244

(£669,700), of which 12,049,000 marks (£602,450) were

paid for treatment of patients in hospitals or by medical officersfor medicines and bandages and for the maintenance of thepatients and their families, the rest being outlay for clubpremises, salaries, and other expenses of management.

(To be continued.)

MEDICINE AND THE LAW.

The Liability of Nursing Associations for the Negligence oftheir Nurses. ’IN Hall and another v. Lees and others,l the plaintiffs, .

husband and wife, sued the committee of the Oldham jNursing Association for compensation for injuries caused to the female plaintiff £ by the negligence of a nurse

engaged by her from the defendants. The jury foundthat there was negligence and that the defendant asso-- elation was liable for the negligent acts of its nurseson the ground that they were its "servants." TheCourt of Appeal has now decided that the rules of theNursing Association did not show the nurses supplied by itto be its servants so as to make it liable for acts done bythem in the performance of their duties towards patients towhom the association supplied them. The case is an

important one for nursing organisations, many of which nodoubt do not differ materially in their relations towards theirnurses from that of Oldham; it is also of importance tomedical men who will have to be careful that they do notstand in the position of " masters " with regard to nurses

whom they often engage for the benefit of their patients,.and to whom they necessarily give directions for their

patients’ treatment. It is also of considerable importance topatients who may be injured through negligence on the partof their nurses. This importance, it need hardly be pointedout, lies in the fact that the nurse is frequently one whosepecuniary position is not such as will enable her to paysubstantial damages to an injured person. The patient,therefore, will always direct his claim against the nursingagency or the medical man if there is any chance of makingeither of them liable. This is a hardship upon the nursingagency and upon the medical man on the one hand, butfrom the other point of view-that of the patient-it is to beobserved that if the nurse has nothing to lose and if no oneelse is responsible for any want of care on her part theefficiency of nursing is not likely to be increased. It wasmentioned after the delivery of the judgment of the Court ofAppeal that the case might go to the House of Lords, so it isnot desirable to comment upon it further.

When a Drain becomes a Sewer.An interesting question for public health authorities in

crowded urban districts was decided by the Divisional Courton July llth, the point at issue being whether certain openchannels conveying sink water from houses into the sewerswere drains so as to make the owners of the houses liablefor a nuisance caused by them, or were themselves sewersand so under the charge of the local authority. The

magistrates had held the former view and had convictedthe owners of the houses who accordingly appealed. Thehouses in question were arranged so as to form one

end and part of two opposite sides of a court anda drain from each house carried the sink water from itinto open channels running parallel to the pavement and tothe sides of the court. These side channels conveyed therefuse water to the sewers and had been held by the magis-trates to be "drains," causing a nuisance for which theowners of the houses were responsible, the contention forthe appellants being that as they received the refuse ofmore than one house they were sewers. The answer to the

question thus raised depended upon the interpretation to beput upon the definition .of a drain in the Public Health Act,1875, which lays down that for the purposes of the Act it’is to be any " drain of and used for the drainage ofone building only or premises within the same curtilage,and made merely for the purpose of communicating there-from with a cesspool or other like receptacle for drainage,or with a sewer into which the drainage of two or morebuildings or premises occupied by different persons is con-veyed." The Lord Chief Justice in giving judgment

1 THE LANCET, Dec. 5th, 1903, p. 1611.

expressed some regret at casting a fresh burden upon thelocal authority, but considered the Court to be bound byauthorities cited. These included no case which wouldenable the learned judges to hold that a combination ofhouses in a court having to some extent common accessand accommodation but occupied by different people were" within the same curtilage." The local authority, therefore,and not the owners of the houses were liable in respect of thechannels in question. The decision appears to be in accordancewith the language of the definition and if it casts a liabilitvupon the ratepayers it should at all events insure theprompt abatement of nuisances of the kind complained ofby the action of the local authority without recourse beinghad to the magistrate. Presumably drainage or sewerage, ifit should be so termed, of the kind described is only to befound connected with old buildings. Newer tenements are

compelled to be better provided.The Detention of Lunatics in Unlicensed Houses.

Attention was drawn recently by Mr. Troutbeck at aninquest held by him at Battersea to the circumstances inwhich the deceased, a woman aged 49 years, had beenadmitted to, and detained in, a nursing home when of un-sound mind. The home was not one licensed for the

reception of lunatics and neither the keeper of it nor

the nurse provided by her had had any special trainingto fit them for the task which they allowed to be im-

posed upon them. The matter may become the subject ofspecial inquiry and the facts were not fully gone into atthe inquest as there was nothing to show that the treatmentreceived by the deceased in the home either caused or

accelerated her death. Some of the observations, however,of the coroner made to the jury in summing up may bequoted as explaining the policy of the legislature with regardto persons of unsound mind and the dangers likely to arisefrom a lax interpretation of the Lunacy Act. Mr. Troutbecksaid that " he could well understand how reluctant the rela-tives were that the deceased should be certified as insane,but the whole policy of our law was to insure thatwhen persons were insane they should be treated byauthorised persons, and that it should not be possible for aninsane person to be spirited away into an unauthorised placeand attended by incompetent persons." The coroner wenton to say that the county asylums such as the relatives ofthe deceased wished to avoid for her were admirably con-ducted institutions and to dwell upon the total want ofeducation and experience admitted by the persons in thehouse to which she had been taken and he added that thiswas not the kind of institution to which to intrust a personwho was on the borderland-wavering; such a person requiredthe utmost skill." With regard to the treatment of " border-land cases " there appears to be a prospect of the formalitiesnow im osecl by the law being modified, with the result that;patients of this class will be treated suitably without the

. relatives being tempted to have recourse to such institutions)

as that described at Battersea.

ASYLUM REPORTS.

Donn District Asylum (Annual Report for 1903).-Theaverage number of patients resident during 1903 was 649,comprising 344 males and 305 females. The number of cases

admitted during the year amounted to 139-viz., 77 malesand 62 females. Of these 115 were first admissions. Mr.

M. J. Nolan, the medical superintendent, states in his reportthat as the resident population of the asylum exceeded thelegitimate limit of accommodation at the beginning of theyear, only the most pressing cases were admitted pending thecompletion of the additional buildings. Thus there were but139 cases admitted as against 184 in the previous year. Thenumber of senile and feeble cases among the admissions tendsto increase, adds Mr. Nolan, so that the death-rate is enhancedand the rate of recovery is reduced. I - Until the usualnormal admission rate recurs-that is to say, until the actionof the committee in enlarging the institution to meet all thelunacy requirements of the district shall have been in opera-tion for some considerable time, this condition will prevail."The number of cases discharged as recovered during the yearamounted to 45-viz., 32 males and 13 females, or 6’9 percent. of the average number resident. The deaths duringthe year amounted to 63, or 9’ 7 per cent. as calculated on