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Medicine and the Law

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550 mature trained personnel and of money 4 but probably also through " the failure of some workers to employ similar objective methods for the evaluation of the mode of treatment under consideration, even though super- ficially they have appeared to do so." 5 There are, for example, still investigators studying the adrenal respon- siveness on groups including" 30 male patients, aged 30 to 63 years, who have been hospitalized because of schizophrenia for 2 to 19 (average 11) years." These investigators 6 were repeating some earlier experiments 7 in 34 chronic cases "20—40 years old and with an average duration of hospitalization of 2-5 years." Another report describes eighteen male patients with dementia praecox who " ranged in age from 20 to 45 years, with the mean age being 31 years." 8 Surely schizophrenia, being a regressive process, should not be investigated in terms of average values. Analogously, in the case of human growth and maturation. another but differentiating process, it would be futile to determine hormone values in a group of males aged 2 to 19 (average 11) years. Obviously before investigating groups of individuals at a certain stage of the process under study, one must first observe the development of the process in individuals. ROLAND FISCHER. Division of Psychiatric Research, Psychiatric Services Branch, Saskatchewan Department of Public Health, Regina General Hospital, Canada. 4. Kubie, L. S. Science, 1952, 116, 239. 5. Hope, J. M., Elmadjian, F., Malamud, W. J. clin. exp. Psycho- path. 1951, 12, 267. 6. Hiatt, H. H., Rothwell, W. S., Horwitt, M. K. Proc. Soc. exp. Biol., N.Y. 1952, 79, 707. 7. Pincus, G., Hoagland, H. Amer. J. Psychiat. 1950, 641, 651. 8. Young, M. K. jun., Berry, H. K., Beerstecher, E. jun., Berry, J. S. Univ. Tex. Publ. 1951, no. 5109, Biochemical Studies no. 4 : p. 189. 9. Bristol med.-chir. J. 1951, 68, 121. PROVINCIAL MEDICAL JOURNALISM E. WATSON-WILLIAMS. SIR,—It was with melancholy pleasure that I read Dr. Brockbank’s graceful obituary of the Bristol Medico- Chirurgical Journal : a Journal of the Medical Sciences for the West of England and South Wales—to give what was always its full title. For such, alas, his tribute is. A journal may change hands or policy, but when it changes its name it becomes merely a memory. Nay, less than that-who today even remembers the Morning Post, the Bristol Tirrzes and Mirror, the Medical Circular, the Transactions of the Provincial Medical Association, or (to return to the subject) the Transactions of the Bristol Medico-Chirurgical Society ? Fuerunt! ! Vain now our efforts to keep the journal afloat throughout the war, vain the Sisyphian struggle for subsequent solvency. Dr. Brockbank’s suggestions for the local journal ignore the dilemma he himself has stated-rapid rise in costs contrasted with meagre prospects of increased income. The editor, always conscious that to set the type for one page consumes four annual subscriptions, must severely limit original articles, and jettison reports of discussions, correspondence, humour. " Economic pressure led to the abandonment of Notes on Preparations for the Sick ’ in 1921 and of ’ Progress of the Medical Sciences ’ in 1924. [In 1951] no sooner did the increase in subscriptions and in advertisement income promise -some relief than a further advance in expenses of production snatched it away.... BVe have eliminated Reviews, Lists of Books Received, Obituarv Notices and most of the examina- tion results ; and can hardly go further in this direction. Without constant care it would be quite easy to squander a whole year’s income on a single quarterly issue.’’ 9 Compelled, after serving the journal for 29 years, to resign the chair, and all unconscious of this eluctable doom, at least I handed on my charge punctual and solvent. Absumet heres. DIRTY ANÆSTHETIC MACHINES Messrs. Howards & Sons Ltd., of lIford, Essex, write : " One of the manufacturers of anaesthetic ether recentlv received a complaint from a hospital that the ether supplied was below standard and that the patients would not take it. On investigation it was discovered that the fault lay in the bottle of the anaesthetic machine itself, which had not been properly cleaned. VVe are writing on behalf of the makers of anæsthetic ether to draw attention to the danger of using such machines without old ether having first been removed." Public Health Influenza THE subsidence of the influenza epidemic, already apparent for some time to general practitioners in many areas, is now reflected in a substantial decrease in the number of deaths from influenza in the last week of February. In the 160 great towns of England and Wales there were 314 deaths in the week ended Feb. 28, com- pared with 521, 530, and 446 in the three preceding weeks. Deaths in the London and south eastern region decreased to 90, as against 201 in the week ended Feb. 21 ; and there were also fewer deaths in the northern half of the country, where there had been a slight increase in the preceding week. But the number of claims for sickness benefit received by the Ministry of National Insurance is still considerably higher than at the corresponding time last year. Infectious Diseases in England and Wales * Not including late returns. Medicine and the Law Negligence Negatived HEADLINES in the daily press are accustoming the public to findings of negligence against hospital manage- ments and medical practitioners and to the consequential award of damages which are often substantial. The result of the case of Slater v. Liverpool and District Eastern Hospital Management Committee and Pugmire is the more satisfactory to the successful defendants inasmuch as the plaintiff’s claim was put forward a,4 one in which the facts spoke for themselves. A three-month-old baby, it was said, was admitted to hospital on Nov. 11, 1947, suffering from gastro- enteritis ; she was a perfectly formed, normal child. A fortnight later, as the baby could not take her food. it was decided to give an intramedullary drip into the left tibia. The fluid was dripping continuously into the leg for 32 hours, during which time (it was alleged) a condition was set up which ultimately led to the loss of a foot. The left foot became gangrenous and on Dec. 15 it dropped off. Here, it could be said, was a baby which entered a hospital with two feet and came
Transcript
Page 1: Medicine and the Law

