2
988 explanation, suggested is that contamination may have escaped the cordon of precautions during a rush period when there was an abnormal demand for cream. Although the evidence is thus incomplete the report is full of instruction as to the methods taken to track down the origin of an outbreak of this kind. The incidence of paratyphoid fever in London dates from the war period. It was anticipated that the return of overseas troops in 1918 and after would give rise to such outbreaks, for the micro-organisms of the Salmonella group may be carried by patients long after recovery and may be discharged by them intermittently over a long period of time. The previous outbreak of 1927 in Hertfordshire was traced to the infection of the milk-supply by two persons on a farm suffering from the disease in an unrecognised form. Modern sanitation and constant vigilance on the part of sanitary authorities have combined to keep in check the risks which are ever present. Happily the condition favourable to the spread of the disease are generally absent when accidental infection by a carrier has occurred. An -appendix to the report makes short work of the shameless capital made of this outbreak by some of those who wished to see the food regulations revoked, for it shows that the prohibited preservative could have had no effect whatever upon the growth of paratyphoid B ; when the organism was implanted in cream even 4 per cent. of boric acid failed to prevent its growth. ____ THE LEGAL ASPECT OF STERILISATION. A RECENT episode at the Old-street police-court may some day be hailed as the first tentative step towards the sterilisation of mental defectives by magisterial direction. A young man having been charged with drunkenness and assault, Dr. Williams, a member of the medical staff of the London County Council, stated that he had examined him and was prepared to make an order concerning him under the Mental Deficiency Act, 1913. The London County Council, he said, was prepared to place the young man in an institution. Upon request being made on behalf of the relatives that the accused should be allowed to remain at large, Mr. Clarke Hall, the police-court magistrate, answered that, if set at liberty, the young man might propagate other mental defectives. A brother gave the court .an assurance that the accused would not marry. Even so, rejoined the magistrate, he might have children. At this point the representative of the relatives is reported to have asked the brother if he was prepared to have the accused " medically treated "—" medical treatment " apparently meaning sterilisation. The brother is reported to have answered in the affirmative, Dr. Williams observing that " it would be rather a new process in this country." After an adjournment the relatives were still anxious that the defendant should remain at liberty, but his mother was not prepared to agree to the suggested operation. The magistrate therefore made an order for his detention in an institution ; " I do not want," said Mr. Clarke Hall, " to turn out this mental defective of low grade to produce other mental defectives." Upon this incident a learned contempor- ary, the Solicitors Journal, makes the comment that the suggested operation would be entirely illegal. " A doctor who performed this operation on a person mentally incapable of giving assent would, at the very least, be guilty of a serious assault or unlawful wounding ; it may also be laid down with some confidence that, even in the case of a person capable of giving assent and doing so, the operation would amount to an assault in a country where the law forbids consent to that minor form of battery, with temporary instead of permanent result, known as the " knock-out." If sterilisation is volunteered on behalf of the defendant to the magistrate as an alternative to detention and as a basis on which a charge shall be disposed of, it may seem strange that there should be any element of illegality. Evidently, however, the law as it stands to-day has its complications. One high authority on criminal jurisprudence lays down the principle that people have a right to consent to the infiiction upon themselves of bodily harm not amount- ing to maiming. He explains that injuries short of maiming are not criminal at common law unless they are assaults, and an assault is inconsistent with the idea of consent. Maiming (or, to use the old legal term, 9 9 mayhem") has a technical meaning. To maim a man, according to Coke upon Littleton, " signifieth a corporal hurt whereby he loseth a member by reason whereof he is less able to fight-as by putting out his eye, beating out his fore-teeth, breaking his skull, striking off his arm, hand, or finger, cutting off his leg or foot-or whereby he loseth the use of any of his said members." Hawkins’ Pleas of the Crown specially mentions castration as a maiming. The element of diminishing the victim’s value as a soldier is interesting if anachronistic. It can even be suggested, as an academic thesis, that the person who consents to sterilisation is guilty of the criminal offence of self-maiming, because, in the language of the Solicitors Journal, " it may be suggested that the Sovereign is entitled to rely on his subjects to ensure their continuance." There is a statutory offence of wounding with intent to maim ; under Section 18 of the Offences against the Person Act, 1861, it is punishable with penal servitude for life. A surgical operation, if it breaks the continuity of the outer skin, comes within the definition of a wound ; but, so far as Section 18 is concerned, the prosecution must prove that the wound was inflicted " unlawfully and maliciously." As for operations upon a person incapable of giving consent, it is clear that a parent has a right to consent to an operation upon a child who is too young to exercise a reasonable discretion. And if a patient is in such circumstances as to be incapable of giving consent to an operation-e.g., if he is rendered unconscious by a motoring accident which makes it necessary to amputate a limb-it is not a crime to operate without his consent. But these propositions seem to presuppose that the operation is reasonably necessary for the saving of life or the repairing of bodily injury. As we indicated last week, certain American States have experimented with the legalisation of sterilising the insane, and the Minister of Health has said lately in Parliament that he thinks a proper scientific inquiry into the subject will some day be necessary. At present, however, he seems not to regard the matter as urgent. Our mental defec- tives are, he says, broadly the product of one-tenth of the population, and, out of that one-tenth, only one-tenth (or 1 per cent. of the whole) are themselves definitely defectives. The others may be unrecognis- able as defectives, and thus sterilisation can scarcely be an adequate and final solution of the problem. THE CICATRISATION OF WOUNDS. I IN the Presse JJfédicaZe for April 3rd Prof. R. Leriche makes some suggestive observations on the processes which normally lead to the cicatrisation of a wound. Why, when an incision is made into the tissues, processes of repair should immediately be set in action and the wound should heal has always been unex- plained. The question has a practical as well as a philosophical bearing on the everyday work of the surgeon, for if the inner nature of these processes were known it might be possible to hasten repair and thereby shorten convalescence after operations. The suggestions put forward from time to time, such as Weigert’s theory of the release of restraining tissue tension and the idea of a stimulus by the products of the digestion of damaged cells, have none of them been really satisfactory. It is scarcely credible that a simple modification of tissue tension should be capable of making connective tissue, stabilised for many years, return to an embryonic state. And as for the second hypothesis, a wound heals all the quicker by first intention when disintegration is reduced to a minimum ; moreover, the normal changes happen at once,whereas
