176

authority, or the medical officer of health acting under a formal autho-risation, may require the delivery of infected articles ...... for disinfec-tion....... Compensation for unnecessary damage incurred in the processof disinfection may be paid. Temporary shelter or house accommoda-tion shall be provided free of charge for ...... any family...... compelledto leave their dwelling while disinfection is being carried out....... Apenalty not exceeding 25 is imposed for obstructing a duly authorisedofficer ...... in carrying out ...... disinfection, and the officers are givena right of entry.......Hospitals and dispensaries.-Part II. of the Act ...... deals with the

provision by the council of any county (including the town council of acounty borough), of hospitals, sanatoriums, and dispensaries for thetreatment of the inhabitants of their county or county borough sufferingfrom tuberculosis .......

bliscellaneo2ss provisions.-Part III. of the Act ...... contains pro-visions intended to deal with the prevention of tuberculosis. Sanitaryauthorities ...... may arrange for public lectures and for the distribu-tion of literature on subjects relating to tuberculosis, and they mayprovide drugs and appliances, for example, spitting flasks....... Poweris given to county councils to appoint a bacteriologist, being a medicalpractitioner, for the examination of meat or milk or milk products,and of sputum or pathological specimens....... In any county in whicha bacteriologist has been appointed power is given to any medicalofficer of health ...... to take samples of milk or milk products forexamination or analysis....... Penalties for obstruction are imposed,amounting in the case of a first offence to :E20....... Where a veterinarysurgeon certifies any milch cow to be affected with tubercular diseaseof the udder the sanitary authority may cause the animal to beslaughtered and may pay the owner compensation, the amount ofwhich ...... shall not in any case exceed £10. The carcase ...... shallbe ...... disposed of as the circumstances require.......

It is not our purpose on the present occasion to make anydetailed reference to the Act as a legislative measure, butmerely to mention some obvious features of the instructionsissued by the Local Government Board for Ireland in itsMemorandum and Orders. Speaking generally, and keepingin mind the Parliamentary exigencies already mentioned, webelieve that the Board has been actuated by an earnest desireto make the new legislation acceptable to the public. Thisis essential, for, as we have often remarked, no scheme for theprevention of epidemic disease can be permanently suc-

cessful without the intelligent cooperation of a considerablesection of the community. On the other hand, we think thatthe instructions are highly unsatisfactory from the medicalpoint of view, and that there is good reason for the mis-givings expressed by our Dublin correspondent in THE LANCETof July 10th. In each of the Orders a paragraph is quotedfrom the Act in the following terms :-

If any medical practitioner attending on any person within any dis-trict to which Part I. of the Act extends becomes aware that thatperson is suffering in any prescribed circumstances from tuberculosis ofany prescribed form or at any prescribed stage, the medical practitionershall within seven days after he becomes aware of the fact send to themedical officer of health a certificate in the prescribed form andcontaining the prescribed particulars.

Definitions of the prescribed circumstances, form, andstage will be found in the preceding quotations from theMemorandum. Let us assume that a patient of the wage-earning class, such as a shop assistant, a clerk, an artisan, ora laundry ironer, comes to a surgery complaining of cough,expectoration, and loss of appetite, but nevertheless in fullemployment. The clinical history and the physical signs ofpulmonary tuberculosis may be so obvious that there wouldbe no difficulty in certifying the sputum to be infectiouswithout bacteriological tests, but the medical practi-tioner is placed in the dilemma that the patientprobably works in association with healthy persons andis therefore presumably notifiable. Inquiries concerninghis fellow workers and previous medical advisers wouldarouse the patient’s suspicions and trustworthy answerscould not always be expected. If the practitioner fails tonotify a case he takes the risk of being prosecuted and fined£2. If he is informed that the patient’s fellow workers arehealthy he perceives that the case is notifiable according tothe statute, but he feels that in sending a statutory notifica-tion to the proper quarter he is taking the risk of receivingno fee because the sanitary authority may in reply inform himthat the case has been notified already. If the patient is, orclaims to be, married the case is notifiable when the partneris healthy, but not so when the partner is tuberculous. Howis the practitioner to ascertain this without an examinationof the other individual, who probably does not want to beexamined and has no intention of paying a fee ? ? The incon-sistencies and difficulties of the practitioner’s position areso obvious that there is no need of further examples. In short,it would be amply sufficient to ask the practitioner to notifythe patient’s name and address, together with a certificatethat he suffers from tuberculosis in an infective stage, leavingthe question of ’’ prescribed circumstances " to be investigatedby the officials of the sanitary authority.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

