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Nitrous Fumes Cause Death
259
MEDICINE AND THE LAW Nitrous Fumes Cause Death THE death of William McDonald, investigated by Dr. R. L. Guthrie at an inquest held at Poplar on Jan. 20th, was found to be due to an unusual and unexpected cause. The deceased man had been in charge of operations with an oxy-acetylene " superwarmer " on the Dunbar Castle lying in the West India Dock. A man working under his directions stated that he could go on no longer, owing to the overpowering fumes causing difficulty in breathing. Mr. A. Stevenson, chief of the technical staff of the British Oxygen Company, stated that there had been no previous fatalities when the super-warmer was used and that, before it was allowed to play on a surface, paint which might give off lead fumes should be removed. An engineering inspector of factories stated that tests made on the Dunbar Castle showed that as much as 102 parts per million of nitric oxide were produced when the appliance was working, and that 40 parts per million were dangerous. It was not previously known that the super-warmer might produce dangerous amounts of nitrous fumes. Medical evidence showed that death was due to asphyxia which could be explained by the presence of so much nitrous fumes. A verdict of accidental death due to insufficient ventilation was returned, with the recommendation that in future improved ventilation should be provided. It does not seem to be generally recognised that the oxygen and nitrogen combine to form nitric oxide when air is heated, and this in turn is rapidly oxidised to N2O3 and N02. Evidence of nitrous acid can be found even in the smoke from a cigarette or the air round a red-hot wire. At the temperature of an oxy-acetylene flame a considerable production of nitrous gases would no doubt take place. The use of such appliances in confined spaces is
obviously dangerous. A Physio-medical Practitioner Anyone who is in need of medical attention, said the coroner at a Southport inquest last week, is at liberty to call in a blacksmith, a wheelwright, a carpenter, or a man who sells treacle or soap. The people thus called in are entitled to accept the invitation. It is, added the coroner, all a matter of choice ; personally, he himself preferred the registered medical practitioner. But whoever accepted the invitation had a certain duty to perform. Mr. Brighouse made these observations in a case where a retired coal dealer, aged 61, had been attended by Mr. Arthur Boothman, a "physio-medical practitioner," of Arbour-street, Southport. Mr. Boothman had given what was described as a certificate to the effect that the cause of death was diabetes and pulmonary congestion and exhaustion. Dr. W. E. Cooke, pathologist to Wigan Infirmary, described the conditions disclosed by a post-mortem examination. The right foot was black and shrivelled ; when he unwrapped the bandages the foot separated from the leg at the ankle-joint. In Dr. Cooke’s opinion death was due to cellulitis of the right leg, brought about by gangrene of the right foot. In reply to the coroner he said that amputation would have afforded a good chance of recovery ; the trouble was not curable by pills or medicine. Questioned by a legal representative on Mr. Boothman’s behalf Dr. Cooke said he found no evidence of diabetes ; gangrene frequently supervened upon a diabetic condition. Mr. Boothman, aged 32, stated that he
had practised for two years as a physio-medical practitioner ; about 17,000 people had passed through his hands and he had never had a fatal case before. He claimed that the deceased’s leg had healed under his treatment. Asked by the coroner why he made no mention of the leg on his " certificate," he explained that he thought the primary cause of death was diabetes. The jury returned a verdict that Mr. Boothman had discharged his duty " to the extent of his knowledge." The coroner directed them to retire and give an answer to his question without qualification. They then returned a verdict that Mr. Boothman had discharged his duty. The verdict negatives a charge of criminal negligence. One of the few limitations upon the scope of the unregistered practitioner is the disability which prevents him giving a valid certificate of the cause of death. Hence when the unregistered practitioner’s patients die a post-mortem examination and inquest and may well be inevitable. It seems confusing " " irregular to dignify by the name of certificate a document which presumably amounts to no more than a notification of the fact of death. It is perfectly true that a sick person may (as Mr. Brighouse breezily explained to the jury) invite the ministrations of a blacksmith or a seller of soap ; he is free to choose. In the interests of public safety we have evolved a system of death registration which requires that the best information be given of the cause of death. There is not the slightest suggestion of any irregularity in the death of Mr. Boothman’s patient, but it is highly misleading that what purported to be a statement of the cause of death should have omitted to mention the condition of the right leg, and should have mentioned diabetes of which a post-mortem examination showed no evidence. While such mistakes can occur, it is hardly safe to relax the law.
IRELAND
(FROM ST.
OUR OWN
VINCENT’S
CORRESPONDENT)
HOSPITAL CENTENARY
past week St. Vincent’s Hospital, Dublin, celebrated the centenary of its foundation. It was in 1834 that Mother Mary Aikenhead, a Sister of the Order of Charity, opened a hospital ward in a fine old mansion in St. Stephen’s Green, which had previously been the town house of the Earl of Meath. This ward-formerly. the drawing-room of the house -is still in daily occupation. From the first the hospital gained public confidence, and Mother Mary Aikenhead’s courage won the support of the public. The hospital, which is still under the control of the Sisters of Charity, is one of the most progressive in Dublin, and the Sisters have shown an eagerness for scientific advance not less than their religious benevoDURING the
lence. Although controlled by a religious order the benefits of the hospital are open to patients of every creed. The staff in the past, as in the present, has included many of the most distinguished physicians and surgeons in Dublin. At present it has some 250 beds and a large nursing-home attached, while its training school for nurses has the highest reputation. The centenary celebrations included various religious and social functions in which many guests took part. The medical profession of Ireland joins in congratulation to their colleagues at St. Vincent’s on the completion of a hundred years of charitable and scientific work.
