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wrote that the surgeon in question was Mr. LawsonWhale. Mr. Whale naturally took action upon thesedamaging statements. As his counsel explained, he didnot seek punitive damages but merely asked for a verdictwhich would discourage such allegations as Mr. Sargantmade. The three women were not Mr. Whale’s patients ;it was no part of his duty to interfere in their treatmentunless invited to do so. Mr. Sargant had been told thathe was misinformed ; he had, however, refused to acceptthe statement. Mr.- Whale denied in the witness-boxthat the hospital was conducted in the spirit of gettingrid of patients as quickly as possible. Mr. JusticeAtkinson asked if the Ministry of Health had issued anyinstruction for turning patients out on a war-time ratherthan a peace-time standard. Mr. Whale replied that hehad always found it. easy to keep patients there as longas he would have done in normal times. The hospitalstaff had been warned to regard themselves as a casualtyclearing station rather than as a base hospital; actuallythey had found it possible at all times to act as a basehospital. Mr. Arthur Gray, F.R.C.O.G., a colleague atthe hospital, expressed the opinion that the three womenwere not in fact suffering from shock.

Mr. Sargant gave evidence on the second day of thehearing and explained his motives. ’. His original letterhad said that he made his protest as a ratepayer ; in hiswritten defence he had pleaded that the occasion wasprivileged inasmuch as he addressed the hospital as acitizen, taxpayer and ratepayer of Hampstead, in goodfaith and without malice, under a sense of duty to some-one who had a corresponding duty in the matter and inthe honest belief that the contents of his protest weretrue. If the occasion were privileged Mr. Whale wouldnot succeed unless he could prove malice. Having heardMr. Sargant’s evidence, Mr. Whale felt satisfied that thedefendant had acted in good faith. He himself had beenconcerned merely to protect his reputation against whatseemed the malicious attack of a busybody. He wasnow prepared to withdraw the action and pay thedefendant’s costs ; Mr. Sargant on his side acknowledgedthat his letter had been too strong and expressed his,regrets. The judge approved the settlement. In hisview the occasion of the letter was undoubtedly privi-leged. It was important, he observed, that it should bemade clear that there had been no plea of justification ;Mr. Whale’s course of action implied no admission thatcomplaint was well founded. So long as there was noreflection upon Mr. Whale, his lordship was satisfied withthe result ; he did not wish it to be thought that thistermination of the case reflected upon the plaintiff inany way.

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SCOTLANDTHE SCOTS HOSPITAL PROBLEM

ON Oct. 14 the Secretary of State for Scotland, replyingin the House of Commons to a question on hospitalpolicy, said that he was having consultations with thebodies concerned and could not at that stage add any-thing to the general statement made by the Minister ofHealth. The bodies concerned are presumably thevoluntary hospitals, the local authorities and the Nuffieldcommittee. The Minister of Health in his generalstatement foreshadowed some special measures applicableto Scotland in the formulation of hospital policy, anddoubtless these special measures will be under discussionat the meeting to which Mr. Johnston referred. Thedifference between the hospital problem in Scotland andthat in England is essentially one of degree. Scotland,as is well known and as was brought out in the reportof the Committee on Scottish Health Services, is notnearly so well provided with hospital beds as is England.If, as Mr. Johnston said in opening the Ayrshire CentralHospital recently, it is the aim of the Government in theirplans for the post-war hospital service to ensure thatproper treatment is available to every person in need ofit, the question of adequate provision in Scotland is onethat is bound to be compelling. It is probably true, asthe Secretary of State said at Ayr, that there are largenumbers of people suffering unnecessary pain or dis-comfort, unable to pull their full weight, the condition ofmany of them deteriorating. He wants to remove thatreproach to our hospital system, and he wants to developthe hospital service in the form of a kind of partnershipamongst the various hospital authorities, and especially

to see the greatest possible cooperation between volun-tary hospitals and local authorities, so that every hospitalmay fill the roll best fitted to it in a coordinated schemeon a regional basis. The Secretary of State desires, byimplication, to retain the voluntary hospitals, anddoubtless he must be giving serious thought as to thebest method of giving necessary state aid to them-whether through the agency of local authorities or not.He must be concerned, too, to know how best to utilisethe ad-hoc hospitals erected under the auspices of hisdepartment and directly administered by it. Thesehospitals were primarily designed to fill gaps in thetreatment of war’ casualties, but it would be preposterousto allow them to fall into disuse when the war is over,though there may be a strong Treasury urge in thatdirection. It seems probable that these hospitals willhave to be retained as important entities in a coordinatedservice involving local authorities, voluntary hospitalsand the Department of Health. Whether the last namedwill wish to continue to administer these hospitalsdirectly is one of the intriguing but comparatively minorproblems that beset the Secretary of State.

