MEDICINE AND THE LAW

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In the clinic connected with the Institute ofNutrition patients were selected for purposes of

investigation who were suitable for a treatmentexclusively dietetic-particularly persons sufferingfrom liver and kidney diseases, from acute rheumatism,from gastro-intestinal diseases, and from some formsof heart disease. Conditions such as gastric ulcerare treated as constitutional rather than local diseases,and the idea seems to be prevalent in the U.S.S.R.that drugs should be avoided wherever possible.The patients seemed to be very well cared for, butit was of course impossible in a single visit to judgeof the success of the methods used. This last truth,indeed, applies to the formation of any opinion withregard to the state of social welfare in the wholeSoviet Union. Only those who have made morethan one visit are competent to report whetherprogress is being made or not, and it is on the makingor not making of progress that a favourable or anunfavourable verdict must be based.

In judging the hospitality of the Government ofthe U.S.S.R. towards foreign scientists, however,every member of the Congress is an expert, and thereis no doubt that the verdict would be completelyunanimous. A more delightful welcome has neverbeen offered.

MEDICINE AND THE LAW

Motorist’s Consent to Medical Examination

SOME months ago a High Court judge invented atelling method of challenging the medical evidenceadduced against motorists who are charged withdriving a car while under the influence of drink.He impaled the witness upon the horns of a dilemma.The police surgeon had no right to examine themotorist without the latter’s consent : a drunken mancannot give consent. Either, therefore, the motoristwas sober because he gave a valid consent to beexamined, or else, if he was drunk, his conditioncould not be described and the prosecution mustfail for want of evidence. Alert advocates have

naturally made use of this weapon in defence ofmotorists, for what it may be worth. Thus at theSouth Western Police-court last month the point wastaken by Mr. Laurence Vine on behalf of Mr. R. M.Hutchinson, better known as Harry Tate, thecomedian. Dr. R. Anderson, the divisional surgeon,was describing his examination of the accused whenMr. Vine objected that there was no legal right toexamine a man who is under the influence of drink.The witness said he had asked the defendant’s per-mission to examine him. " You must have thought,"suggested Mr. Vine, " that he was in reasonablepossession of his faculties or you would not haveasked such an important question about his consentto the examination." The witness replied that heasked the question before he had come to any deci-sion as to Hutchinson’s condition. The case, whichwas remanded, presented no other feature of interestexcept that the magistrate queried whether it wasquite a fair test to ask a man of 63 to stand on oneleg-" some elderly people may not be able to standon one leg, drunk or sober."When Mr. Justice Rigby Swift first introduced

to the public this forensic dilemma about medicalexamination, the Home Office and the Directorateof Public Prosecutions are believed to have beentaken somewhat by surprise. Later the point wasviewed with more equanimity. It was a better

point under the earlier law when a motorist could

be punished for being drunk while in charge of acar than under the present law (Section 15 of theRoad Traffic Act, 1930) whereby it is an offence tobe merely " under the influence of drink." Magis-trates may often find themselves able to decide thata man was not too drunk to have consented to beexamined and yet drunk enough to have imperfectcontrol of a car. At common law a drunken personis not incapable of contracting. His contracts arevoidable only if he was, at the time and to the otherparty’s knowledge, unable to understand the effectof the transaction. In criminal cases the drunkardis said to obtain no privilege from his condition;he has voluntarily abandoned control of himselfand, in Sir E. Coke’s words, " what hurt or ill soeverhe doeth, his drunkennesse doth aggravate it."The law to-day is unlikely to tolerate an argumentwhich would prevent a medical witness from describ-ing the defendant’s condition when that conditionis the main element in the alleged offence. Theaccused would gain little if the police surgeon states" his condition was such that in my opinion he wasunable to give consent to medical examination."

The Taking of FingerprintsIf medical examination without the examinee’s

consent can be regarded as a technical assault, it isakin to the taking of a person’s fingerprints withoutauthority. Last week some juvenile offenders werebeing dealt with by magistrates when a parentprotested that his son’s fingerprints had been taken,and asked (though without success) that they shouldbe destroyed. It is nowadays forbidden to use thewords " conviction " or

" sentence " n connexionwith a child or young person who is dealt with sum-marily (Section 59 of the Children and Young PersonsAct, 1933), and, if we are no longer to brand juvenileoffenders as criminals, the protest was natural.The police, however, may well wish to have somerecord (if proper power exists to take it) wherebythey can check the activities of young persons whoget into trouble. It is necessary to use every aid todetect the identity of an offender even if, whenbrought before the magistrates, the offender suffersno severe penalty. No authority has any power totake persons’ fingerprints, unless they consent,without first having such persons committed to

prison. It is not quite clear why the boys, in therecent case just mentioned, had been so treated. In

prison the procedure is presumably governed by thePrison Rules of 1933. These prescribe that thename, age, height, weight, particular marks, andsuch other measurements and particulars as may berequired are to be recorded when the prisoner isadmitted to prison and from time to time afterwardsin such manner as may be directed. He may also," if required for purposes of justice," be photo-graphed on reception and subsequently; but no

copy is to be given to any unofficial person. Insome countries the taking of fingerprints is allowedfull scope for civil purposes ; in England there is afierce prejudice against the process for any butcriminals. We do not object to having our births,baptisms, addresses, and marriages recorded but wefind it degrading to have our fingerprints registered.Persons found wandering and suffering from sup-posed loss of memory cause endless trouble beforethey are satisfactorily identified; bodies cast upby the sea or found dead elsewhere remain mysteries ;innocent persons are arrested and inconveniencedfor want of easy proof of their bona fides. In allsuch cases anxiety and expense are caused becausethere is no universal system of registering finger-

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prints. Classification of skin impressions could indexthe whole human race. In England public opiniontolerates the system for the purpose of criminalrecords only.

