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proceed to the study of requirements for surgical andother types of hospitals, laboratories, radiology anddentistry.Such then is the machine as it at present exists. In

view of the difficult character of its work, opening up vastpossibilities in the alleviation of suffering, I feel sure thatthe medical advisory committee can count on the interestand sympathy of the medical profession.

MEDICINE AND THE LAWAnother Cancer Act Prosecution

WHEN Parliament forbade advertisements of offers oftreatment for cancer, in the Cancer Act of 1939, it musthave had in mind the cruelty and the danger of allowingunqualified persons to exploit the hopes and fears ofpatients. Not many prosecutions have hitherto takenplace under the act, but it is clear that, when proceedingsare taken, the utmost publicity is desirable. Peoplemust somehow learn that these advertisements constitutea criminal offence.At Leicester last month William Peter Vickerstaff

was charged with publishing an advertisement in hisshop window containing an offer to treat persons forcancer and also for taking part in publishing a bookletentitled Public Opinion which infringed the act. Theadvertisements in his window, it was said, contained

his photograph and a statement that he was the firstrecognised herbalist in the world to cure cancer. Thebooklet, given away free to persons entering the shop,mentioned a claim to have cured a Derbyshire man ofcancer and included such statements as " delivered fromdeath," " a hopeless case " and " Collier was going todie." The case was said to have occurred in 1929 andthe defendant claimed to have effected the cure. Forthe defendant it was stated that, since the act tookeffect, he had refrained from treating_ cancer, but hadthought that, as in the past, he was free to publishlegitimate tributes to his work which could be provedand would stand the test of investigation. It was furthersaid that the profession of herbalist was unfortunatelynot recognised as within the law in this country-astatement difficult to reconcile with the so-calledHerbalists Charter, the act of Henry VIII " thatpersons, being no common surgeons, may ministermedicines outward," and with the concessions so per-tinaciously extracted in Parliament when the Pharmacyand Medicines Act was under discussion in 1941. Thebench dismissed the charges against Vickerstaff underthe Probation of Offenders Act on payment of 15guineas costs. The prosecution had stated, in openingthe proceedings, that the defendant had been in businessat the shop for many years and had claimed to cureasthma, diabetes and skin diseases by natural methods.This claim presumably related to the period before theoperation of the Pharmacy and Medicines Act, since theact prohibits any advertisement of articles in termscalculated to lead to their use for treating diabetes.Workmen’s Compensation claimed for TumourRecently at the Stafford county court an applicant

unsuccessfully claimed compensation for the loss of hisleft leg which had been amputated because of a tumour.In 1940 he was kicked by a restive cow while working forhis employers in demonstrating a milking machine.He suffered pain but continued at his work. Threemonths later he was given notice to terminate hisemployment. Subsequently a tumour was discoveredin his left leg which was amputated below the knee.Was this an injury by accident arising out of and in thecourse of his employment ? He claimed that it was.His employers repudiated liability on the ground thatno mention was made of the kick from the cow till severalmonths later. If there had been a report at the time, theleg could have been examined. There was apparentlysome medical evidence that the tumour was not due tothe kick. The court held that the applicant had not discharged the burden of proving that the tumour was due tothe accident as claimed. No award was therefore made.

ROYAL SociETY OF ARTS.-At 1.45 PM on Wednesday, March3, Dr. J. D. Robertson will read a paper to this society oncalcium metabolism in health and disease. The meetirig willtake place at the hall of the society, John Street, Adelphi,London, W.C.2.

BREAST CANCER AND IRRADIATION

AT a meeting of the radiological section of the RoyalSociety of Medicine on Jan. 15 was discussed the valueof irradiation in association with surgery in the treatmentof carcinoma of the breast. Dr. G. E. VILVANDUK, wnospoke last, might well have voiced his wonder earlierthat in a èivilised country any such discussion shouldtoday be deemed necessary. It may be that Britishsurgeons are more conservative than those of any othercountry ; certainly they have been slower than others toaccept radiology as a part of th routine treatment ofcarcinoma of the breast.Air-Commodore STAMFORD CADE, who opened the

discussion, pointed out the need to establish a commonmethod of assessing the stage of the disease, so that atrue comparison of result can be made. We must look,he said, not only at the acknowledged best, but also atthe average result of treatment because these representthe usual results among the general public. He believed.that the extent of the disease gives the best basis fordescription, though other variables, such as the age ofthe patient, must be taken into account. In stage 3-the stage of dissemination to neighbouring areas whenthe carcinoma is generally acknowledged to be inoperable-radiology offers its chief gains, as he was able to showfrom published figures collected from various sources.Moreover the evidence seems to indicate that whereirradiation can be combined with surgery it has advan-tages over surgery alone at all stages ; and this is truewhether the irradiation is by radium, X rays, or a com-bination of the two. He spoke, he said, as one convincedof the value of irradiation in spite of the striking resultobtained by pure surgery in some hands ; he regardedX rays as a more flexible weapon than radium, but ad-mitted a place for both, and uses both in his own practice.He holds that radiotherapy is no longer to be regarded asan auxiliary method of treating carcinoma of the breast;it is as important as surgery and sometimes moreimportant.