HEALTH OF EIRETHE report of the department of local government and

public health for the year ended March 31, 1940, recordsa decline in the incidence and mortality of the principalinfectious diseases, in infant mortality and in maternalmortality. The number of notifications of infectiousdiseases-6146-was the lowest since 1930, and about1900 fewer than in 1938. This reduction was mainlydue to a fall in the incidence of scarlatina and of diph-theria, the latter probably due to the campaign ofpreventive immunisation carried out in recent years bythe county medical officers of health. Yet there werestill 2097 cases of diphtheria with 245 deaths and 2779cases of scarlet fever with 43 deaths. Compared withthe previous year, typhoid notifications had risen from254 to 385 and the number of deaths from that diseasefrom 46 to 56. Many of the cases were traced to carriers.In a local epidemic in co. Kerry, with 103 cases and 8deaths, infection was spread by separated milk from acreamery. The milk was apparently infected by a caseof typhoid in one of the farms supplying the milk. Inthe creamery the cream was pasteurised and convertedinto butter, but the separated milk was sold untreated.In most of the cases there was definite evidence that theseparated milk had been consumed by the patient; no

case was traced to the butter. There were only 5 casesof’typhus, with 3 deaths, and this disease seems to begradually disappearing. Only 76 cases of puerperalsepsis were notified, the smallest number for many years ;the number of deaths from this cause was 38, the loweston record.The infant mortality-rate was 66 per 1000 births,

which is lower than that for Northern Ireland (70) orScotland (69), but higher than that for England andWales (50). Congenital debility heads the list of thecauses of infant mortality, premature birth comes

second and diarrhcea and enteritis third. The infantiledeath-rate in urban areas was 83 per 1000 births-90 in Dublin-and the rate for rural areas was 55.Mortality from tuberculosis had increased---1.13 per1000 of the. population as against 1-09 in the previousyear. But these are the two lowest figures ever recorded.There are no trustworthy statistics to show the inci-dence of the disease, as notification is only mandatorywhere the sputum or other infective discharge is liableto spread infection. This useless order dates back to1919 and has always hampered the campaign againsttuberculosis. Nevertheless, owing to the great effortwhich was made to assure notification and certificationit is probable that the increase was not real. Themedical officer of Cavan said : " The generation nowgrowing up has little .or no conception of the universaldread of this plague which prevailed when the campaignagainst tuberculosis was- initiated thirty years ago."Most of the medical officers of Eire have worked hard toovercome this dread, which lived in Ireland long after ithad died elsewhere, and because of their efforts and thegrowing enlightenment of the people concealment oftuberculosis is gradually passing, but it is still prevalent,especially in the west. In 1939 135,404 school-childrenwere examined. Dental defects were observed in 46-6%,

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and disease of the tonsils or throat in 19-1%. Treatmentof these conditions is provided free where necessary.The administration of the Milk and Dairies Act by

the local authorities has been on the whole satisfactory,and legal proceedings for non-compliance with statutoryrequirements have been successfully instituted, thoughthe report adds that some local authorities were

reluctant to take action on the recommendations oftheir medical and veterinary advisers. This seems tounderstate the case, for many local authorities fail toappreciate the importance of the act and are unwillingto prosecute negligent milk-producers, while. the localjustices fail to impose adequate penalties in the casesbrought before them.During the year 952,936 new cases were attended by

the 646 dispensing medical officers. It seems, therefore,that about a quarter of the population of Eire receivedmedical attendance under the Medical Charities Act.The income of the Hospitals Trust Fund for 1939 wasover £1,202,600, and the expenditure £367,800. Grantsof joe270,384 were made to poor-law and county hospitals,and 2209,822 to voluntary hospitals, of which job126,072was to meet current expenses.

ARGENTINA

. AVIATION

A SERVICE of air ambulances for both official and privateuse has been established under the control of the nationaldepartment of health. When used for private patients.the charge is 50 centavos a kilometre. Three machinesare permanently attached to this service in the sparselypopulated regions of the Chaco and the southern terri-stories. Analysis of the effects of aviation on bothhealthy and sick people has led Prof. M. R. Castex and hiscolleagues to conclude that of the cardiac and circulatorydisorders only cases of myocardial degeneration can safelybe carried by air, and that patients with respiratoryaffections other than bronchitis or chronic pleural disordersof a non-exudative nature should also avoid flying.

It is planned to establish a division for the sanitarysupervision of aircraft in the department of health, witha view to checking the spread of infection by aircraftarriving from infected regions. Aviation is on theincrease in the Argentine. In 1938, there landed inBuenos Aires 770 aircraft carrying 7300 passengers,whereas in 1940 the figures were 1800 aircraft and15,800passengers. Aircraft may carry infected insects, butthere is also the .risk that passengers may still be in theincubation period of an infectious disease when theyarrive and so will not appear ill.

