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of language used in the report of a tuberculosis conferencewhich he had attended at Hackney in June, 1950. The

report, after describing claims he made at the meetingfor the success of his own method of treatment and thestatements of his supporters " including several patientswhom he had brought with him to demonstrate so-called’cures,’" went on to say that

" the conference, however,soon recognised the language of the quack remedyadvertisements and passed on to discuss tuberculosis

problems in East London." Dr. Crofton complained thatthese words meant that he had falsely claimed to haveeffected cures, was not fit to be on the Medical Register,was advertising himself in an unprofessional manner,was a pedlar for his own profit of cures which he knewto be valueless, and had conspired with others to deceivethe public. The defendant denied those implications, butadmitted that the words could mean that the plaintiffwas advertising himself unprofessionally in that sense,said the defendant, the words were true in substanceand in fact ; in so far as they were matters of opinion ; ;they were fair comment without malice on a matter ofpublic interest: The jury found that the words weredefamatory, that they were not t;rue in substance andin fact, and that they meant that Dr. Crofton was acharlatan, not fit to be on the Register, dishonest in

falsely claiming to have effected cures, advertisinghimself in an unprofessional manner and peddling a

method of cure which he knew to be valueless, for his

own profit. In further answers to the judge’s questionsthe jury said that, if the words meant only that theplaintiff was advertising himself in an unprofessionalmanner, they were untrue, that they were not faircomment, and that the defendant was actuated bymalice in publishing them.

Dr. Crofton, in the witness-box, explained that hismethod was to take a culture from tuberculous patients’sputum and so produce immunisation. There was nosecret about it ; he had publicised it as much as he could.After his attention had been drawn to the report, and itsauthor had been identified, he received a private letterof apology ; but, three days later, the defendant had puton record in the present action his plea that the wordswere true and that lie meant them to imply advertisementin an unprofessional manner. Mr. Justice Finnemore,in his summing up to the jury, distinguished between adoctor saying " Come to me and I will cure you " andsaying " Here is a method which any doctor can use andwhich, if used, will eliminate tuberculosis."The law of libel in England is a remarkably flexible

instrument for deciding a dispute. If the judge and juryin Dr. Crofton’s case were not exactly performing thefunction of the Medical Research Council or the Ministryof Health in assessing the merits of his system of treat-ment, they were in some degree deputising for the GeneralMedical Council in passing judgment on his professionalconduct.

Parliament

Priority for the Mental Health ServicesREPLYING to a debate on the adjournment in the House

of Commons on May 7, Miss PATRICIA HORNSBY-SMITHsaid that the number of inpatients who were mentaldefectives at the end of 1952 had risen to 53,066 as against

i 51,194 in 1951. But there was still a growing waiting-list, and a large proportion-about 4000 out of 8714-were children. These children were mostly in the age-group 4-7 when it was difficult to keep them at home.But progress in staffing beds had been made. At thebeginning of January, 1952, there were 2145 unstaffedbeds in mental-deficiency institutions. At the beginningof 1953 there were 1587 unstaffed beds. The first problemwas more nurses and the second more buildings.The Minister of Health had repeatedly said that

priority must be given to the mental side in capitalexpenditure. In the Leeds area, for example, in the two-

, year programme, out of an expenditure of .6190,000 thesum of £102,000 was going to mental deficiency, and inEast Anglia 649,000 was being allocated out of .6181,000for the 1953-54 programme. The largest project on handwas Greaves Hall, near Southport, which would cost3 million, take five years to complete, and provide 1040beds. In the last two financial years 6899,000 had beenspent on improvements in the purchase of buildings andadaptations for mental-deficiency work.The staff in 1948 were 6000 full-time and 50,000 part-

time, and at the end of 1952 the figures were 6610full-time and 54,665 part-time ; but she agreed that theystill needed many more.

QUESTION TIMEAccommodation for Mental Defectives

Mr. B. R. BRAINE asked the Minister of Health if he wouldgive the figures of recognised bed-space set aside for mentaldefectives in England and Wales and the number of beds notused for lack of staff or other reasons.-Mr. IAIN MACLEODreplied: On Dec. 31 last, including certified institutions andapproved homes outside the National Health Service, the bedfigures were as follows: recognised bed-space, 50,401 : out ofuse, 1921 ; occupied, 53,914.

Mental-deficiency NurseslIIr, BRAINE asked the Minister what steps had been taken

on the advice of the Mental Health Advisory Committee andothers to recruit additional staff for mental-deficiency nursing.—Miss M. P. HORNSBY-SMITH replied : The Standing Mental

Health and Nursing Advisory Committees have not yet com-pleted their study of the problem, but they have tenderedinterim advice to the Minister of Health, in the light of whichhe hopes to issue a memorandum of guidance to the manage-ment committees concerned in the course of the next fewweeks. - He is also considering, with the Minister of Labour,the desirability of devoting the resources available for recruit-ment publicity in the current financial year largely to therecruitment of mental and mental-deficiency nurses.