This view of radiotherapy in breast cancer was

supported by Dr. ROBERT McWmRTER from the evidenceof his own work done in Edinburgh, and by Mr. JOHNRICHMOND who derived his statistical evidence from thevery large number of patients treated at the Mayo Clinic.There was no quarrel with this view of the situationon the part of the remaining speakers, Air-CommodoreGEOFFREY KEYNES, Dr. N. S. FINZI, and Dr. ANTHONYGREEN. Dr. Finzi on the technical side emphasisedthe importance of homogeneity of dosage with bothradium and X rays. Dr. Green demonstrated a neatinstrument for reinforcing the clinical diagnosis bybiopsy. This was designed to give an adequate specimenfor histological examination, while enabling the trackthrough which it had been obtained to be sterilised bydiathermy, and thus avoiding mechanical disseminationof the disease.

In summing up, Air-Commodore CADE said that itwas still necessary to educate surgeons in the advantagesof radiotherapy and radiotherapists in the achievementsof surgery. The two skills are seldom combined in oneman. This field of therapeutics has too long been thescene of competition between supposedly local schools.Resources must be pooled.if the unfortunate sufferersfrom one of the commonest forms of malignant diseaseare to have the best chance of survival.

SCOTTISH HOSPITALS AFTER THE WAR

THE Edinburgh medical planning study group,formed at a general meeting of the profession andincluding representatives of the allied health services,has summarised the lessons learnt in a six months’study of postwar problems in a memorandum. Itassumes that the administrative organisation of,-hos-pital services will be on a regional basis, and" thatScotland for this purpose will be divided into five regions, .four being centred on medical schools in associatedhospitals. All hospitals, cottage hospitals, convalescenthomes, &c. in the region, including the EMS hospitals,will be related to these key hospitals and will work withthem as a team. All the hospitals in the region will befor major administrative purposes under one regionalcontrolling authority which will be responsible to a

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central authority for Scotland. This regional controllingauthority is designated a regional health authority andwill consist of representatives of the hospital medicalstaff and general practitioners, the larger local authorities,boards of management of hospitals, the nursing servicesand the public. The central authority to which theregional health authorities will be responsible should bea statutory body constituted to formulate policy, andfirst to establish and later to correlate the administrationof the regional health authorities ; it should be respon-sible to the Secretary of State for Scotland. The membersof the body should be nominated by the Secretary ofState and should include representatives of the Depart-ment of Health, hospital staffs, medical officers of health,genetal practitioners and allied health services.The group suggest that with each regional health

.authority should be incorporated four regional councilsadvisory to the regional health authority :

(1) The hospital advisory council, which should discuss allmatters of general policy cognate to hospital services and makerepresentations to and advise the regional health authorityon them. It should consist of certain members of the regionalhealth authority together with " additional " membersappointed directly to it by the interests concerned.

(2) The medical advisory council, which should advise andmake representations to the regional health authority onmatters concerning hospital policy and efficiency. All themedical members of the regional health authority should bemembers and additional members should be appointed fromteaching hospital staffs, other hospitals, university facultiesof medicine, extra-mural schools, royal medical incorporations,medical officers of health and general practitioners. Thecouncil would set up from its members a medical. appointmentspanel to which local authorities, the boards of management ofthe.voluntary hospitals or the medical committees of otherhospitals desiring to make any appointment to ,their medicalstaff (other than a house-appointment) would submit the listof candidates from which the appointments panel would makea recommended selection, the right of final choice being leftto the body concerned, who would then notify the appoint-ments panel of its decision. It is considered that whilemembers of the medical staffs would be appointed to individ-ual hospitals they could be seconded for certain purposes andfor a limited period to other hospitals in the region by theregional health authority. The medical advisory councilwould also make recommendations concerning and inaugurateschemes for research and the study of statistical informationin the region and in collaboration with other regions.

(3) and (4). Domiciliary and nursing advisory councils.-The constitution of these would be along the same lines as forthe other advisory councils. The domiciliary advisorycouncil would be appointed when domiciliary medical ser-vices become regionally organised, as it is contemplated that infuture the regional health authority will supervise and admini-ster domiciliary services as well as hospital services. The

nursing advisory council would consist chiefly of membersof the nursing profession, and would consider the recruitment,training and allocation of the necessary domestic staff andmake recommendations to the regional health authority.The regional health authority should, in the group’s

opinion, set up a regional medical bureau with an office’centrally situated. Among other duties it would prepareday-to-day information about the vacant beds in eachhospital and in special departments and would arrangefor admission of patients in conjunction with the generalpractitioners concerned. It would organise a regionaltransportation service and arrange for transport of casesto and from hospital and the transfer of cases from onehospital to another.