550

mature trained personnel and of money 4 but probablyalso through " the failure of some workers to employsimilar objective methods for the evaluation of the modeof treatment under consideration, even though super-ficially they have appeared to do so." 5 There are, for

example, still investigators studying the adrenal respon-siveness on groups including" 30 male patients, aged 30to 63 years, who have been hospitalized because of

schizophrenia for 2 to 19 (average 11) years." These

investigators 6 were repeating some earlier experiments 7in 34 chronic cases "20—40 years old and with an averageduration of hospitalization of 2-5 years." Another reportdescribes eighteen male patients with dementia praecoxwho " ranged in age from 20 to 45 years, with the meanage being 31 years." 8

Surely schizophrenia, being a regressive process,should not be investigated in terms of average values.Analogously, in the case of human growth and maturation.another but differentiating process, it would be futileto determine hormone values in a group of males aged2 to 19 (average 11) years. Obviously before investigatinggroups of individuals at a certain stage of the processunder study, one must first observe the development ofthe process in individuals.

ROLAND FISCHER.Division of Psychiatric Research,

Psychiatric Services Branch,Saskatchewan Department of Public Health,

Regina General Hospital, Canada.

4. Kubie, L. S. Science, 1952, 116, 239.5. Hope, J. M., Elmadjian, F., Malamud, W. J. clin. exp. Psycho-

path. 1951, 12, 267.6. Hiatt, H. H., Rothwell, W. S., Horwitt, M. K. Proc. Soc. exp.

Biol., N.Y. 1952, 79, 707.7. Pincus, G., Hoagland, H. Amer. J. Psychiat. 1950, 641, 651.8. Young, M. K. jun., Berry, H. K., Beerstecher, E. jun., Berry, J. S.

Univ. Tex. Publ. 1951, no. 5109, Biochemical Studies no. 4 :p. 189.

9. Bristol med.-chir. J. 1951, 68, 121.

PROVINCIAL MEDICAL JOURNALISM

E. WATSON-WILLIAMS.

SIR,—It was with melancholy pleasure that I readDr. Brockbank’s graceful obituary of the Bristol Medico-Chirurgical Journal : a Journal of the Medical Sciencesfor the West of England and South Wales—to give whatwas always its full title. For such, alas, his tribute is.A journal may change hands or policy, but when it

changes its name it becomes merely a memory. Nay, lessthan that-who today even remembers the Morning Post,the Bristol Tirrzes and Mirror, the Medical Circular, theTransactions of the Provincial Medical Association, or

(to return to the subject) the Transactions of the BristolMedico-Chirurgical Society ? Fuerunt! ! Vain now ourefforts to keep the journal afloat throughout the war,vain the Sisyphian struggle for subsequent solvency.

Dr. Brockbank’s suggestions for the local journalignore the dilemma he himself has stated-rapid rise incosts contrasted with meagre prospects of increasedincome. The editor, always conscious that to set the typefor one page consumes four annual subscriptions, mustseverely limit original articles, and jettison reports of

discussions, correspondence, humour." Economic pressure led to the abandonment of Notes on

Preparations for the Sick ’ in 1921 and of ’ Progress of theMedical Sciences ’ in 1924. [In 1951] no sooner did theincrease in subscriptions and in advertisement income promise-some relief than a further advance in expenses of productionsnatched it away.... BVe have eliminated Reviews, Lists ofBooks Received, Obituarv Notices and most of the examina-tion results ; and can hardly go further in this direction.Without constant care it would be quite easy to squander awhole year’s income on a single quarterly issue.’’ 9

Compelled, after serving the journal for 29 years, toresign the chair, and all unconscious of this eluctabledoom, at least I handed on my charge punctual andsolvent. Absumet heres.

