95MEDICINE AND THE LAW.-IRELAND.

not be withheld from Mr. Duff’s widow. Perhaps themost reassuring feature of the whole story hithertohas been the fact that the action taken by Mr. Duff’smedical attendant upon the doubtful symptoms whichaccompanied the final illness ensured the opportunityfor judicial inquiry at the time.

The Prosecution of Col. Kynaston.The police-court proceedings against Lieut.-Colonel

J. W. Kynaston have ended in a victory for him onone point and a defeat (unaccompanied .by seriousconsequences) on another. At the further hearingof the summons against him at Marlborough-streetpolice-court on July 2nd the ground was considerablycleared. The defendant, it will be recalled, is chargedwith wilfully and falsely pretending to be a doctor ofmedicine, and wilfully and falsely using the title of" M.R.C.S. Eng." contrary to the Medical Acts.Mr. G. D. Roberts, for the prosecution, explained thathe was not saying a word against Col. Kynaston’shonour. The prosecution did not impute fraud, anddid not ask for a large penalty. The view of theprosecution was that the General Medical Council, ashead of the medical profession, was the judge of thestandards of professional honour, and had statutorypower to strike persons off the Medical Register ifcertain conduct was found proved. Rightly or

wrongly, the General Medical Council, in 1922, foundcertain conduct by Col. Kynaston proved, and struckhim off the Register. The use of the title " doctor,"coupled with medical practice, must (said Mr.Roberts) amount to a representation that the defendantwas a doctor of medicine. The Royal College ofSurgeons had taken away his diploma ; consequentlyCol. Kynaston was not entitled to use the description" M.R.C.S." Col. Kynaston’s case, on the otherhand, is that his name was illegally removed from theRegister for reasons described in THE LANCET lately(June 29th, p. 1376) in connexion with his applicationfor a mandamus. If the law courts will not allow themerits or legality of that removal to be reopened orquestioned, then Col. Kynaston maintains that nomedical man is obliged to register, that he himselfhad never claimed to be on the Register, that he has Ibeen a doctor for 20 years, and in the common andpopular sense of the word he is still a

" doctor," nomatter though his name has been removed from theRegister or though the Royal College of Surgeons hasautomatically (and, as he maintains, unlawfully)deprived him of his diploma upon such removal. Mr.Cancellor, the magistrate, gave liiC decision on July 9th.He found-presumably as a question of fact-that thedefendant did not wilfully and falsely pretend to bea doctor of medicine ; the summons on this pointwas therefore dismissed. He also found that thedefendant did commit a breach of the statute bycontinuing to use the letters " M.R.C.S. "_; but he edismissed the summons under the Probation ofOffenders Act with a serious caution and warning thatpersistence in publishing his advertisement wouldmake the defendant liable to serious penalties. Themagistrate was for various reasons reluctant to.record a conviction against him.

Dr. Bell’s Acquittal.The re-trial of Dr. H. W. Bell, of Oakley-street,

Chelsea, on the charge of manslaughter, and of havingperformed an illegal operation upon Miss KathleenKelly, ended on July 2nd, in a verdict of " NotGuilty," on both counts. The previous proceedings,when the jury disagreed, were summarised in THELANCET of June 15th, p. 1273. In the course of therecent re-hearing before Mr. Justice Swift, at theCentral Criminal Court, Sir Henry Curtis Bennett,appearing for the defence, emphasised Dr. Bell’shigh reputation. Dr. Bell, he said, had merely madean examination of the young woman, which he wasperfectly entitled to make, and which was perfectlylawful; he advised that she should go into a nursinghome, where she could be properly looked after. Dr.Bell gave evidence after counsel’s opening speech forthe defence, and the jury returned their verdict ofacquittal without leaving the jury box.

IRELAND.

(FROM OUR OWN CORRESPONDENT.)

A PROPOSED MILK BILL.

