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The patient is kept in bed for a fortnight, and acareful watch is kept upon the ligature to see that it isalways tight. It is a good plan to increase thetension slightly every second day by untying theknot and refastening it. Sometimes the constanttraction on the ligature causes it to cut its way outabout the tenth day: if this does not occur it may bepulled through by traction upon one end.

07’c7n<Zo-ce6KopM/.The operation for the replacement of the testicle

in the abdomen is very similar to that of orchidopexyexcept that instead of bringing the testicle downinto the scrotum it is placed in a bed made for itin the extraperitoneal tissue and retained there bycatgut sutures. The hernial sac is dealt with as in aradical cure for hernia.

Orchidectomy.When the testicle is to be removed the inguinal

canal is exposed by an oblique incision similar tothat used in orchidopexy. The testicle within theprocessus vaginalis is freed up to the internalabdominal ring. The spermatic cord is ligatured atthe abdominal ring and the testicle removed. Twoor three catgut sutures are passed from the deepaspect of Poupart’s ligament to the conjoined tendonand tied, thus obliterating the inguinal canal. Theexternal oblique is then united by a continuouscatgut suture, and the skin closed by a continuoussilkworm gut suture.

The End-results of Treatment.As regards function, patients with bilateral

undescended testicles are found to be sterile. Onmicroscopical examination of over 50 undescendedtesticles removed by different surgeons I have notbeen able to find any normal genital cells or

spermatozoa in any of the specimens examined.The operation itself often fails in anchoring thetesticle in the scrotum, for in cases examined severalyears after operation the testicle is often found highup in the scrotum or at the external abdominal ring.

It may be said : Why should an operation beperformed at all ? First, complications may arisein connexion with an undescended testicle ; thesehave already been mentioned. Secondly, there aredefinite and important social reasons for operation.The position could not be put better than in thewords of a recent leading article in THE LANCET(1926, i., 353) : " The genital organs carry such anemotional charge that, even though they remainconcealed in ordinary circumstances, the reactionsof the individual to any loss or defect are oftengreater than when he bears a loss literally upon hisface. Moreover, in the case of children, we mustbear in mind that mental development in the psycho-sexual sphere is so powerful in determining the wholebehaviour of the individual that, apart from endocrineinfluence, the physical state of the genitalia as theyappear to the person concerned must play a part,though its extent may be debatable, in fashioning hisreaction modes and character traits."

COMCMStOM. .In conclusion, it may be said that in those cases

where there is an imperfectly descended testicle onone side and a well-developed fully descended testicleon the other, the partly descended testicle should beremoved, unless it can be brought down into thescrotum without any tension or division of any ofthe constituents of the spermatic cord. In bilateralcases it is advisable to take means to preserve theinternal secretion on both sides and not to sacrificethe gland. An attempt should be made to bring onetesticle into the scrotum, in order that some chance offertility may be afforded the patient, and to returnthe other testicle to the abdomen.

CECIL P. G. WAKELEY, F.R.C.S. Eng.,Assistant Surgeon, King’s College Hospital,

and Belgrave Hospital for Children.

Special Articles.MEDICINE AND THE LAW.

Afr. Harnett’s Appeal.THE judgment of Mr. Justice Horridge dismissing

Mr. Harnett’s action against Dr. Holdrich Fisher (fordamages for negligence in certifying him to be a.

lunatic in 1912) has been upheld by the Court ofAppeal. The point was a short one. Mr. Harnett,escaped from the asylum at Croydon in 1921, andcommenced his action by writ at the end of May,1922. Two sections of the Statute of Limitationswere material. Section 3 enacts that actions suchas Mr. Harnett’s must be begun within six years.after the cause of action arises; Section 7 enactsthat this time-limit shall not apply if the plaintiffis non compos mentis. It was of the essence of Mr.Harnett’s action that he was not insane in 1912when his cause of action arose ; a jury found in his.favour on this point. But if he was sane in 1912,he could not simultaneously be non compos mentis-so as to evade the Statute of Limitations. The Masterof the Rolls observed that he felt compelled to saythat great hardship might be occasioned to a defendantif a cause of action should survive so long as Mr.Harnett’s against Dr. Fisher. It was, indeed, twoavoid that hardship that the Statute was passed.The appeal, however, though dismissed, was dis-missed without costs, inasmuch as the appellant hadobtained the verdict of the jury on the issue of hissanity and had been awarded 2500 damages. lVIr.Harnett, of course, lost the benefit of that verdictand those damages when Mr. Justice Horridgedismissed his claim ; but they remained an elementin the case which won him the sympathy of theCourt of Appeal on the question of costs.

