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it was seldom necessary for the soldier concernedto be struck off duty. After oral administrationheadache was the chief complaint in the case oftablet B and next in order of frequency came gastricdisturbance, diarrhoea, anorexia; with tablet A,diarrhcea was most frequent and next in order camegastric disturbance, feeling of tiredness, abdominaldiscomfort, headache.

General DOPTER (France) said that a law had beenpassed in France making immunisation againstdiphtheria compulsory in the French army when thecompetent local authority considered such action

necessary. He also said that diphtheria immunisationwas now carried out simultaneously with T.A.B.inoculation when possible. This reduced the numberof inoculations and the period of inefficiency.

OTHER SUBJECTS DISCUSSED

A resolution was passed stating that the congress" having considered the constantly increasing dangersof bombardment to which medical units and fixed

hospital establishments are likely to be exposed"makes the following recommendations :-

(1) That hospital areas be reserved for the exclusiverequirements of the medical service and placed under thesign of the Red Cross.

(2) That regulations be introduced as early as possibleto determine the conditions of application of this recom-mendation in the Geneva Convention for the ameliorationof the lot of the sick and wounded in the armies in the field.

Meetings were also devoted to the treatment of themore urgent surgical cases in the front area duringwar of movement ; consideration of a specialised unit,its organisation and tactical employment ; the

preserved foods forming part of the rations issued inthe Services in peace and war ; and a comparativestudy of the organisation of the different militaryservices as regards dental and administrative services.

DEMONSTRATIONS

During the course of the Congress surgical operationswere carried out by several visiting foreign surgeonsat the large Military Hospital of Carabanchel (3000beds). This hospital was recently completed and isa line modern institution. One special feature is theprovision of accommodation for the members of thefamilies of officers who are under treatment in the

hospital.An exhibition of medical and surgical equipment

was held in the grounds of the Retiro Park. Thisincluded a demonstration of a fully equipped armyhospital with operating theatres, X ray equipment, andother special services. In addition a field hospitalorganised by the Spanish Red Cross Society was onview. This was fully equipped and staffed and gavethe impression of being a thoroughly serviceable unit.In the exhibition proper there was a display of thefirst field dressings of various countries and of thefield operating equipment used in the Spanish Army.This was contained in stainless steel cases, the instru-ments being arranged in trays superimposed one

on another. In a display of radiological equipment,a full size X ray photograph of the human skeletonwas shown.The opening meeting was presided over by the

President of the Republic, who later held a receptionat the National Palace. The next congress will beheld in Bucharest in 1935.

CORNELIA AND EAST DORSET HOSPITAL.-Thishospital at Poole, which has been rebuilt and extendedthree times in the present century, has now been furtherenlarged. The additions, which include a theatre on themost modern lines and cost E7000, were opened last weekby Lord Dawson.

MEDICINE AND THE LAW

Doctors in Slander Action

AT the Chester assizes last week the plaintiffand defendant were medical practitioners living in thesame town in North Wales, the defendant being themedical officer of health. The plaintiff claimed damagesfor slander on the following grounds. A womanwho was his panel patient had, it was said, appliedto the local authority for more suitable accommoda-tion. She was referred to the defendant as medicalofficer who asked, "who is your doctor " When shenamed the plaintiff the defendant was said to havesaid, " You know I take panel patients as well."On another occasion the defendant was said to haveremarked to her of the plaintiff, " Oh ! he is no good ;why don’t you change for men " Defendant, it wasalleged, had also shown her a number of envelopescontaining panel patients’ cards and had added," They are all changing from him to me ; why don’tyou do so?" The defendant doctor denied the

allegations and said he had always been on friendlyterms with the plaintiff. The jury evidently disbelievedthe denial. They found a verdict for 50 damagesfor the plaintiff, for whom judgment was given withcosts.There are few graver breaches of professional

propriety than the disparagement of a brother

practitioner and the poaching of his patients. Whilethe medical profession invariably suffers when onemember of it sues another, it is hard to see whatother course the plaintiff could have taken in theface of the facts which the case must be taken tohave established.

Ambulances and Red TapeIn view of the evidence at a recent inquest, some

coordination of the ambulance services of adjoininglocal authorities seems called for. A car was over-turned on the Kingston by-pass road and thedriver was fatally injured. The scene was 70 yardsfrom the stream which forms the boundary betweenthe urban district of Surbiton and that of Maldenand Coombe. Four minutes after the accident theSurbiton council’s ambulance appeared. Its driver,observing that the injured man lay on the wrong sideof the boundary, halted at the stream, reversedhis vehicle and drove away. Apparently he hadstrict orders, very definitely framed a few years ago,not to cross the boundary into an adjoining district.Some 20 minutes later the Malden and Coombeambulance arrived and thus, after a delay whichwould often have serious results, the patient wasremoved to hospital. At the inquest an officialof the Malden and Coombe council said that coöpera-tion with Surbiton in this matter had been attemptedsome years ago but had broken down for want ofagreement as to the payment of charges. Maldenambulances, he said, had gone into the Surbitonarea at least six times in the past 12 months. Theclerk to the Surbiton council said there were twosides to the question ; on one occasion a Surbitonambulance had gone into another district and hadafterwards been asked by the local authority concerned(not Malden and Coombe) to keep away in future.The coroner rightly observed that human life wasthe first consideration.Doubtless the authorities concerned will make

joint arrangements to prevent the repetition of suchincidents without further delay. It is no time tostand upon geographical dignity when a man lies

dying. If adjoining councils cannot agree, there

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will be a strong case for organising ambulanceservices by larger units. The present system of

summoning help on the fringe of the metropolisseems to demand more knowledge than many peoplepossess. The London Telephone Directory, instructingus how to contend with emergencies of fire, crime, oraccident, bids us ask the Exchange for " Fire

Brigade," "Police," or "Ambulance" as the case

may be, " specifying, if known, the appropriate fire

brigade or police station or ambulance authority."How many travellers on the Kingston by-pass couldspecify the correct ambulance authority with confi-dence ? Few of us, at any rate, would be otherthan dissatisfied if the fire-engine or the policeman,summoned in emergency, passed by on the other sideout of excessive respect for boundaries and jurisdic-tions. The good Samaritans of the ambulanceservice must not be Pharisees.

