The Legal Responsibilities of Medical Men

THE

L E G A L R E S P O N S I B I L I T I E S OF M E D I C A L MEN.

~for midden privies. In cross-examination he ~expressed himself diametrically opposed to the views of Dr. Hime, b u t thought that it might be consistent with health in an isolated district in the country where there was only one house, to have a privy. The Inspector afterwards visited the premises in question and will report to the Local Government Board in due course. The Board's decision will be awaited with interest by medical officers of health of midden towns, many o f whom will hesitate to endorse the views expressed in favour o f privies, which act as hot-beds for disease germs, contaminate the air with their foul emanations, pollute the soil by leakage, and are responsible for the insufferable nuisance by which their emptying is attended. Since the above was written a letter has been received from the Local Government Board, dated the ~sth January, in which it is stated that t h e Board have had under their consideration the report made by Mr. Walton after the inquiry held by him with reference to the appeal, and that they propose to issue an order confirming the decision of the City Council in the matter. From this order there is no appeal.

THE

LEGAL

RESPONSIBILITIES

OF

M E D I C A L MEN. IN an interesting Presidential Address to the Nottingham Medico-Chirurgical Society, on "Some of the Legal Responsibilities of Medical Men," Dr. J. S. Tew, Medical Officer of Health, Basford R.S.D., deals inter alia with the two following subjects. His remarks ofl these subjects are given in full. OATttS ACT. Previous to giving evidence before any Court, the necessary preliminary has to be performed of "taking the oath," or at least of intimating by some sign or shibboleth that on that particular occasion we intend to confine ourselves to the expression of the truth. A considerable amount of newspaper correspondence has appeared from time to time on the subject of "kissing the book," and, although the contraction of actual disease by this means is probably rare, yet the procedure is, like several other ecclesiastical and civil rites, not altogther consistent with our ideas of nineteenth century cleanliness, especially when we consider that the ceremony of "kissing the book" is performed much more frequently and more audibly by the great unwashed than by any other class of the community. Many examples are on record of the application

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of the principle that witnesses are to be sworn in that form which they consider binding on their consciences, and a few examples (several of which are on the authority of the late Mr. Coleman, Senior Clerk to the late Lord Chief Baron Pollock) may be of interest. Members of the Kirk of Scotland, and others, who object to kissing or touching the book, have been sworn by lifting up the hand while the book lay open before them ; and swearing by "uplifted h a n d " in the Scotch manner is expressly made permissible by the Oaths Act, 1888, 51 and 52 Vict., c. 46, s. 5~ which exacts that the oath shall be administered to a person who desires to swear without further question. In Ireland, Roman Catholics are (or, at least, were) sworn on a New Testament with a cross delineated on the cover. Jews are sworn on the Pentateuch, keeping on their hats, the language of the oath being changed from " S o help you G o d " to " S o help you Jehovah." Mohammedans are sworn on the Koran, and the ceremony adopted in R. ~. Morgan is thus described: - - " The book was produced. The witness first placed his hand fiat upon it, put the other hand to his forehead, and brought the top of his forehead down to the book, and touched it with his head ; he then looked for some time upon it, and on being asked what effect that ceremony was to produce, he answered that he was bound by it to speak the truth." A Chinese witness was sworn as follows : - - O n getting into the witness-box he knelt down, and a china saucer having been placed in his hands, he struck it against the brass rail of the box and broke it. The officer then administered the oath in these words: " Y o u shall tell the truth and the whole truth ; the saucer is cracked, and if you d o not tell the truth your soul will be cracked like the saucerY According to a newspaper report, this form was followed at the Middlesex Sessions, April end, 1855 , in a case of R. ~,. Sichoo, with the addition that the saucer was filled with salt. Practically the Oaths Act in this country meets all requirements, but it has been suggested that the most desirable course would probably be to substitute affirmations for oaths in every case, to print on each subpoena a statement of the punishment of perjury, and to add a repetition of such statement to the affirmation which each witness is about to make. The cosmopolitan requirements of the present day render it desirable that a method should be universally adopted which is neither ridiculous in performance nor repugnant to the feelings-religions, racial, or otherwise--of those about to make judicial statements of such importance as witnesses (and particularly medical witnesses) are called upon to do.

