NOTES ON LEGISLATION AND LAW CASES.

These notes are copied by permission from The Law Reports published by
The Incorporated Council of Law Reporting for England and Wales.
For full text of these see Law Reports, which can be referred to in the
Library of the Institute.

ADULTERATION-Milk-Written Warranty-Copy of Warranty with Written Notice of Intention to rely thereon "sent” to Purchaser “within seven days” after service of summons--Time—Sale of Food and Drugs Act, 1899 (62 and 63 Vict. c. 51), s. 20, sub-s. 1.

By s. 20, sub-s. 1, of the Sale of Food and Drugs Act, 1899, "a warranty or invoice shall not be available as a defence to any proceeding under the Sale of Food and Drugs Acts unless the defendant has, within seven days after service of the summons, sent to the purchaser a copy of such warranty or invoice with a written notice stating that he intends to rely on the warranty or invoice, and specifying the name and address of the person from whom he received it, and has also sent a like notice of his intention to such person."

Held, that, in the absence of any words in the sub-section indicating that the word "sent" is used with any other than its ordinary meaning of "dispatched," it must be construed as bearing that meaning, and that if a copy of the warranty with that written notice is posted to the purchaser within seven days from the issue of the summons it is "sent" in compliance with the requirement of the sub-section, although it does not reach him till after the expiration of seven days. RETAIL DAIRY COMPANY, LIMITED, V. CLARKE. Div. Ct., 388, K. B., Vol. II July, 1912.

UNSOUND FISH-Intended for Food of Man-Prosecution-Condition Precedent - Condemnation by Justice of the Peace-Public Health (London) Act, 1891 (54 and 55 Vict. c. 76), s. 47, sub-s. 2.

...

....

By s. 47, sub-s. 2, of the Public Health (London) Act, 1891, "if it appears to any justice that any animal or article which has been seized or is liable to be seized under this section is diseased, or unsound, or unwholesome, or unfit for the food of man, he shall condemn the same .; and the person . . . . on whose premises the same was found, shall be liable on summary conviction to a fine not exceeding fifty pounds for every animal or article, or if the article consists of fruit, vegetables, corn, bread, or flour, for every parcel thereof so condemned, or, at the discretion of the Court, without the infliction of a fine to imprisonment for a term of not more than six months, with or without hard labour."

Held (Pickford, J., dissenting), that, the words "so condemned" must be read as "so liable to be condemned," and that, therefore, condemnation by a justice of the peace of an animal or article which has been seized, or is liable to be seized, under the section is not a condition precedent to a summary conviction for an offence under the sub-section.

HEWETT V. HATTERSLEY. Div. Ct., 35, K. B., Vol. III., September, 1912.

JOURNAL

OF

THE ROYAL SANITARY INSTITUTE

The Control of Tuberculosis as practised in the County Town of Lewes, by J. R. STEINHAEUSER, M.D., D.P.H., Medical Officer of Health, Lewes.

ON

Read at Sessional Meeting, Lewes, October 4th, 1912.

N first entering practice after leaving the hospital, I was much impressed by the difficulty experienced by consumptive patients of the poorer class in gaining admission to a sanatorium. I constantly saw early cases declining into the advanced stages of the disease in their unsuitable homes, for the reason that they could not get letters of admission to a sanatorium, or that, what was worse because more tantalising, after obtaining a letter they had to wait many weeks or even months for a vacancy, during which time they perhaps became too ill to be received at the sanatorium in question.

Moreover, although sanatoria were becoming more numerous, the poorer class of consumptive's case for institutional treatment had become harder, because the general hospitals, becoming alarmed on account of the now recognised danger of infection, were refusing to admit any but sufferers. from urgent complications of the disease. Twenty years ago it was usual to see in any medical ward of a general hospital two or three cases of ordinary more or less advanced cases of phthisis; to-day you will probably

not see one.

In 1905, therefore, I'enlisted the sympathy of the Lewes Town Council and of residents in the neighbourhood interested in the prevention and treatment of the disease. Practical sympathy was given; in the case of the Town Council, by granting me license to use their hitherto unused smallpox hospital as a sanatorium; the residents (especially one family) by donations and by their time. A committee was formed and a scheme

NOTE.-The Proceedings of the Congress at York will be continued in No. 12. VOL. XXXIII. NO. 11.

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inaugurated. The smallpox hospital is in a disused chalk-pit on the Downs about half a mile north of Lewes. Local circumstances had necessitated its facing east, an unfortunate position. Still, the site is a most bracing one, and, at all events, the building is sheltered from strong south-west gales. The building consisted of two wards, holding four patients each, separated from each other by a nurses' room and kitchen. Through the kindness of the Town Council, water was carted from the Water Company's mains.

It was thought impossible to treat patients of both sexes with such limited accommodation; accordingly we decided to admit males only. It was also decided that those admitted should be residents of Lewes and the neighbourhood, whose physical condition was such as was likely to be definitely improved by sanatorium treatment.

At first our finances and considerations of climate induced us to keep the place open only during the summer months. The patient was asked to pay 10s. 6d. weekly, the rest of the cost of maintenance was met by voluntary subscriptions, the total cost per head being 30s. weekly.