Irresistible Impulse.The Court of Criminal Appeal on July 12th refused

to accept the principle that irresistible impulse maybe a good defence in criminal trials. The appeal wasthat of Joseph Edward Flavell, convicted at WorcesterAssizes of the murder of his step-brother. Flavellwas 24 years of age, but was described as having theintelligence of a boy of 14 or 15. His father died at31 from Bright’s disease and epilepsy ; no fewer thaneight of the appellant’s blood relations had eitherdied in, or been confined in, lunatic asylums. Flavellhad got up in the night, put on his best clothes, gonedownstairs, procured a wood-chopper and killed hisstep-brother as lie lay in bed with two blows severeenough to cause instantaneous death. He wasconvicted of murder, and his appeal failed, though theHome Office has since commuted his sentence. SirEdward Marshall-Hall, for the defence, recalled therecommendation made in 1923 by Lord Justice Atkin’sCommitteel to the following effect : " It should berecognised that a person charged criminally with anoffence is irresponsible for his act when the act iscommitted under an impulse which the prisoner wasby mental disease in substance deprived of any powerto resist." The Committee added that it might requirelegislation to bring this rule into effect, but, as SirEdward Marshall-Hall observed, Parliament has done-nothing, and now the judges have once more refusedto intervene. The Court of Criminal Appeal gave itsusual answer that the judge had summed up fairly atthe trial, and the jury had found a verdict supportedby evidence, and that the further disposal of theaccused man rested with the Home Office. In fact,we are back where we were before the case of RonaldTrue focused public attention upon the discrepanciesbetween legal and medical theories of criminal responsi-bility, and before the Lord Chancellor set up the AtkinCommittee.

1 THE LANCET, Dec. 8th, 1923, p. 1262.

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Sir Edward Marshall-Hall was urging the argu-ments six years ago in R. v. Holt (15 Cr. A.R., p. 10) ;he contended then that it was the duty of the lawyerto keep pace with the scientist. Indeed, the legal viewwas nearer to the medical view then than now, for inHolt’s case, as Lord Reading, C.J., has pointed out,the trial judge did at least leave the question ofuncontrollable impulse to the jury, though the jury’sverdict negatived the defence founded thereon. Thelater cases seem to show a stiffening of the legal view.In 1921, for example, in R. v. Quarmby (15 Cr. A.R.,p. 163) counsel for the defence argued that the.subconscious mind of a person afflicted with delusionswas a factor to be considered in connexion with actscommitted by one whose unrestrained passionsresulted in crime. " The King’s Bench determinesthe existing law," said Darling, J., on that occasion,"not what the law might be if amended by thelegislature." " Foreign and colonial codes," addedSankey, J.,

" admit the defence of irresistible impulse ;English law does not." In the following year Sir H.Curtis Bennett plied Mr. Justice McCardie with.arguments on " impulsive insanity " in the case ofRonald True and addressed the Court of CriminalAppeal to the same effect, but without securing an.acquittal. The latter court showed itself even morehostile to the theory of uncontrollable impulse inR. v. Kopsch last year (19 Cr. A.R., p. 50). Kopschstrangled a Mrs. Thornton in Ken Wood with hisnecktie ; they had been lovers, and his defence wasthat she asked him to strangle her and that he actedunder an impulse which he could not control. LordHewart, C.J., was severe upon the defence. " Thecourt," he said, " has to-day had a repetition of an.argument which from time to time is heard here,with an ingredient added that is not common-namely, that, according to the experience of counselfor the defence, His Majesty’s judges are continuallysumming up to juries on the question of insanity inthe way for which he has contended. That statementis surprising. No such summing up is known to thiscourt. The law with regard to criminal insanity is that.every man is presumed to be sane and to possess a.sufficient degree of reason to be responsible for his.crimes until the contrary is proved to the satisfactionof the jury. To establish a defence on the ground ofinsanity, it must be clearly proved that, at the timeof the committing of the act, the party accused waslabouring under such a defect of reason, from diseaseof the mind, as not to know the nature and quality ofthe act he was doing, or, if he did know it, that hedid not know he was doing what was wrong. " Havingthus laid down the existing law, the Lord Chief Justicecriticised the arguments for the defence as havingdrifted round to the contention that the law ought tobecome what he stigmatised as the " fantastic theoryof uncontrollable impulse, which, if it were to becomepart of our criminal law, would be merely subversive."It is not yet part of the criminal law, added Lord I