Dr. E. F. Stephenson, chief medical adviser of theDepartment of Local Government and Public Health,in a press interview a few days ago, gave informationabout a milk Bill which the Government intendsshortly to introduce. Early last year an inter-departmental committee furnished a report whichcontained several recommendations for the improve-ment of the milk-supply of the country. It is on theserecommendations that the provisions of the Bill arebased. Dr. Stephenson states that the Bill aims atthe production of clean milk-not the cleansing ofdirty milk-by enforcing strict supervision of thecow, the dairy, and the distribution. To secure theseends a wider interpretation will be given to the words" milk" and " dairy," and the registration of allpersons carrying on the trade of dairymen, in additionto the registration of premises, will be made mandatory.It has been shown that clean milk can be producedwithout any great capital expenditure in alteringbyres, and that method, rather than buildings,determines its hygienic properties. The productionof clean milk is not difficult. Dr. Stephenson drawsattention to the educative work that has been doneby various voluntary organisations, and to the stepsthat have been taken by his Department to persuadelocal sanitary authorities to enforce existing laws andregulations. He points out that the Dairies, Cowshedsand Milkshops Order of 1908 is somewhat out of date.The Regulations under the new legislation will notalone deal with the lighting, ventilation, cleansing,drainage, and water-supply of the dairy, but willsecure a more thorough supervision, inspection, andexamination of dairy cows, the proper grooming ofanimals, personal cleanliness of milkers anddistributors, the cooling of milk, and its conveyanceand distribution in sterilised vessels and utensils.Furthermore, the grading of milk and the use ofspecial designations will be authorised, and misleadingterms prohibited. The bacteriological examinationof milk will be a guarantee to the purchaser of a highquality article, and a protection to the honest vendoragainst unfair competition. Drastic penalties againstselling dirty milk will be enforced. The use ofpreservatives in milk was prohibited by an Orderwhich came into operation in October last.Much has already been done, Dr. Stephenson

remarks, to prevent the spread of the acute specificfevers through the medium of milk, and the recordsof the Saorstat compare favourably now with thoseof other countries as regards milk-borne infection.The Bill now to be introduced enables a medical officerof health to stop the sale of milk if there is epidemio-logical or other evidence that it is the vehicle ofinfection. The safeguards relied on in the Bill for theprotection of the public against bovine infectionare: (1) inspection and examination, (2) tuberculintest, (3) bacteriological examination. The highergrade milk proposed under the Bill must be producedfrom cows which have passed the tuberculin test and aclinical examination.He adds that the placing of the Bill amongst the

Statutes of the State is a matter of little account inproportion to the spirit with which it is administered.The appointment of a county medical officer of healthin every county is essential to attain the objects inview under the present measure. " Success can onlybe achieved by steady, firm, and uniform administra-tion exercised by a whole-time trained sanitarian.The necessity for these officers is now well recognised,and their appointment is being pressed."

MOUNT VERNON HOSPITAL : STAFF APPOINTMENTS.Mr. Geoffrey Keynes and Mr. Stanford Cade have beenappointed surgeons, Lady Barrett and Dr. MalcolmDonaldson gynaecologists to the hospital.

96 PUBLIC HEALTH SERVICES.

Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.THE following are 1928 statistics of one borough Iand one urban district :-

z I

Ilford.Dr. A. H. G. Burton says that the year 1928

was characterised by a heavy incidence of infectiousdiseases. The attack rate for scarlet fever anddiphtheria was the highest for the past five years.There was a small outbreak of paratyphoid feverand small-pox occurred on one occasion. There were25 cases of paratyphoid, 10 of which occurred inApril. The cases continued cropping up at intervalsuntil November. All possible sources of food infectionwere investigated with no result, and Dr. Burtonhad no reason to trace the cases to infected cream,which was considered to be the cause of the Londonepidemic. None of the cases proved fatal. Therewas one case of small-pox in an unvaccinated girlof 14 and another Ilford resident developed small-poxoutside the borough. Both cases were of the mildtype and in neither case was the origin discovered.Tre much-needed cubicle wards at the isolationhospital have been completed. One is a new blockconsisting of four wards on each side of the dutyroom with glass partitions and an operating theatreat one end. Another block of obsolete pattern has beenconverted so as to provide eight cubicles.The open-air school has been completed and Dr.

Burton points out that in the majority of cases

new schools cannot be built on open-air lines andthat a further advantage of the open-air schoolis that delicate children unfitted for ordinary schoollife can be educated together and receive specialcare, observation, and treatment. Two needs of theschool medical service are an increase of the dentalstaff and the provision of a complete orthopaedicscheme. An immunisation scheme against diphtheriahas been under consideration and the Ministry.have pointed out that such a scheme would not beeligible for a grant under the maternity and childwelfare regulations. Scarlet fever has been, on thewhole, of a more severe type and has shown a tendencyto involve the mastoid bone. Nine per cent. of thecases of scarlet fever developed middle-ear diseaseand six cases of mastoiditis occurred. In the previousyear 5 per cent. of the scarlet fever cases developedmiddle-ear disease and there was no case of mastoiditis.Antenatal work makes progress. The number offirst attendances at the clinics was 198 in 1921 andhas gradually increased to 653 in 1928. The numberof women admitted to the maternity home hasincreased from 139 in 1919 to 481 in 1928, and allthe patients admitted, who are to be attended bya midwife, are examined at the antenatal clinic.During 1928 all the new houses built, numbering

877, were private enterprise subsidy houses and theonly two notices served for overcrowding were

complied with.

