44 UNITED STATES OF AMERICA

insurance company in the name of Dr. DouglasColquhoun for serious damage due to a traffic acci-dent. His forensic experience was his undoing. His,second wife meets at Portsmouth one of the ever-increasing tribe of " Mr. X." Dr. Davies demandsmoney under threat of divorce proceedings. There isone trivial obstacle in his path. Being still marriedto his first wife, he is technically unable to divorcehis second. Dr. Davies, however, does his best. Hehas an acquaintance called Duke, an ex-railwayofficial who has been compensated with 1800 onretirement from a redundant post and who is now ataxi-driver. Duke is asked to assume the name of

Medway and is cast (though Duke himself deniesthis on oath) for the part of the solicitor who is con-cerned with the divorce proceedings. Dr. Davies,Duke, and Mr. X meet in London, but eventuallythe police intervene. Dr. Davies is found guilty onten counts of fraud charged in different forms. He

pleads guilty to bigamy. There are four outstandingcharges, one for forgery of a motoring licence, whichthe court is asked to take into account. The judge,in sending him to penal servitude for four years,.seems almost to apologise for his leniency. Bad ashe finds the case to be, he can imagine worse ;so the maximum of five years is rightly deemedinappropriate.

Unless it was one of the unspecified charges takeninto consideration in passing sentence, the offence ofmasquerading as a doctor, it may be observed, was-not before the court at the trial. The country showsno concern over this minor aspect of Dr. Davies’scareer. Had he been tried under Section 40 of theMedical Act, there would doubtless have been an.argument as to whether he had acted " wilfully andfalsely " ; his patients would doubtless have goneinto the box to testify their gratitude for the benefits,of his treatment ; and the public would doubtlesshave suspected that this was just another persecution-of a brilliant unorthodox practitioner by the hide-bound representatives of old-fashioned medicine.Be that as it may, it is perhaps worth noting that,almost at the moment of Dr. Davies’s conviction,the architects obtained the second reading of a Billwhich is to prevent anybody from calling himself anarchitect unless he is a " registered architect ’.’ underthe Act of 1931. The Bill has none of the old nonsenseof " wilfully and falsely." And the House of Com-mons is told that the Bill is necessary in order to

give architects the same degree of protection as themedical profession enjoys. It seems not to have been

appreciated that the medical profession has no moreprotection than the architects have already obtainedunder the 1931 Act. Architects are to be given whatis denied to doctors. The Bill, said the proposer,was necessary for the protection of the public;laymen were defrauded if, in their ignorance, theyemployed an unqualified man. Architects, said theseconder, are not made in a night ; it takes yearsof training. But why all this fuss about curriculaand examinations Whether we are legislating forthose who build houses or for those who merelyattend to the health of the people, the romance ofDr. Davies has shown us a far, far better way.

Delusional Insanity and the Disposing MindMr. Justice Langton gave judgment on Dec. 21st

in the prolonged dispute over the disposal of the180,000 estate of the late Mr. A. H. L. Bohrmann.Two solicitors (who were the executors) propoundeda will and four codicils thereto. The general effectof these documents was to give the bulk of theestate to charities in the United States, subject to

a few legacies to relatives. The next of kin contestedthe will and codicils on the ground that Mr. Bohrmannsuffered from delusions and obsessions which madehim incapable of making a valid will. One of thewitnesses called on behalf of the next of kin was Dr.R. D. Gillespie. He said that he found in the evidencethe symptoms of mental disease. He classified thetestator as a paranoid psychopath-i.e., a personnot certifiable as insane and often of good intelligencebut so far lacking in the balance of fundamentalinstincts, emotions, and sentiments common tomankind as to be disabled from the discharge of

important social responsibilities. It was the mildestform of a mental disease which was constitutionaland hereditary. Mr. Bohrmann had shown a morbidcapacity to bear animosity. Mr. Justice Langtonsaid that the law did not recognise any half-wayhouse between delusional insanity and sanity. Thecourt had been asked to say that the category ofpersons described as paranoid psychopaths (whofell short of delusional insanity) had not testamentarycapacity. It was not within the judge’s power tomake such an advance; he was not able to say thata paranoid psychopath was incapable of making awill. Mr. Justice Langton was, however, satisfiedthat a delusion as regarded the London County Councilwas perfectly well established. This had causedMr. Bohrmann to make an extraordinary declarationin the last of the codicils whereby the word " England "was deleted and the words " United States of America"substituted. Although the judge thought that thewill as a whole must be upheld, he decided to deletethat part which had been dictated by delusional

insanity. It is doubtful whether there is any pre-cedent for this course. The courts have been readyto delete parts of a will which have not been broughtto the knowledge and approval of the testator. Inthis case the particular passage had not been broughtto the knowledge and approval of the testator as asane and balanced man.

UNITED STATES OF AMERICA’ (FROM OUR OWN CORRESPONDENTS)

THE FUTURE OF VOLUNTARY HOSPITALS

ACCORDING to Mr. D. H. M. Pyle, president of theUnited Hospital Fund, who estimates the populationof New York City in the year 1960 at 10,800,000,adequate hospital provisions for the expected popu-lation require a further investment of$371,000,000,a sum only slightly less than the present hospitalinvestment. Can such a sum be raised by voluntarycontributions ? Revenues from paying patientshave fallen off, and gifts have decreased by one-thirdsince 1930.The occasion for this speculation about the future

of New York’s hospitals was a special meeting ofthe trustees of the United Hospital Fund to con-sider a report on the hospital survey which has beenconducted over the last two years under the directionof Dr. Haven Emerson, former health commissioner ofthe city and now professor of public health practice atColumbia University. This survey has called atten-tion to the need for reform in certain directions. litMr. Pyle’s words :

" The survey has demonstrated the shocking lackof coordiriation between ourselves, hospitals underother types of control, convalescent homes, homes forthe chronically ill, independent dispensaries andvisiting nurse groups. It has proposed an integration

45BUCHAREST

of our separate services, each with the other. It hasrecommended the extension of our services into thehomes so that those who cannot afford private carein illness need not necessarily occupy hospital beds....

