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work. What we did not know in the treatment oftuberculosis was the morbidity of the disease. Hewould like to see the hospital with a dispensaryattached and a week-end rest centre for ex-patientswho came back for advice or a week-end’s rest. Hebelieved that way they would get a unified system.

Dr. F. W. BURTON FANNING said that the propor-tion of early cases amongst admissions to sana-

toriums varied from 25 to 40 per cent., and askedwhether the doctor was to blame for late diagnosis,or the patient for not giving him a chance of makingit. An impartial scrutiny of patients’ histories madeby Dr. W. E. Jolliffe and Dr. D. Wilson at Kelling,suggested delay or mistake on the doctor’s part in25 per cent., culpable delay on the patient’s part inseeking advice in 20 per cent., and in 6 per cent.tubercle was discovered unexpectedly in the courseof a routine examination for insurance or other

purposes. Similar inquiries made in regard to100 consecutive patients belonging to the more

educated and wealthy classes suggested that thedoctor had been unduly slow in making the diagnosisin 36 cases, and the patient had unduly delayedconsulting him in 20. The balance in favour of thepanel over the private doctor might be an exampleof the advantage of ready access to the tuberculosisofficer with his full equipment for X ray and otherinvestigations.

Dr. EvELYN M. HOLMES referred to recent experi-mental work in Denmark. The Lowenstein-Jensenmedium appeared to be extremely selective, enablingparticles of sputum to be directly inoculated in themedium without preliminary washing. As a rule,the human type of bacillus gave a free growth after17-21 days, the bovine type after 28-32 days ; the

growth obtained being quite different in appearance.Dr. Holmes gave the results of a series of tests, madeover a period of months, on all the sputa receivedby a large laboratory which were T.B.-negative byordinary staining methods. Over 50 per cent. gavea positive result by culture on this medium. Themethod had an obvious value in the examinationof such things as pleural fluid, cerebro-spinal fluid,or pus obtained from joint abscesses.

MEDICINE AND THE LAW

Oysters and Typhoid FeverAFTER eating oysters at a St. Leonards hotel a

visitor had an attack of typhoid fever which kept himaway from his work for five months. He sued thehotel for damages for breach of warranty and negli-gence ; the hotel denied liability and brought in thefishmonger who had supplied the oysters ; he in turnbrought in the company which sold him the oystersfrom its oyster-beds. There is nowadays a new

procedure for these actions where third and fourthparties are involved. While the first party is attackingthe second, the third and fourth are allowed to appearand cross-examine the witnesses but cannot themselvescall evidence till the first issue is decided. There is arisk, of course, that the jury may take a view on thefirst issue which it would have rejected if it had heardthe evidence subsequently called on later issues. Atpresent the new third-party procedure is in theexperimental stage ; this case about the oysters isbelieved to have been the first of its kind to be dealtwith by a jury under the new method.As a matter of law the hotel proprietors had to

admit that, if food was sold there which made thebuyer ill, the seller was liable even though every care

was taken to secure wholesomeness. There was no ’

doubt the hotel management had been careful, and itwas naturally argued that there was no conclusiveproof that the typhoid fever was due to the oysters.The jury, however, was satisfied with the evidencegiven by Lord Horder and others on the plaintiff’sbehalf and awarded 5:.725 damages. The case thenentered the next stage, the hotel proprietors changingfrom defendants into plaintiffs and suing the fish-monger. He could not deny his legal responsibility inthe face of the verdict already given ; he thereforesubmitted to judgment for the sum of 5:.725 in favourof the hotel and forthwith proceeded in turn to suethe company from which he obtained the oysters. He

produced some new evidence. There had apparentlybeen other cases of typhoid in Hastings at the materialtime. One of these patients had eaten oysters beforehis illness ; did not this show that the oyster-bedshad somehow become temporarily contaminated ?The company which owned the oyster-beds had somefresh evidence too. Several persons at Hastings werecalled to say that they had had typhoid withoutoysters, several others to say that they had hadoysters without typhoid-oysters, too, from theselfsame barrel as those which the original plaintiffhad eaten at the hotel. Bacteriologists produced therecords of the oyster-beds and gave them the highestcharacter. Whereas the expert witnesses for the