Hewart, and he hoped the day was far distant whenit would be made so.With profound respect to the learned Lord Chief

Justice, one may ask whether he has not overstatedthe position. Can a doctrine be unknown when Mr.Justice Greer expounded it to the jury in Holt’scase ? Can it be fantastic and subversive when sostaid and cautious a body as the Atkin Committeegave it support ? Lord Justice Atkin’s colleaguesincluded official lawyers like the present Master of theRolls (then Attorney-General) and Sir Leslie Scott<(then Solicitor-General), authorities deeply versedin criminal prosecutions like Sir Herbert Stephen,Sir Richard Muir, and Sir Archibald Bodkin, andHome Office representatives like Sir Edward Troupand Sir Ernley Blackwell. These gentlemen statedin their report that they were satisfied that cases ofmental disorder did exist where the impulse to do acriminal act recurs with increasing force until it is,in fact, uncontrollable. They found that cases werenot uncommon in which mothers, normally devotedto their children, cut their children’s throats or other-wise took their lives. In such cases, they said, the

accused knows the nature of his act and knows thatit is wrong, and the McNaghten formula is notlogically sufficient. " We think," said the Committee," that it would be right that such cases should bebrought expressly within the law by decision or

statute. We think that it should be made clear thatthe law does recognise irresponsibility on the groundof insanity where the act was committed under animpulse which the prisoner was, by mental disease, insubstance deprived of any power to resist." TheCommittee gave some grounds for thinking that theexisting law was already as thus stated. " No doubtsome judges have charged juries to that effect ; on theother hand, there seem to be definite decisions of theCourt of Criminal Appeal the other way. It seems tous that, if this legal doubt should continue, it wouldbe advisable to make the law clear by an expressstatutory provision. We have no doubt that, if thismatter were settled, most of the criticisms from themedical point of view would disappear."The Atkin Committee was remarkably conservative

and cautious. It made this modest contribution tosettle the controversy between law and medicine, butthe recommendation put forward with such highauthority has been ignored. The suggested rule hasbeen confirmed neither by statute nor by decision.The Court of Criminal Appeal faces the arguments ofthe Committee with a blank negative. Have the LordChancellor and the Home Office thrown the AtkinCommittee over ?

The Mystery of the Fishmongers.Two fish salesmen were fined ;650 each with 25 5s.

costs at the Mansion House some days ago for sellingputrid fish at Billingsgate. One had sold two boxescontaining 24 hake, the other had sold 57 lobstersunfit for human consumption. The defendantsattributed the sale to the slackness of their servants,who let the fish pass without sufficient examination.More recently three other fish salesmen of BillingsgateMarket were each fined <625 with .83 3s. costs forselling a box containing 27 codfish which were unfitfor human food, the charge being made underSection 47 (2) of the Public Health (London) Actof 1891. On both occasions the prosecutions wereundertaken by the Fishmongers’ Company undera charter of 1604. At that date King James I.reincorporated the " wardens and commonalty ofthe Mystery of Fishmongers in the City of London,"and gave them the usual powers to make lawsfor the good government of the mystery. Thecompany received rights of survey, search, govern-ment, and correction of all persons whatsoeverselling, having, or possessing any fish. Power wasgiven to enter premises and to view, search, and surveywhether the fish be wholesome for man’s body andfit to be sold or no, and, if found unwholesome,corrupt, or unfit to be sold, to seize and dispose of it.It was under these powers that the Fishmongers’Company acted in the recent prosecution. The statusand capacities of this ancient corporation were

expressly recognised in the Salmon and FreshwaterFisheries Act of 1924 (Sections 34 (2), (4), and 78 (d)).It is in keeping with immemorial traditions of municipallife in this country that each trade should be organisedto supervise its own members. The Mystery of theFishmongers has always attached great importanceto its duties of supervising fish supplies. Our citycompanies amply justify their existence by under-taking such work in the interests of the community.

