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BRITISH INSTITUTE OF RADIOLOGY
1390 a percentage or commission for yourself in resnect of bHs for E32s. and El2s. 9d. respectively of the said P. W. Norman rendered to Miss S. J. Jarvis, a patient of yours, for glasses. (b) You attempted to obtain from one, P. W. Norman, an optician, a percentage or commission for yourself in respect of a bill of the said P. W. Norman rendered to A. W. Baverstock, a patient of yours, for glasses. And that in relation to the facts so alleged been guilty of infamous conduct in a professional you have "
respect."
The complainants were the Joint Council of
Qualified
Opticians.
Mr. Dias appeared, accompanied by Mr. Hempson, behalf of the Medical Defence Union, and Mr. J. Scott-Henderson, counsel, instructed by Messrs. Wedlake, Letts and Birds, solicitors, addressed the Council in support of the charges. He called two witnesses and put in letters from Mr. Dias asking for commission. Mr. Hempson said that Mr. Dias, a native of India, admitted the facts alleged against him. He had been with a firm who had received commission from spectacle-makers. Since he had been in practice on his own he had received commission from chemists, and had not realised that he was not entitled to it from opticians. He had been ignorant that he was doing wrong. His only livelihood was the capitation fees he received in respect of 166 insured patients, and a small income from lodgers. The President announced that the Council would postpone judgment for a year subject to the usual on
provisos.
for several weeks ; he also suffered from weakness of the muscles of the ,heart. It was unusual, the witness said, but not very unusual, for food poisoning to take effect so quickly as had happened in Mr. Barclay’s ease. He agreed in cross-examination that he had known no previous case where food poisoning had lasted a year. He admitted he had said to a doctor who was examining the patient on the defendants’ behalf that the absence of diarrhoea forced him to conclude that the patient’s condition could not be proved due to food poisoning. When asked about the possibility of gastric influenza, the witness said the patient’s subnormal temperature was inconsistent with the suggestion. On the other side, a doctor called by the defendants stated that the symptoms pointed to gastric influenza rather than to poisoning. Poisoning without diarrhoea was very rare, and he had himself never known a case of food poisoning resulting in almost immediate collapse. The conflict of opinion, as well as the dispute of facts, caused the jury to disagree. The result is that the plaintiff is free to
begin
his action all
over
again.
Murder by Mental Hospital Patient At Birmingham assizes last week Joseph Millard was found " guilty but insane " on a charge of murdering his wife at their home on Nov. 22nd. Millard, said the prosecution, had also murdered his three children at the same time. He was a man of character who, after a long period of unemployment, had gone into the Dudley Road Hospital. He
good
of obscure pains and apparently had delusions that the doctors were conspiring to kill him, and that the nurses tried to inject germs into his body to make him insane. Two days after admission he tried to run out of the ward without his clothes ; that night he had to be forcibly tied to his bed. He was then transferred to Ordington House, a public assistance institution, for observation of his mental condition. There was medical evidence that at Ordington House he was violent and had to be confined in a padded cell. The fact which naturally surprised the court was that a mental patient in this condition had been discharged from the hospital on the application of his wife a few days later. " If that is the law," observed the commissioner who was trying the case, " the sooner it is altered the better." It was explained on behalf of the local authority that an inquiry had already been set on foot. The patient, it seems, had not been admitted to hospital on an order under the Lunacy Act, and this fact presumably made it difficult to detain him when his wife applied for his discharge. Further light will doubtless be shed on the facts when the inquiry is completed. Meanwhile it is possible to make the general reflection that the law courts, by awarding huge damages against medical practitioners on allegations of wrongful certification or otherwise, have not exactly encouraged the medical profession to run any risks with the law.
