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MEDICAL AUXILIARIES IN THE HEALTHSERVICE

THE-Minister of Health and the Secretary of State’forScotland have set up eight committees to review questionsof recruitment, training, and qualifications of medicalauxiliary workers in the National Health Service. Allthe -committees will be under -the chairmanship of Mr.V. Zachary Cope,. F.R.C.S., a former president of theBoard of Registration of Medical Auxiliaries. -Dr. G. A.Clark, a principal medical officer of the Ministry ofHealth,- and Mr. A. B. Taylor, an assistant secretaryof the Department of Health for Scotland, will also siton all the- committees. Other members of committeesare : -,’ .

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Almoners.—Dr. F. Grundy, Miss M. M. McInnes, andMiss’M. J. Roxburgh.

Chiropodists.—Mr. St. J. D.’Buxton, F.R.C.S., Miss D. GrantNisbet, Miss C. F. Norrie, and Dr. J. A. Scott.

Dietitians.—Miss M. C. Broatch, Prof. S. J. Cowell, F.R.C.P.,Dr. D. P. Cuthbertson, Dr. George Graham, and Miss R.Pybus.

Laboratory Technicians.-Mr. T. C. Dodds, Mr. A. Norman,and Prof. G. S. Wilson, F.R.C.P. ,Occupational Therapists.-Miss M. D. Barr, Miss E. M.

Macdona.ld, Mr. L. W. Plewes, F.R.C.S., and Dr. T. P. Rees.

Physiotherapists.—Mr. J. T. Buchan, Mr. J. H. C. Colson,Dr. J. L. Livingstone, Miss M. 1. V. Mann, Miss M. U. Sharpe,Mr, T. T. Stamm, F.R.C.S., and Dr. W. S. Tegner.

Radiographers.—Dr. S. Cochrane Shanks, Prof. G. Stead,D.SC., Mr. C. Lovell Stiles, Mr. R. White, and Prof. B. W.Windeyer, F.F.R. ’ -

Speech Therapists.—Dr. E. J. Boome, Dr. J. B. Gaylor,Mr. V. E. Negus, F.R.C.S., and Dr. C. C. Worster-Drought.The secretary of all the committees is Mr. J. G. Paterson,

Ministry of Health, Whitehall, London, S.W.I.

GENERAL MEDICAL COUNCILOPENING the 175th session of the council on May 25,

Sir HERBERT EASON, the president, spoke with deepregret,of the death of Dr. J. W. Bone (a treasurer since1939), and Mr. Edward Sheridan (formerly chairman ofthe dental education and examination committee).At the end of 1947, said the president, the Medical

Register contained the names of 77,929 practitioners, ofwhom 67,261 were registered on qualifications grantedin the British Isles, 6509 (including 813 temporarilyregistered) in the Commonwealth list, and 4159 (including3748 temporarily registered) in the foreign list. Thenumber of names added or restored to the register in1948 was 3984-the highest number on record. Butat the end of the year the number of names in ’theregister (76,292) was 1637 less-than at the end of 1947,and exactly the same as at the end of 1946. Under theMedical Practitioners and Pharmacists Act, 1947, thoughthe names of 1396 practitioners were added to the foreignlist, the names of 4467 were removed from the registeron the determination of their temporary registration.Of these, 3119 had not applied for normal registrationwithin the statutory time-limit, and it could safely beassumed that most of them were practitioners from theCommonwealth or from the United States who havereturned to practise at home. " I am sure that thecouncil would wish me to take this opportunity of sayingthat the arid details of registration and removal fromthe register do not obscure for us the immeasurableself-sacrifice and devotion of these medical men andwomen who joined the ranks of their colleagues herewhen the need was dire." .

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The executive committee, continued the, president,were gratified to report that the law regulating medicalpractice in Saskatchewan was amended on March 31 byan, Act designed to afford to the registered medicalpractitioners of the United Kingdom privileges of prac-tising in the Province which would justify the reinstate-ment of the reciprocal relations established between theProvince and the United Kingdom in 1916 but broughtto an end in 1926. ’

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" If, as: the Committee hope and. believe, Saskatchewanis thus soon to be added to ’tihe four Canadian Provinces-Alberta, Manitoba, Nova Scotia, and Prince Edward Island-between which and the United Kingdom reciprocalrelations exist, they cherish the further hope that the waymay be opened to the resumption of such relations withNew Brunswick, Ontario, and Quebec, with which theyformerly existed, and to the establishment of such relations’for the first time with British Columbia."

