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only 18, and it is on this figure alone that the whole ofDr. Stewart’s argument is based. Both sets of figures maybe of equal importance, and the only way in which theycan be explained is by stipulating a pre-existing morbidfactor, in either mother or foetus, which predisposes to thelater occurrence of leukaemia.

Dr. Court Brown and Dr. Doll, in their very interestingreply (Jan. 12) to the points I raised, state that 20,000,000people will have to be exposed to a mean marrow doseof lr in excess of that received by the general populationand observed for ten years before it can be decidedwhether or not a dose of lr can be responsible for leuk-æmia. This may be the statistical ideal, but it doesnot seem feasible to apply such a method in practice.

In the consideration of low-level radiation effects, however,the data which we possess on the general incidence of leukaemiaare most h3lpful. Natural atmospheric background radiationreceived by every human being amounts to O’lr per year.Therefore, after ten years, everybody has been subjectedto Ir, and after a lifetime of seventy years, to 7r. If smalldoses of radiation are a cause of leuksemia one would expect,on statistical grounds alone, that as dose increased with ageso would the incidence of leukaemia ; and, in fact, this isnot so.

Dr. Court Brown and Dr. Doll consider that the

present evidence does not justify the belief in a thresholddose of between 100 and 200r, but they have not beenable to adduce a single fact or experiment in whichit has been proved that a low dose of radiation wasleukæmogenic. To their comments I should like tomake the following points :

(1) They attribute the absence of leukaemia in the offspringof pregnant mothers in Hiroshima to shielding by buildings.I gave the figure of 1500r as a maximum dose to whichsome had been exposed. The fact that so many of themdeveloped severe radiation injuries indicates that they musthave been exposed to many hundreds of r. While thesewomen had many abnormal children, especially micro-

cephalies, none of them developed leukaemia within nineyears of observation.l

(2) I suggested that among the survivors of Hiroshimaand Nagasaki beyond a distance of 2000 metres, doses of100 or even 200r must have been common because so manypeople had radiation sickness. Dr. Court Brown and Dr. Dollthink that this may be the malaise, with nausea, vomiting,and diarrhoea, induced by physical and emotional stress.I am convinced that the very careful investigators ofthe Atomic Bomb Casualty Commission would not haveclassified these cases as due to radiation if they hadbeen of psychological origin. I cannot remember similar

symptoms in people exposed for months on end to thestresses of air raids in this country. But even if the total

exposure dose received by the 155,000 people was only 8rat a distance beyond 2000 metres, that still confirms myoriginal contention that such a dose was inadequate toincrease the normal incidence of leukaemia. If Dr. Stewart’sargument is correct, then even this low dose would haveraised the amount of leukaemia considerably beyond thenormal limits. Yet the incidence among the very largenumber of exposed people remained roughly within normallimits.2

(3) In quoting the figures collated by Dr. Court Brown andDr. Doll on the radiation treatment of ankylosing spondylitis,I intended to give further support to- my argument that allrecorded cases of post-radiation leukæmia were caused bylarge doses-in this case, doses of at least 400r.

(4) I fully admit that the course of leukaemia in animalsafter irradiation 3 is not exactly comparable to that in humanbeings. Nevertheless it seems unlikely that man is 100 to200 times more susceptible than a rat, or that a dose of lrproduces leukaemia in man when 2500r is needed in dogs.Experiments have proved that a small dose must be repeatedmany hundred times in every kind of animal before a tumourdevelops. With a daily dose of 0-lr at 250 kV it was not

possible to produce leukaemia in rats, however many doses1. Plummer, G. Pediatrics, 1952, 10, 687.2. Folley, J. H., Borges, W., Yamawaki, T. Amer. J. Med. 1952,

13, 311.3. Medical Research Council Report. Cmd. 9780. H.M. Stationery

Office, 1956 ; p. 87.

were given. With 05r daily at 250 kV, 225 and 491 treat.ments had to be given before leukaemia occurred in 2 animals.With Ir daily at 1000 kV, it was impossible to induceleuksemia in any of 42 rats. Though animal experiments werenot primarily designed to investigate low-level radiation.the fact that leuksemia could not be induced with thesedoses suggests that a fairly substantial dose is, in fact.needed to produce it.4

I am glad that radiologists, such as Dr. Brailsford(Jan. 5), with many decades of experience have con.

firmed that they have never seen a case of leukaemiawhich could be attributed to a diagnostic dose of radiation.For practical purposes the risk to the feetus (even

assuming there is one) seems so small as to make it ’,desirable to counteract the erroneous impression createdamong the general public by the preliminary resultsof the investigation. At present, when the recruitmentof radiographers is becoming increasingly difficult,an official statement by the Faculty of Radiologistson the lack of evidence that small doses of radiationare harmful might be appropriate.