A QUARTERLY meeting of the Council was held on

July 8th, the President. Sir HENRY MORRIS, Bart., being inthe chair.The PRESIDENT reported the result of the annual election

of members of Council, as already reported in THE LANCET,and Sir W. Watson Cheyne, Mr. R. Clement Lucas, and Mr.Harrison Cripps were introduced, and, having made declara-tions in the terms of the oath prescribed by the Charter of1800, took their seats in the Council.A report was received from the museum committee with

reference to the revision of the pathological catalogue, andthe recommendations of the committee were approved;these included, among others, the appointment of a patho-logical assistant in the museum and the appointment of anexpert to advise as to the gyæcological specimens. Thebest thanks of the Council were given to the authorities ofthe Egypt Exploration Fund for their valuable gift of 83skulls of the Sixth Dynasty, recently found at Abydos inEgypt.

- . - - - - - -

An address was read, which had been presented by thePresident, on behalf of the College, to the chancellor, masters,and scholars of the University of Cambridge on the occasionof the commemoration of the centenary of Charles Darwin’sbirth. The best thanks of the Council were given to thePresident for preparing the address.The following lecturers were appointed for the ensuing

year :-Hunterian professors : Dr. Arthur Keith, four lectureson the Anatomy of the Negro and Negroid Races ; Mr. W. S.Handley, two lectures on the Surgery of the LymphaticSystem ; Mr. George Coats, two lectures on Congenital Abnor-malities of the Eye ; Dr. R. Horace Paramore, two lectures onthe Functions of the Pelvic Floor Musculature; and Dr. C.Bolton, two lectures on the Pathology of Gastric Ulcer.Arris and Gale lecturers : Mr. Sydney R. Scott, one lectureon the Physiology of the Human Labyrinth; and Dr. PeterThompson, two lectures on the Erect Attitude, its Adoption,Maintenance, and Failures, with Especial Reference toCertain Surgical Conditions. Erasmus Wilson lecturer:Mr. Samuel G. Shattock, six demonstrations on SurgicalPathology. Arnott demonstrator: Dr. Arthur Keith, sixdemonstrations of the Contents of the Museum.

Mr. H. T. Butlin was unanimously elected President, andMr. Pearce A. Gould and Mr. Clement Lucas were appointedVice-Presidents.The next meeting of the Council will be held on Thursday,

July 29th. ______________

MEDICINE AND THE LAW.

More about the Workmen’s Compensation Act, 1906.IN a recent letter to our columns Mr. Albert Benthall

made the recommendation that when an accident has incapa-citated a workman it is in the interest of the employer to paythe half wages required by the Workmen’s CompensationAct with promptitude, and also to see that the workman is

receiving proper medical attention and nursing, as this willin many cases shorten the period of invalidism. This soundadvice might be taken notice of by insurance companies, whopresumably are usually responsible for the attitude adoptedby the employer, and would he applicable to cases wherethere is no doubt as to the liability to compensate. The

suggestion as to medical attention and nursing might oftenprove valuable in instances where the workman is honestlyanxious to get well, but a substantial number of cases

under the Workmen’s Compensation Act have unavoidablyformed the subject of legal intervention and one pointeems to have been elicited with frequency-namely, thatthe injured man, supposing that he is injured, is not

lecessarily in a hurry to be declared sound again. It has,lowever, been more often the liability of the employer toJompensate which has formed the subject of repeated argu-nent than any question as to the duration and extent of thenjuries.The case of Craske v. Wigan, which was recently made the

1 THE LANCET, May 29th, p. 1555.