Not Negligent

1286 Union and financed by contributions from each nation amounting to 05 % of its defence budget; and if he would endorse the proposal himself.-The PRIME MINISTER replied: The Minister of Health has received a letter from his French colleague outlining this proposal. We will certainly consider this proposal most carefully, and in this we shall be helped by discussions between officials

to

be held in Paris later this month.

Hertford British Hospital, Paris In the light of the continuing need for the services which this hospital provides to British residents and visitors in France, the Government have decided to cancel a debt of 53,000 due to the War Office, and to transfer to the committee of management the adjacent site which was used to house staff during the occupation of the hospital as a British military hospital from 1957 to 1961. The site will be used by the hospital management to provide accommodation for a doctor and for the British nurses, and to secure a regular income from additional accommodation which the management proposes to erect there. This help, together with private benefactions, is expected to make the hospital self-supporting. The Government do not intend to make any further contribution towards the hospital’s maintenance.

Leukaemia Deaths from leukaemia and aleukaemic leukaemia in and Wales for 1938 and the past five years were:

England

by him

to resist his removal to unreasonable " convicted him.

hospital was unjustified He appealed against

and the

conviction.

Lord PARKER, the Lord Chief Justice, said that since the application form was not at the time duly completed by the addition of the doctor’s medical certificate, none of the persons there had any lawful authority to restrain the patient and convey him to hospital; indeed, they were trespassers in the house. It was unfortunate, because the doctor had refrained from filling up the form because he honestly wanted to see whether it was a proper case in which to make a recommendation, and could not say whether it was until he had seen the patient during that visit. It was very difficult to understand what the justices had had in mind. Unless it was to be said that a liberty holder was to sit down and submit, not only to his housebeing infringed in the house, but also to assault by injection and to his liberty being removed in hospital, the Court could not say that to hit out at a person in such circumstances was an unreasonable use of force. The justices must have misdirected themselves by not considering the full picture on the basis that these four men were there without any lawful authority, and the only course was to quash the conviction. Mr. Justice WINN and Mr. Justice FENTON ATKINSON

agreed. Townley v. Rushworth. Queen’s Bench Divisional Court: Lord Parker, C.]., Winn and Fenton Atkinson,]]., Dec. 4; 1963. Counsel and solicitors: R. R. Leach (Gibson & Weldon, for Smith, Fazackerley, Ashton & Co., Preston); Norman Miscampbell (Director of Public Prosecutions). L. NORMAN WILLIAMS Barrister-at-Law.

Not

Medicine and the Law

Right

of

Entry

THE wife of a patient signed a form of emergency application for his admission to hospital for observation under section 29 of the Mental Health Act, 1959, and handed the form to his doctor to provide the single medical recommendation to comply with the provision of section 31 that an application " duly completed " was sufficient authority for detention. The doctor, before signing the recommendation, made a domiciliary visit, accompanied by the patient’s brother-in-law and two police constables. He had deliberately refrained from signing the form until he had seen the patient. The doctor entered the house alone, and was told by the patient to get out. He then brought the other three men into the house and the patient said to them: You have no right to come here; you need two doctors; I am going to my bedroom; you can get out." He went to his bedroom, followed by the four men. The doctor there referred to the emergency application and said that the patient would have to go to hospital for a little while whether he wished to or not, whereupon the patient became angry, and the doctor said that he would have to sedate him by injection, and left to prepare the injection. The patient said he wished to telephone the chief constable, but one constable forcibly restrained him from leaving the bedroom and the other constable, seeing a scuffle, came up, as the patient said he thought, to strike him. The patient struck that constable a blow which fractured his nose. The doctor returned, injected the patient, summoned an ambulance, and then signed the form of medical recommendation. The patient was charged with an assault occasioning actual bodily harm to the constable whose nose was broken, and the justices, being of the opinion that, although the form of medical recommendation was not completed at the time, the patient " had no proper ground for believing that he was about to be struck, and that the force used "