" Our system of voluntary hospitals, viewed in theaggregate and financially speaking, is virtually inliquidation.

" Many of our plants are fast wearing out, becoming- obsolete; a third of our building investment, a

half of our bed capacity, is in buildings over twentyyears old. We have made no financial provisionthrough depreciation reserves for the eventual

replacement of old buildings but have relied on thehope, once justified by experience but now no longera certainty, that the amounts necessary for newplants would be given us when required .by a generouspublic. Our operating surpluses and spendablefunds are depleted so that now we have little morethan half the total of$80,000,000 available at theclose of 1930.

" Nearly a half of our separate units have eitherno operating surplus or an amount so small as tonot provide a safe minimum of working capital. Bycomparison with 1930, our revenues from payingpatients are less than it seems reasonable we shouldexpect them to be in view of our increased bedcapacity. Increasingly we are dependent upongovernment payments for public charges. Our con-tribution support for current purposes has declinednearly a third since 1930. We now receive from thatsource nearly double the amount paid to us by thecity in 1930. The hospitals have recently requesteda change in the basis of payment that will increasethese revenues another 50 per cent.

" And in the face of all this, it now seems clear thatwithin the next twenty-five years, the hospital-system of New York City, of which we are a part,must replace 24,300, or nearly half of its present bedsand in addition provide 25,500 new beds."

The moral drawn by Mr. Pyle is that the voluntary.agency must select for itself a function which it canfulfil well, within its financial limitations, and must-co6rdinate its activities with those of governmentalinstitutions and agencies. " Unless we put our housein order," he concludes,

" circumstances perforce will:require that government do it for us."

PROPOSED LEGISLATION FOR DANGEROUS DRUGS

’The disaster caused by the distribution of an elixirof sulphanilamide which contained a highly toxicdiethylene glycol has given a new impetus to thepreparation of corrective legislation. The reportfrom the Secretary of Agriculture on the deaths inthis disaster includes the following recommendations :

1. License control of new drugs to insure that they willnot be generally distributed until experimental andclinical tests have shown them to be safe for use. Thedefinition of what constitutes a new drug should include(a) substances which have not been used sufficiently asdrugs to become generally recognized as safe, (b) com-binations of well known drug substances, where suchcombinations have not become generally recognized assafe, and (c) well known drug substances and drug com-binations bearing label directions for higher dosage ormore frequent dosage or for longer duration of use thanhas become generally recognized as safe. Exemptionshould be made for new drugs distributed to competentinvestigators for experimental work. A board of expertsshould be provided who will advise the Secretary ofAgriculture on the safety of new drugs.

2. Prohibition of drugs which are dangerous to healthwhen administered in accordance with the manufacturer’sdirections for use.

3. Requirement that drug labels bear appropriatedirections for use and warnings against probable misuse.

4. Prohibition of secret remedies by requiring thatlabels disclose fully the composition of drugs. Many

foreign countries now impose this requirement. Manydrugs manufactured in the United States are exportedto such countries under labels bearing such disclosure.The same drugs are sold to our citizens under labels thatgive no hint of their composition.

This, it is hoped, is ’one of the steps toward theintroduction and passage of a suitable Food and DrugAct at the next regular session of Congress.

THE A.M.A. BROADCASTS TO THE SCHOOLS

" To the schools of America : your health " is the

weekly greeting sent out over a national network of88 broadcasting stations by the National Broad-

casting Company’s announcer from the company’sstudios in Chicago. Yesterday, through the kind-ness of Dr. W. W. Bauer, director of the bureau ofhealth and public instruction of the American MedicalAssociation, I was able to see the performance of theAssociation’s weekly health play in the N.B.C. studio.Professional actors read the script, a professionalorchestra supplies the incidental music, a specialistsupplies " sound effects " as required. Yesterdaythe subject of the play was tuberculosis and thepresentation exceedingly dramatic : the actors wore

ordinary clothing but indulged in gestures and facialexpression just as though they had been on the

stage. At the close of the play Dr. Bauersummarised in a few minutes the practical lessonsabout tuberculosis which the story had broughtout.

In order that teachers in junior and senior highschools may gain the maximum benefit from thisambitious programme of health education the Asso-ciation has made available to them at a nominal costa " pupil’s work book and guide " containing ques-tions for the student to answer and space for hisanswers ; framework for tabulations of his observa-tions and experiences and appropriate references tothe literature of each subject. All this is arrangedin weekly lessons each to correspond with the subjectof the weekly broadcast. A series of " briefs " onthese lessons is also published for the benefit of theteachers. These give suggestions for educational" projects " and further reference to books and

papers.The course of broadcast lessons begun in October

will continue until the middle of June-that is forthe extent of our school year. The main headingsof the course, each with four sub-titles, are as follows :personal health, hygiene, diet, contagious diseases,preventing future illness, public health, health educa-tion, mothers and children, using health knowledge.The broadcasts are so timed that they may be heardin school hours whether the school is located on theeast coast or on the west.

BUCHAREST

(FROM OUR OWN CORRESPONDENT)

PUBLIC HEALTH SERVICES

BEFORE the Liberal Government resigned it gavean account of its work during its four years of office.M. Costinescu, Minister of Health, when he took uphis post regarded as his first duty the reorganising ofthe medical profession, and at the same time augment-ing the State medical and auxiliary services. Heraised the number of official physicians from 1700 to2413. At every rural centre a dispensary has beenestablished-in the last three years 549 have been