The council, he added, have not departed from theaspirations they expressed as follows nearly twentyyears ago :

" The council, regarding the matter from the professionaland scientific point of view, desire that there should beregulated freedom for British practitioners, in the widestsense of the term, throughout the world, or that, at all,events, this freedom should subsist throughout the Empire.They would gladly do anything in their power to promote, a

. satisfactory arrangement which would meet the views ofthe Dominion authorities, and at the same time providean equitable basis upon which the matter might be settled."

Medicine and the Law

- "M.D. BLN "

As he finished delivering the important judgment ofthe full King’s Bench court in Younghusband v. Luftigon May 17, the Lord Chief Justice declared that the caseson section 40 of the Medical Act were " in a completefog." The court " thought that the time had comewhen the position might be clarified by further legis-lation." There is probably a poor prospect of theGovernment whips encouraging Parliament to discussthe improvement of the Medical Act; meanwhile onewonders why the judges themselves cannot clarify theconfusion of the judge-made law. ,

The facts in the Luftig case were as follows. Thedefendant, having obtained ’a doctorate in medicine inBerlin in 1913, became a naturalised British subject in1938. His name has never been placed on the MedicalRegister. He did not apply for registration under theMedical Practitioners and Pharmacists Act, 1947 ; perhaps indeed he could not have qualified as a

"

foreignpractitioner." Though unregistered, he practised suc-

cessively in London, Northampton, and, since 1944, inBrighton. At Brighton he described himself on hisplate and notepaper as " M.D. BLN " ;

" BLN

" was an

abbreviation of Berlin ; he gave up using the full wordbecause he had received threatening letters and hadswastikas marked on the wall of his house. He informedhis patients orally or in writing that he was not on theBritish Medical Register and that he held a Berlin degree.

Unregistered practice is, of course, in itself no crimewhatever, but it is an offence under section 40 of theMedical Act if anyone

" shall wilfully and falsely pretend to be or take or use thename or title of a physician, doctor of medicine... or anyname, title, addition or description implying that he is

registered under this Act...."

The question in the recent case was whether Dr. Luftig(who never employed the description " M.D." withoutadding either " Berlin " or

" BLN ") had brought himself

within section 40 by his use of "M.D. BLN." The

Brighton justices said he had not. The King’s Benchjudges refuse to interfere.

It is common knowledge that there are, or have been,"

bogus concerns "-to use Lord’Goddard’s expression-"

masquerading as universities which sell bogus degrees."If a man, possessing no better qualification than a

doctorate bought from some such commercial concern,called himself a doctor of medicine, the courts wouldknow how to deal with him. But nobody suggestedthat Dr. Luftig’s degree was other than genuine. Thatbeing so, if he called himself " M.D. Berlin," he com-

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mitted no 6ffen,.-,e,;: he was merely describing himself aswhat he was. (The facts indeed, if one may interjectthe comment, were not unlike those in Ellis v. Kellywhere Baron -Wilde remarked : " The defendant had aGerman diploma which he might reasonably believeentitled him to describe himself as he did." Mr. Justice

Humphreys, during the hearing of- Jutson v. Barrow in1936, commented that it was hard to understand whyMr. (or Dr.) Kelly was ever prosecuted.) To return,however, to Dr. Luftig’s case, the real difficulty was hisuse of the abbreviation " BLN." But, said Lord Goddard,it was for the Brighton justices to decide whether he was" wilfully and falsely " pretending to take or use thename or title of a doctor of medicine ; their decision wasthat he did not do so.Then came the further point-had Dr. Luftig used a

description " implying that he was registered " ? Counselargued against him that the title of " doctor ofmedicine " could only be used by a person who wasregistered.In Jutson v. Barrow, where Captain Horace Barrow,.having

had no professional training, displayed the description"

manipulative surgeon " and seemed to assert that the ’word" manipulative " was chosen in order to distinguish himfrom duly qualified surgeons whose names were on the

Register, Lord Hewart said that the words " implying thathe is registered " were not words describing the individual’sintent but describing the effect. " The section is to protectthe public, and what is regarded is not the mind of theindividual but the meaning likely to be conveyed by thewords that are used."