complained
MEDICINE AND THE LAW
Poisoning or Influenza ? IN Barclay v. Spiers and Pond, Ltd., the plaintiff Food
claimed damages for an illness said to be due to food poisoning at the defendants’ restaurant; the defendants said it was gastric influenza. Mr. Barclay described how the lentil soup which he ordered one Monday had an acid taste, and how, before he had consumed half of it, he had a feeling of nausea and He was a general sensation of fainting and collapse. unable to eat the fried sole he had ordered to follow ; the feeling of sickness increased, he went back to his office and was obliged to go home, where he was violently sick. He was ill for Imonths and away from work for a year. The defendants gave evidence of the constituents of the soup, the vegetables and hot milk, and a ham-bone ; no canned food was used. Plaintiff’s counsel concentrated upon the ham-bone as the source of the alleged bacterial infection ; a medical witness said a ham would develop toxin in 24 hours. The defendants’ chef recounted the history of the ham. It came in on that Monday morning and figured on the menu He sawed off the knuckle-bone, as braised ham. chopped it into four pieces and put it into the soup, which was strained and kept in a stone jar standing in boiling water ; 13 or 14 portions of the soup were served to customers, and the rest was finished by the staff next day. For the restaurant it was said that nobody else complained ; a waitress suggested that the plaintiff looked ill when he came in. The plaintiff and his wife gave evidence that at an interview the management had admitted liability for the poisoning and had discussed the amount of compensation. This the defendants denied. The plaintiff’s doctor, who saw him on the day after the meal, had no doubt he was then suffering from food poisoning. The patient was confined to his bedroom
flavouring, butter,
BRITISH INSTITUTE OF RADIOLOGY ON Dec. 8th Dr. STANLEY MELVILLE took the chair at a discussion on radiotherapy, with special regard to the Value of Hard and Soft Rays Dr. W. LEVITT discussed the meaning of the term radiosensitivity. He advanced the view that the all-important factor in determining whether a malignant growth would respond to radiations or not was a question of dosage. In some cases, such as
1391 seminoma and lymphosarcoma, the requisite dosage could be applied without obvious effect upon the healthy tissues. These were the cases we have learnt to call highly radiosensitive. In certain other cases, such as carcinoma of the cervix, the requisite dosage
would produce
a
moderate, though recoverable,
to the surrounding tissues, and these we have learnt to term moderately radiosensitive. In still other cases, such as carcinoma of the rectum, the requisite dosage could not be given without running the risk of severe damage to the surrounding tissues, and these are the radio-resistant cases. It was known that carcinoma of the oesophagus tends to be of a histological type which is moderately radiosensitive, and arguing on these lines it should therefore be possible to apply to these cases a sufficient dose to cause disappearance of the growth without undue damage to surrounding organs. He had recently treated at St. Bartholomew’s Hospital a series of eight unselected cases of carcinoma of the oesophagus by a new method designed to ensure adequate dosage to the cesophageal growths, and of these eight cases, all of which had high degrees of obstruction, seven were now swallowing normally, and in six the disease seemed to have disappeared completely. One patient had been at work for nearly six months ; the others were very recent. In all these cases general reactions were produced by the treatment ; yet seven of the eight patients were now swallowing normally. He had no doubt that the best results were only to be obtained by the use of adequate doses of hard (or short wave-length) radiations. In Paris, Frankfurt, Berlin, Stockholm, and New York the use of soft rays and small doses in malignant disease had long since been abandoned. Dr. RussELL REYNOLDS emphasised the value of long wave-length therapy, particularly for benign growths, while admitting that the shorter wave-lengths were more valuable for carcinoma. Any condition that would recover under treatment with long waves should, he thought, be treated with them, on account of their less harmful effect on the blood-cells. Dr. G. F. STEBBING said that the improved results obtained by treating malignant growths by X rays had coincided with the shortening of the wave-length of the radiation used. Intensity of radiation and the time over which it was administered were both important factors, but the greatest improvement in the future was to be expected by the use of shorter waves. Such waves had two valuable properties : (1) greater penetration without damage to the overlying skin, particularly where it was possible to treat the growth by a number of converging beams ; and (2) selective action on malignant tissue. This selective action was not universally admitted, but many clinicians and some physicists-e.g., Failla-were convinced of it. Once it was proved that short waves could give results not to be obtained in any other way, he thought there would be no difficulty in getting X ray apparatus of higher voltage and large masses of radium. Dr. HERNAMAN-JoHNSON said he had leaned to the view that X rays had a selective destruction action on cancer cells, and that if a " critical " dose could be given all would be killed. Accumulating evidence had, however, convinced him that the action was mainly indirect, a vital reaction in which the surrounding tissues played a heavy part. On this view the healthy tissues were allies instead of mere hindrances to efficient dosage. On the question of the relative value of short and long wave-lengths he could say little. A sufficient dose must be got to deep-seated lesions, but whether the wave-length
