts of certain tradesmen toget the " Grade A " price for a lower grade article.The production of higher grade milk is going throughthe usual phases : from not needed, not wanted, notpracticable, not a

"

paying proposition," to wanted,practicable, and paying. It is now a common experi-ence of the child welfare centres to find even the lesswell-off mothers inquiring as to Certified and Grade Amilk for their babies, who must have the best. Theproducers are now active on a large scale. At acrowded meeting of producers of Certified milk andGrade A (tuberculin-tested) milk, held in Glasgowrecently, it was decided to form a society to promotethe sale of such milk in Scotland. The society will becalled Scottish Certified and Grade A (T.T.) MilkProducers, Ltd., and a whole-time secretary will beappointed. The expense of purveying these highergrades of milk is still out of all proportion to thesmall demand, and the object of the new society isto stimulate and create a better market. In somecases, where herds had been cleared of tubercle,milk of the highest grades had to be converted intocheese or fed to calves and pigs. This is not credit-able to our social sense. But the omens are favour-able. Paisley Corporation has contracted for Certifiedmilk for their hospitals. Glasgow Corporation hascontracted for Grade A (T.T.) milk, and it is said thatthe Edinburgh hospitals and infirmaries are movingin the same direction. When the pressure of the newDairies Act begins to be felt, the whole movementwill show a substantial acceleration.

The Royal Edinburgh Hospital for Sick Children.The annual report shows that this hospital is main-

taining its place worthily among the first-classScottish hospitals. Indoor cases treated in 1926 were :medical, 1593 ; surgical, 1248 ; against 1642 and1213 in 1925. The average residence was 17 days,and 1106 operations were performed. Other figuresgiven are : out-patients (new), medical. 2361, with6479 re-attendances ; surgical, 3263, with 13,452 re-attendances ; vaccinations, 49 ; total, 25,604, against25,958 in 1925. Artificial sunlight is in active use,and is available for out- as well as for in-patients.The report says : ’’ The benefit in selected cases isunquestionable, and there was no difficulty in gettingparents to bring their children regularly for the con-siderable number uf exposures that were necessary."

The tuberculosis cases admitted to the wards " showedno decrease from the average for the years imme-diately preceding the war. The total of 276 included97 cases of tuberculosis of cervical glands, 83 ofabdominal tuberculosis, and 63 of tuberculosis ofbones and joints." It is stated to be now generallyrecognised " that a very considerable proportion ofcases of tuberculosis in children is due to the drinkingof infected milk." The work of Stiles, Fraser, andMitchell in this field is classical. It is disappointingto find that the cases are still so numerous, aftersome 20 years and more of keen effort. It is, however,to be remembered that the tuberculosis cases do notall hail from the city of Edinburgh. Of rheumatismthere were 76 cases, and it is pointed out that theinstitutional treatment in Scotland is insufficient.The hospital is making a strong appeal for funds,which in view of the good work being done shouldmeet with a generous response.

The Royal (Dick) Veterinary College.Speaking at the annual prize distribution of the

Royal (Dick) Veterinary College Dr. T. G. Nasmythput in a plea for coöperation between veterinary andmedical practitioner. Each would be able to tell orsuggest something of interest and utility in thedomain of comparative pathology. Principal O.Charnock Bradley expressed optimism as to the

prospects of the veterinary profession, pointing outthat appointments both at home and abroad weregetting more plentiful. Lord Provost Stevensonshowed how intimate the corporation and the collegehad always been, and how closely the work of vete-rinary surgeons bore on the public health. In itsrecently established meat regulations and itsdairy regulations the Scottish Board of Health hasdone a great deal to make the veterinary surgeon aneffective officer in the control of the meat and milktrade. The Empire Marketing Board, in the develop-ment of its scientific policy, is opening up new fieldsfor the highest quality of veterinary men. The factthat the Highland and Agricultural Society holds itsshow this year in Edinburgh is of interest to thoseconnected with the College. The society presentseach year 11 silver medals to the College, and, at thevery foundation of the College, gave material assist-ance to the founder, who would hardly recognise hismodest beginnings in the large and highly equippedCollege of to-day.

