COURT OF QUEEN'S BENCH.

COURT OF QUEEN'S BENCH.

170 who died while he was administering chloroform to him, really died from its effects. Very few who have read the report of this case would have any...

430KB Sizes 1 Downloads 32 Views

170 who died while he was administering chloroform to him, really died from its effects. Very few who have read the report of this case would have any doubts on the subject. Todeny, at this advanced period of its history, and after more than fifty deaths caused by it have been published, that there is very considerable risk from chloroform, would be ridiculous, but still the advantage gained may overbalance this risk. Besides the insensibility produced by it, the assertion has been made, and the records of hospitals havebeen broughtforward in support of the assertion, that amputation and other great operations are rendered safer by its use, in consequence of the improvement which it causes in the condition of the patient. It is difficult to prove a matter of this kind by statistics, and a counter statement was made some years ago by one who had examined the records of operations, some performed with, and others without, chloroform, in the principal American hospitals. Nor is Dr. Snow’s statement more satisfactory, that the pulse and general appearance of a patient who has taken chloroform manifests this improvement. A large quantity of brandy would for a time also give this appearance of improvement, (and probably from a similar or identical action on the system,) but would the ulterior consequences of such stimulation be advantageous to the patient? I fear that there is detriment, and not advantage, from chloroform in this respect, and that we are not authorized, in making up the account, to place lives only supposed to be saved in this manner against those that are certainly destroyed. M. Jules Guerin, in a report made to the Academy of Medicine in Paris, says "he believes that cases of death some time after, but in consequence of the exhibition of chloroform, are very numerous; and that in making inquiries of many surgeons, both in Paris and in the provinces, most of them have confessed that they had had occasion to regret the occurrence of these accidents." Still, in cases where the patient will not submit to deep-seated operations without perfect anaesthesia, we are authorized to employ chloroform. In those cases, however, where the same effect can be produced by local measures of perfect safety, it is unjustifiable to incur the hazard of life by the employment of chloroform. Here the argument, that the patient’s condition is improved by it, (even admitting its soundness in other cases,)hardly applies, for in small operations this is a consideration of comparatively little importance, and our duty is to perform these without any anæsthetic, or to employ one that is perfectly safe. To kill another patient by chloroform for theextraction of a toe-nail, for instance, (already there have been four deaths from this cause,) would now, as the public is fully aware of its danger, be considered culpable homicide. In concluding these observations, I must express regret that greater care is not taken to enable us to form a correct judgment on this question, by the publication of the injurious effects of chloroform which happen in hospitals. In private practice this cannot be expected, and there is little doubt that few of such unfortunate events occurring privately are ever heard of. About a fortnight ago (January 13th) a medical periodical contained a list of the operations which had been performed, during three of the summer months, in certain provincial hospitals, and in this document a brief reference was made to a case of death from chloroform which had occurred in one of these hospitals more than three months before. The chloroform had been exhibited previously to an intended removal of a small encysted tumour from under the eyebrow; and but for what may be called the accidental publication of this list of operations, the death from etherization would probably never havebeen reported. As the question of the propriety of exhibiting chloroform rests altogether on the question of the amount of danger incurred, it can never be properly settled unless more accurate knowledge is obtained of the facts from which we must reason. I am, Sir, your most obedient servant, JAMES ARNOTT. London, January, 1855.

likewise

presented drawings representing

these

ganglia,

and

to his dissections for the accuracy of these statements. Yet when the dissections came to be examined, the whole was found to be an entire fabrication; for no such structures existed. I do not wish to conclude that the same wilful misrepresentation has been practised with reference to the ganglia of the uterus. For a period of more than fifteen years he has perseveringly urged this subject upon the attention of

appealed

profession; and however disagreeable it may be, I feel it due to myself to gratify his apparent urgent desire for inquiry. Let it not therefore be supposed that silence on his part can stop this inquiry; for such silence will but carry the conviction, that like the ganglia on the heart, so are the reputed ganglia of the uterus, a deception. I again call upon him to explain the following questions :(a.) Why the cellular tissue, or neurilemma, has been allowed to remain on the nerves in the dissections of the gravid uterus, figured in the " Philosophical Transactions," 1841-42, and in THE LANCET, October 28th and December 9th, figures Nos. 1, the

now

and 5 ? 4, (b.) Why the

.