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R E P O R T S OF M E D I C A L O F F I C E R S OF H E A L T H .

INFEC'rlOUS DISEASES NOTIFICATION ACT. It is far beyond the scope of this address to discuss the merits and shortcomings of the Infectious Diseases Notification Act; but one fact is so prominent in the administration of the provisions Of the Act, that I should like to bring it clearly before you. It is this. Whenever a prosecution is instituted against persons for infringing the A c t - whether it be for failure of the parent or other in charge to notify--in those cases where a medical man has not been called in--or, where a person in an infectious state is exposed in a public place to the danger of others, the plea of ignorance is always advanced ; they were not " aware" of the nature of the illness or of the consequences of their carelessness ; and, unfortunately, magistrates have as a rule so far treated these offenders with the utmost leniency. In the leading legal treatise on "Evidence" we find what is, I think, a thoroughly correct view of the untenable position of such offenders. I f the abstract question were proposed, "What is the most unjust thing that could be d o n e ? " the answer would probably be, " T h e punishing of a man for disobeying a la~ of the existence of which he was not acquainted." And yet that must constantly occur everywhere, there being no rule of jurisprudence more universal than this, that every person in a country must be conclusively presumed to know its laws sufficiently to be able to regulate his conduct by them. Hard as this may seem, it is indispensably necessary in order to prevent infinitely greater evils; for the allowing violations by the criminal or contraventions of the civil code to pass without punishment or inconvenience, under the plea of ignorance of their provisions, would render the whole body of jurisprudence utterly worthless.

i f none were amenable to the taws but t~ose who could be proved to be acquainted wiNz lhem, not only would ignorance be continually pleaded, in criminal cases esf)ecially, but persons would naturally avoid acquiring knowledge whic/z carried suc~ ~erilous consequences along with iL

M I L K A N D E N T E R I C FEVER. Dg. l~IC~, in a recent number of the Berlin I
privies, often in close proximity, are of a very primitive character. But no typhoid fever had been known to exist in the district for several years. Seventeen farmers were in the habit of sending milk, to the amount of about 6oo litres daily, to a cheese factory at Oberschmotlen which was estabhshed in i89i , receiving back the whey to be drunk by the labourers, servants, and children. The water used in the dairy was drawn from a well, which having long been disused, was then cleaned out, deepened, bricked, and provided with a moveable wooden cover and pump. Three years later, between the 6th and I7th of last February, typhoid fever broke out in every farm house supplying the dairy with the exception of one, where the whey was not taken back. In February thirty-four persons were attacked, and in March twenty, of whom five only did not live in the farm houses. In all ninety persons were attacked, constituting fifty per cent. of the households; eighty per cent. of the patients being farm servants or children. Those who drank the whey only after boiling escaped, leaving no doubt as to the whey having been the vehicle of the poison, but how it became infected is not so clear, for though suspicion would naturally fall on the well, not only were there no cases of fever at the dairy itself, but several other farms and inns where the same water was drunk escaped, and no bacilli were detected in its water.

R E P O R T S OF M E D I C A L O F F I C E R S OF HEALTH. HACKNEY.

Lack of Discrimination in Hospital Reception of Fever Cases.--Dr. King Worry states : - - I n consequence of the enormous amount of fever prevalent in London during the summer of 1893 , the hospital accommodation at the disposal of the Managers of the Asylums Board was found to be quite inadequate for the wants of the Metropolis. Besides this want of accommodation there was in Hackney a great lack of discrimination as to the cases received into the Board's hospitals. That is to say, the preference was not always given to cases occurring in over-crowded or densely populated districts or to those mostly in need of medical attendance. Preferenqe ought, in my opinion, where the hospital aecommddation is limited, to be given to such cases as thesej if this were done the spread of infectious disease would, I am certain, be much lessened. The Board's officials labour under one disadvantage, that they cannot know the social conditions and surrounding s of patients at the time application is made for their removal ~ but after notification their surroundings are enquired into, and the possibility or otherwise of-isolation and