BREAST-MILK CENTRE

The government has established a non-profit-makingcentre in Buenos Aires for extracting, preserving anddistributing surplus breast milk. The old mothers’-milkstations were mainly based on the wet-nurse system, butthis centre obtains its milk from normal mothers, and itis found possible to take 200-300 grammes from manymothers without depriving their own children. Thedonors’ family histories are inquired into, and theyundergo a periodic clinical, radiological and serologicalexamination. During 1940 over 5000 litres oftnilk weresupplied to 1200 babies from 350 donors. The pricecharged ranged from 7s. a litre down to nothing accordingto the means of the recipient ; more than half of the milkwas supplied gratuitously.

PSITTACOSIS

During the pandemic of 1929-30, which involvedBuenos Aires and part of northern Argentina, about200 cases of psittacosis were reported. Then in the nextnine years there were only isolated cases, but in 1939 anoutbreak in Buenos Aires produced 27 cases, of which13 (48%) died. The disease mainly attacks adults of45-55 and hardly ever children. Men and women areaffected equally, and bird-dealers are, as might be sup-posed, the commonest sufferers. Cold weather seemsto favour the propagation of tne disease, and the incuba-tion period is 7-14 days. During this last epidemichaemorrhagic skin lesions have been observed. Notreatment has been of any avail.

HEART DISEASEOf 10,000 school-children examined in Buenos Aires

2-4% had organic heart disease, ’2% being acquired and

the remainder congenital. It is hoped that early recogni-tion of cardiac lesions will improve the prognosis, forProf. Rafael Bullrich estimates that the mortality fromcardio-articular rheumatism is at present as high if nothigher in the Argentine than in any other conntry, and aspeaker in the Senate said that 2-4% of Argentinechildren under 14 die from the disease. According toMacera, and Costa Bertani the fatality from acuterheumatism in children under 15 is 22% in Buenos Airesand 12-5% in Rosario.

Professor Bullrich has also made a clinical and statis-tical study of people over 60, and in the last ten yearshe finds that circulatory diseases accounted for 43% ofthe deaths between 60 and 80 ; if nephritis is included(and nearly all cases in this age-group are circulatory inorigin) the figure rises to 47%. Since 540,000 of the131 million population of the Argentine are over 60 thesocial significance of these diseases is clear. The numberof hospital beds for such cases is insufficient, but muchmay be hoped from the work of the Institution for SocialAssistance to the Cardiac, of .which Professor Bullrich isdirector. This institution, which is a voluntary oneand has been running for three years, undertakes thecare of pregnant women, nursing mothers and childrenwith cardiac lesions, promotes the organisation andequipment of dispensaries and colonies for their treat-ment, and puts forward legislation on behalf of work-people with heart disease. At a congress of the institu-tion recently held in Buenos Aires it was urged thatclinics for heart disease should be established in theArgentine such as already exist in Britain and the U.S.A.Dr. Luis Sabathie, who has lately published an extensivemonograph on the subject, emphasised the inadequacyof purely medical methods in treatment. One remark-able statement made by subsequent speakers was that70% of anarchists and other revolutionaries suffer fromsome physical disability which prevents them fromfollowing a normal calling.

WOMEN CONFER ON INDUSTRYTHE second session of the London Women’s Parlia-

ment, held on Oct. 27 at the Conway Hall, was attendedby 371 delegates representing 211 groups, which includedcooperative organisations, guilds, trades unions, dis..;’cussion groups and education committees. Mrs. NAN.McMILLAN, recently president of the National Union ofWomen Teachers, took the chair.

Miss MARY CORSELLIS, the organiser, was able toinform the meeting of the results of the first session.Improvements had been reported from factories to whichthe L.W.P. had sent delegates. The Parliament hadbeen recognised by the Minister of Labour ; suggestionson milk rationing and the differential distribution oforanges had been adopted. An investigation of condi-tions in factories had been carried out and an inquiryinto the provision of day nurseries and into school feedingwas foreshadowed.

Discussion at the second session ranged over a bill toregulate supplies and distribution of food, and a series ofproposals designed to remove the obstacles now prevent-ing women from playing their full part in industrialproduction.The speakers were lucid and brisk, much more con-

cerned with facts than theories. Among them werecouncillors, teachers, transport workers, ambulancedrivers, clerks, housewives, nursery school supervisors,canteen managers and workers from clothing, munitionand aircraft factories. They had many abuses to pointout, but there was a striking growth, during the meeting,of the conviction that it was not by individual andintermittent grumbling that these could be remedied,but by the deliberate and combined action of the womendoing the jobs. The factors held to be largely responsiblefor keeping women from keen participation in the workof production were low wages, insufficient day nurseries,long working hours and consequent shopping difficulties,bad canteens and inadequate transport.

WAGES AND WORK

Of these perhaps low wages received least attentionin the discussion, although the hardship caused by thisfactor is sometimes great. Some girls under 20 areunable to earn a wage on which they can get enough toeat. In most factories women are paid much lower