Damages in Dollars for Negligent Treatment of American Visitor

1409 MEAN VALUES AMONG FEMALES IN STUDY BY DEVEREUX ET AL. AND IN FRAMINGHAM STUDY

Medicine and the Law Damages in Dollars for Negligent Treatment of American Visitor American then aged 47, was visiting London in THE plaintiff, August, 1976. He had pain in the right arm which he attributed to lifting heavy luggage. He consulted the defendant general practitioner, who diagnosed tennis elbow. The diagnosis was not in dispute. The doctor administered lignocaine, hydrocortisone, and an

hyaluronidase by injection. Subsequently, liability for negligent admitted. After the first injection, the plaintiffcomplained offurther pain in the elbow and he was feverish. He was then given penicillin by injection and oxytetracycline by mouth. He continued his travels and arrived in Holland, where he became so ill he was admitted to hospital. Within a few days an abscess formed in the region of the right elbow which necessitated multiple incisions under general anaesthesia. A staphylococcal infection was present. He was discharged on Sept. 21 and returned to the United States, where he was admitted to hospital. The right upper arm was wasted and the function of the radial nerve was in question. Amputation was considered, but every attempt was made to save the right arm. On Oct. 16, 1976, an operation was performed "to clear the distal humerus and the elbow joint of infected tissue and to remove the head of the radius. The forearm was also opened from end to end on the extensor aspect and the extensor muscles were debrided and cleansed... Another infected area on the anteromedial aspect of the elbow was also opened and a soft tissue infection drained ... the articular cartilage was removed from the surfaces of the elbow joint with the aim of obtaining an arthrodesis". The plaintiff, who had occupied a high position in his work, was able to return to work in a lower position with another company, at a lower salary, on May 1, 1977. Radiographs taken in October, 1977, showed absence of the radial head and solid fusion of the right elbow at an angle of 75° of flexion. The plaintiff suffered a fall in January, 1978, resulting in a transverse undisplaced supracondylar fracture of the right humerus, which was treated in a plaster cast for six weeks. There was no dispute that, but for the condition of the arm resulting from the defendant’s negligence, the plaintiff would not have sustained that fracture when he fell. His bones were osteoporotic, secondary to a long period of infection, immobilisation, and disuse. When the fracture had healed, the distal end of the ulna was resected in an attempt to improve forearm rotation, and capsulectomies were performed in several joints. The plaintiff, who was right-handed, was left with a considerable residual disability: an arthrodesed elbow and severe impairment of wrist and hand function. He was greatly limited in ordinary daily tasks and in his work. He had to give up leisure pursuits he had treatment was

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*For the Devereux study, values for non-cases minus values for cases. For the Frammgham values for the given age-group minus the values for the 35-39 year age-group.

study,

A comparison (table) with published blood pressure figures from the Framingham studyll suggests that the blood pressure differences between MVP cases and non-cases may be completely accounted for by the age difference. On the question of whether MVP in females is associated with lower blood pressure or with a lower prevalence of hypertension the verdict must be "not proven". Honolulu Heart

Program,

Kuakini Medical Center,

Honolulu, Hawaii 96817, U.S.A.

ABRAHAM KAGAN

ASPIRIN FOR GLUTEN ENTEROPATHY?

SIR,-Dr Martin (Nov. 13, p. 1099) has suggested a possible therapeutic action of aspirin in gluten intolerance. Any agent which might alleviate gluten-induced intestinal damage without the associated tedium of a gluten-free diet or the adverse effects of steroids would be welcome. The critical question is whether Dr Martin does have gluten enteropathy in the classical sense. He may well be gluten intolerant, and happily his symptoms have responded to exclusion of certain foodstuffs. This does not necessarily mean that he has adult coeliac disease since he provides no objective evidence of a true malabsorption syndrome and does not mention whether his diagnosis has been confirmed by jejunal biopsy. If we are to find out whether cyclo-oxygenase inhibitors really benefit patients with gluten enteropathy, then subjects such as Dr Martin-or rather their intestinal villi-must stand up and be counted, both before and after treatment. Basildon Hospital, Basildon, Essex

