814

Medicine and the Law

Prosecution for Alleged Abortion ,THE trial of two women doctors and a receptionist

on charges of using an instrument to procure the mis-carriage of women patients ended at the Old Baileylast week in the discharge of all three of the accused.Mr. Anthony Hawke, in opening the case for the Crown,explained that operations of this kind, though generallyunlawful, are not unlawful if performed for the purposeof preserving the life of the mother. Dr. B., who wassaid to have illegally used an instrument in the case offour women, had in two of these cases referred the patientfirst to Dr. F., the other accused doctor. Dr. F., it wassaid, sent the two patients back to Dr. B. with a certificatethat, for reasons indicated, the operation could lawfullybe performed. One of the patients, called as a witnessfor the prosecution, stated in cross-examination thatthere was haemophilia in her family and that she toldDr. F. that she had an overwhelming fear of dyingin childbirth. The man who was responsible for hercondition had two children, one deformed and the other" very peculiar." Dr. B., giving evidence, describedthe reasons for the operations. In one case there wasno pregnancy and she had operated for a quite differentcondition.The case against Mrs. E., the receptionist; was that

she had assisted Dr. B. in the operations on the fourwomen ; it was said that she had received extra payfor this work. The judge ruled that there was notsufficient evidence against Mrs. E. to justify leaving hercase to the jury ; the prosecution would have to provethat she knew she was taking part in something unlawful ;in his view there was no evidence fit to sustain thatcharge. -

Dr. F., who was charged in respect of two womenpatients, denied the allegations and gave her reasons foradvising or taking part in the various operations.The prosecution drew attention to certain circum-

stances of suspicion. Dr. B. had performed four opera-tions on pregnant women within five weeks. She hadherself said that she had sent " between five and twenty "patients to Dr. F. for her opinion ; most of theseconsultations were on the desirability of terminatingpregnancy. One witness said that she was asked tobring Dr. B. a fee of £75 in £1 notes. Dr. B. wasquestioned about her books which she said she hadburned. "What are you going to do in the future,"queried Mr. Hawke,

" if a woman asks you to terminatea pregnancy ? Would you lay the patient on a couchin your surgery and operate with an unskilled assistantstanding by ? " She replied " I would."The jury found both doctors " Not guilty."

Leukaemia and War Service

Mr. Justice Denning’s judgment in Kinkaid v. Ministerof Pensions, reported in the Times of May 8, is almosta medical treatise on the doubtful origin of leukaemia.A man died from monocytic leukaemia while still servingin the Army. His dependants were therefore entitledto a war pension unless the Ministry could prove that theillness was neither attributable to, nor aggravated by,war service. In rare cases a war pension has beenawarded for a death from cancer. There was the caseof Captain Jones who, from a strong sense of duty,refused to report sick although obviously overworked andseriously ill; when at length he was taken to hospital,an inoperable growth was discovered ; taking the viewthat the patient’s zeal in remaining at duty was " reason-able " and that the delay in diagnosis and possibletreatment had aggravated the illness, the court awardeda war pension to the widow. There have been otherawards of pension in cancer cases where there was notenough evidence for the Ministry to discharge its obliga-tion of proving non-attributability or non-aggravationor where the man concerned had been exposed to radio-active substances in his work. The result of the expertmedical evidence on which the Kinkaid judgmentwas founded is that the material facts in one leukaemiaare usually indistinguishable from those in another,and that the consequences are the same. It follows

that leukaemia is finally established for the purposeof war pensions claims as a disease not attributableto, or aggravated by, war service.

Leukaemia, said Mr. Justice Denning, is cancer of theblood. A healthy man is suddenly struck down forno apparent cause and dies. The evidence of Sir LionelWhitby indicated that the circumstances in which thisdisease arose or developed were the same as with othercancers. The court was furnished with an impressivereport and statistics by Dr. Dixon, who explainedthat in the last nine months an international committeeof experts had removed leukaemia from the classificationof diseases of the blood-forming organs and had placedit among the malignant neoplasms. Dr. Dixon reportedthat, though the aetiology of leukaemia was unknown,experience, trial experiments, and statistics made itpossible to state confidently that it was :

" not caused or hastened by trauma (except in rare casesof intolerable exposure to radioactive substances), infection,diet, climate, exposure, physical and mental strain or

stress. It is not infectious or contagious and is not con.veyed by eating or drinking contaminated food or drink.No previous illness predisposes to it."The conclusion from this expert testimony was that

Mr. Kinkaid’s death from acute monocytic leukaemia,was due to natural causes and would have occurred atthe same time had he never been in Army service. Theonus of proof resting upon the Minister of Pensionshad been discharged beyond all doubt, and this decisionwill dominate all future claims where death is due toleukaemia.

Public Health

Travel to the U.S.A.

THE regulations of the United States Public HealthService require that each person entering the U.S.A.shall present a smallpox vaccination certificate showingthat vaccination has been done not more than threeyears before arrival, and including a note on the reactionobserved. These regulations apply to all travellers,including Government officials and diplomatic officers.Failure to present a valid certificate renders the travellerliable to vaccination on arrival or a period of observa-tion (isolation). Travellers are advised to obtain aninternational form of certificate which, when completed,gives the information required by the U.S. authorities.

Aircraft RegulationsThe Minister of Health announces (circular 74/48)

that Eire is now included among the areas exceptedfrom the terms of the Public Health (Aircraft)Regulations, 1948.1

AppointmentsENSOR, G. F., M.R.c.s., D.o.M.s. : asst. county nt.o. for ophthalmic

work, Essex.HAY, C. P., M.D. Edin., M.R.c.p.E.. D.P.H. : asst. senior M.O., East

Anglian regional hospital board.HILL, J. L., M.B. Belf., D.P.H. : asst. county M.o. and M.o.H., Eton

rural and urban districts.LowE, J. J. H., M.D. Durh., M.R.C.P.. D.P.M. : regional psychiatrist,

Leeds regional hospital board (region 2).Ftossow, H. E., M.B. Durh. : orthopsedic surgical registrar, Hartle’

pools Hospital.Ro&ERS, K. B., M.B. Lond.: clinical pathologist, Children’s Hospital,

Birmingham. ’

London County Council Mental Health Services:Asst. M.O.’s :.-DONNELLY, JOHN, M.B. Lpool : -Cane Hill Hospital.ENGLER, MARKUS, M.D. Vienna : St. Lawrence’s Hospital.HUGHES, A. L., M.B. Aberd. : The Manor.KRAMBACH, REINHARD, M.D. Leipzig, D.P.M. : Claybury Hospital.KRUGER, JoHAN, M.D., B.SC. Amsterdam, M.R.C.O.G. : Banstead

Hospital.RICH, E. J., L.M.S.S.A. : Claybury Hospital.RoBixsoN, H. H., B.A., M.B. Dubl. : St. Ebba’s Hospital.SILVESTER, T. ST. J. H., M.R.C.S. : Bexley Hospital.

Joyce Green Hospital, Dartford:First assistan,ts in neurosurgical unit :

NORTHCROFT, G. B., M.R.C.S.MCCAUL, 1. R., M.B. Glasg.

1. Lancet, March 13, p. 429.