cellular tissue, or neurilemma, has been removed in the dissections of the virgin uterus, figured in "Memoirs on the Ganglia and Nerves of the Uterus, by Dr. Robert Lee, 1849," and in THE LANCET, December 9th, figures Nos. 2 and 3 ? (c.) Why the cellular tissue has been removed from the nerves in the dissection of the heart, figured in the Philosophical Transactions" for 1849, part i., plate 5 ? (d.) Why the nerves of the gravid uterus surrounded by the cellular tissue, or neurilemma, have been compared with the nerves of the virgin uterus without the neurilemma? (e.) Why the removal of the cellular tissue, or neurilemma, has been publicly condemned as a proceeding " altogether un. warranted and unprecedented," and yet has been secretly and surreptitiously removed in his recent dissections ? ( f. ) This will also afford Dr. Lee an opportunity to explain, What has become of the fifty ganglia described and represented on the nerves of the heart in May, 1847, with " a lnxuriance of number and size;" yet when the preparations which were referred to as the basis of this communication came to be examined, "none of the fifty ganglia depicted could be discovered ?" I am, Sir, your obedient servant, T. SNOW BECK. February, 1855. GLOVER

VERSUS

To the Editor

SYME.

of THE LANCET.

SIR,—I have this

moment read, with peculiar pleasure, your pithy and admirable comment on the letter addressed to you by Mr. James Bell, and beg to express my cordial concurrence in all you have said. Mr. Syme has done good service to the medical profession in Scotland, by the manly stand he has made against a system which was absolutely intolerable; and whatever may be the feeling amongst lawyers, he has the almost unanimous gratitude of the profession throughout Scotland, and, I doubt not, wherever the report of the trial is read. Mr. Syme is, fortunately for himself, not in a. condition requiring reimbursement for the heavy expenses he has incurred as the result of the verdict. I may add that I have not seen Mr. Syme since the trial, nor for long before it, and that I have no personal interest whatever in the case that led to the trial; but that for his good deeds in this, as in many other professional matters, I avow

myself,

Edinburgh, February,

1855.

COURT OF THE QUEEN V.

THE ANATOMY OF THE NERVES OF THE UTERUS.

SMITH,

AN ADMIRER

OF

MR. SYME.

QUEEN’S BENCH.

THE REGISTRAR OF THE PHARMACEUTICAL SOCIETY.

THis was a special verdict found upon the trial of an issue raised upon a writ of mandamus to the Pegistrar of the Pharmaceutical Society, commanding him to make and maintain a [LETTER FROM DR. SNOW BECK.] register of the members according to the provisions of the To the Editor of THE LANCET. statute the 15th and 16th of Victoria, c. 56. The question was SIR,—Without affording Dr. Robert Lee another opportu- whether the registrar was justified in registering as members nity to explain his conduct -with regard to the dissection of the persons who had been admitted as such, without nndergoing uterus, I am unwilling to adopt the conclusion which seems examination, on the payment of certain fees for certificates. The case had been argued some time since hy Sir F. Kelly inevitable from the facts of the case. I am aware that some time ago he sent 2, paper to the Royal Society, wherein several (with whom was Mr. H. Lloyd) on the part of the Crown - and Mr. Bramwell, Q.C. (with whom was Mr. Brown) for the ganglia on the surface of the heart were clescribed; that he