C. P. WILLOUGHBY

BERNOULLI

(NOT VENTURI)

SIR,-The publication of an article on his ingenious "Venturi mask" by Professor Campbell (Nov. 27) in the same issue as the paper by Dr Goldstein, together with an editorial, prompts me to call on Professor Campbell to correct his 22-year-old injustice to Daniel Bernoulli (1700-82), for it was Bernoulli and not Giovanni Baptista Venturi (1746-1822) who discovered the hydrodynamic principle on which the mask operates. This is hinted at both by Dr Goldstein and in your editorial and I am sure that Professor Campbell will be only too happy to give credit where credit is due. He need not go so far as to rename the device, but it would be nice if the makers now marketed the "Bernimask". Department of Materia Medica, Stobhill General Hospital, Glasgow G21 3UW 11.

Kagan A, Gordon T,

G.J.ADDIS

Kannel WB, Dawber TR. Blood pressure and its relation to coronary heart disease in the Framingham Study. In: Hypertension- vol VII: Drug action, epidemiology and hemodynamics: Proceedings of the Council for High Blood Pressure Research, American Heart Association (November, 1958). New York: Amrican Heart Association, 1959: 53-81.

previously enjoyed. He had difficulty in writing and could no longer pursue his hobby of photography. He had formerly been skilled in domestic crafts (building, carpentry, plumbing, repairs, and decoration) and he was able to do only some 10% of his former work in the home. In March, 1981, he lost his new job, but planned to start a consultancy business. Talbot _7 itemised the damages as follows: Agreed special damages medical expenses

loss of holiday cost of employing others to work in home loss of earnings to date of trial Pain and suffering and loss of amenities resulting from permanent injury to right arm and left elbow condition: Reduced earning capacity, lump sum Future losses from domestic tasks now to be carried out by others

U.S.$ 23820 2 000 7 000 55 108

19 000 U.S.$ 150 000 7 000

considering what currency the award should be made in, Talbot J asked, "With what currency is the plaintifl’s loss closely linked? In my judgment undoubtedly all the losses in effect which I When

1410

particularly to the interest calculated in the interim period between start of proceedings and trial, as well as to payment made by defendants into court at an earlier stage) were averted.

have awarded in damages, other than that for pain and suffering, are closely linked with U.S. dollars. To meet the losses which arise as a result of his injuries he will have to pay in dollars, and therefore, so far as the judgment is concerned, with the exception of the 19 000, the judgment will be in U.S. dollars." By consent, judgment was for 161 736.79. In this way, difficulties produced by a fluctuating exchange rate (in relation

.

v

Sofaer.

Talbot], QBD. May 1, 1981. DIANA BRAHAMS, Barrister-at-Law

Obituary

HENRY VAN ZILE HYDE

ARTHUR IVAN GRANVILLE McLAUGHLIN

Dr Hyde, formerly an Assistant Surgeon General in the U.S. Public Health Service, died on Nov. 5, aged 76.

M.D.

F.R.C.P.

M.D.

Sydney, Dr McLaughlin made great strides in the study and treatment of occupational lung disease. He died on Oct. 23. He

Hoffman

was

with honours from in 1920. He his career in medicine as an began officer in the Australian Army Medical Corps during the occupation of New Guinea, a former German colony. He came to England in 1922 and was successively resident medical officer at the London Chest Hospital, chief assistant in the tuberculosis department, St

born in Australia and

graduated

Sydney University

Thomas’

