53

for- more than twenty-four hours. I should like to addthat it is not reliable unless the slides used are absolutelyclean, because many of the false positive tests I obtainedby the Scriver and Waugh method appeared beforetwenty-four hours.

LIE-INJO LUAN ENG.

University of Indonesia,Department of Parasitology

and General Pathology,Salemba 6, Djakarta.

Parliament

Ostracism " following Diagnosis of VenerealDisease.

BEFORE the House of Commons rose on Dec. 18 forthe Christmas recess, Mr. ARTSUR MOYLE pleaded for anex-gratia payment for a constituent of his who had lostan action in the High Court of Birmingham in Octoberfor damages for negligence against two doctors attachedto the West Bromwich General Hospital.The patient, who is now 36 years of age, was sent by his

family doctor to a venereal-disease clinic, and seven monthslater, on Jan. 1, 1949, was admitted to the West BromwichHospital for a minor operation. During his stay in hospitalhe was subjected to

" ostracism." All his linen and crockerywere specially marked, and a screen placed round his bed.These precautions were taken on the assumption that he wassuffering from a venereal disease, but in March, 1949, it wasdiscovered that he had in fact a form of cancer rare in a manof his age, and in July, 1949, he underwent a grave amputation.

Mr. Moyle suggested to the Minister-of Health that anex-gratia payment, without prejudice to the judgmentor to the interests of the Ministry or the Treasury, mightbe made to compensate the young man for the socialostracism which he had unfairly sustained and for thedelay in the diagnosis of his disease.

Miss PATRICIA HoRNSBY-SMITH, parliamentary secre-tary to the Ministry, said that she had the greatestsympathy with this young man, who had been thevictim of a disease’ rarely found in a man of his age.But, she pointed out, according to the judgment in theHigh Court he had failed to establish that earlier diagnosisof his condition would have made less necessary a totalamputation. Nor would she like to accept the suggestionthat he had been harshly treated in hospital or undulyostracised beyond the normal medical precautions takenin the best interests of the patients. Mr. MOYLE inter-posed that it was surely unusual for a screen to be putround the patient’s bed, and for linen and crockery to bemarked in his name, for the three days he was in hospital.Miss HORNSBY -SMITH considered that, if these were theprecautions deemed necessary, it was not fair to challengethem. The young man had now been fully cleared of anystigma.To give an ex-gratia payment, she continued, to a

- patient who had lost in court a claim on grounds oi

negligence would technically override the decision oithe court. If the patient had wished to reopen the caSEhe could have taken the case to appeal, but he had noidone so. She had real sympathy for the unfortunatEyoung man, but she believed that it was not for thEMinistry or the Treasury to override the decision of th<court, and, by making a payment, impute to the doctorsa negligence which the courts did not admit, thus openingthe floodgates to any and every appeal on grounds osympathy.

QUESTION TIME

Prescription CostsMr. GILBERT LONGDEN asked the Minister what were the

results of the steps he had taken to encourage doctors toreduce the cost of their prescribing in order to release fundsfor improvements elsewhere in the National Health Service.- Mr. IAIN MACLEOD replied: While the average cost of aprescription has hitherto increased progressively every yearsince the N.H.S. started I am glad to say that in Augustthe estimated cost fell to about 1-’2d. less than in August,1952. This was maintained in September and there was afurther reduction to 2d. in October. I am glad to have thisopportunity to thank the Joint Committee on Prescribingfor their valuable work in classifying- preparations, and the

General Medical Services Committee and the whole body ofgeneral practitioners for their cooperation in producing thisencouraging result.Mr. LoNGDEN : Does this satisfactory result follow upon

the advice given to general practitioners about prescribingdrugs of doubtful therapeutic value ? Mr. MACLEOD : Itseems almost certain that the two are linked because theletter referred to was sent out by my chief medical officeron July 18 and the first noticeable drop was in the followingmonth.

Dr. EDITH STJMMERSKILL: Will the Minister consider

giving instructions to doctors not to prescribe certain drugsif there is an equivalent in the National Formulary ?-Mr.MACLEOD : I think that would be too big an interferencewith the ordinary discretion of doctors. In view of the

satisfactory results of cooperation, I think we should continuealong these lines.