original plaintiff had inclined to suspect oysters asa not uncommon source of typhoid infection, theexperts of the final defendants said that nowadays thesuspicion was no longer justified. Dr. G. F. Buchan,medical officer of health for Willesden and author ofbooks on typhoid fever, stated that, if there had beencontamination of the beds as suggested, he wouldhave expected a widespread outbreak of infectiousdisease wherever the oysters had been sent. He also

thought the period of incubation of typhoid fromshell-fish would normally be much shorter than in theoriginal plaintiff’s case. It might be only three days ;the longer period was consistent with the disease

having been contracted after leaving St. Leonards.The judge reminded the jury that no complaint hadbeen made against the cleanliness of the fishmonger’spremises or against his handling of the oysters. The

jury came to the conclusion that the fishmonger hadnot satisfied them that he was supplied with con-taminated oysters by the company. Thus, pending apossible appeal, the whole liability falls on him ; hemust pay the first plaintiff the damages of 5:.725, andnot only can he not pass on this burden but he mustalso pay the costs of the hotel proprietors and of theoyster company. Old-fashioned members of the legalprofession who have not yet learnt to love the newprocedure are asking whether the jury would havefound in the first instance that the patient’s typhoidwas due to the hotel’s oysters if it had heard the

subsequently given evidence of those oysters’ blamelessUDbrina’inar.

Coroner and DoctorAt the resumed inquest at Leigh on the death of

five miners in the Lancashire colliery explosion, amedical witness was questioned by the coroner

(Colonel R. M. Barlow) about his action in havingtaken specimens of blood from four of the bodieswithout the coroner’s permission. He explained thathe understood that in any investigation after an

explosion it was important for the blood of the mento be examined for carbon monoxide as early aspossible ; he had therefore taken samples at once.He had, he said, no object except the public goodand had acted on request. The coroner, who eventuallyclosed the incident by accepting the apologies of all

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concerned, stated that this was the third occasionwithin a year that there had been interference witha body which was in his custody. There was a questionwhether it did not amount to contempt of court.

According to the authorities a coroner has undoubtedpowers of punishing contempt by fine or imprisonment,since his court has the dignity of what is called acourt of record. There is less certainty as to thesepowers where the action of which he complains doesnot take place in the presence of the court. But itis in any case a common-law misdemeanour not onlyto prevent the holding of an inquest but also toobstruct the coroner in the course of his investigation.To tamper with a body, so that -the coroner cannotbe sure whether it is or is not in the same conditionas when found, is clearly an interference which istechnically an offence. It should be possible to arrangewith the coroner’s permission, or rather, indeed, underhis actual direction, for prompt action in taking bloodspecimens in these cases. He will no doubt be fullyaware of the evidential value of the earliest possibleexamination.

PARIS

(FROM OUR OWN CORRESPONDENT)

NEW CHIEFS FOR THE PASTEUR INSTITUTE

SINCE the almost simultaneous death of Rouxand Calmette a few months ago, the choice of theirsuccessors has engaged the attention of all concernedand of sundry others. Members of the executivecommittee have visited the various departmentsof the institute and have familiarised themselveswith their activities. Although many names havebeen mentioned in connexion with the two vacancies,it is satisfactory that at the decisive meeting on the

afternoon of May 17th the appointments were madeby a unanimous vote. Louis Martin, the new director,was born in 1864, and is a brother of the presentMinister of Finance. Martin’s introduction to thePasteur Institute in Paris dates back to 1892. Sincethen he has been continuously engaged on importantresearch work, but being in charge of the hospitalattached to the institute he has never lost touchwith the clinical side of medicine. In 1894 the epoch-making communication on the serum treatmentof diphtheria made at Budapest was signed by LouisMartin as well as by Roux. Among the notablecontributions to medical science made by the newdirector are those concerned with experimentaltuberculosis and the serum treatment of ictero-