Prison Clothing.An unusual action was lately heard in the Bedford

county court when a man who had been placed inBedford prison on remand claimed 2100 damagesagainst the late governor of the prison for removal ofhis clothing. The judge awarded 5 5s. damages withcosts and spoke strongly of the repulsive result ofcompelling a man of decent upbringing to wearunderclothes previously worn by persons who wereoften verminous and sometimes diseased. It was notapparently suggested that the plaintiff in this case

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had been compelled to put on verminous or infectedclothing ; otherwise the damages would doubtless havebeen heavier. The Prisons Rules for England, likethe corresponding code more recently issued forScotland, naturally direct that every convicted Iprisoner must be provided with a prison dress andshall be required to wear it. But a person remandedto a prison is very far from being a convicted prisoner.According to the English rules a prisoner awaiting trialmay wear prison dress if he desires it ; apparently hecannot be compelled to do so unless his own clothesare insufficient or unfit for use or are necessary to bepreserved for the purposes of justice, or except duringa period when his own clothes are being disinfected toprevent the introduction or spread of infectiousdisease. The county court judge said he was satisfiedthat the late governor of the prison, who was beingsued, was responsible for what had occurred ; headded that his judgment would emphasise his strongopinion that there was persistent infraction of one ofthe most important rules in favour of a prisoner.The incident gives rise to wonder whether the prisonvisitors pay attention to this point, and whether thePrisons Rules are sufficiently explicit or whether thefault lies in their non-observance.

LONDON SCHOOL OF HYGIENE ANDTROPICAL MEDICINE.

PRESENTATION TO DR. ANDREW BALFOUR.

THE members of the teaching staff of the LondonSchool of Hygiene and Tropical Medicine assembledin the library on Friday last, July 23rd, in order topresent the Director, Dr. Andrew Balfour, with apicture by Mr. A. 0. Lamplough as a token of esteem,and in recognition of his great services to the School.The presentation was made by Prof. R. T. Hewlett,who said :-

Dr. Andrew Balfour,-We are gathered here to-day tomake you a little presentation as a token of goodwill andesteem in which you are held not only by your colleagues ofthis School, but by many other outside friends. If you willlook at the list of those who have contributed to this presen-tation you will find that it includes a representative of theRockefeller Foundation, past and present members of theteaching staff of the School, members of the staff of theTropical Diseases Hospital, representatives of the Seamen’sHospital Society, members of the Bureau of Hygiene andTropical Diseases,and of your administrative staff (and in thisconnexion Mr. Harris writes to say how sorry he is to beunable to be present to-day and how proud he is to serveunder you). Many years ago-more years probably thaneither you or I care to reckon&mdash;I had the honour andpleasure of being present at a dinner to bid you farewellon your approaching departure for Khartoum.

I little thought then-a score of years or more ago-thatI should in the future be the unworthy mouthpiece of thosewho desire in a sense to welcome you back again in theimportant and honourable post of Director of the LondonSchool of Hygiene and Tropical Medicine. I need hardlysay how glad I am to do this and appreciate the call, thoughI am bound to say I suspect it is a somewhat dubiouscompliment to myself based on length of service and greyhairs rather than on actual merit !We have now reached what may, perhaps, be regarded as

the third stage in the career of the School of Hygiene. Thefirst stage was the noble gift by the Rockefeller trustees offunds for the foundation of the School. The second stagewas the altogether admirable appointment of yourself as