Hospital,

Dorothy

Cross research fellow of the Medical Research Council, and a member of the medical unit, University College Hospital, London. He began writing about lung disease in the ’20s, and his interest in occupational lung disease was stimulated by his work with Dr LeRoy Gardiner at Saranac Lake, U.S.A. In this sphere he gained an international reputation. His appointment as H.M. Medical Inspector of Factories in 1934 gave him an opportunity for the close study of occupational lung disease in its clinical, industrial, and radiological aspects. He was particularly interested in foundry workers, and his name will always be associated with foundry workers’ pneumoconiosis. In 1958 he was a member of the committee of the International Labour Office which developed the first International Classification of Radiographs of the Pneumoconioses. When he resigned from the Factory Inspectorate in 1958 he seemed to take a new lease of life, for he joined Donald Hunter’s unit at the London Hospital as deputy director. At the same time he began to build a formidable reputation as an expert witness and continued to provide expert evidence until he was 81. He was that rare combination of a first-class physician with a passion for the effects, not only on the lung, of the working environment. Essentially modest, he was an acute observer who wrote beautifully and argued vehemently. There was little chance of observer error when Mac looked at an X-ray. He was ever ready to impart his knowledge of industrial medicine in general and of industrial lung disease in particular to his younger colleagues, and he continued writing for medical journals until a few days before his death. Under a very superficial irascibility he was a warm and true friend, and many young people owe him a debt of gratitude. Throughout an impressive career he had the devoted support of his wife, Rose, who shared his interest not only in medicine but also in ceramics, silver, and antiques, of which he had profound knowledge. He was good enough to have played tennis at Wimbledon and was indeed a man of many parts. He was a good family man and loved, and was much loved, by his wife and two sons and two daughters. He never sought the limelight and was concerned primarily with the uncompromising pursuit of truth and excellence. This was recognised by his election as a fellow through distinction of the Faculty of Occupational Medicine in the College which he loved. He was in the tradition of Sir Thomas Legge and John Bridge and, like them, was a pillar of the occupational medicine of his time. R. M.

Temple

Johns Hopkins

He took his first degree at Yale and qualified in medicine at Johns Hopkins; after a short period in private practice he worked for the New York Department of Health on pneumonia control and then joined the U.S. Public Health Service in 1943, remaining in it for his main career until his retirement in 1961. He will be most widely remembered for his contribution to the formation and development of Health Organisation the World from the time of the Interim Commission until his retirement. He represented the U.S.A. on the executive board almost continuously through that period and was its chairman in 1954 and 1955. Retirement from the U.S.P.H.S. did not end his international career, for he was director of the international division of the Association of American Medical Colleges until 1972 and then became executive director of the World Federation of Medical Education, an appointment he held until the end of his life. Through nearly 40 years he knew and worked with all the leading personalities in international health and contributed as much as any of them to its development. Van was an endearing character, vigorous and forthright, yet knowing well the need to persuade and counter the doubts and suspicion that are invariable accompaniments of attempts to secure international concordance. Behind the inevitable confrontations at the meeting place there was always Van the friend and helper towards a settlement. However sharp the differences might be-and however blunt their exposition-they were never allowed to extend into personal relationships. Van and his wife, Ellen, were indefatigable travellers and among the most popular figures at international health gatherings. They had seen and understood problems in developing countries that most of us know only by hearsay and reading. Well into his middle seventies, and apparently inexhaustible, Van was still a force in his own right. His was not just the Geneva merry-go-round-I met him also in Delhi, Varna, Lagos, and Ibadan, and we entertained each other in our own homes. The visitors’ book at Bradley Boulevarde in Bethesda must have read like an international gazette. The Hydes, their daughter and two sons were a close family; their loss will be reflected in the sadness of friends all over the world. G. E. G. .

’

ARTHUR JAMES O’HEA M.D.

Glasg., F.R.C.Path. Dr O’Hea was consultant bacteriologist at Monklands District General Hospital, Airdrie. He died suddenly on Oct. 10, aged 59. He

born in Wishaw and

was educated at Our Lady’s School, Glasgow University, where he graduated in 1945. After house-appointments in medicine and surgery he was appointed to the university department of bacteriology in the Western Infirmary, firstly under Prof. Carl Browning and later Prof. (now Sir) James Howie. Bacteriologists who trained in the department will remember with gratitude the time and trouble was

Motherwell, and

at