PARIS.(FROM OUR OWN CORRESPONDENTS.)

Artificial Pneumothorax in Childhood.SINCE 1922 Prof. Armand-Delille, of Paris, has

produced artificial pneumothorax in more than 300young children suffering from pulmonary tuberculosis.At first he confined the treatment to one side only,but of late he has tried simultaneous bilateralpneumothorax in several cases. He claims a largenumber of cures and concludes that artificial pneumo-thorax is at present the only means at our commandof arresting the course of a disease which almostalways proves fatal once ulcerative lesions havedeveloped.

Osiris Prize to Dr. Charles Nicolle.The special committee of the Institut de France,

charged with the award of the Osiris prize (100,000francs) has announced its intention to propose thename of Dr. Charles Nicolle for acceptance at themeeting of the five constituent Academies of theInstitut, which will he held this month. Dr. Nicolle,who directs the Pasteur Institute at Tunis, will thusbe rewarded for the work on typhus and recurrentfevers which led to effective control of these diseasesduring the late war. -

Small-pox in Paris.During the last few months several hundred

cases of small-pox, arising it is believed from infection

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imported from Northern Africa, have appeared inParis, 214 cases having been treated at the ClaudeBernard hospital alone. Twice as many women asmen have taken the infection : the case mortalitv hasaveraged 33 per cent., being higher in young children.Compulsory vaccination of everyone leaving NorthAfrica for France is being urged.

Results obtained with a new autolysate for thetreatment of cancer, devised by J. Thomas, havebeen presented to the Académie des Sciences. Inthree cases, now dating from two, three, and 12years respectively, the autolysate has appeared topossess curative value.The memory of Pravaz, deviser of the hypodermic

syringe which bears his name on the continent, isbeing honoured by the erection of a monument inthe town of Pont-de-Beauvoisin, in Savoy, and bygiving his name to a street in Lyons.A course in broncho-cesophagoscopy is to be held

at the Lariboisiere Hospital and elsewhere in Parisfrom July llth to 30th, by Prof. Chevalier Jacksonwith the cooperation of Prof. Sebileau. It will includepractical work for six applicants only, and particularsmay be had from the Doyen of the Faculty of Medicine,12, rue de l’Ecole de Medecine, Paris.The Director of the H6pital Maritime de Berck-

Plage (Pas-de-Calais) announces that a course insurgical tuberculosis and the elements of practicalorthopaedics will be given there from July 18th to30th. Dr. Delahaye of the H6pital will send theprogramme on application. ,

The twentieth Voyage d ’.etudes Medicales will be held from Sept. 1st to 10th, under the scientificdirection of Prof. Paul Carnot, when the spas of theEastern Pyrenees will be visited. The inclusive feewill be 1150 francs for British participants. Particularsmay be had from Mr. Rene Gayet, 54, rue duFaubourg St. Honore, Paris, or in London, Mme.Juppe-Blaise, Federation of the Health Resorts ofFrance, 19A, Tavistock-square, W.C. 1.

CHINA.

(FROM OUR OWN CORRESPONDENT.)

Prostitution in Canton.EFFORTS are being made by the Canton Government

to make legalised prostitution a thing of the past.The Governor of Kwangsi Province has promulgatedan order dividing the women of the underworld intothree classes. The mistresses of first- and second-classhouses will be paid$60 and$30 per girl respectivelyas compensation for the loss they will sustain in closingtheir houses. A Government home has been providedfor the unfortunate women who will be confined thereuntil such time as they may enter into marriagecontracts, when they will be released. This home is onsimilar lines to one in Chinatown, San Francisco,California, where the Federal authorities send most ofthe Chinese girls who are found earning their livelihoodas prostitutes.