injury
of importance there were no sufficient data to determine. Dr. D. WEBSTER said that he was not satisfied that there was any true differential action dependent on wave-length, and he thought that all physicists except Failla and Russ agreed with him. In his experience similar results could be obtained with X rays or radium. Dr. F. ROBERTS said he thought the shorter wavelengths were of advantage owing to the greater depth it was possible to reach with them, but he was not convinced of the differential action of short waves. Dr. L. A. ROWDEN stressed the importance of rapidity of growth as a factor of radiosensitivity, and said he found the administration of potassium iodide during radiation a help. Dr. N. S. FINZI said that the shorter the wavelength the better the result, and referred to cases of his own in which the healing of the growth was obtained with very little reaction of the healthy tissue by short waves. was
British Institute of Radiology and Roentgen Society The annual dinner of these united bodies was held on Friday, Dec. 8th, at the Trocadero Restaurant, London, Dr. Stanley Melville, president, being in the chair. The toast of the Institute was proposed by Mr. Thurston Holland in a humorously colloquial style, concluding with a warm congratulation to the society in having elected the present occupant of the presidency to direct their activities, when he set out the assiduous part that Dr. Stanley Melville had played in the advancement of radiology. Dr. Stanley Melville, in returning thanks, said that the institute was originally started as an act of faith on the personal guarantee of four medical members, but in 1927 it amalgamated with the old-established Roentgen Society. The membership, he said, now consisted of medical radiologists and other medical men in sympathy with their objects : physicists, without whose guidance progress would have been impossible, and leaders in the industrial world. Scientific knowledge had secured progress on the practical side. He referred particularly to the attitude of the manufacturers when certain tragedies among the workers proved the dangers of their duties. The dangers were sadly appreciated, but the means of combating them were then unknown. At this juncture, in 1921, the X Ray and Radium Protection Committee was formed, and through the good offices of Mr. G. W. C. Kaye, D.Sc., was granted the resources of the National Physical Laboratory. The first recommendations published by the committee required the immediate scrapping of apparatus and the disorganisation of manufacturing specifications. Without a moment’s hesitation the British manufacturers came whole-heartedly into the new scheme regardless of considerable financial loss. At the International Congress, held at Stockholm in 1928, the British recommendations were adopted as the " International Standard of Protection," when the British manufacturers got the meed of praise that was their due. The example was soon followed by other countries, which until then had not the foggiest idea of what protection implied. To this same body of people was due the remarkable exhibition of apparatus during the present annual congress. The toast of the Guests was proposed by Mr. Cuthbert Andrews, who was very thorough in the way in which he worked through the lists of guests, making biographical notes as he went along. Prof. J. C. M’Lennan and Sir Squire Sprigge replied.
HOLME
LACY
AS
MENTAL
HOME. — Subject
to
certain structural improvements, the Ministry of Health is now prepared to give general approval to the scheme of the Herefordshire county council for using Holme Lacy as a home for private mental patients. The house, for long the seat of the Earls of Chesterfield, was presented to the council by Mrs. Noel Wills. The scheme will require a capital expenditure of £ 18,000.
,
respect."
The complainants were the Joint Council of
Qualified
Opticians.
Mr. Dias appeared, accompanied by Mr. Hempson, behalf of the Medical Defence Union, and Mr. J. Scott-Henderson, counsel, instructed by Messrs. Wedlake, Letts and Birds, solicitors, addressed the Council in support of the charges. He called two witnesses and put in letters from Mr. Dias asking for commission. Mr. Hempson said that Mr. Dias, a native of India, admitted the facts alleged against him. He had been with a firm who had received commission from spectacle-makers. Since he had been in practice on his own he had received commission from chemists, and had not realised that he was not entitled to it from opticians. He had been ignorant that he was doing wrong. His only livelihood was the capitation fees he received in respect of 166 insured patients, and a small income from lodgers. The President announced that the Council would postpone judgment for a year subject to the usual on
provisos.
for several weeks ; he also suffered from weakness of the muscles of the ,heart. It was unusual, the witness said, but not very unusual, for food poisoning to take effect so quickly as had happened in Mr. Barclay’s ease. He agreed in cross-examination that he had known no previous case where food poisoning had lasted a year. He admitted he had said to a doctor who was examining the patient on the defendants’ behalf that the absence of diarrhoea forced him to conclude that the patient’s condition could not be proved due to food poisoning. When asked about the possibility of gastric influenza, the witness said the patient’s subnormal temperature was inconsistent with the suggestion. On the other side, a doctor called by the defendants stated that the symptoms pointed to gastric influenza rather than to poisoning. Poisoning without diarrhoea was very rare, and he had himself never known a case of food poisoning resulting in almost immediate collapse. The conflict of opinion, as well as the dispute of facts, caused the jury to disagree. The result is that the plaintiff is free to
begin
his action all
over
again.