Tetanus after Appendix OperationAn inquest was concluded at Rochester on

August 29th upon the death of Miss Alma Leworthyfrom tetanus. The deceased, aged 32, had undergonean operation for appendicitis in St. Bartholomew’s

Hospital, Rochester. Dr. Schulenberg, resident

surgical officer, described the results of his post-mortem examination. The operation wound, hesaid, was soundly healed. It was examined for piecesof catgut; only a piece of thread was found ; thiswas kept for culture. Asked by the coroner as tothe source of the tetanus germs, the witness statedthat the germ must have entered the patient’s bodywhile she was in hospital, and the abdominal woundwould be the site of infection. He could not sayif it was due to the catgut. Instruments and catgutwere sterilised ; but this was an abdominal operation

and tetanus might arise from the intestines. Thetetanus germ was found in the intestines of a smallproportion of people; it might lie dormant till itentered the system through a wound. The coronerread a report from the pathological department ofthe Ministry of Health. It stated that there was noevidence of Bacillus tetani in the samples of catgutsent by Dr. Schulenberg, but that cultures taken oftissue gave convincing evidence of the existence ofsuch bacilli. The witness observed that the reportmerely proved that death was due to tetanus ; itdid not explain the source of infection. A theatresister described to the coroner the process of sterili a-tion of catgut at the hospital, as it had been in

operation for the last eight years. In summing up,the coroner referred to the possibility of the tetanusgerms entering an abdominal operation wound fromthe intestines, no matter how careful the surgeonmight be. He considered that the high reputationof the hospital had not been tarnished. The juryreturned a verdict of death from misadventure andexonerated from blame all concerned in the case.

PANEL AND CONTRACT PRACTICE

Extension of Medical Benefit

IT is generally agreed that medical benefit underthe National Health Insurance Acts, although good sofar as it goes, does not go far enough. From that

point however two lines of thought diverge. Theadherents to the one line of thought say, "let usextend medical benefit to the dependants of insured

persons and thus make national health insurance an

integral part of the general health services of the

country." Those who take the other point of viewsay, "let us improve medical benefit itself andendeavour to provide specialist services, laboratoryservices and the like, to those persons who are insuredand who are, therefore, paying for it." The NationalAssociation of Insurance Committees adheres to thelatter view, and in conjunction with the NationalConference of Friendly Societies has decided to calla conference for the purpose of discussing an extensionof the services at present available to the existingbody of insured persons. The medical professionwill be represented at the conference, at which will bediscussed the provision of expert medical advice andtreatment and laboratory services to supplementand render more effective the general practitionerservice for insured persons, in the form of an inde-

pendent scheme organised under the general directionof the Minister of Health as an integral part of medicalbenefit.

A Revised Clause

The new Medical Benefit Consolidated Regulationsare already in proof, and it is expected that theywill be issued very shortly. One amendment in theterms of service, which form the first schedule to theregulations, will be of special interest to insurancepractitioners. Under the revised Clause 7 (3) aninsured person who, having failed to make thepractitioner aware of his claim to be entitled tomedical benefit, has incurred expenses either by wayof payment or by receiving an account, may applyto the insurance committee for an adjustment of thematter. The committee, if satisfied of the applicant’stitle to benefit and of the bona fides of his application,may, if they think fit, either refund the amount

charged and debit the doctor’s account or require the

withdrawal of the account rendered; in either eventthey must credit the practitioner with the remunera.tion to which he would have been entitled if the

applicant had been attended by him as a temporaryresident. Applications for consideration under thisclause must be made by the insured persons withinone month at present, and it is by no means in everycase that insurance committees accede to the applica-tions. Superior persons who cannot be botheredwith the panel, and so on, until they have incurred.expense or received an account meet, as a rule,with short shrift at the hands of committees. Butthere are more worthy cases-e.g., the man who hasbeen out of work for a long time and whose title tosickness benefit has perhaps expired, and who maythink (who can blame him ) that his title to medicalbenefit has also expired; or the woman who hasbeen married and has been transferred to Class " K."It is proposed in future to extend the period of onemonth to three months, and to make the clause

applicable to cases where a bona-fide mistake hasbeen made by a doctor either in charging a fee or inrendering an account, irrespective of whether thepatient is, or is not, on his list. Hitherto Clause 7 (3)has not applied in cases where the patient was on thedoctor’s list and, strictly speaking, in any case wherea doctor had charged for treatment rendered to apatient whose name was in fact included in his listthe case fell to be dealt with by the medical servicesubcommittee. Obviously there is here a dividedresponsibility. It is the applicant’s duty to make itclear to the doctor that he is an insured person, buton the other hand the doctor has been supplied bythe insurance committee with a list of his patientsin the shape of forms of medical record. Cases have

frequently arisen in which, there being no suggestionof bad faith on the part of a doctor, insurance com-mittees have turned a blind eye to the potentialbreach of the terms of service and have adjusted thematter, with the consent of both parties, by debitingthe doctor and refunding the amount paid to theinsured person. Adherence to the letter of theregulations would have led to quite unnecessaryhearings by service subcommittees. The revisedclause will give them proper authority for dealingwith genuine mistakes in another way, and it will bewelcomed alike by doctors and by committees.