DIRTY ANÆSTHETIC MACHINES

Messrs. Howards & Sons Ltd., of lIford, Essex, write :" One of the manufacturers of anaesthetic ether recentlvreceived a complaint from a hospital that the ether suppliedwas below standard and that the patients would not take it.On investigation it was discovered that the fault lay in thebottle of the anaesthetic machine itself, which had not beenproperly cleaned. VVe are writing on behalf of the makers ofanæsthetic ether to draw attention to the danger of usingsuch machines without old ether having first been removed."

Public Health

Influenza

THE subsidence of the influenza epidemic, alreadyapparent for some time to general practitioners in manyareas, is now reflected in a substantial decrease in thenumber of deaths from influenza in the last week ofFebruary. In the 160 great towns of England and Walesthere were 314 deaths in the week ended Feb. 28, com-pared with 521, 530, and 446 in the three preceding weeks.Deaths in the London and south eastern region decreasedto 90, as against 201 in the week ended Feb. 21 ; andthere were also fewer deaths in the northern half of thecountry, where there had been a slight increase in thepreceding week. But the number of claims for sicknessbenefit received by the Ministry of National Insuranceis still considerably higher than at the correspondingtime last year.

Infectious Diseases in England and Wales

* Not including late returns.

Medicine and the Law

Negligence NegativedHEADLINES in the daily press are accustoming the

public to findings of negligence against hospital manage-ments and medical practitioners and to the consequentialaward of damages which are often substantial. Theresult of the case of Slater v. Liverpool and DistrictEastern Hospital Management Committee and Pugmireis the more satisfactory to the successful defendantsinasmuch as the plaintiff’s claim was put forward a,4

one in which the facts spoke for themselves.A three-month-old baby, it was said, was admitted

to hospital on Nov. 11, 1947, suffering from gastro-enteritis ; she was a perfectly formed, normal child.A fortnight later, as the baby could not take her food.it was decided to give an intramedullary drip into theleft tibia. The fluid was dripping continuously into theleg for 32 hours, during which time (it was alleged) acondition was set up which ultimately led to the lossof a foot. The left foot became gangrenous and onDec. 15 it dropped off. Here, it could be said, was ababy which entered a hospital with two feet and came

Page 2: Medicine and the Law

551

out with only one. Evidence was offered that the costof supplying and repairing an artificial limb till thechild reached the age of 65 would be nearly £1000. One

question was whether the decision not to amputatewas right. The defendants contended that it was more

important to build up the child’s health, that amputationwould have shortened the eventual length of the limb,that the gangrene would not be painful, and that, asthe foot was already dead, no poison would be carriedfrom it to the rest of the body. It was contended furtherthat the patient’s clinical condition made the driptreatment necessary.

Mr. Justice Gorman directed the jury to concentrateupon the facts given in evidence and to discard emotion.After an hour’s deliberation they found in favour ofthe defendants. The legal costs were stated to be f:7500.The claim was brought forward under the Legal Aid andAdvice Act. The judge made no order as to costs.Counsel for the plaintiff had suggested that the jurymight take the view that the defendant doctor was’’ a little out of his depth." They evidently did not.

ObituaryMARC DANIELS

M.D. Paris, B.Sc. Mane., M.R.C.P., D.P.H.THOUGH Marc Daniels came late to medicine and died

while he was still in his forties, he had won an inter-national reputation as an epidemiologist. His applicationof statistical technique to the complex problems thrownup by tuberculosis was masterly. The success of theimpressive M.R.C. clinical trials of the new drugs fortuberculosis was largely due to his gift for translatingpaper plans into practice.He was born in Cairo in 1907, but in 1912 he returned

with his parents to Manchester where his father had atextile business. He waseducated at ManchesterGrammar School and spenta year in Paris where hetook a course in the basicsciences. He graduatedB.sc. from ManchesterCollege of Technology andthen joined his father’s firm.But after two years he wasconvinced that he did notwish to spend his life incommerce, and in 1929 hereturned to Paris to studymedicine. In 1936 whenhe took his M.D. Paris hewas awarded a bronzemedal. After spendingsome months at a post ina French sanatorium hedecided to return to this

cuuntry. As his Paris degree did not admit him to theEnglish register, he took the Scottish triple qualificationin 1937.