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In the Luftig case Lord Goddard emphasises thesignificance of "wilfully and falsely" in section 40.Mens rea, the guilty mind, is-an element in the offence," and the presence or absence of that state of mind mustbe tested on ordinary principles and in the light ofcommon sense." ’Lord Goddard rejected counsel’s con-tention that " doctor of medicine "could be used onlyby a person who was registered. He also rejected analternative contention that the Medical Act at leastprevented a man from using the- title unless he wasqualified to be registered ; the court could find no basisfor this argument in the statute. The cardinal fact wasthat the justices had found that the description " M.D.BLN" did not imply that Dr. Luftig was registered.They could, said Lord Goddard, have decided the otherway. They had found that Dr. Luftig had not actedwilfully and falsely ; it could not be said that there wasno evidence to support this finding ; the appeal againsttheir finding must therefore be dismissed. :’

In the " complete fog " of cases under section 40 onepoint seems clear. - If an unregistered practitioner reallywishes to avoid confusion with registered practitioners,he can find means of doing so.

" BLN

" is not a familiarabbreviation of Berlin ; to avoid the threatening lettersand the swastikas some hieroglyphic was presumablysought which would not- suggest Berlin very readily.Whatever " BLN " may convey to the uninitiated, theLord Chief Justice remarked that "it was to be

hoped that Dr. Luftig would not in future use thatabbreviation." ’

’,,’ "

Public Health

A RURAL OUTBREAK OF SCARLET FEVERDUE TO A NON-NOTIFIABLE CARRIER

FRANK T. MADGEM.D. Lpool, D.P.H.

MEDICAL OFFICER OF HEALTH TO THE COMBINED COUNTY

DISTRICTS OF WESTMORLAND

A MILKER and roundsman with chronic subacuterheumatic fever was responsible for an epidemic of

hæmolytic streptococcal infections during the spring andsummer of 1948 in a small remote village of the EnglishLake District. There were 13 clinical cases of scarletfever and 12 reported cases of other streptococcalillnesses. ,

The epidemic was interesting for two reasons : first,limitation of the infection to this village and its visitors ;and secondly, the difficulty of controlling a non-notifiablecarrier of a notifiable disease.The outbreak occurred in four separate phases :1. The initial illness of the milker in January, 1948, and

other reputed cases of tonsillitis in the village.2. A probably milk-borne spread in early April, with 7 cases

of clinical scarlet fever and 4 cases- of other suspiciousinfections.

3. The third phase, which occurred in May, was alsoprobably milk-borne, comprised 4 cases of notified scarletfever and 4 cases of suspicious infections, and was limited topersons who did not adopt the precautions advised.4. The fourth phase was in July, consisting of 3 cases ofnotified scarlet fever and 1 case of tonsillitis, possibly milk-borne or possibly by direct contact.The farm was a small one, about half a mile above the

village, and the dairy herd was limited to five cows inmilk. The shippon was dark, low, and old-fashioned,with cobbled floors, and a barn overhead. A portion ofthe farmhouse was used as a dairy and technique wasprimitive. The water-supply was surface drainage. The

milk-supply was confined to the local, village, and -themilk was retailed loose. The - adverse effect of-theseconditions was reflected in the bacterial content, of

the milk, and the stage was set for the, advent oftrouble. ,

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The milker was a member of the family living in thefarmstead and certainly intermittently infected one, ifnot all, of the other occupants, who were apparentlynon-susceptible. The family also let a portion of thefarmhouse for board-residence to holiday visitors,several of whom were infected.

THE FIRST PHASE The milker and roundsman, aged about 23, developed asevere sore throat in January, 1948, but there was norash. He’made rather a slow recovery from this illness,and his convalescence was complicated by polyarticularsynovitis and muscular pains: He- resumed work on thefarm but could walk only with difficulty and -was ’obvi-ously suffering considerable discomfort. He continuedin this state of malaise for about three months and didnot obtain real relief until the warmer weather airivedabout midsummer.

There had been many sore throats in the village sinceChristmas, but no serious case was traced, and therehad been no notification of scarlet fever for manymonths. ’ ’

’,’, ’THE .SECOND PHASE , ’ ,

CASE 1.—A man, one of a party of five adults and fivechildren who had arrived in the village on March 25 andtaken a furnished house next to the farm, fell ill on March 29and went next day to Batley, where he was found "to havescarlet fever.

CASE 2.—-A- girl, aged 6 years, daughter of case 1, developedscarlet fever on April 4, whereupon the rest of the, party leftthe district next day.

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As no other cases of scarlet fever had been iiotifi46d inthe district, it was felt that the father had probablybrought the infection with him, and that the daughter,being a close contact, -had been infected by him.CASE 3.-In the village a girl, aged 4 years, developed a

high temperature on April 8 and a scarlatinal rash on April 9.Since -a maid from the furnished house -where leases 1 1and 2 had occurred had visited ’13his ’ patient’s home, on