National Health Service Cost

Major TUFTON BEAMISH asked the Minister of Health whatextra cost would fall on the Exchequer in this financial

year if the National Health Service were made free in all

respects.-Mr. MACLEOD replied : It is, of course, difficult toestimate the level of demand that would result if charges wereremoved, and therefore no accurate estimate is possible; butI think that the extra cost in a full year would be at leastE40 million.

Committee on N.H.S. Costs -

Mr. SoMERViLLE HASTINGS asked the Minister what know-ledge and experience of the work and management of hospitalswas possessed by the members of the committee that was toinquire into the cost of the health service.-Mr. MACLEODreplied : The inquity is to be independent and objective ;the members appointed have, therefore, no direct connectionwith any part of the health service. The committee will decidetheir own procedure, but I have no doubt they will wish totake evidence from organisations and individuals with

knowledge and experience of the working of the service.Mr. HASTINGS : Does not the Minister feel that some knowledgeof the work of a hospital is necessary for those whose job itis to assess the value of what is spent on that hospital ?-Mr. MACLEOD : Frankly, I disagree. If we once start havingrepresentatives of hospitals, in any sense of the term, I shouldhave to have representatives of doctors, consultants, dentists,local authorities, opticians, and the rest. I wanted this

problem to be examined by a committee of five wise men, orfour wise men and one wise woman-whatever we like to callit. I think we shall get the best result from that.

Mr. ARTHUR. BLENKINSOP: Could the Minister say why hehas by-passed the central advisory committee, which is there,surely, to give him advice on this and other matters ?-Mr.MACLEOD : For the very reason I have just explained ; becausethe Central Health Services Council is representative of allthe interests in the health service. For that reason, in myview, it is the wrong body for this kind of inquiry.

Junior Hospital House-officersDR. BARNETT STROSS asked the Minister whether he was

aware of the difficulty experienced by some hospitals in

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obtaining candidates for junior house positions ; what wasthe extent of this problem ; and whether he would considerincreasing the payment for locums for these positions fromthe present rate of jE8 per week.-Mr. MACLEOD replied : I amaware that this problem is widespread, particularly in theremoter hospitals. I am considering how it can be solved, butI do not think a solution can be found on the lines suggested.

Dr. STROSS : Does the Minister recall that I wrote to himabout a hospital which is not remote and which has 1000 bedsin Stoke-on-Trent where I think that four out of the fivesurgeons have no assistance ? Does he not think that increasingthe remuneration above E8 per week might help them to getlocums ?-Mr. MACLEOD : One of the difficulties about thescale was that it was only promulgated in November, 1952.The second difficulty seems to me to be that to encouragepeople to take locum jobs is not right from the long-termpoint of view. The best solution may well be secured by seeingwhat happens as a result of the preregistration Act which hascome in this year.

-

Specialists and Merit AwardsDr. JEGEB asked the Minister how many merit awards

had been made each year since the system was insti-tuted.-Mr. MACLEOD replied : 1740 awards were made in

England and Wales for 1948-49 ; 439 new or higher ones for1950, and 229 for 1951. Recommendations have not yet beenreceived for 1952.

Mr. BLENKINSOP asked the Minister the total number offull-time specialists now employed in the N.H.S., as comparedwith the number twelve months ago.-Mr. MACLEOD replied :There were 2149 whole-time consultants and senior hospitalmedical and dental officers at the end of 1950 and 2445 a yearlater. Mr. BLENKINSOP: This will give some satisfactionbecause of the rather anxious reports which have been putout by many full-time consultants that there has been a greatfalling away of that service. But, nevertheless, it is very muchmore costly to encourage recruiting of part-time specialiststhan to encourage further full-time appointments.-Mr.MACLEOD : Those figures only take us up to a little more thana year ago. I have not the 1952 figures-which will be inter-esting-but I hope to have them by about the end of themonth.

Atmospheric PollutionOn the motion for the adjournment in the House of

Commons on May 8 Mr. A. E. MARPLES, parliamentarysecretary to the Ministry of Housing and Local Government,stated that the Government had decided to appoint a com-mittee under an independent chairman to undertake a com-prehensive review of the causes and effects of air pollutionand to consider what further preventive measures were

practicable.