by

171 the register is made. The meaning of the term " pharmaceutical chemist" was the subject of some discussion, and the Lord CAMPBELL now delivered the judgment of the Court as Act does not give any definition of it. The 6th section imfollows:-The question raised by the special verdict in this plies that pharmaceutical chemist is the generic term under which each member of the society is comprised as a species, case was whether registrar did his duty in placing on the register of pharmaceutical chemists made in November, 1853, the and the 10th section implies that a person who has passed his The name of examination without being elected a member is another species, names of William Mardock and John Abraham. John Wright is also mentioned on the record; but, as his title and these two species or classes are expressly declared by the to be registered is the same as that of John Abraham, he need Act to be entitled to be on the register of pharmaceutical Rot be further noticed. It is found that neither Mardock nor chemists, and any person not on the register is prohibited by Abraham was a member of the Pharmaceutical Society on the the Act from using the title either of pharmaceutical chemist, 30th of June, 1852, when the Act of 15th and 18th Victoria, or member of the society. To this extent the statute is clear, and this is sufficient for the decision of the present case. For c. 56, passed, nor had either of them been examined under that Act, but each was in business as a chemist—Mardock before these reasons we think the registrar is shown by the verdict the 18th of February, 1843, the date of the Charter of Incorpo- to havedone his duty, and that the judgment must be for the ration, and Abraham, before the 30th of June, 1852, the date defendant. of the passing of the 15th and 16th Victoria, c. 56. Each had Judgment for the defendant. obtained a certificate of this fact and of being qualified for admission as a member of the Pharmaceutical Society, and thereupon Mardock’s certificate was approved by the council, and he was elected a member of the Society; and Abraham, having been registered or certified to be qualified for admission according to certain by-laws made in November, 1852, was afterwards elected a member of the Pharmaceutical Society RoYAL COLLEGE op SURGEONS.—The following gentleunder by-laws made in May, 1853, and both names were men having undergone the necessary examinations for the afterwards placed on the Register of Pharmaceutical Che- diploma, wereadmitted Members of the College at the meeting mists of November, 1853, above mentioned. Each was re- of the Court of Examiners on the 2nd inst.:gistered on the ground that he was a member of the society, ANDREWS, HENRY CHARLES, Brabourne, near Ashford, Kent. and the title of each to be a member is derived in part from the DOWNES, WILLIAM, Mount-street, Grovenor-square. Charter and in part from the by-laws, and the matter to be GREATR.Ex, AUGUSTUS BRABBINS WEBB, Taunton, Somerset. decided is whether the title of each was valid. By the Charter HARRIS, ROBERT RAWLINSON, Tottington, near Bury, Lanthe society consisted of members of four classes-first, those cashire. who were chemists on their own account at the date of the HAYWARD, GEORGE, Shenield. charter; second, those who should have been examined, or the HoLMAN, HENRY COLGATE, East Hothley, Sussex. council should have deemed proper; third, those who should MACKLEY, WILLIAM RANDALL, Bradford, Yorkshire. have been certified to be duly qualified for admission; and, MOORE, JOHN, Moy, Co. Tyrone. those who be elected as should fourthly, superintendents by TREVOR, GEORGE RAYMOND, Hon. East India Company’s the council Mardock claimed to be in the first class-that Service, Madras. is, a chemist on his own account at the date of the Charter. At the same meeting of the Court, Mr. JOSEPH KING passed Abraham claimed to be in the third class-that is, to have been certified to be duly qualified for admission; and, as the his examination as Naval Assistant-Surgeon. LICENTIATES IN MIDWIFERY.