Director of the School, and the third stage was initiatedthe other day by the laying of the foundation-stone of thepermanent home of the School.Some of us of the old London School of Tropical Medicine,

so successful in the past under the spgis of the Seamen’sHospital Society, to whom a warm tribute ought to be paidfor their wisdom and foresight in undertaking so desirable,though at the same time so great, a venture, some of us ofthe old Tropical School may feel some regret at its disappear-ance as a separate entity, for believe me under the inspirationand leadership of Sir Patrick Manson we throve wonderfullyand were a very happy family. But all of us, I think, agreethat the incorporation of the Tropical School in the newSchool of Hygiene was a right and proper step, and we inparticular, members of the old Tropical School, welcomeyour appointment as Director because we believe that the

great Mansonian tradition will be worthily maintained inyour hands as regards the tropical side of the School’sactivities.As regards other activities of the School, in your hands, too,

we may rest assured that they will be in equally safe keeping.The physical side of health training certainly will, for haveyou not won, if not spurs, at least many hacks and bruiseson university and international football fields ? You haveexperience of public health administration, you have travelledwidely and have a broad outlook on health problems, youare a research worker and know the importance of a liveschool combining teaching with research. When I look atthe list of decorations and degrees you have acquired, of theprizes you have won, of the appointments you have held, ofthe campaigns in which you have taken part, and of thecommittees upon which you have served, I begin to askmyself : Has Scotland produced only one Admirable Crichton?

Moreover, by your silver speech and ready pen you domuch for the School. Was not the last named (your readypen) partially trained in the realm of romantic fiction ? Wemay be sure you will not be

" Cashiered," may we hope thatyour course may be a smooth one, not determined " ByStroke of Sword " nor recourse " To Arms," and that in yourpresent post you have in some degree entered into " TheGolden Kingdom."

This little gift which we have for you I beg you to accept,firstly, as a welcome (somewhat belated perhaps) to theSchool; secondly, as an appreciation of all you have done forthe organisation of the School activities and of the inaugura-tion of its permanent home ; and thirdly, as a token of cordialesteem and goodwill from colleagues and other friends. Itmay also serve to remind you of the time you have spentin tropical climes in the service of humanity and of yourcountry.

Finally, it is a pleasant supplement to the presentationto yourself to ask Mrs. Balfour, your closest colleague,kindly to accept this rose-bowl as a memento of this occasion.

Dr. Andrew Balfour, in reply, expressed his thanksat the welcome given him by the staff of the Schoolin the arduous task of reorganisation of its activities,and expressed his hopes for the future prosperity andsuccess of the School of Hygiene and Tropical Medicinebased upon the loyalty of the present staff.The presentation picture was one of the artist’s

well-known Eastern effects, representing a Sudaneseon his camel, and recalling Dr. Balfour’s distinguishedservices in the Sudan and his activities as advisor tothe Forces in Cankal Africa during the war.

NOTES FROM INDIA.

(BY OUR OWN CORRESPONDENTS.)

The Supply of Quinine.THE Madras Government Cinchona ]Department

has begun new plantations in the Anamalais Hills, .

where the Government possesses fully 20,000 acres

suitable for growing cinchona. More than 50 acreswere planted before the present monsoon, and it ishoped that in a very short time the bark availablefrom these and other sources will make India indepen-dent of foreign supplies. During the year 1924-25,280,000 lb. of bark were harvested from Governmentplantations, and the Madras factory produced over23,000 lb. of quinine sulphate, besides 362 lb. ofquinine bihydrochloride and a smaller amount ofbisulphate. The output of cinchona febrifuge was1143 lb. and its popularity is evidently increasing. Anofficial test made in the Madras hospitals two yearsago showed that the febrifuge has great potentialitiesin the treatment of benign tertian infections,though it still remains to be seen whether it is effectivein preventing the relapses which are the real problemin malaria. Further work on the periodides of quinineand quinidine indicate that experiments with thesesalts would be well worth while, and supplies areoffered for research purposes:

1lTecliccZ Education.In different parts of India there are now 256 women

studying for medical degrees, of whom 198 are Indians.At the Lady Hardinge Medical College at Delhi thenumber of students is at present 106 ; they are drawnfrom 14 different Provinces and States, and representma,ny different nationalities and religious beliefs.