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1207 inhalation of carbon monoxide ; the plaintiff’s case was that gases generated by a gas-burner in the kitchen had found their way into the bathroom by way oi the linen-shoot. As usual the cause of action was framed both as breach of contract and breach of duty. The claim alleged that the house was not fit for habitation but dangerous by reason of the gas- burner not having a chimney flue pipe or other outlet; further, that the burner was negligently installed so that the products of combustion were emitted direct into the house. The defendants (from whom the deceased man had taken the house) knew, argued the plaintiff’s counsel, of the existence of a dangerous trap, or ought to have known of it, and were under a duty to warn the occupier. The defendants denied all these allegations. The jury found that death was due to carbon monoxide coming from the boiler, that the gas-heater installed by the defendants had no flue and, in connexion with the shoot to the bathroom, was dangerous for use in a dwelling-house, and, finally, that the defendants did not know it was dangerous but ought to have known it. On the effect of this last finding legal argument was necessary. Defendant’s counsel said that, if the danger had been concealed, his clients would have been equally liable whether they knew or ought to have known of its existence. But here there was nothing concealed ; the dead householder could see all that the defendants could see. The gas-heater, he said, was not dangerous in itself, though it might be dangerous through defect in its construction or the way in which it was worked. The defendants, he argued, had only the duty to give warning of the danger actually known to themselves, and the jury bad found that the defendants had no knowledge which could be communicated. Mr. Justice Hawke ruled that the findings of the jury amounted to a decision that the defendants had been negligent in dealing with a dangerous thing (presumably the gases generated by the boiler in the kitchen) ; he gave judgment for the plaintiff but granted a stay of execution pending appeal. It is the kind of case that may occur elsewhere and, as there seems to be some uncertainty as to the legal liability, an authoritative ruling will be welcome. IRELAND. (FROM OUR 011--N CORRESPONDENT.) THE SWEEPSTAKES AMENDING BILL. AN interesting debate took place in the Dail last week ou the second reading of the Sweepstakes Amending Bill, or, to give it its proper title, the Public Charities Hospitals (Amendment) Bill, 1931. The Bill proposes to enlarge the scope of the principal Act in two directions, so as to include new classes of hospital. In the first place, five institutions are included by name. It is understood that these institutions are ineligible under the present Act, in that they do not maintain the requisite number of free beds. In the second place, one-fourth of the proceeds is to go to the county-i.e., rate-supported- hospitals for the purpose of improvement or equip- ment ; the idea being," said the Minister, "that none of the proceeds should go to the maintenance of patients or directly to the relief of the rates." (One may ask whether equipment is not a duty of the ratepayers, and whether money from an outside source devoted to equipment is not in relief of the rates.) The Bill also provides new machinery for deciding various points concerning sweepstakes by means of a committee of reference which will, in particular, examine the claims of the several charities which apply for participation, and decide on the distribution of the funds. Mr. MacEntee, although not opposing the Bill, pointed out certain dangers in the reliance coming to be placed on sweepstakes. He pointed out that some of the hospitals were being induced to undertake capital expenditure which would impose on them further commitments for maintenance and operation, which, if sweepstakes were to be discontinued, would involve them in grave financial difficulties. On the other hand, Mr. Davin thought that as long as the money was coming from outside countries, there was no reason for discontinuing the sweepstakes, but he thought they should be under the direct control of the State. Sir James Craig thought that some of the hospitals named in the Bill would require scrutiny in com- mittee. As the introducer of the original Act he confessed himself "rather appalled " by the success of the scheme he had started, and he appealed to the Minister to consider whether he should curtail the period for which the original Act was to run. Mr. Good pointed out that while there was a well- informed opinion in favour of amalgamation of the smaller hospitals, the present method of distribution of funds tended to perpetuate the small hospitals, efficient and inefficient. The sweeps might, on the other hand, be used to carry out amalgamation. Several deputies expressed disapproval of the whole system, Mr. Haslett declaring that the Act had made the country a byword among the nations. The Minister, in reply, agreed with Mr. Good that the present would be a suitable time to consider amalga- mation, although the question did not arise under the Bill. The second reading of the Bill was agreed to. I SWITZERLAND. (FROM 1 OCCASIONAL CORIZE2-PONDENT.) A SUCCESSFUL ACTION FOR NEGLIGENCE. AN interesting case of medical responsibility has just been decided by the Federal High Court. In July, 1927, five children of a family in the Lower Engadine developed an affection of the throat. The local practitioner diagnosed in all cases common sore-throat and, when asked by the parents, strictly denied the possibility of diphtheria. As the disease showed no sign of improvement the surgeon of the next district hospital was called in for consultation, with the result that two of the children were transferred to the isolation hospital at Schuls with the diagnosis of diphtheria. Despite injections of serum they both died within the next few weeks. The father of the children, being of opinion that their death was due to wrongful diagnosis, lodged a complaint against the practitioner and asked damages amounting to francs 10,000. District court and cantonal court dismissed the complaint. Both courts, however, agreed that the practitioner did not make use of all methods, such as bacteriological examination, to detect the nature of the disease ; that it was possible, even probable, but not certain, that with immediate proper treatment death could have been avoided. The plaintiff lodged an appeal with the Federal High Court. The appeal was successful and damages amounting to francs 3000