—At a meeting of the Midwifery charter is declared by the first section of the Act to be in full force, except such parts as are varied or repealed thereby, and Board of the Royal College of Surgeons on the 6th inst., the as the provisions of the.Charter relating to those two classes of ’i following members of the College, having undergone the members are not varied or repealed by the Act, that part of necessary examinations, were admitted Licentiates in Midthe title of each claimant which depends on the Charter is i wifery :made good. The legislature intended an examination to be in BARRETT, FERBERD LESSIONS, Kingston-Bagpuize, Berkshire ; diploma of membership dated Dec. 22nd, 1854. general the condition on which members were to be elected. But some other classes had been made admissible by the BOULTON, WiLLiAM WHYTEHEAD, Beverley, Yorkshire; Dec. 15th, 1854. Charter to prevent the displacement of existing interests, and the admissibility of the same classes was continued by the Act FLETCHER, JOHN FLETCHER, Weston St. Mary’s, Spalding; on the same principle, leaving the extent to which it should April 28th, 1854. be carried to be regulated by by-laws, to be made under proper LANGFORD, WiLLiAM, Brixton; Jan. 26th, 1855. ROWLAND, EVAN, Llangeitho, Cardiganshire; May 19th, 1854. precautions. The remainder of the title of each of these claimants depended upon the by-laws. Mardock claiming TOMLINSON, JOHN TOMLINSON, Manchester; Dec. 18th, 1854. under the by-laws made after the statute, the by-laws under WALKER, JOHN SwirT, Sheerness; Oct. 7th, 1853. which Mardock claims are clear from any doubt. They were WEBB, FREDERICK ERNEST, Maida-vale; April 21st, 1854. valid according to the Charter, and their validity was expressly WOODWARD, WILLIAM, Ledbury, Herefordshire; Dec. 18th, continued by the second section of the Act, and under them 1854. Mardock was admitted a member. Therefore his registration APOTHECARIES’ HALL.—Names of gentlemen who passed The by-laws under which Abraham was admitted was right. their examination in the science and practice of Medicine, and as a person certified to be duly qualified for admission were received certificates to practise, onmade after the passing of the Act-that is, in November, Thursday, February 1st, 1855. 1852, and May, 1853, and their validity depends upon section 2 of the Act, empowering the council of the society to alter COLEMAN, JOHN MAJOR, Wolverhampton. the by-laws of the society made under the Charter, and to FLETCHER, JOHN FLETCHER, Weston St. Mary’s, Spalding. make new by-laws for the purposes contemplated by the HOLLAND, THOMAS SEWARD, Cork. Charter in the Act, subject to a proviso that the new by-laws CIVIL HOSPITALS FOR THE ARMY.—The governors of and the altered by-laws shall be confirmed by a special general St. Bartholomew’s Hospital, following the good example of the meeting and a secretary of state, and subject also to a proviso Middlesex and St. Thomas’s, have placed 40 medical and 40 that the existing by-laws shall continue in force until the beds at the disposal of the Army Medical Department, annual meeting in May, 1853. As the by-laws under which surgical for the use of the sick and wounded returned from the Crimea. Abraham claims were new by-laws, not collections of the APPOINTMENTS.—R. C. Hickson, Esq., L.R,.C.S.I., has existing by-laws, and as they are found to have been duly been made and confirmed, we think that they were valid under the appointed High-Sheriff for the County Kerry, Ireland, for the the and were the not restricted ensuing year.—R. Aulsebrook, Esq., M.R.C.S.E., power granted by section, by proviso continuing the existing by-laws till the next meeting L. A. C., lately one of the medical staff at the Hanwell Asylum, in 1853, and under them Abraham is found to have been duly was, on the 6th inst., elected medical officer to the Lambeth admitted. Thus he also becomes a member of the society, Workhouse. ROYAL COLLEGE OF PHYSICIANS.—In consequence of and, if a member, therefore entitled to be registered; for the makes no distinction between different classes of members the delivery of the Hunterian Oration at the Royal College of Act in respect of registration, the registrar being forced by section Surgeons on Wednesday, the 14th inst., the first Croonian 5 from time to time to make a complete register of all persons Lecture, at the Collegeof Physicians, will take place on Tuesbeing members of the society-that is, members at the time day, the 13th inst., instead of Wednesday.

defendant. tion.

The Court had taken time to consider the ques-

Medical News.