hsemorrhagic spirochaetosis and trypanosomiasis.While Louis Martin succeeds Roux, Gaston Ramon

becomes sub-director, more or less in the place ofCalmette. Ramon was born in 1886, and his namehas for many years been associated with the anatoxintreatment of diphtheria. At Garches, only a fewmiles out of Paris, Ramon has been for several yearsin charge of that branch of the Pasteur Institute whichis concerned with the preparation of diphtheriaserum. When the possibility of his being appointeddirector instead of sub-director was being discussed,only one serious fault was found with him ; he wastoo young. But as this defect will be correctedautomatically, it is likely that eventually Ramonwill guide the destinies of the Pasteur Institute withthat combination of administrative ability andscientific acumen which have distinguished his sojournat Garches. An innovation is the provision of thePasteur Institute with a scientific council, whosemembers include Prof. Jules Bordet, of Belgium, and

five other eminent pupils of Pasteur-GabrielBertrand, A. Borrel, Mesnil, Nicolle, and Yersin.The term of office of each member of this councilis for one year only, but provision is made for re-elec-tion as well as for the appointment of new membersas needs arise.

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A NEW TREATMENT FOR SPRAINS

Four years ago Prof. Leriche, of Lyons, publisheda paper which set out some unorthodox views onthe genesis and treatment of sprained joints whicharoused some controversy. Two of his assistants,G. Arnulf and Ph. Frieh, have now 1 brought forwardevidence in support of his claims, which are the moreinteresting in that they promise a shortened periodof invalidism. According to Prof. Leriche a sprainis not due to rupture of a ligament. It is suggestedthat no one has ever seen such a rupture, but that ithas been taken for granted ; a hypothesis has becomean affirmation, and eventually a dogma. In thetwo cases of sprains of the ankle in which he was ableto look and see, Leriche found the external ligamentsto be normal, not even infiltrated with blood. Heholds that the lesion in a sprain involves the sensitivenerve-endings in a joint. A vasomotor reflex isset up and gives rise to oedema, a local rise oftemperature, the familiar functional disturbances,and atrophy of the muscles involved. If, now, theinjured parts are promptly infiltrated with novocain,even in the presence of oedema, hyperthermia, pain,and almost complete loss of movement, normalconditions are restored in a few moments ; the

patient no longer suffers pain, and is able to walkhome quite happily. Often, after three or four hoursthe pain suddenly returns, lasts for an hour or two,and then disappears. On the following day a secondinjection, and in a few cases a third, may be required.The ailment, thus treated, is said to last a matter ofonly 48 hours. If Leriche’s explanation is correct,the intraligamentary injection of novocain issuccessful because it breaks a vicious circle by blockingthe centripetal impulses travelling to the brain fromthe injured nerve-endings in the joint. The techniqueis simple, and the injections can be given even by thepractitioner whose knowledge of anatomy has becomesomewhat rusty. With the exception of the hip,most joints are easily accessible. A few c.cm. ofa 0-5 to 1 per cent. solution of novocain are depositedin the periarticular structures, near a tender point ifthis can be found. With proper aseptic precautionsthere should be no risk of infection. A few momentsafter such an injection the patient is told to move hisjoint, and is generally astonished to find how suddenlyand almost completely normal conditions have beenrestored. This treatment is said to be of value inthe differential diagnosis of injuries to the joints,its failure indicating the existence of some grosslesion requiring a radiographic examination and thespecial treatment resulting from its findings.

IRELAND

(FROM OUR OWN CORRESPONDENT)

PROGRESS IN PUBLIC HEALTH

THE annual report of the Department of LocalGovernment and Public Health for the year endedMarch 31st, 1933, has recently been issued. Countymedical officers of health have now been appointedin 18 counties, which include over three-quartersof the entire population. A number of assistant

1 Presse Méd., April 14th, 1934, p. 597.