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jealously bestowed ; but we can all interpret the

steadily progressing mass of medical knowledgewhich is our heritage and our acquirement in termsof helpfulness to our patients, and so make our con-tribution to the happiness and to the welfare of ourfellows. And, in the best sense of that phrase whichotherwise sounds so selfish, " have a good time " indoing it.The career of general practice itself enlarges and

improves as the years go by. The existence of

partnerships allows of some useful specialisation asbetween the various members of the firm, and’ thisis especially so in the provinces. The doctor’s workis raised to a higher level, and both he and the patientis the gainer. Decentralisation of hospitals affordsanother facility. The up-to-date cottage hospital,with paying wards and beds, improves efficiency allround. These things, which make an appeal to theintelligent public, tend to raise the status of thedoctor, and to enhance his value in society.

NATIONAL HEALTH SERVICES

The question of a State medical service is one

which has caused a large amount of discussion andconsiderable feeling. The fear that anything likethe nationalisation of medicine may come to passin this country, as least so far as the general practi-tioner is concerned, is, I think, unjustified. Thecitizen’s right to choose his own doctor is deeplyembedded in the public mind, and is likely todetermine this issue for a very long time, if not

permanently. All the same, the extension of thenational health services which has taken place inrecent years, and which is still proceeding, appearsto be not only in the public interest, but in theinterest of practitioners also. Any increase in

organisation by which the doctor finds himself betterequipped, and less subject to wastage of time andeffort, is to be welcomed. The only inalienablefactor, without which no good doctoring can reallybe accomplished, is that preservation of a directcontact of doctor and patient which experience provesto be essential to success. This is the crucial matterwhich has to be watched. The temperament ofthe medical man is a pertinent matter in connexionwith his type of work. There are some who can onlydo their best work when the element of completefreedom of action is preserved throughout. Thereare others who are so constructed that their bestefforts are seen when they occupy whole-time postsas part of a scheme for which they are not themselvesresponsible. Between these two extremes come

others who are happiest and most efficient when theymix a certain amount of private work with attendanceat clinics which are organised for them, and are runindependently of them. Here again medicine, as

at present practised in Great Britain, is able to

provide an ample choice.I think I ’have said enough to justify my contention

that medicine is a career that is well worth following,and is one which offers tremendous opportunitiesto those who enter it. Having entered, however,there are certain obligations laid upon us. I wantto touch upon these in closing this short address.A man may be pardoned for plagiarising himself,or at least he cannot be accused of theft if he doesso. So I will borrow from myself in my concludingsentences :-You will find medicine a jealous mistress, but you

have chosen her, and if you serve her loyally she willreturn your devotion in full measure. This doesnot mean that you will lead small, ignoble lives. Youwill follow George Wyndham’s dictum : " If we

cannot makes our lives long, let us make them broad."Indeed, that is a part of your duty. You will needall the antennae that you can develop so that you cantouch people at many points. All this you can doand still be your self, made wise by fusion with life,so that you become an artist and not a mere technician.In your work, however, though you will be temptedto diffuse, you must concentrate. Politics, literature,art-each one will say to you, " Come out and tryus," but you will decline. More subtle will be the

temptation to stray into some by-way of medicineitself, something that promises the panacea thatmen crave for. You will resist this also. You willbe chary of the short cut, the royal road, and theleap that science, no more than nature, never takes.Always you will keep an open mind. It will be wellif you add to your daily prayer : "Save me fromobsessions." You will remember that, just as inlife nothing can bring men peace, so in medicine

nothing can bring them health, but the triumph ofprinciples. This thought reminds me of Sydenham,the father of English medicine, and I cannot morefitly end these remarks than with a quotation fromhim. He is concluding his " Epistolary Dissertation,"and he says, "And now, worthy Sir, I desire youto accept this small treatise favourably which wasdesignedly written to return you thanks for yourapprobation of my other works. And indeed, Ihave so seldom received anything like approbation,that either I have merited no such thing, or else thecandid and generous men whom nature has framedwith such excellency of mind as to know how to begrateful, are very few, ... yet, notwithstanding,I endeavour all I can and will do so, to learn andpromote the method of curing diseases, and to instructthose who are less conversant in practice than myself,if any such there be. Let other people think of mewhat they please. For having nicely weighed whetherit is better to be beneficent to men or be praised bythem, I find the first preponderates and most conducesto peace of mind. As for fame and popular applause,they are lighter than a feather or a bubble, and morevain than the shadow of a dream."

MEDICINE AND THE LAW

Coroner and Witness’s Name

AT a Croydon inquest last week the identity ofa young woman who gave evidence was not disclosed.The deceased had been killed by a motor-car nearhis home. The witness said that earlier in the dayon which he died she had arranged to dine with himbut, finding that he had been drinking, she declinedto carry out the arrangement. At the close of herevidence a man asked the coroner why the witness’sname had been suppressed. He claimed that it wasa public court and that, as a member of the public,he was entitled to an explanation. Dr. BeecherJackson, the coroner, rightly refused to have hisdiscretion questioned. He answered that no publicexplanation would be given ; there was, he added, aperfectly good reason why the name should be

suppressed.It is unnecessary to emphasise the wide power of

the coroner to ensure privacy in proper cases. As issaid in " Jervis on Coroners," it is a power necessaryfor the due administration of justice, and it is impos-sible that the proceedings should be conducted withdue order and solemnity, and with the effect thatjustice demands if the presiding officer has not controlof the proceedings. The practice of withholding a

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witness’s name is at present being freely used byHigh Court judges at assizes in the effort to stampout the odious crime of blackmail. This is doneeither by directing that the name of the prosecutorshall not be mentioned in court or by asking therepresentatives of the press to see that the name doesnot appear in reports of the case. If some member ofthe public stood up in court and asserted an abstractright to know the name of the prosecutor in blackmailproceedings, the judge would speedily disillusion him.