After holding a house-appointment at Hereford GeneralHospital, he came to London to take a D.P.H. course atthe London School of Hygiene and Tropical Medicine.He al,e served as an assistant medical officer at theXoith Western Fever Hospital. At this time he wasattracted to work in the public-health service, and in1940 he was appointed an assistant medical officer of healthand tuberculosis officer in Lincolnshire, where someuf the rural conditions shocked his social conscience.H, was rescued from work that he was finding increas-ingly frustrating by his election in 1942 as scholar tothe Prophit Survey of the Royal College of Physicianson the incidence of tuberculosis among young adults.Here for the first time his special capabilities in medicalresearch showed themselves. The outbreak of war haddisturbed the plans for the survey, and Daniels’s firsttask, V. H. S., who later joined him in this work, recalls" was to reorganise its scope to meet war-time conditions,abandoning some sections in which further work had becomeimpossible, but expanding others to obtain the greatest

possible amount of information. He then turned to the

analysis of results, and it was here that his clear precisemethods were of the greatest possible value. His interimreport in 1943 on the results in nurses paved the way for thefinal report, the complete plan of which he designed beforea word of text was written. Writing papers in collaborationis a difficult task ; assisting him with the compilation of theProphit report was the pleasantest and most instructive

experience of my professional life."

The final report of the survey, published in 1948, estab-lished the importance of exposure to contact as a causeof the disease, and it was one of the factors which laterled to the recognition of tuberculosis among nurses andhospital workers as an industrial disease.

Before the Prophit report was complete Daniels wasalready working part-time with UNRRA in London, andas soon as the draft was ready he went overseas, asone of the organisation’s tuberculosis consultants, towork in Italy, Poland, Czechoslovakia, Austria, andGermany. The wide experience he gained during thesenext twelve months he later described in his Milroylectures to the Royal College of Physicians (1949) whenhe spoke on Tuberculosis in Post-war Europe. Part ofhis success in this work was due to his command oflanguages, for he was at least as much at home in Frenchas English (he once asked whether a particular gram-matical construction often used in French was goodidiomatic English) ; and he could read German and hadsome knowledge of Italian.

In 1946 the Medical Research Council set up a com-mittee under the chairmanship of Sir Geoffrey Marshallto report on the new drug streptomycin which had thatyear been introduced into this country. The clinicaltrials of the drug were entrusted to the group of workerswhich later became the M.R.C. tuberculosis researchunit; and the director, Dr. P. M. D’Arcy Hart, invitedDaniels to return to London to take charge of the project.Here he was the right man in the right job at the righttime. For during the next few years one new promisingantituberculosis drug has followed the other, andDaniels’s trials of streptomycin widened to include com-parable investigations into the efficacy of p-aminosalicyli cacid in pulmonary tuberculosis, and into tuberculousmeningitis, and still more recently into the efficacy ofisoniazid. The last report with which he was associatedappeared in the British Medical Journal last week.Since 1950 he had also been engaged in trials of B.c.G.and vole bacillus vaccines in groups of school-leavers.But during these years of research Daniels was not

allowed to remain quietly at home, for his work had madehis name known in many countries. In 1947 he was amember of the fact-finding mission sent to Germany bythe Foreign Office to investigate the prevalence oftuberculosis in the British Zone. In 1948 he visitedNew York as a member of the W.H.O. streptomycinsubcommittee. In 1951 he inspected for the U.N. HighCommissioner for Refugees and for W.H.O. displacedpersons’ camps in Trieste. The same year he was alsoin Dublin to take part in a colloquium on the chemo-therapy of tuberculosis held by the Medical ResearchCouncil of Ireland. Last year, he lectured in Oslo,Bergen, and Paris, and only last month, when alreadygravely ill, he sent a stimulating letter to a debate in ourcolumns on tuberculin sensitivity. He died on March 3in Westminster Hospital.

Daniels was tall and handsome, always dressed withcolourful taste ; but it was difficult to guess his characterexcept that he was certainly artistic. In committee heoften looked detached, even bored, but when somethingstirred him, or he spoke, he was transformed. He wasable to convey to others the enthusiasm which laybehind all his own work, and his satisfaction in thesuccess of any team-work in which he shared was hisgreatest reward. He held that a man’s work and hisphilosophy can be effectively merged, and his sternsense of duty in research was backed by a strong socialconscience. He was a member of the Association ofScientific Workers and of the Socialist Medical Associa-tion, and he gave active help to trade unions and otherbodies in their tuberculosis problems He was also amember of the Medical Association for Prevention ofWar, and in his unobtrusive way he did much by exampleand persuasion to focus the attention of his fellows on


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