J. RABINOWITCH.

4. Metcalf, R. G., Inda, F. A. In Biological Effects of ExternalRadiation. New York, 1954.

Medicine and the Law

The Duty of Care

IN a case at the Glamorgan Assizes before Mr. JusticeSellers the duty of care owed by a hospital committeefor the state of the hospital premises was under scrutiny.The widow of a patient claimed under the Fatal

Accidents Act 1846 for herself and under the Law ReformAct 1934 for her husband’s estate. The husband, aged59, a diabetic for many years, had returned home earlyfrom work feeling dazed and giddy. He was admitted tohospital in the afternoon to a general male surgical ward,and seen by the sister and doctor who made routine exami-nations. Next morning, apparently very cheerful as usual,he went to wash and to the sluice-room. A few minuteslater he was found dead in the yard beneath a corridorwindow. The window was open and there was somescraping on the brickwork below. It seemed clear that i

he had fallen ; but there was no reliable evidence asto whether the window was open before he went alongthe corridor, or information as to who had opened it. !

According to the medical evidence called for the hospitalit seemed that the possibility of a prediabetic coma ’,producing uncontrolled swaying in this man was slight;and that the duty owed must be seen as that owed toa general ward patient. In giving judgment for thehospital the judge based his conclusions on the fore-

seeability of the event happening. If the reasonableman could have foreseen that this accident was ownthe cards " and that to prevent it steps ought to havebeen taken to make the windows secure, and those

steps were not taken, the hospital might have beenliable in negligence. But this was a corridor window.the sill 2 ft. 3 in. from the ground (its total depth 15 in.).and the lower sash opened to 2 ft. Nothing unusual hadbeen observed in the conduct of the patient to makeextra precautions necessary ; and allowing the patientto move about was a feature of treatment, in thatmaximum freedom of movement was desirable. For

young children or mental patients extra precautions iseemed clearly necessary, but it appeared to be unreasoil- ’,able and even undesirable to restrict the amount of airand the sense of freedom available in the hospital.The widow had admitted that, though she and her familytried not to leave the deceased alone in the house, hemight well be upstairs on the first floor alone, and noblocks had been fitted to the windows. The position

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there seemed to be parallel to the state of affairs in thehospital.There was one other feature. In 1954 a patient had

apparently committed suicide by jumping through awindow at the hospital, and blocks had been fitted by orderof the committee responsible, so that the window openedto no more than 7 in. On the painting of the framesthe blocks were removed from this and other windows,and there seemed no clear evidence as to why the blockson this window had not been put back. The questionthen arose-had the hospital set itself a standard of careill supplying blocks, the removal of which by some servantof the hospital, and the failure to replace by a relevantauthority, had provided the required incident of negli-gence ? His Lordship did not accept this as a test, andapplied clearly the test of reasonable foreseeabilityso that, to avoid the situation whereby the hospitalauthorities became insurers, the defendants were heldnot liable to the widow. The floor was in a good condi-tion, and the height and width of the ledge made it

improbable that the man could have fallen unless alreadypart projected through the window frame. It wasdifficult to see what blame-since fault and breach ofduty must be seen in this tort-could be cast upon thehospital committee or its servants for an incident whichcould not reasonably have been foreseen as likely to

happen.

1. Med-leg. J. 1956, 24, 89.

" Truth Drugs "