The Dustman and the Gas CylindersAn unusual claim against a medical practitioner

for damages for negligence (Pattendon v. Beney)was dismissed with costs before Mr. Justice Horridgeon Oct. 6th. Two dustmen at Bromley, calling fromhouse to house to collect refuse, were asked by adoctor’s wife to take away four metal cylinders. Thedustmen did not know what the cylinders contained ;they put them in a pail at the back of the dust-cartand drove on to the next house. One of the men,subsequently collecting at another house, heard aloud explosion. Going back to the road he foundhis mate sitting by the roadside evidently in greatpain. One of the cylinders lay in the road with itscap off. The injured man died next day in hospital,his injuries being apparently due to a severe blowin the stomach. The widow claimed damages forherself and her children. Her counsel argued thatthe cylinders were dangerous explosives. On behalfof the defendant doctor it was said that these wereold cylinders ; the doctor had examined them pre-viously and had come to the conclusion that there wasnothing in them ; neither the doctor nor his wifehad any knowledge that there was even any potentialdanger in the cylinders. Great force, it was said,was necessary to remove the cylinder cap. To avoidthe expense of a re-trial it is usual nowadays to puta series of complicated questions to the jury. To the

questions put to them in Pattendon v. Beney thejurors answered as follows : (1) there was not suffi-cient evidence to prove that the death was due tothe explosion of the cylinder, but, in their opinion,the cause of death was the handling of the cylinder;(2) assuming that the cylinder was dangerous in thecondition in which it was given to the dustman, thedefendant doctor did not know, but ought to haveknown, that it was dangerous; (3) the deceasedwas not guilty of contributory negligence. The jurywent on to award 600 damages, but after legalargument as to the effect of the findings the judgedeclared that the action failed.The case against the doctor was that (a) the

cylinder was dangerous because it might explode,and (b) it did explode and the explosion caused thedeath. The jury, Mr. Justice Horridge said, foundthat there was not sufficient evidence that theexplosion caused the death. The judge observedthat the cylinders were constructed to withstandgreat pressure from the inside ; they could have hadvery little gas in them ; in the judge’s opinion therewas no danger in giving them to the dustman. The

judge naturally had to consider the effect of thejury’s findings that the doctor ought to have known(but did not know) that the cylinder was dangerous.Here he referred to one of his own previous decisions,Bates v. Batey and Co., delivered in 1913. A boyhad lost an eye through the bursting of a ginger-beerbottle in the process of opening the bottle. Therewas a defect in the bottle of which the ginger-beermanufacturers did not know, but which they mighthave discovered with reasonable care. On thatoccasion the judge held that the manufacturers were,

in the circumstances, not liable, and incidentallythat a ginger-beer bottle is not in itself a dangerousthing. Last year the House of Lords dealt withanother ginger-beer bottle case (M’Alister v. Stevenson)where the presence of a snail in the bottle was allegedto have caused illness. Mr. Justice Horridge observedthat Bates’s case had been mentioned during thearguments in M’Alister’s case but had not beenoverruled; he therefore proposed to follow Bates’scase in dealing with the gas cylinder, and to holdthat the doctor was not liable if he did not know(though he ought to have known) that the cylinderwas dangerous.The ginger-beer bottle cases involved peculiar

legal questions of privity of contract as between theoriginal manufacturers and the ultimate consumer,as the latter did not buy the bottle directly from theformer. These questions do not arise where a

dustman is given a gas cylinder by a householder.In Bates’s case the judge reviewed several otherdecisions about things alleged to contain inherentdanger. There was one about a defective lamp(where the defendants had no reason to suspectlatent defect, but had they been expert technicalengineers might have realised the danger), anotherabout a defective gun, and a third about a vicioushorse where Mr. Justice Lush had seemed to favourthe view that if the seller of the animal ought to haveknown of its vice his actual ignorance thereof wasimmaterial. In the cylinder case, if it is the provinceof the judge to rule whether or not the thing isdangerous, Mr. Justice Horridge seems to havesettled the matter finally. More, however, may yetbe heard of it, for a stay of execution was grantedwith a view to appeal.

PARIS

(FROM OUR OWN CORRESPONDENT)

THE GRANCHER SYSTEM IN 1932

RECENT statistics of the application of the Granchersystem of isolating children from tuberculous familieswere presented to the Academy of Medicine recentlyby Dr. Armand-Delille. During 1932 alone as manyas 6044 children were placed in healthy homes. TheGrancher system has for some time been linked upwith Calmette’s system of B C G inoculation, and thechild found to give a negative skin reaction to tuber-culin is inoculated with B C G. A negative Pirquetreaction is not a necessary qualification for transferof a child living in tuberculous surroundings toa healthy home in the country. A skiagram of thelungs however is required and any changes visiblein the lungs or glands disqualify a child for treatmentunder the Grancher system. The clinical examinationalso must be negative. The results obtained by theParis branch of the Grancher system between 1907and 1931 are held to be encouraging. During thisperiod only 12 out of 4000 Grancher children developedtuberculosis-a morbidity of 0-3 per cent., as comparedwith a morbidity of more than 60 per cent. amongthe children remaining in tuberculous surroundings.Similar striking differences were observed in thetuberculosis mortality-1 per cent. instead of 40 percent. The general mortality, including that fromgastro-enteritis and broncho-pneumonia, was 6 percent.-a ratio which corresponds approximately tothat observed among other children placed outwith foster parents. The Grancher system with itsvarious branches is mainly financed from privatesources ; of the more than seven million francs