A Technically Pauper PatientThe -How county court judge gave judgment last

week in a curious case where the Essex CountyCouncil was suing a former patient of the WhippsCross Hospital. To his surprise the patient foundhimself classed as a pauper (or, as we must nowadayssay, a rate-aided person) malgré lui. He had beenknocked down in a London street by a tram lastyear and had been taken to the Whipps CrossHospital with a broken leg and detained for eightweeks. At his admission the hospital authoritieswent through his pockets and found E7 in notesand 8s. in silver which they retained. When hewas discharged he asked for his money but was toldthat it had been applied towards his maintenance.A fortnight later he received a bill for E25 4s. 8d.for the balance of the cost of his maintenance inthe hospital. This he refused to pay. He sued theEssex County Council for the money which had beentaken from his pockets. The defendant counciltold him that having been treated in a poor-lawhospital he was technically a pauper and must handover the property found upon him. He answered thathe was not an able-bodied pauper but a certificatedpublic accountant with a broken leg, who hadnever applied for relief by way of public assistance.The solicitor to the West Ham Corporation explainedto the court that the Local Government Act of 1929had abolished boards of guardians and that the

Whipps Cross Hospital had been transferred toWest Ham. It was intended to appropriate thehospital as a Public Health Act institution, but thebuilding had not been so appropriated. It thereforeremained a workhouse infirmary, and anybody whocrossed its threshold automatically became a pauperby virtue of his admission as a patient. Consequentlythe authorities were right to take away his money.This argument the judge found himself obliged touphold. It was, he said, unfortunate for the plaintiffthat the place to which he was taken in emergencyfor treatment was a poor-law institution and not ageneral hospital.The Local Government Act has created an impres-

sion that all pauperdom has been removed and thatall public hospitals have now pooled their resources.The case may help to stir the public conscience inthe matter of the liability to pay for hospital treat-ment for traffic casualties. There is an idea that theservices of hospitals (and of the doctors and surgeonswho administer treatment in this connexion) are

a fairy gift miraculously available at no cost to thepatient. This obscures the sense of obligation to

pay on the part of those patients who can afford todo so.

IRELAND

(FROM OUR OWN CORRESPONDENT)

NATIONAL HEALTH INSURANCE

INTERESTING evidence was given recently before

a Select Committee of the Senate in reference to the

National Health Insurance Bill now before that

body. Sir Joseph Glynn, for many years chairmanof the National Health Insurance Commission,pointed out that there was no medical benefit inthe Irish Free State, and said that the absence ofmedical benefit tended to vitiate the system ofcertification of incapacity. He said also that thewhole question of unemployment went with sickness.As unemployment increased, sickness increased.It was the same in all countries. Mr. L. J. Duffy,chairman of the Association of Trade Union ApprovedSocieties, welcomed the abolition of the voluntarysocieties. He believed that the increase in sicknessbenefits was in part due to irresponsible certification.Mr. M. P. O’Donnell and Mr. T. Hutchinson, onbehalf of the Approved Societies’ Association ofIreland, also criticised the system of medical certifica-tion. Dr. R. J. Rowlette, President of the IrishMedical Association, said that national healthinsurance should be something more than mere

payment when a person was sick. It should attemptto improve the health of the country as a whole,and particularly of a class which came under theinsurance. It should be coordinated with the publichealth system of the country. The present Billwould create an extremely powerful body whose dutywould be only to carry out one part of the healthwork of the country without being in contact at allwith the other health activities. The societies hadnever concerned themselves very much with thehealth of their members, and contented themselveswith the provisions of benefit. In answer to questionshe said that if there was going to be unification thereshould be a nationalised State system of insurance.The provision of medical benefit was an essentialpart of any scheme of national health insurance.As regards certification, he did not question thatevidence of laxity and remissness in their issue couldbe got. It was not, however, representative of thepresent system as a whole. Mr. S. T. O’Kelly,Minister for Local Government and Public Health,said that they were attempting to deal with a crisisthat was threatening in national health insurance.When he came into office as Minister he was advisedby the officials of his Department that a Bill of thissort was urgent. The danger was that if they didnot tackle the problem in this way there might bereduced benefits. They thought it would be moreequitable to bring all the insured persons into onesociety, sharing credits and losses all over. SenatorDowdall said there was a consensus of opinion thatunemployment caused the greater drain on benefits.It had been suggested that this was due to laxcertification. He himself thought that a medicalofficer was entitled to give a certificate on borderlinecases. The Minister said that was a matter thatrested with the conscience of the doctor, and hebelieved that the mass of medical men were humani-tarian. Personally, his inclination would be to actgenerously, but as Minister he would be boundby the law. He mentioned a case where he hadheard that a doctor had signed a book of certificates,and left it on his hall table, so that certificates couldbe given to people calling.