Murder by Mental Hospital Patient At Birmingham assizes last week Joseph Millard was found " guilty but insane " on a charge of murdering his wife at their home on Nov. 22nd. Millard, said the prosecution, had also murdered his three children at the same time. He was a man of character who, after a long period of unemployment, had gone into the Dudley Road Hospital. He
good
of obscure pains and apparently had delusions that the doctors were conspiring to kill him, and that the nurses tried to inject germs into his body to make him insane. Two days after admission he tried to run out of the ward without his clothes ; that night he had to be forcibly tied to his bed. He was then transferred to Ordington House, a public assistance institution, for observation of his mental condition. There was medical evidence that at Ordington House he was violent and had to be confined in a padded cell. The fact which naturally surprised the court was that a mental patient in this condition had been discharged from the hospital on the application of his wife a few days later. " If that is the law," observed the commissioner who was trying the case, " the sooner it is altered the better." It was explained on behalf of the local authority that an inquiry had already been set on foot. The patient, it seems, had not been admitted to hospital on an order under the Lunacy Act, and this fact presumably made it difficult to detain him when his wife applied for his discharge. Further light will doubtless be shed on the facts when the inquiry is completed. Meanwhile it is possible to make the general reflection that the law courts, by awarding huge damages against medical practitioners on allegations of wrongful certification or otherwise, have not exactly encouraged the medical profession to run any risks with the law.
complained
MEDICINE AND THE LAW
Poisoning or Influenza ? IN Barclay v. Spiers and Pond, Ltd., the plaintiff Food
claimed damages for an illness said to be due to food poisoning at the defendants’ restaurant; the defendants said it was gastric influenza. Mr. Barclay described how the lentil soup which he ordered one Monday had an acid taste, and how, before he had consumed half of it, he had a feeling of nausea and He was a general sensation of fainting and collapse. unable to eat the fried sole he had ordered to follow ; the feeling of sickness increased, he went back to his office and was obliged to go home, where he was violently sick. He was ill for Imonths and away from work for a year. The defendants gave evidence of the constituents of the soup, the vegetables and hot milk, and a ham-bone ; no canned food was used. Plaintiff’s counsel concentrated upon the ham-bone as the source of the alleged bacterial infection ; a medical witness said a ham would develop toxin in 24 hours. The defendants’ chef recounted the history of the ham. It came in on that Monday morning and figured on the menu He sawed off the knuckle-bone, as braised ham. chopped it into four pieces and put it into the soup, which was strained and kept in a stone jar standing in boiling water ; 13 or 14 portions of the soup were served to customers, and the rest was finished by the staff next day. For the restaurant it was said that nobody else complained ; a waitress suggested that the plaintiff looked ill when he came in. The plaintiff and his wife gave evidence that at an interview the management had admitted liability for the poisoning and had discussed the amount of compensation. This the defendants denied. The plaintiff’s doctor, who saw him on the day after the meal, had no doubt he was then suffering from food poisoning. The patient was confined to his bedroom
flavouring, butter,
BRITISH INSTITUTE OF RADIOLOGY ON Dec. 8th Dr. STANLEY MELVILLE took the chair at a discussion on radiotherapy, with special regard to the Value of Hard and Soft Rays Dr. W. LEVITT discussed the meaning of the term radiosensitivity. He advanced the view that the all-important factor in determining whether a malignant growth would respond to radiations or not was a question of dosage. In some cases, such as
1391 seminoma and lymphosarcoma, the requisite dosage could be applied without obvious effect upon the healthy tissues. These were the cases we have learnt to call highly radiosensitive. In certain other cases, such as carcinoma of the cervix, the requisite dosage
would produce
a
moderate, though recoverable,
to the surrounding tissues, and these we have learnt to term moderately radiosensitive. In still other cases, such as carcinoma of the rectum, the requisite dosage could not be given without running the risk of severe damage to the surrounding tissues, and these are the radio-resistant cases. It was known that carcinoma of the oesophagus tends to be of a histological type which is moderately radiosensitive, and arguing on these lines it should therefore be possible to apply to these cases a sufficient dose to cause disappearance of the growth without undue damage to surrounding organs. He had recently treated at St. Bartholomew’s Hospital a series of eight unselected cases of carcinoma of the oesophagus by a new method designed to ensure adequate dosage to the cesophageal growths, and of these eight cases, all of which had high degrees of obstruction, seven were now swallowing normally, and in six the disease seemed to have disappeared completely. One patient had been at work for nearly six months ; the others were very recent. In all these cases general reactions were produced by the treatment ; yet seven of the eight patients were now swallowing normally. He had no doubt that the best results were only to be obtained by the use of adequate doses of hard (or short wave-length) radiations. In Paris, Frankfurt, Berlin, Stockholm, and New York the use of soft