Negligent

In 1958, 11 days after an appendicectomy, a patient was discharged from hospital, but was readmitted 4 days later, as the wound was infected. The surgeon did not order a culture to be taken, having determined upon, and undertaking 17 days after readmission, treatment by saucerising operation. After a further 17 days the wound was resutured; 11 days after that the wound was reopened and not resutured, but, after antibiotics were administered, the patient recovered and he was discharged from hospital. He brought an action against the hospital management committee and the surgeon, claiming that they were negligent, inter alia, in failing to take a culture on his readmission or later, and failing to administer antibiotics earlier than they were administered. He contended that, since the antibiotics were successful when they were eventually administered, the failure to take the culture, which was an essential preliminary step to prescription, deprived him of the chance of benefiting from their earlier administration, and avoiding having to undergo two further operations. Mr.

Justice ASHWORTH said that the surgeon had to the whole situation, keeping in mind that infection was present and that if he wanted to know what caused the infection he had to have a culture taken. In 1958 the first rush of enthusiasm was over, and it was realised that, far from being a panacea for all evils, antibiotics could, in some circumstances, be responsible for worse trouble than that they were intended to cure. The task of balancing the danger inherent in the use of antibiotics and the benefit from their use was eventually completed at the bedside. A dean of a faculty of medicine had given evidence that he taught that where a surgeon could find out he must not guess. It would have been wise to take a culture before the saucerising operation, but the surgeon had decided to weigh

1287

dispose of the case by surgery, and, in view of the state oi medical opinion then, he was not negligent in doing thatthough, if antibiotics had been prescribed, the subsequent breakdown might not have occurred. Was it fair to hold him guilty of negligence because he failed to take a step of inquiry non-essential to the course of treatment which it had been decided to pursue ? It was one thing to say that it was wiser to take a step, quite another to say that it was negligent not to do so. The burden of proof was on the plaintiff; he had not discharged it, and there were no grounds for suggesting that the surgeon was negligent. Whichello v. Medway and Gravesend Hospital Management Committee and another. Queen’s Bench Division: :Ashworth,., Nov. 22,1963. Counsel and solicitors: Edward Gardner, Q.c., and Peter Boydell (Gregory Rowcliffe and Co. for Wood, McLellan & Williams, Chatham); James Stirling, Q.c., and Norman Lerman (Booth, Hearn & Stratton, Chatham); Owen Stable, o.c..

DELETION OF CHLOROCRESOL FROM FORMULIE OF EYEDROPS

THE council of the Pharmaceutical Society of Great Britain have authorised certain amendments to the British Pharmaceutical Codex 1963, and these include the deletion of chlorocresol (0-05 g.) from the formulx of the following eyedrops: Amethocaine Physostigmine Atropine methonitrate Pilocarpine Silver protein Atropine sulphate Chloramphenicol Sulphacetamide Cocaine Sulphacetamide, strong and Cocaine Zinc sulphate homatropine Zinc sulphate and adrenaline (subHomatropine Hyoscine stituting for chlorocresol in this Lachesine formula chlorobutol 0-25 g.) Mild silver protein

and Peter Webster (Hemosons).

L. NORMAN WILLIAMS Barrister-at-Law.

Obituary ROBERT McNAIR WILSON .

Dr. McNair

M.B. Glasg.

Wilson, who died

Nov. 29 at the age of years and was medical of The Times for another thirty. Neither

81, practised medicine for

correspondent doctor

on

ten

journalist was he bound by purely professional interest, and his lively mind and lively pen ranged acceptably over many diverse topics. as a