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inhalation of carbon monoxide ; the plaintiff’s casewas that gases generated by a gas-burner in thekitchen had found their way into the bathroom byway oi the linen-shoot. As usual the cause of actionwas framed both as breach of contract and breachof duty. The claim alleged that the house was notfit for habitation but dangerous by reason of the gas-burner not having a chimney flue pipe or otheroutlet; further, that the burner was negligentlyinstalled so that the products of combustion wereemitted direct into the house. The defendants(from whom the deceased man had taken the house)knew, argued the plaintiff’s counsel, of the existenceof a dangerous trap, or ought to have known of it,and were under a duty to warn the occupier. Thedefendants denied all these allegations. The juryfound that death was due to carbon monoxide comingfrom the boiler, that the gas-heater installed by thedefendants had no flue and, in connexion with theshoot to the bathroom, was dangerous for use in adwelling-house, and, finally, that the defendants didnot know it was dangerous but ought to have knownit. On the effect of this last finding legal argumentwas necessary. Defendant’s counsel said that, if thedanger had been concealed, his clients would havebeen equally liable whether they knew or ought tohave known of its existence. But here there wasnothing concealed ; the dead householder could seeall that the defendants could see. The gas-heater,he said, was not dangerous in itself, though it mightbe dangerous through defect in its construction orthe way in which it was worked. The defendants,he argued, had only the duty to give warning of thedanger actually known to themselves, and the jurybad found that the defendants had no knowledgewhich could be communicated. Mr. Justice Hawkeruled that the findings of the jury amounted to a

decision that the defendants had been negligent indealing with a dangerous thing (presumably the gasesgenerated by the boiler in the kitchen) ; he gavejudgment for the plaintiff but granted a stay ofexecution pending appeal. It is the kind of case

that may occur elsewhere and, as there seems tobe some uncertainty as to the legal liability, anauthoritative ruling will be welcome.

IRELAND.

(FROM OUR 011--N CORRESPONDENT.)

THE SWEEPSTAKES AMENDING BILL.

AN interesting debate took place in the Dail lastweek ou the second reading of the SweepstakesAmending Bill, or, to give it its proper title, thePublic Charities Hospitals (Amendment) Bill, 1931.The Bill proposes to enlarge the scope of the principalAct in two directions, so as to include new classesof hospital. In the first place, five institutions are

included by name. It is understood that theseinstitutions are ineligible under the present Act, inthat they do not maintain the requisite number offree beds. In the second place, one-fourth of theproceeds is to go to the county-i.e., rate-supported-hospitals for the purpose of improvement or equip-ment ; the idea being," said the Minister, "thatnone of the proceeds should go to the maintenanceof patients or directly to the relief of the rates."(One may ask whether equipment is not a duty ofthe ratepayers, and whether money from an outsidesource devoted to equipment is not in relief of the

rates.) The Bill also provides new machinery fordeciding various points concerning sweepstakes bymeans of a committee of reference which will, in