rays and small doses in malignant disease had long since been abandoned. Dr. RussELL REYNOLDS emphasised the value of long wave-length therapy, particularly for benign growths, while admitting that the shorter wave-lengths were more valuable for carcinoma. Any condition that would recover under treatment with long waves should, he thought, be treated with them, on account of their less harmful effect on the blood-cells. Dr. G. F. STEBBING said that the improved results obtained by treating malignant growths by X rays had coincided with the shortening of the wave-length of the radiation used. Intensity of radiation and the time over which it was administered were both important factors, but the greatest improvement in the future was to be expected by the use of shorter waves. Such waves had two valuable properties : (1) greater penetration without damage to the overlying skin, particularly where it was possible to treat the growth by a number of converging beams ; and (2) selective action on malignant tissue. This selective action was not universally admitted, but many clinicians and some physicists-e.g., Failla-were convinced of it. Once it was proved that short waves could give results not to be obtained in any other way, he thought there would be no difficulty in getting X ray apparatus of higher voltage and large masses of radium. Dr. HERNAMAN-JoHNSON said he had leaned to the view that X rays had a selective destruction action on cancer cells, and that if a " critical " dose could be given all would be killed. Accumulating evidence had, however, convinced him that the action was mainly indirect, a vital reaction in which the surrounding tissues played a heavy part. On this view the healthy tissues were allies instead of mere hindrances to efficient dosage. On the question of the relative value of short and long wave-lengths he could say little. A sufficient dose must be got to deep-seated lesions, but whether the wave-length
injury
of importance there were no sufficient data to determine. Dr. D. WEBSTER said that he was not satisfied that there was any true differential action dependent on wave-length, and he thought that all physicists except Failla and Russ agreed with him. In his experience similar results could be obtained with X rays or radium. Dr. F. ROBERTS said he thought the shorter wavelengths were of advantage owing to the greater depth it was possible to reach with them, but he was not convinced of the differential action of short waves. Dr. L. A. ROWDEN stressed the importance of rapidity of growth as a factor of radiosensitivity, and said he found the administration of potassium iodide during radiation a help. Dr. N. S. FINZI said that the shorter the wavelength the better the result, and referred to cases of his own in which the healing of the growth was obtained with very little reaction of the healthy tissue by short waves. was
British Institute of Radiology and Roentgen Society The annual dinner of these united bodies was held on Friday, Dec. 8th, at the Trocadero Restaurant, London, Dr. Stanley Melville, president, being in the chair. The toast of the Institute was proposed by Mr. Thurston Holland in a humorously colloquial style, concluding with a warm congratulation to the society in having elected the present occupant of the presidency to direct their activities, when he set out the assiduous part that Dr. Stanley Melville had played in the advancement of radiology. Dr. Stanley Melville, in returning thanks, said that the institute was originally started as an act of faith on the personal guarantee of four medical members, but in 1927 it amalgamated with the old-established Roentgen Society. The membership, he said, now consisted of medical radiologists and other medical men in sympathy with their objects : physicists, without whose guidance progress would have been impossible, and leaders in the industrial world. Scientific knowledge had secured progress on the practical side. He referred particularly to the attitude of the manufacturers when certain tragedies among the workers proved the dangers of their duties. The dangers were sadly appreciated, but the means of combating them were then unknown. At this juncture, in 1921, the X Ray and Radium Protection Committee was formed, and through the good offices of Mr. G. W. C. Kaye, D.Sc., was granted the resources of the National Physical Laboratory. The first recommendations published by the committee required the immediate scrapping of apparatus and the disorganisation of manufacturing specifications. Without a moment’s hesitation the British manufacturers came whole-heartedly into the new scheme regardless of considerable financial loss. At the International Congress, held at Stockholm in 1928, the British recommendations were adopted as the " International Standard of Protection," when the British manufacturers got the meed of praise that was their due. The example was soon followed by other countries, which until then had not the foggiest idea of what protection implied. To this same body of people was due the remarkable exhibition of apparatus during the present annual congress. The toast of the Guests was proposed by Mr. Cuthbert Andrews, who was very thorough in the way in which he worked through the lists of guests, making biographical notes as he went along. Prof. J. C. M’Lennan and Sir Squire Sprigge replied.
HOLME
LACY
AS
MENTAL
HOME. — Subject
to
certain structural improvements, the Ministry of Health is now prepared to give general approval to the scheme of the Herefordshire county council for using Holme Lacy as a home for private mental patients. The house, for long the seat of the Earls of Chesterfield, was presented to the council by Mrs. Noel Wills. The scheme will require a capital expenditure of £ 18,000.
,