Public Health

SmallpoxA FURTHER 3 cases of smallpox have been reported from

Yorkshire, bringing the total of confirmed cases in theoutbreak to 30, with 7 deaths. The daughter and sonof the Leeds mortuary attendant who was admitted tohospital on May 2 are now known to have smallpox.The girl, who was vaccinated for the first time on May 2,fell ill on May 6, and the boy, who had his primaryvaccination at the same time, on May 10. The thirdnew case is that of a miner, aged 19, who lives at Baildonand works in a colliery at Gomersall. He was not undersurveillance as a contact, but he lives 3 or 4 miles fromone of the earlier patients. He fell ill on May 1 and wasadmitted to hospital on May 5.Death from smallpox may take place in the pre-

eruptive stage or when there are only sparse focal rashes.The patient may be desperately ill-perhaps comatose-on reaching hospital, and in the absence of any rash hiscondition may easily be attributed to some other acutemedical or surgical illness, such as uraemia or an abdominalcondition requiring laparotomy. A patient who hasbeen very ill in the early stages of smallpox does notnecessarily develop a definite rash later. Thus small-pox enters into the differential diagnosis of anyunexplained fever and toxaemia, particularly with haemor-rhage or petechiæ. When there is the slightest doubtmaterial should be kept for virological examination,and the medical officer of health notified.

In England Now

A Running Commentary by Peripatetic CorrespondentsI RAN the Pathologist to earth in a rather small dirty

room. He was smoking a cigarette, his glasses werepushed up on his forehead, and he didn’t seem too busy." Can you tell me, sir, please," I asked, " why differentialwhite-cell counts are always given as percentages of thetotal whites ? ... I mean, the different white cells don’tbear any particular relation to each other, do they, sir ? "He appeared to be trying to take this in, so I wasencouraged to make it a bit simpler. " Supposing youenumerated all the different objects in a living-room,for instance," I said ; " within normal limits you mightexpect one grand piano, half a dozen chairs, two or threetables, a few rugs, curtains, vases, pictures, and, say, acouple of hundred books. Your percentage of grandpianos would average about 03 % and would dependlargely upon the number of books. It might be as low as0’15 % in a library, or as high as 2 % in a studio. Right?Very well, but supposing there were two grand pianos inthe room, sir-" He took me up promptly. " There arepeople who would need two. Rawicz, for instance. AndLandauer, too, I wouldn’t mind betting." " So that theycould visit each other, turn and turn about ? " I hazarded." And Sellick and Smith ? Oh, but they are married,aren’t they, sir ? " He nodded sagely, and went on withenthusiasm. " And there’s that thing of Bach’s thatold H. J. was so fond of at the Proms that takes threegrand pianos. He used to give it to his students. My nieceplayed in the team one year, I remember. Outside right,I think she was." " Really, sir ? Then I may have seenher." I persevered, " But my point is that more thanone grand piano in a room has a definite significance.Half a dozen would be pathological." He agreed, " Halfa dozen would be excessive.... Didn’t they have four inLes Noces, up on the stage? "-" No, two I think. Fourvoices, or was it eight, but only two pianos. But lots ofpercussion." He nodded happily, " Yes, lots of percus-sion." I ploughed on, " Well, people can have from oneto three grand pianos in the room and still keep withinthe normal percentage range, so long as there are enoughbooks and vases and things to balance them up, or doI mean dilute them ? " " I can’t see anything wrong inthat," he replied after deliberation. " Good," I said." Now, sir, some of your white cells-I can’t remembertheir names-are as scarce as grand pianos, and theiractual number can be doubled and trebled withoutanyone paying much attention if their number is

expressed merely as percentages of the white-cell count.In fact, I’m surprised you don’t lump in the reds as welland divide the number of thingummy cells by five millionodd...." " I dare say we could do that for you. It wouldonly mean dividing by five and shifting the decimal point.Would that help you ? " " No, no, sir," I exclaimedhastily. " Not a bit. Quite the contrary in fact. I’dlike you to divide each cell quantity by its own particularnormal so that your path. report would read-Polysnormal, Lymphos two-thirds normal, Thingummy cellsfive times normal." There was a pause and then thetelephone rang. With heavy deliberation he took upthe receiver and listened. With his right hand he drew .

on his blotter an Aberdeen terrier balancing a sugar-lump on its nose, putting in the shading very carefully.A laboratory assistant barged in, noisily dumped a basketof test-tubes on the desk, looked at me pityingly (Ithought), and barged out again. The telephone earpiececackled and burred. "All right," said the Pathologist," I’ll hang on," and went on with the shading. I creptout. :

The remarks of your non-psychiatric, but withoutdoubt psychologically eminent, peripatetic correspondent(April 4) who has designed a de-luxe body for his 10-HP.car reminds me of an awkward situation which I success-fully overcame in my youth (1939). I had an ancient1926 Austin Seven of which I was inordinately proud.It was, however, always embarrassing, especially whenthere were young ladies aboard, to hear a stream ofscurrilous and derisory remarks whenever I stopped ata garage. There was one garage hand, a large, lanky,ginger-haired coarse youth, whom I particularly disliked,