Opium Smoking.Prominent citizens of Canton are endeavouring to

get the Governor to take an interest in the suppressionof opium smoking. By far the greater part of thisnarcotic consumed in the city comes from the provinceof Kwangsi, of which Canton is the capital ; importedopium is much higher in price than the native-grownproduct. Every day 10,000 ounces of opium are soldin Canton and it is estimated that one out of everyten adult males in Canton is a smoker to a greateror lesser extent. There does not seem, however, to bethe slightest chance of General S. H. Wong, theGovernor, being induced even to curtail the opiumtraffic at this time, as the principal source of Govern-ment’s income in Kwangsi is derived therefrom.Were this revenue lost it would be impossible tosupport the army, and in these times of civil warfaremilitary needs come first, even at the cost of thepeople’s welfare.

Correspondence.

THE CERTIFICATION OF LUNACY.

"

Audi alteram partem."

To the Editor of THE LANCET.SIR,—The position of the practitioner called upon

to give a certificate of unsoundness of mind has becomemore difficult than ever. The usual procedure forbringing a patient under care and treatment hasbeen, in private practice, by " Reception Order onPetition," that is by an Order of a judicial authoritymade on the petition of the relatives of the patient,the practitioner giving a certificate on the under-standing that if he acts in good faith and withreasonable care he will not be liable to civil or criminalproceedings. It has now unhappily become impossiblefor him to have any assurance that good faith andreasonable care will secure him from legal proceedingsand an adverse verdict. In any given case, even

though the practitioner’s good faith and reasonablecare are admitted, if the jury is of opinion that aperson at the time of certification was not in such astate of mental or nervous disorder as to requiredetention in a mental hospital, the practitioner isliable to a verdict against him, to damages and costs.In short, the jury is vested with diagnostic powers.But beyond that emerges the curious conclusion that

a doctor owes to his patient the duty of reasonablecare, but that nothing short of a jury can ultimatelydetermine whether he should take precautions to advisethat the patient should be placed under care andtreatment or be left without proper care and treatment.Beyond the diagnostic power conferred, the jurybecomes also vested with therapeutic skill.The practitioner must also realise that though the

jury has become invested with so many of the fruitsof prolonged medical education and hard-wonexperience, the judicial authority in the case of" Reception Orders on Petition " has virtually lostthe legal powers which are nominally his. TheOrder which he makes is in no real sense an order atall, but is a piece of perfunctory and superfluouspantomime. It is the unhappy practitioner, whois neither legal nor judicial, who in fact is the personto make the order ; at any rate the entire responsibilityis his. He has to take the consequences while thejudicial authority stands aside.What then is to be done ? Until further judicial

decision or legislation, necessarily a long time hence,the practitioner must continue to take most seriousrisks, his action being ultimately determined by hissense of duty to his patients and to the public. Thepath of

" Reception Orders on Petition," as laid downin the Lunacy Act, 1890, Sec. 4 et seq. is a mostdangerous one for him. There are, however, othermodes of procedure available. There is that byInquisition, a very distinctly judicial proceeding,in which it is to be hoped that the medical witnessreceives the protection accorded to any other witness ina court of law. Inquisition is, however, slow,cumbersome, and expensive. There are also procedures

L by Summary Reception Orders, in which, as it would! appear to a non-legal reader of the Act, the onus of

causing an alleged lunatic to be visited by medicalLpractitioners is divided between constables, relievingL officers, overseers, and justices being judicial authoritiesL under the Act (Sec. 13 (1) (2)). Proceedings under7these Sections do not remove the dangers attending? certification, but on the face of the Act it would appear

to distribute responsibility more equally, and more3 directly to implicate the judicial authority. I ventureito suggest the more extended use of summary- Reception Orders, and at least think it would be. desirable that the method, as applied to those cases) in which proceedings by Reception Order on Petition

have in the past been usual, should be ventilated andcriticised.-I am, Sir, yours faithfully,

--

Harley-street, W., July 5th, E. D. MACNAMARA.