’

In the postwar development of a coordinated hospitalservice the best of the individual characteristics found inthe voluntary hospitals and in local authority hospitalsshould be retained and developed. In the voluntaryhospitals the medical staff have had the opportunity ofinfluencing directly and even determining the type andcharacter of the work carried out. It appears desirablethat future hospital service should retain these principles.The memorandum recommends thatpatients be normallyrequired to make some payment for hospital services :those of low income should pay a compulsory contribu-tion to the state ; those with incomes above a certainlevel should pay either by voluntary insurance or directlywhen availing themselves of hospital services.

The following scale of remuneration of medical staff issuggested.

Whole-time senior appointments : 2000-2500.Part-time senior appointments : pro rata, based on a full-

time salary of :E1500-2000.Whole and part-time appointments other than senior, pro

rata, based on a full-time salary of 1000—1600 for assistantsurgeon and physician and 550—900 for ciinical assistant andtutors.

Whole-time house-appointments, with board: junior100-200 ; senior 250-350.

Medical superintendents of key hospitals : £1500-2000.This figure to be reduced pro rata where there are otheremoluments such as existing pensions or where house &c. is

provided. ’

The regional health authority should allocate moniesto the governing bodies of the voluntary hospitals andto the local authorities according to the needs of theirrespective hospitals determined on the advice of anassessor.

In England NowA Running Commentary by Peripatetic CorrespondentsHOT-HOUSE germs are all very well for a living but most

pathologists itch to hunt them in the wild. Caged in alittle pot, fed on dreary synthetics, spread-eagled on abit of glass, what after all can a poor germ do ? Therewas an old practitioner who sent us gallon pails of faecesbut even that gave them only half a chance. So whenthe chief mentioned a typhoid epidemic in Little Cesspoolwe were glad of the prospect of a more equal fight. Wedid the thing in style, of course, and with sanitaryinspectors and water engineers as beaters we madestraight for the quarry’s lair. A well in the back-yard ofthe Bull was marked with a big red cross on our chartsand in the cottages surrounding the Bull lived thevictims, but when we got there we found that the wellhad been filled in four years before and we felt ratherlike the dog who nosed our car wheels in the pouring rain.Then we remembered what we’d come for. All this talkof wells and drains and watercress and shellfish was somuch poppycock. Eberthella prefers cohabitation withfat ladies-cress and fish are only useful alibis. So whenMrs. Stoutbody opened the door of No. 5 we knew wehad Eberthella on the run ; for Mrs. Stoutbody had aglint in her eye and in her spotless kitchen there was awarm sudoriferous aura which we felt was as it should be.Yes, she’d had typhoid all right-" but that were beforeme husbing died 20 year ago, doctor ; that couldn’tharm me kiddies." Her kiddies were two evacuees fromLondon, clean and bright and the pleasantest littlefellows you could imagine. We explained that typhoidhad a pretty shady past, that he might lie low fur fortyyears and never reform. Being a sensible lady Mrs.Stoutbody agreed, and she and the little boys bared theirarms like men and filled our pots and bottles withalarming alacrity. Our triumph, we knew, was completeas we shook hands all round and jumped into the car forhome. We’d been gloating for five minutes whensuddenly the chief changed the car gears from top toreverse. He looked worried. " I’d like a cigarette," hesaid, " but I’d better not. I’m certain Mrs. Stoutbody’shandshake meant; at least 100 m.i.d. of Bact. typhosum."Heavens alive, and I’d been scratching my lip fiveseconds previously. " Let’s get to the nearest hotel," Isuggested, " for a wash and something to eat." Butthe hotel couldn’t serve lunch though the inn-keeperpointed to a little cafe where he thought we might belucky. No, they hadn’t any place where we could washbut they’s give us what was left for lunch. We sat downgingerly at a long table with ten other people staringacross and a menu-card that said, soup, steak pie andsuet pudding. That at least was all right. The souparrived and we gaily set-to ; gaily, until I noticed thatmy spoon hadn’t been dried after washing. Yes, I was.certain a drop of moisture slid down the handle from myfingers into the soup. The only comfort, the soup washot but not hot enough and the culture would be dilutedat least 10 -s I started to break a piece of bread." Bread isn’t a bad platinum-loop," said the chief as Itried to spit out the piece I’d already chewed. " Sorrythe meat and pudding are done," said the waitress coming