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subjected himself to severe and useless suffering ;he asserted that the specialists had diagnosed hiscase wrongly, the operation had been unnecessary, andhe was entitled to compensation of over SIOOO. Theevidence showed that both professors had beentreating the man free of charge, and that the patient’swife had made no attempt to obtain any information,about her husband’s condition before the operation.The defendants stated that they acted correctlyand humanely in not disclosing to the patient thathe was suffering from cancer, although the diagnosiswas clear to them. It was only in the course of anexploratory operation that it was ascertained thatthe disease had gone too far to respond to operativetreatment, and there was no other means of estab-lishing the size of the growth. They had notcommunicated with the patient’s wife, as she hadnever before asked for information, and they werenot aware that the patient had a regular medicalattendant. The plaintiff’s legal adviser pointed outthat the patient has a right to know what his conditionis, and must give his consent to any major operation ;but the defendants disagreed. Prof. Finsterer

explained that as long as the public was convincedthat cancer is incurable-though this is actually nolonger true-he would never tell a patient flatly thathe had cancer. Innumerable suicides would be the

consequence of such a practice, and the shock of sucha diagnosis has in several cases turned an operablepatient into an inoperable mental wreck. Prof.Zweig also stated that under similar circumstanceshe would not tell a patient the truth bluntly. The

opinion of medical experts was unanimously in favourof this attitude. The hearing was adjourned to obtainfurther evidence, but a discussion in medical circlesshowed that an overwhelming majority of medicalmen upheld the course taken by the two professors,though admitting that there are individual patientsto whom the truth can safely be told.

NEW REGULATIONS CONCERNING NOTIFIABLE DISEASES

The Epidemics Act of 1913, which deals with theduties of the medical profession in cases of infectiousdiseases, has lately been brought up to date. Thereare two groups of notifiable diseases in Austria. Thefirst group comprises scarlet fever, diphtheria, typhoidand paratyphoid fever, dysentery, cerebro-spinalfever, puerperal sepsis, typhus, small-pox, cholera,plague, recurrent fever, leprosy, trachoma, yellowfever, glanders, anthrax, rabies, chicken-pox, polio-myelitis, epidemic post-vaccinal and post-infectiousencephalitis, and malaria. Every case or suspectedcase of these diseases, and every death due to them orsuspected of being due to them, must be reportedto the local health authorities. The only exceptionis puerperal sepsis ; suspected cases of this diseaseneed not be reported. The second group containsdiseases which are to be notified only under certainconditions. They are measles, whooping-cough, andmumps in places such as spas, health resorts, andwatering places, and in schools and institutions wherethere are children under 15 years ; rubeola in suchschools and institutions ; influenza in Vienna ; activetuberculosis of the lungs and larynx in hospitals ortenements, or where infection is likely ; other formsof tuberculosis when the patients live in tenementswhere there are children under 12 years ; and venerealdiseases (gonorrhoea, ulcus molle, syphilis) if trans-mission is feared. Doctors are also bound to reportvenereal cases if the patients evade treatment,but the greatest care must be taken to ensure strictsecrecy. In all cases of compulsory notification

(Group I.) a final report must be sent to the same

health authority when the infection is at an end ;this is also required in cases of measles, rubeola,whooping-cough, and mumps, which have beennotified. A medical man who fails to comply withthese regulations is liable to a fine not exceeding2000 Austrian shillings (65) for the first group, 600shillings for the second group, and 40 shillings for casesof tuberculosis. If a correct diagnosis cannot bearrived at without laboratory tests the physicianmay avail himself, free of charge, of the services of alaboratory attached to a municipal or local hospital.The new regulations also deal with the problem ofinfectious cases which are nursed at home.