More Beds for Mental HospitalsReplying to a question Nlr. MACLEOD, Minister of Health,

said that schemes for additional mental hospital beds hadbeen authorised as follows : >

In 1954-55, in addition to the provision which boards wereexpected to make from their own capital resources, a specialallocation had been made which should provide for about800 mental hospital beds and 2200 mental-deficiency hospitalbeds. Completion of these schemes would be spread overmore than one year.

Mr. SOMERVILLE HASTINGS asked the Minister how manybeds were allocated for mental-deficiency cases ; and whatwere the waiting-lists for them in the areas of administrationof each of the extra-metropolitan regional hospital boards.- Mr. MACLEOD replied : The numbers on December 31, 1952.were as follows :

* The waiting-list for the Manchester region includes some patientswho are also included in the waiting-list for the Liverpoolregion.

1. London County Council : Report of the County Medical Officer ofHealth and School Medical Officer, 1951. Pp. 195. 2s. 6d.

Public Health

London in 1952

London’s vital statistics for 1952 were much affectedby the damaging fog in December, and a detailedstatistical account of the disaster is included in the

report for 1952 by Dr. J. A. Scott, medical officer ofhealth for the county. The death-rate for the year was12-0 per 1000 population ; and 0-5 of this annual ratewas contributed by the deaths during the fog. Butfor the sudden increase in the number of deaths inDecember, the death-rate would have returned approxi-mately to the 1950 level of 11-3 per 1000 population.On the other hand, the infant-mortality rate was againlower at 23-1 per 1000 live births, compared with 25-4:in 1951 ; and the neonatal rate decreased to 15-8 per1000 live births-a new low record for London.During 1952 the number of confirmed notifications

of poliomyelitis in the county was 309, which was con-siderably lower than the epidemic years of 1947, 1949.and 1950. An appendix to the report analyses the 1949epidemic of poliomyelitis and draws certain conclusionsabout the relation between infection and previousinoculation. In the conditions of 1949 and over thewhole year, there was an increased risk-nearly fourtimes the normal risk in the three months or so afterinoculation-of poliomyelitis following inoculation with

54

the combined diphtheria and pertussis vaccine ; butinjections with diphtheria (A.P.T.) antigen involvedless risk and one to which less statistical confidencecould be attached. This survey fully justifies the actiontaken to stop the use of combined vaccine during Sep-tember, 1949 ; but, as the account of the investigationconcludes, " it does not follow that these considerationswould apply in the face of any future epidemic as thenewer combined prophylactics may not be subject tothe same risks and it is now the practice in many areasto suspend inoculation during epidemic prevalence ofpoliomyelitis."The number of pregnant women who made at least

one attendance at a L.C.C. antenatal clinic during theyear continued to decline-from 52 % of all womenneeding antenatal care in 1949 to 41 % in 1952. The

proportion of children attending a Council child-welfarecentre at least once during the first year of life remainedfairly constant ; in 1952, the proportion was 84 %.The L.C.C.’s domiciliary midwifery service dealt with6047 confinements during the year, compared with7040 in 1951. The report attributes this reduction partlyto the decreasing birth-rate (15-3 per 1000 populationin 1952, compared with 15-6 in 1951) and partly to theattraction of hospital confinement.As we mentioned last year the proportion of children

under the age of five who have been immunised againstdiphtheria is disturbingly low. Dr. Scott’s report saysthat the steady decline since 1949 in the number ofchildren receiving primary immunisation has now beenchecked (the total in 1952 was 42,958, compared with40,339 in 1951), but the estimated proportion, at theend of 1952, of those under five who had at any time beenimmunised was only 50-2%, compared with 53-0% in1951 and 55-4% in 1950. Commenting on the difficultiesof persuading parents to have their children immunised,the report observes :

" Public alarm about the danger of paralysis followinginoculations causes great difficulty both in the maintenanceof a continuous propaganda campaign and in explaining toparents the necessity for postponing immunisation duringthe season when poliomyelitis is most likely to occur. Fromthis point of view it is perhaps unfortunate that nationalimmunisation campaigns tend to be launched just before thepoliomyelitis season and it seems that much might be gainedby intensifying propaganda as soon as possible after polio-myelitis has ceased to be widely prevalent."