Xarcoanalysis is a legitimate and valuable techniquein psychotherapy, though it is true to say that the barrierto repressed material can often be raised by analyticalmethods alone. If drugs are used, their main advantageis to speed up the process. But when the informationthat is sought is being held back by conscious suppressionof guilty knowledge, drugs seldom release it. Most of theevidence suggests that voluntarily suppressed mattersare rarely revealed under narcosis, and that " truthdrugs " are useless in police inquiries. Indeed, a guiltyperson may, under narcosis, manufacture evidence tosuit himself, or what is worse, devise fantasies involvinghimself in crimes he has not committed. Moreover, thesuggestible neurotic or psychopathic criminal can bemade to say almost anything. These and other objectionsto evidence obtained under the influence of drugs werewell brought out at a meeting 1 of the Medico-LegalSociety.Even if there were a drug that could unlock the truth,

statements made under its influence would clearly beinadmissible in a court of law. First, it is a fundamentallegai principle that a statement must be made voluntarilywithout threat, duress, or other influence. Secondly,the statement would have to be read by the doctor whoadministered the narcosis, or someone other than theaccused, and that would make it hearsay and thereforeinadmissible. The principle at the root of the Britishexclusion of hearsay evidence is the absence of the oath.It is clear that a man deprived of his senses cannot swearto speak the truth, and when he regains full consciousnesshe is at perfect liberty to say that his statement underthe drug was nothing but a product of delirium andwithout a vestige of truth.Only a qualified doctor should induce narcosis-yet

few would be prepared to do so for reasons other thanmedical treatment. Indeed, it is hard to imagine a morestriking breach of the Hippocratic oath than the use ofmedical skill to obtain evidence that will lead to a prisonsentence. Moreover, the doctor concerned would haveto be called by either prosecution or defence, thus

immediately seeming to show partiality ; and thedoctor could, quite fairly, be charged by the other sidewith the manufacture of evidence by suggestion-acharge which would be hard to refnte.

Obituary

ERIC BARRINGTON BROOKE

M.A., M.B. Camb., F.R.C.P., D.P.H.

GERIATRICS is one of the youngest of the specialties.and by the death of E. B. Brooke it has lost one of itspioneers. His work at Carshalton and later at Southamp-ton was a memorable demonstration of how much canbe achieved by personality in administration.

Dr. Brooke was educated at Bradfield College, Cam-bridge University, and St. Bartholomew’s Hospital.After qualifying in 1923 he held house-appointments atBarts, and later became assistant medical officer atSt. Giles Hospital, Camberwell. In 1925 he took theD.P.H. and two years later the M.R.C.P. The next yearshe spent at Redhill Hospital, Surrey, at first as deputy

medical superintendentand then as super-intendent. But the mostimportant part of hiswork began with hisappointment in 1941 assuperintendent of St.Helier Hospital, Car-shalton. D. D. relateshow he met the chal-lenge of those war-timedays when the buildingsunder his charge werenew and empty, andwhen man-power andmaterials were difficultto obtain :

The patients at St.Helier in the early yearswere a heterogeneous col-lection - evacuees fromLondon hospitals, air-raidcasualties, and soldiers,as well as people from alarge area of North Surrey.

Determined to make the best use of the beds, Dr. Brookekept a close personal watch on all the wards, but he neverinterfered with the clinical work of his colleagues in otherdepartments. Indeed, no matter how remotely any newdevelopment or change of administrative policy might affectour work, he invariably sought our opinions before takingaction. With the general practitioners of the area, also, heestablished a friendship and cooperation which they and thehospital staff continue to enjoy. His geriatric work grew outof his personal interest in the patients and their doctors, for,try as he would, the aged sick could not always be admittedto hospital, and often had to wait for a bed. He worked outa scheme to help them to live more happily at home, perhapsafter a short stay in hospital for investigation and rehabili-tation, and his imaginative understanding of the needs of oldpeople led him to bring hospital facilities, laundry services,and meals-on-wheels to their homes, so that hospital bedscould be freed for more urgent cases.His determination was well exemplified by the way he

managed somehow to extricate himself unaided, in spite ofsevere facial injuries, from his house when it was reducedto ruins by one of the bombs that fell on the hospital. Return-ing to work after treatment, he would joke about our " one-eyed superintendent

" and regale us with stories of the mateypeople whose company he had enjoyed in the large ward thathe preferred to a private one during his short stay at a con-valescent hospital. The secret of his success seemed to liein his intense interest in people and his almost boyish sense ofhumour. In the early days he knew all his staff well, frommaids to medical specialists and, as the work of the hospitalgrew, he still managed to retain this personal touch. His aimwas to have a happy as well as an efficient hospital, and visitorsfrom many countries whom he conducted round it neverfailed to be impressed by the atmosphere that he hadcreated.

Another of the innovations he introduced to meet anadministrative emergency was domiciliary visiting,which quickly proved its clinical worth and is now an