THE DEVELOPMENT OF THE BRAIN

At a recent meeting of the Biological Society Prof.Versluys, the zoologist and biologist, read a paperon the volume and capacity of the brain. Accordingto the researches of Dr. Dubois, the teaching ofDarwin that the brain has enlarged in correspondencewith increased demands upon it is erroneous. On thecontrary research has shown that the volume of thebrain has developed by leaps and bounds, and thatthis development is due to intrinsic factors whoseultimate cause is the reduplication of the nerve-cells.The increase in size produces an increase in efficiencyand enables the individual to lead a more complicatedlife. But it is the increase in the size of the brainwhich comes first. In applying these principles tohuman development, Dubois draws the followingconclusions. The brain of man in remote times was

bigger than his needs demanded, and he only graduallylearned to make proper use of its possible efficiencyand qualities. The Neanderthal man had a brainequal in size and number of nerve-cells to the brainof a man of to-day. To-day any Negro child fromCentral Africa is able to carry out complicated studiesat a university which his parents, endowed with thesame brain, entirely ignored. Dubois considers thatthe explanation of how man has gained faculties andqualities which have no direct practical value in thestruggle for life-for instance, higher mathematics orphilosophy-is that he always had brain cells whichwere capable of such development. This theoryraises the question whether modern man has notalready attained the peak of efficiency which the sizeand volume of his brain make possible.

PAYING PATIENTS AT THE MIDDLESEXHOSPITAL

No one who contemplates the uninspired facadeof the new Woolavington wing of the MiddlesexHospital could guess with what cunning its interiorhas been modernised. The conversion of a blockwhich used to provide accommodation for nursesand residents to a wing for paying patients has beenmade possible by the generosity of Lord Woolavington,who provided the cost of a complete reconstruction,little more than the outer shell remaining. Theapproach is through the courtyard of the hospital(Fig. 1) or through a separate entrance in Cleveland-street, and since the wing remains an integral partof the hospital building the patient can be takento any department for special investigation or treat-ment-for example, to be X rayed-without havingto go out of doors. In the main, however, his needsare met within the wing. Two operating theatresand anaesthetic rooms are provided, and smooth

working lifts and rubber-covered corridors minimise

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FIG. 2.-A ward with curtained cubicles.

the vibration and noise too often associated withmovements of patients in hospitals. The rooms

themselves, whether containing one bed or six, arefurnished attractively with the comfort of a bedroomat home rather than the austerity of a hospital ward.Each bed has a silk eiderdown with curtains to match,and so arranged that the patient has some free spaceall round his bed and can see out of a window without

being overlooked by his neighbours. He has also

(Fig. 2) a really serviceable bedtable, with metallegs, and a black glazed top on which there is room

FIG. I.-Garden front of the BVoolavington wing.

for his own flowers and books as well as for a food

tray, and a switchboard with plugs for bell, readinglamp, telephone, and wireless, as well as for anyelectrical apparatus which may be necessary fordiagnosis or treatment. He is not worried by thesound of other people’s bells, because no ring isaudible ; the bell actuates a red light outside theroom which can only be extinguished by a switchat the patient’s bedside. Radiators and electricheaters are provided, but each room has a grate foran open fire if this is preferred by the patient.The dietary is in charge of a trained food supervisor,

and the patient has a choice of menus for each meal.Precautions are taken to ensure that meals are servedhot, and that any special diets ordered are presentedin varied and palatable forms. A sister-superin-tendent is in charge of the nursing services, and ahigh proportion of fully trained nurses is employed.Patients may be visited by their friends, subject tomedical approval, on any day between 11 A.M. and12 noon, and between 3 P.M. and 6 P.M. ; a waitingroom for guests is provided.

Altogether 64 beds are available in the wing,divided as follows : 12 beds in curtain cubicle wardsat four guineas a week ; 28 single rooms at sevenguineas and 16 at twelve guineas ; and 7 to 9 cots.for children at charges ranging from four to tenguineas a week. Accommodation for mother or

nurse can be provided where desired. Services.

charged as extras are special nursing and massageand electrical treatment. Only patients who are

paying reduced fees to the physician or surgeon incharge are admitted to rooms at seven guineas aweek or under, and the total professional fees paid bythese patients will not exceed fifty guineas. Everypatient admitted is under the care of a member ofthe honorary medical staff of the hospital, but,

practitioners are given every facility for visitingpatients and may collaborate in their treatment byinvitation. Altogether the arrangements here madefor the convenience of paying patients seem to bein every way admirable.

THE HAMMERSMITH HosPiTAL.-In reply to inquirieswe are happy to state that the plans of the new BritishPostgraduate Medical School, reproduced in our articlelast week, were drawn up in the architect’s department ofthe London County Council. The architect to the L.C.C.is Mr. G. Topham Forrest, F.R.I.B.A.