Edmonton.Dr. H. W. Harding says that the housing problem

in this urban district is not solved in spite of theefforts of the council. On the one hand are folkliving under sordid conditions and quite contented.On the other there are families living under conditionsof overcrowding which must sap the vitality of thestrongest. Rents are high and so-called furnishedrooms are let at an exorbitant figure. The interiorof overcrowded houses rapidly becomes dilapidatedand the sanitary inspectors have difficulty in decidingas to which defects the owner of the house shouldbe held responsible for. Of the 676 new houses186 were subsidy houses erected by the local authorityand 24 were subsidy houses erected by privateenterprise. An unusual occurrence was a plague offlying beetles, which began in one part of the districtearly in May. The beetles (Harpalus ruficorius)swarmed in myriads against the backs of neighbouringhouses from fields in which a good crop of potatoeswas raised. The trouble lasted about two monthsand various disinfectants were tried without apparentbenefit. On the advice of the Ministry, the farmerplanted his land with wheat, which would standheavy rolling, the idea being to crush any beetleswhich remained in the ground. Up to April, 1929,there had been no signs of recurrence. It has beensuggested that these beetles, which are carnivorousin habit, had made a wholesale migration owing tothe exhaustion of their natural food.The day nursery, which is at present run privately,

has been offered to the council and Dr. Hardingsuggests that a new child welfare centre might beerected on the site, as the present centre is inadequate.Early in 1927 an arrangement was made with theguardians for the treatment of cases of rickets,marasmus, &c., at the North Middlesex Hospitalby ultra-violet rays at a charge of ls. per exposure.Dr. Harding complains that out of 128 patientssent to the hospital for this special treatment during1928, 78 discontinued treatment contrary to medicaladvice.

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INFECTIOUS DISEASE IN ENGLAND ANDWALES DURING THE WEEK ENDED

JUNE 29TH, 1929.I Notifications.-The following cases of infectiousdiseases were notified during the week :-Small-pox,160 (last week, 166) ; scarlet fever, 1830 ; diphtheria,965 ; enteric fever, 56 ; pneumonia, 850 ; puerperalfever, 37 ; puerperal pyrexia, 85 ; cerebro-spinalfever, 12 ; acute poliomyelitis, 2 ; encephalitislethargica, 30 ; dysentery, 5 ; ophthalmia neonatorum,128. No case of cholera, plague, or typhus fever wasnotified during the week.The number of cases in the Infectious Hospitals of the

Metropolitan Asylums Board on July 2nd-3rd was as

follows :-Small-pox, 196 under treatment, 8 under observa-tion (last week 239 and 3 respectively) ; scarlet fever, 1314 ;diphtheria, 1635 ; enteric fever, 10 ; measles, 211 ; whooping-cough, 470 ; puerperal fever, 28 (plus 6 babies) ; encephalitislethargica, 124 ; " other diseases," 35. At St. Margaret’sHospital there were 19 babies with ophthalmia neonatorum.Deaths.-In the aggregate of great towns, including

London, there was no death from small-pox, 2 (1)from enteric fever, 34 (7) from measles, 4 (1) fromscarlet fever, 35 (13) from whooping-cough, 21 (3)from diphtheria, 39 (7) from diarrhoea and enteritisunder two years, and 27 (2) from influenza. Thefigures in parentheses are those for London itself.

Liverpool reported 9 deaths from measles ; no other greattown more than 2. Five deaths from whooping-cough werereported from Leeds and 3 from Birmingham. The highestfigures for diarrhoea were 4 deaths each from Liverpooland Manchester, 3 from Birmingham. Four deaths fromsmall-pox are now reported for the month of May from areasoutside the great towns. These have been assigned as

follows :-2 to Gravesend (Kent), 1 each to Bentley-with-Arksey (Yorks W.R.), and Leigh (Lanes).The number of stillbirths reported during the weekwas 294 (corresponding to a rate of 42 per 1000total births), including 54 in London.