particular, examine the claims of the several charitieswhich apply for participation, and decide on thedistribution of the funds. Mr. MacEntee, althoughnot opposing the Bill, pointed out certain dangers inthe reliance coming to be placed on sweepstakes.He pointed out that some of the hospitals were beinginduced to undertake capital expenditure whichwould impose on them further commitments formaintenance and operation, which, if sweepstakeswere to be discontinued, would involve them in

grave financial difficulties. On the other hand,Mr. Davin thought that as long as the money wascoming from outside countries, there was no reasonfor discontinuing the sweepstakes, but he thoughtthey should be under the direct control of the State.Sir James Craig thought that some of the hospitalsnamed in the Bill would require scrutiny in com-mittee. As the introducer of the original Act heconfessed himself "rather appalled " by the successof the scheme he had started, and he appealed tothe Minister to consider whether he should curtailthe period for which the original Act was to run.Mr. Good pointed out that while there was a well-informed opinion in favour of amalgamation of thesmaller hospitals, the present method of distributionof funds tended to perpetuate the small hospitals,efficient and inefficient. The sweeps might, on theother hand, be used to carry out amalgamation.Several deputies expressed disapproval of the wholesystem, Mr. Haslett declaring that the Act had madethe country a byword among the nations. TheMinister, in reply, agreed with Mr. Good that thepresent would be a suitable time to consider amalga-mation, although the question did not arise underthe Bill. The second reading of the Bill was agreed to.

I

SWITZERLAND.

(FROM 1 OCCASIONAL CORIZE2-PONDENT.)

A SUCCESSFUL ACTION FOR NEGLIGENCE.

AN interesting case of medical responsibility hasjust been decided by the Federal High Court. In

July, 1927, five children of a family in the LowerEngadine developed an affection of the throat.The local practitioner diagnosed in all cases commonsore-throat and, when asked by the parents,strictly denied the possibility of diphtheria. Asthe disease showed no sign of improvement the

surgeon of the next district hospital was called infor consultation, with the result that two of thechildren were transferred to the isolation hospitalat Schuls with the diagnosis of diphtheria. Despiteinjections of serum they both died within the nextfew weeks. The father of the children, being of

opinion that their death was due to wrongful diagnosis,lodged a complaint against the practitioner and askeddamages amounting to francs 10,000. District courtand cantonal court dismissed the complaint. Bothcourts, however, agreed that the practitioner didnot make use of all methods, such as bacteriologicalexamination, to detect the nature of the disease ;that it was possible, even probable, but not certain,that with immediate proper treatment death couldhave been avoided. The plaintiff lodged an appealwith the Federal High Court. The appeal was

successful and damages amounting to francs 3000

Page 2: SWITZERLAND

3208

were awarded to the parents. The Federal High Courtbased its decision on the admission of a causal relationbetween the insufficient treatment and the death ofthe children. The High Court further stated thatwrong diagnosis alone was not sufficient to hold adoctor responsible. In doubtful cases it was, however,the duty of the doctor to use all modern methodsto explore the nature of a disease. If this was notdone the doctor was negligent and could be heldresponsible. Both the district and the cantonalcourt were of opinion that the plaintiff had to proveconclusively and strictly that death could havebeen avoided by early treatment with serum injections.In most cases such proof was impossible. It was Ienough for the plaintiff to show that the negligence ofthe doctor was the probable cause of death. TheFederal High Court regarded as generally admittedthat with proper serum treatment mortality in

diphtheria had been enormously reduced. Thereforethe court in the present case found it sufficientlyproved that with proper treatment the two childrenmost probably could have been saved.

OVERCROWDING IN THE MEDICAL PROFESSION.

This little country has been widely blamed formaking it increasingly difficult for foreigners to

practise within its borders, but the truth is that theprofession is becoming more and more overcrowded.In Switzerland we have one doctor to 1244 inhabitants,a proportion which compares oddly with othercountries. In Germany there is one doctor to 1494inhabitants, in Holland one to 1538, in Denmarkone to 1613, in Sweden one to 2947. And despite allwarnings the entry is increasing. In 1929 117students qualified in Switzerland ; in 1930, 138.The same plethora is to be seen in the dental andveterinary professions. The situation is such as tohave given the Federal Minister of the Interioroccasion to write in his last annual report: "Allour observations make us fear that the medicalprofessions are becoming more and more overcrowdedand that their standard will be gradually lowered.The situation must be remedied. The question is

only how this can be effected. One of the remediesproposed, the numerous clausus, is not available. Weshall approach the subject in conjunction with themedical faculties and the professional groups."