MEDICINE AND THE LAW Nitrous Fumes Cause Death THE death of William McDonald, investigated by Dr. R. L. Guthrie at an inquest held at Poplar on Jan. 20th, was found to be due to an unusual and unexpected cause. The deceased man had been in charge of operations with an oxy-acetylene " superwarmer " on the Dunbar Castle lying in the West India Dock. A man working under his directions stated that he could go on no longer, owing to the overpowering fumes causing difficulty in breathing. Mr. A. Stevenson, chief of the technical staff of the British Oxygen Company, stated that there had been no previous fatalities when the super-warmer was used and that, before it was allowed to play on a surface, paint which might give off lead fumes should be removed. An engineering inspector of factories stated that tests made on the Dunbar Castle showed that as much as 102 parts per million of nitric oxide were produced when the appliance was working, and that 40 parts per million were dangerous. It was not previously known that the super-warmer might produce dangerous amounts of nitrous fumes. Medical evidence showed that death was due to asphyxia which could be explained by the presence of so much nitrous fumes. A verdict of accidental death due to insufficient ventilation was returned, with the recommendation that in future improved ventilation should be provided. It does not seem to be generally recognised that the oxygen and nitrogen combine to form nitric oxide when air is heated, and this in turn is rapidly oxidised to N2O3 and N02. Evidence of nitrous acid can be found even in the smoke from a cigarette or the air round a red-hot wire. At the temperature of an oxy-acetylene flame a considerable production of nitrous gases would no doubt take place. The use of such appliances in confined spaces is
obviously dangerous. A Physio-medical Practitioner Anyone who is in need of medical attention, said the coroner at a Southport inquest last week, is at liberty to call in a blacksmith, a wheelwright, a carpenter, or a man who sells treacle or soap. The people thus called in are entitled to accept the invitation. It is, added the coroner, all a matter of choice ; personally, he himself preferred the registered medical practitioner. But whoever accepted the invitation had a certain duty to perform. Mr. Brighouse made these observations in a case where a retired coal dealer, aged 61, had been attended by Mr. Arthur Boothman, a "physio-medical practitioner," of Arbour-street, Southport. Mr. Boothman had given what was described as a certificate to the effect that the cause of death was diabetes and pulmonary congestion and exhaustion. Dr. W. E. Cooke, pathologist to Wigan Infirmary, described the conditions disclosed by a post-mortem examination. The right foot was black and shrivelled ; when he unwrapped the bandages the foot separated from the leg at the ankle-joint. In Dr. Cooke’s opinion death was due to cellulitis of the right leg, brought about by gangrene of the right foot. In reply to the coroner he said that amputation would have afforded a good chance of recovery ; the trouble was not curable by pills or medicine. Questioned by a legal representative on Mr. Boothman’s behalf Dr. Cooke said he found no evidence of diabetes ; gangrene frequently supervened upon a diabetic condition. Mr. Boothman, aged 32, stated that he
had practised for two years as a physio-medical practitioner ; about 17,000 people had passed through his hands and he had never had a fatal case before. He claimed that the deceased’s leg had healed under his treatment. Asked by the coroner why he made no mention of the leg on his " certificate," he explained that he thought the primary cause of death was diabetes. The jury returned a verdict that Mr. Boothman had discharged his duty " to the extent of his knowledge." The coroner directed them to retire and give an answer to his question without qualification. They then returned a verdict that Mr. Boothman had discharged his duty. The verdict negatives a charge of criminal negligence. One of the few limitations upon the scope of the unregistered practitioner is the disability which prevents him giving a valid certificate of the cause of death. Hence when the unregistered practitioner’s patients die a post-mortem examination and inquest and may well be inevitable. It seems confusing " " irregular to dignify by the name of certificate a document which presumably amounts to no more than a notification of the fact of death. It is perfectly true that a sick person may (as Mr. Brighouse breezily explained to the jury) invite the ministrations of a blacksmith or a seller of soap ; he is free to choose. In the interests of public safety we have evolved a system of death registration which requires that the best information be given of the cause of death. There is not the slightest suggestion of any irregularity in the death of Mr. Boothman’s patient, but it is highly misleading that what purported to be a statement of the cause of death should have omitted to mention the condition of the right leg, and should have mentioned diabetes of which a post-mortem examination showed no evidence. While such mistakes can occur, it is hardly safe to relax the law.
IRELAND
(FROM ST.
OUR OWN
VINCENT’S
CORRESPONDENT)
HOSPITAL CENTENARY
past week St. Vincent’s Hospital, Dublin, celebrated the centenary of its foundation. It was in 1834 that Mother Mary Aikenhead, a Sister of the Order of Charity, opened a hospital ward in a fine old mansion in St. Stephen’s Green, which had previously been the town house of the Earl of Meath. This ward-formerly. the drawing-room of the house -is still in daily occupation. From the first the hospital gained public confidence, and Mother Mary Aikenhead’s courage won the support of the public. The hospital, which is still under the control of the Sisters of Charity, is one of the most progressive in Dublin, and the Sisters have shown an eagerness for scientific advance not less than their religious benevoDURING the
lence. Although controlled by a religious order the benefits of the hospital are open to patients of every creed. The staff in the past, as in the present, has included many of the most distinguished physicians and surgeons in Dublin. At present it has some 250 beds and a large nursing-home attached, while its training school for nurses has the highest reputation. The centenary celebrations included various religious and social functions in which many guests took part. The medical profession of Ireland joins in congratulation to their colleagues at St. Vincent’s on the completion of a hundred years of charitable and scientific work.