2. See Lancet, 1953, i, 93.3. Times, Dec. 10, 1953. Birmingham Evening Dispatch, Dec. 9.

Medicine and the Law

Home for Incurables not a "Hospital"Mr. Justice Vaisey’s decision that the Royal Midland

Counties Home for Incurables at Leamington Spa is notvested in the Minister of Health 3 will, after several yearsof control by the Minister, cause difficulties of a practicalkind ; but it proves once again that the courts are notafraid to reject the views of the Executive. The Homewas a charity, regulated by a trust deed. Its rules declaredthat its object was to give relief, by way of accommoda-tion and pensions, to persons of good character andlimited or reduced income who were suffering fromincurable or chronic diseases or incapacity throughinjury or wounds. No-one was to be admitted whosuffered from insanity, epilepsy, cancer, or pulmonarytuberculosis ; no case was to be admitted unless it

required medical supervision and nursing. If the Homewas a

" hospital," it vested in the Minister in July, 1948,under section 6 (1) of the National Health Service Act.Section 79 defined " hospital " as " any institution forthe reception and treatment of persons suffering fromillness or mental defectiveness ... and any institution forthe reception and treatment of ... persons requiringmedical rehabilitation .... " " Illness " was defined as

including mental illness and any injury or disabilityrequiring medical treatment or nursing.

The dispute between the Home and the Minister (who,not surprisingly, contended that the National HealthService could provide all that the rules of the Homeoffered to patients) went to arbitration. The arbitratotdecided that the Home was not a hospital within theAct. Mr. Justice Vais’ey has confirmed that decision. Heattached importance, it seems, to the exclusion ofsufferers from cancer, and he was impressed by the widemeasure of freedom allowed to the residents. He thoughtthe atmosphere of the Home was much less formal andmore home-like than that of any hospital; the residents,in his view, would not in ordinary parlance be describedas being " in hospital." The case might be near theborderline, but the statute was, in a sense, confiscatory;it interfered with vested interests and rights ; it shouldbe so interpreted in consequence that the burden was onthe Minister to prove that the Home came within thestatutory definition. The learned judge observed that thedefinition of " hospital " did not refer to care and atten.tion or nursing of sick persons but only to their treat.ment ; this seemed to suggest something more thanmere palliation ; it implied a process directed to theachievement of a complete, or at least a partial, cure,

He held that the Home had neither been transferred tonor vested in the Minister on the " appointed day." Ithad been taken over and dealt with on the assumptionthat it was a hospital. Steps must be taken to restore itspossession and control to the general committee whoformerly administered it. He was sure the parties wouldact with consideration and in a sensible manner. Theycould apply to the court in case of difficulty. If there werean appeal, matters should be left as at present, pendinga final decision.

ObituaryCYRIL ARTHUR BENNETT HORSFORD

M.D. Edin., F.R..C.S.

Mr. Cyril Horsford, who died on Dec. 16 at the age of77, was perhaps as well known in the world of music,opera, and the stage as in his own profession.Born at St. Kitts, in the West Indies, the son of the =

Hon. S. L. Horsford, he was educated at Bedford Modern --School and Edinburgh University. He graduated M.B.in 1898, and proceeded to the M.D. with honours in 1902and the F.R.C.S. the following year. He continued his :_studies in laryngology at Golden Square and at theCentral London Throat Hospital, where he was registrar.for some eight years. Later he was appointed surgeonto the throat department of the Princess Beatrice’Hospital, Kensington, and surgeon in charge of thethroat and ear department of the St. Pancras Dispensary.During the 1914-18 war he served as aural specialist inthe R.A.M.C. with the rank of captain.For many years he was honorary laryngologist to the

Royal College of Music, the Royal Choral Society, andthe Royal Society of Musicians. His contributions tomedical literature, though few, were essentially practical,and he invented an original method of dealing by suturewith an overhanging epiglottis when it hid the vocal cordsfrom view, which he demonstrated at the InternationalCongress of Laryngology at Berlin in 1911. From timeto time he would make a pungent observation-for heheld decided opinions on most laryngological problems--in the section of laryngology at the Royal Society ofMedicine, of which he was a member for many years.He also regularly attended the dinners of the EdinburghUniversity Club in London, of which he was one of theoldest members.

R. S. S. writes : " Cyril Horsford made his reputationas a particularly helpful laryngologist to singers and!,actors in their problems of voice production and ailmentsof the throat. He had clever hands and unusuallyeffective methods of giving relief when voices were lostfor one reason or another, and many singers swore by !

him and travelled long distances to consult him icemergencies. He was himself an accomplished musician,