NOTES FROM INDIA.

(FROM OUR OWN CORRESPONDENT.)

ALL-INDIA MEDICAL CONFERENCE.

THIS year the conference so named was held atPoona, Dr. Jivraj Ifehta presiding. As one ofIndia’s leading medical politicians no more suitablepresident could have been chosen. Each year thescientific veneer of this conference wears thinner andits political nature becomes more apparent. Thechairman of the reception committee referred to the" antiquated policy of the medical administrationof the country which must be thoroughly over-

hauled," drawing a picture of mediocre I.M.S. officersbeing given all the best medical appointments overthe heads of more highly qualified independentpractitioners. But he had by no means stolen allthe president’s thunder. Dr. Mehta described theaction of the General Medical Council in refusingto recognise certain Indian degrees as an undisguised

blessing ; while it was important for India tohave a central organisation of its own to controland correlate medical education and for securingand safeguarding their rights, he considered itessential that the council should have a non-official

majority. He drew the attention of the conferenceto the fact that it was proposed to exclude licentiatesfrom the all-India register, but did not appear tocommit himself to a definite opinion on this point.The Bill in question was originally an official measureand in previous conferences was attacked as an

attempt on the liberty of the medical profession;it is now criticised because it is insufficiently compre-

hensive. There was a suggestion of reprisals inDr. Mehta’s remark that in his opinion one of thefirst acts of the new council should be to ensure that

only persons registrable in India should be employedin the civil, military, or naval forces. At presentof course nearly all British qualifications are so

registrable. Dr. Mehta did not approve ot theintrusion of the LiILS. into the civil side of medicalpractice and he took exception to the present methodof recruitment. He also criticised the compositionof the governing body of the Indian Research Fundand of the way they administered this fund. Therank and file of the conference were not to be outdoneby their president ; no less than 47 resolutions werepassed, nearly all disapproving of something or other.They disapproved of the Round Table Conferencebecause it had been suggested there that Europeandoctors should be recruited to look after the Europeancivil officials ; they passed votes of censure on thepolice for interfering with the Congress first-aidvolunteers ; they condemned the government for

providing an insufficient number of facilities formedical education and then again for building toomany medical schools, for not providing sufficientlyqualified teachers and for paying their teachers toomuch, and in fact for everything that they had orhad not done. The brunt of the criticism fell on theEuropean officers of the L3I.. for being incompetent,for being overpaid, and for even existing at all-as far as civil practice was concerned. The RedCross administration was attacked by an officer whohad recently been associated with it. All the resolu-tions were carried unanimously, but the conferencewas not very constructive.

MALARIA NEAR CALCUTTA.

The political situation being quieter the dailypress have discovered a malaria scare. The fleshof Calcutta’s citizens is made to creep daily by head-lines such as " Deadly mosquito advancing on

Calcutta, " Firebelt to save Calcutta from malariaepidemic," " Aeroplanes may have to be used," andthe like. The facts are that a few months ago asomewhat sharp outbreak of malaria at some of themills a few miles down the river from Calcutta wasinvestigated. Anopheles ludlowi was found to be thecause of it ; 90 per cent. of the mosquitoes were of thisspecies and of a large number dissected 24 per cent.were found to be infected. The spleen rate in thearea was 90 per cent. Most of the spleens were small,suggesting a recent infection. A. ludlooci was knownto exist further down the river nearer the sea, but hadnot been found so near Calcutta before, and fear hasbeen expressed that it might invade the salt lakesfrom whence the prevailing south wind would soonblow them into Calcutta itseli. This species hasalready been reported in certain places on the rivernorth of Calcutta ; it is suggested that they may havebeen carried there by country boats. The director of

public health considered the situation serious enough