This condition of affairs lasted till 1910, when the sanatorium committee felt that the usefulness of the sanatorium was much curtailed by its closure in the winter, and realised at the same time that their finances could not stand the strain of maintaining patients all the year round.

An expert on tuberculosis and sanatoria was invited, and kindly consented to give his opinion as to the suitability of the site and building for winter. His approval, with certain suggestions as to additions in the building, was given. The committee then approached the Lewes Town Council with a view to securing their co-operation in the extended scheme. This was readily given. The Town Council decided to make the building more weather-proof and comfortable; thus, a new and excellent kitchen was built, a reservoir for receiving rain-water provided, and a pavement laid in front of and all round the building. The Town Council also decided to pay 19s. 6d. weekly for any patient approved of and sent by them from the borough.

Encouraged by the sympathy of the Lewes Town Council, the Sanatorium Committee next approached the authorities of three adjoining districts. These all agreed to pay for patients on the same terms as the Lewes Town Council.

The efficiency and comfort of the sanatorium have recently been added to by the generous gift from a Lewes resident and his wife of a revolving shelter and a detached room for the matron.

So that during the last two years the sanatorium has been open all the

year round, and we are now in a better financial position, and more efficient, than we have ever been.

One hundred cases have been treated from Lewes and the neighbourhood (for it must be understood that the incidence of phthisis in Lewes is no higher than in other country towns), and we can probably shew as good results as other sanatoria. Patients are treated on the usual lines, and tuberculin is used in suitable cases. The cases dealt with are males who have early or chronic, not advanced, phthisis.

With regard to other phthisical persons, the Town Council are now sending suitable cases of women and children to sanatoria at Ramsgate and East Liss. Advanced cases of both sexes, who are eligible, and whose home conditions are unsuitable, both as regards treatment and prevention of the disease, are strongly advised (often successfully) to apply to the Guardians, at whose infirmary at Chailey, provision is made for open-air treatment.

Disinfection of rooms and bedding by means of sulphur dioxide, formalin spray, and steam is always scrupulously practised, and the cleansing of rooms and furniture is urged, after the removal of a phthisical patient from his home.

So far as possible contacts are watched and referred to their medical attendant for examination. The same policy is pursued in the case of children coming up for medical inspection whose history, present condition and environment are suggestive of the development of phthisis in later life.

I should like briefly to consider two general points closely connected with the subject. The first is the necessity for actual sanatoria or hospitals in dealing with the disease. Some writers consider that the results of sanatorium treatment do not justify the cost. Anyone who has seen the progress of a case of a poor consumptive in his own home will agree that successful treatment there is in most instances impossible, and that the advanced consumptive in such a home is a very real source of infection to others living in the same house. Institutional treatment is necessary for the large proportion of cases of phthisis amongst the poor.

The second point is the outlook on the future as to the incidence of tuberculosis. There are many factors for good.

1. The legislature are evidently united in a determined effort to rid the country of the disease. Large sums of money are to be devoted to sanatorium benefit, and it is probable that not only the insured but all persons suffering from tuberculosis will ultimately share in the benefit.

2. The educated section of the community has for long shewn its very practical sympathy with schemes for the preventive treatment of

the disease, while the sanitary conscience of the poorer class is gradually awakening.

3. The housing of the latter class has been much improved of late (in the towns especially), as also the general sanitary condition of factories and workshops.

4. We have the system of medical inspection of elementary school children, whereby the first appearance of the disease may be recognised and probably checked.

5. The sale of tuberculous food is much restricted, and the milk supply is purer.

6. We have, moreover, infinitely better methods of recognising the disease in the early stages, and with the aid of the sanatorium benefit better facilities for treating it.

The mortality from tuberculosis has been steadily decreasing during the last forty years, and in consideration of these six factors, with the increased means, we may confidently look forward to a time in the not very distant future when tuberculosis in this country will be as rare as leprosy.

HIS WORSHIP THE MAYOR OF LEWES (Dr. Hugh Stott) spoke in appreciative terms of Dr. Steinhaeuser's great interest in the subject before them, and said he had made a determined effort to do something long before the matter was being made practically compulsory, and the Town Council rendered him practical assistance. They knew consumption was more prevalent among females than males, but it was absolutely necessary to take into consideration the principal bread winner of the family, and so at the Lewes Sanatorium, with its limited accommodation, they only treated male patients. The dispensary treatment had not been carried out to any great extent, and he should like to ask Dr. Steinhaeuser if in the future he could bring up some simple scheme, if it was not provided by the county, to enable patients suffering from tuberculosis to be treated with tuberculin. The injection of tuberculin, he added, seemed to have a beneficial effect.

DR. DUNCAN FORBES (Brighton) contrasted the old with the more recent methods of treatment. He emphasised the importance of the proper staffing of sanatoria. The case of each patient should receive daily consideration, so that rest and exercise might be properly regulated. He spoke hopefully of the treatment of consumptives with the exotoxin group of tuberculins.

DR. A. A. MARTIN (Eastbourne) endorsed the views that it was essential to commence treatment of phthisis cases early, and suggested stringent regulations for the sale of perishable food-stuffs in the small shops in the poorer quarters of the towns, so as to prevent, as far as possible, handling of food-stuffs by persons already victims of the disease.