Notes and News

nor as a

His father was a West India Merchant and he was brought up in Glasgow in the strict but kindly home of an uncle. McNair Wilson was educated in the city at the Academy and at the university where he graduated M.B. in 1904. After holding house-appointments at the Norfolk and Norwich Hospital and at the Western Infirmary in Glasgow, he spent some years in general practice in Northumberland and Argyll. Later he recalled how his early despair at the futility of what he had been taught changed to growing satisfaction as he learnt to apply it. In 1913 he came to London intending to continue medical practice, but a chance article attracted Lord Northcliffe’s attention and in 1913 he appointed McNair Wilson medical correspondent of The Times. From then on, though he did not give up clinical work he became increasingly engrossed in writing. During the 1914-18 war, he served for a time with the R.A.M.C. and he was Ministry of Pensions consultant on trench fever and its cardiological complications and cardiologist to the War Office Trench Fever Committee. The war also gave him opportunities as a journalist. He hired tugs to carry news of the Irish Civil war to the Northcliffe papers; he reported the arrival of the B.E.F. at Boulogne; and he scooped the battle of the Marne. After the war his interest in cardiology led to his appointment as assistant to Sir James Mackenzie, and in 1926 in the biography, The Beloved Physician, he paid tribute to a man whom he believed to be the greatest doctor of his generation. His other books showed the range of his interests. His knowledge of French history led to his studies of Napoleon, Josephine, and their circle, and of the French revolution itself; his interest in monetary problems to monographs with such titles as Housing Finance and The New Wealth. He wrote a biography of Lord Northcliffe and an autobiography entitled Doctor’s Progress. Under the pseudonym of Anthony Wynne he was responsible for a number of pleasant and adroit detective novels. For nine years he was also editor of Oxford Medical Publications. He retired from The Times in 1942. Dr. McNair Wilson leaves three sons by his marriage to Winifred Paynter and two son by his second marriage to Doris

May Fischel.

HEAD INJURIES CLUB EACH year about 1000 patients with head injuries are admitted to the Birmingham Accident Hospital. Of these, 5 in the end remain severely handicapped, and 5 more never work again. There is no means of translating this into accurate figures for the whole country, but a reasonable estimate is about 1000 new cripples a year. Many of the patients are young, and they need to be helped to earn a living and to become independent ; above all, they need to meet people, to talk, to go on outings, to see films and plays, to listen to music, and to feel that they are part of the community. To provide this social service a Head Injuries Club was founded at the Birmingham Accident Hospital about a year ago. Patients and their relatives or friends form the membership, and the president of the committee is Prof. W. Gissane. A year’s successful running of the venture has now convinced the committee that social activities are not enough, and that, in addition, special workshops with social facilities must be built and staffed. To this end the committee now wants to establish a head injuries rehabilitation trust of which the club will be a part. A pilot scheme limited at first to Birmingham is envisaged. In this way, knowledge of the number and distribution of this group of patients and of how they can best be helped could be applied to the needs of the whole country. RESEARCH ON PITYRIASIS ROSEA

IN 1959 the Medical Research Council sponsored an inquiry into pityriasis rosea.It is proposed to undertake a further inquiry into this condition during 1964, and the cooperation of general practitioners will be welcomed. Those taking part will be asked to complete a very brief record card for every case of pityriasis rosea they see during the year, and to return the cards for analysis. Supplies of the cards for this investigation may be had from the Medical Research Council, 20, Park Crescent, London, W.1. A NEW UROLOGICAL

JOURNAL

THE aim of Investigative Urology,2 which began to appear last June, is to publish papers dealing with clinical and laboratory research on the genitourinary system. In a foreword, the Editor writes: We appreciate the importance of papers aimed at teaching of old knowledge, but our concern in this journal is "

new

knowledge."

of Oxford Dr. P. C. B. MacKinnon has been appointed lecturer in the department of human anatomy. On Nov. 23 the degree of D.M. was conferred on the

University

following: J. P. Blandy, R. G. G. A. K. Missen. 1. 2.

Bannister, Victor Parsons,

Marcel

Kinsbourne,

Abercrombie, G. F. Proc. R. Soc. Med. 1962, 55, 556. Investigative Urology. Editor: Dr. William Wallace Scott, PH.D., M.D., Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A. Published by Williams & Wilkins Company, Baltimore 2, Maryland. London agents: Baillière, Tindall & Cox Ltd., 7 & 8, Henrietta Street, Covent Garden, W.C.2. Annual

subscription

£5.