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Explosion during Electrical Cauterisation
PARLIAMENT
greatest possible precautions, not only to avoid the danger when it was known, but also to find out whether there was danger or not. The employers ought to have suspected it until it was proved harmless. They were starting what they had called an experimental process." It behoved them not only to call in their research chemists "
to tell them how to make it, but also their medical officers to advise them whether it was safe for their workers to handle. It did not seem right that a great concern should exploit a new process at the risk of their workers without a word to them of the dangers it entailed. He would allow the appeal. LORD JUSTICE BIRKETT said that the only question before the Court was whether the defendants ought to have known. For the plaintiff it was said that a literature The question was : search should have been made. When ? Before they began to use powders purchased from other concerns ? Or in 1943, when they began using beryllium oxide for radio valves ? Or when they first began making the powder themselves in 1945 or 1946 ? The growth of knowledge as to the nature of beryllium compounds was not rapid. Even the paper published in the United States in July, 1947, which first really
the industry, contained the significant words that " the case against beryllium is not clear cut." His Lordship could not think that the employers were under a duty of care so stringent as to amount practically to a guarantee of safety when they had no knowledge of the danger and all their experience was to the contrary. He would dismiss the appeal. LORD JUSTICE PARKER, agreeing with Lord Justice Birkett, said that little was yet known of the disease contracted by the plaintiff, save that it was of a delayedaction type. The intensity of the disease bore no direct relation to the concentration of the exposure. While most people were unaffected, there were those in whom the inhalation of but one speck of the powder would set up the disease. On the question of duty, if there were any reason to suspect that a substance was likely to be toxic, a reasonable and prudent employer should make a search such as had been suggested, particularly if the substance had not been used or manufactured before on a commercial scale. But if there were no reason to suppose it was toxic, and it had been used and manufactured for some time by others without ill effects, there was no reason why an employer should do more than act in accordance with the general principles of hygiene observed where a dusty process was involved. His Lordship could not believe that if any of the companies which had supplied the powders to the defendants had been aware of the danger, their knowledge would not have been available in the trade generally. He agreed with the Judge that the plaintiff had not proved any breach of duty in the failure to make an exhaustive search for any literature concerned with these substances. Leave was given to appeal to the House of Lords. HARMAN r. MITCHAM WORKS LTD.-Court of Appeal: Denning, Birkett, and Parker L..T.J.:June 21, 1955. Counsel and Solicitors : Tristram Beresford, Q.c., and Peter H. Ripman (Lewis, Holman, and
enlightened
.
Ross and Son, Horley); E. Ryder Richardson, Q.C., Hopkins (Carpenters). M. M. HILL Barrister-at-law.
Lawrence for and Ronald
Electroconvulsant Treatment hope 1 will not have to consider any case in the future in which there is therapy involving loss of consciousness and a cessation of breathing, however short, on the part of the patient, where only one doctor is present to administer the therapy and look after the patient in an unconscious state." These remarks were made by the North Bedfordshire coroner at the inquest 1 on a man who had died during electroconvulsant treatment. The patient had recently "
I
1.
Bedford Times, June 10, 1955.
37
undergone
an
operation
on
one
lung
and afterwards
suffered from acute melancholia. He was admitted to the Three Counties Hospital, Arlesey, where it was decided to administer a modified form of electroconvulsant therapy evolved at the hospital a year ago and now adopted by a dozen other hospitals in the country. The treatment was administered by a registrar with the assistance of four of the nursing staff. Evidence was also given by an assistant psychiatrist at the hospital who had originated the treatment and the machine by which it was given. He agreed that everything ought to be done to protect a patient, but between 4000 and 5000 such treatments were given every year at the hospital and it would be impossible to have a trained anaesthetist present on every occasion in addition to the doctor giving the therapy. The coroner suggested that in a case such as this, where the patient had recently had an operation for lung trouble, a second doctor might well have been present to provide controlled respiration. He recorded a verdict that the patient had died from spontaneous pneumothorax and chronic pulmonary tuberculosis and that he died by misadventure after electroconvulsant therapy
Explosion during Electrical Cauterisation A girl, aged 11, was undergoing an operation for the removal of her adenoids by electrical cauterisation when an explosion occurred in her mouth. Artificial respiration was applied, after which the patient’s ’.heartbeat became normal, but she died some days later. Death was stated to be due to toxaemia and bronchopneumonia caused by burning of the lung, mouth, and tongue. From the evidence given at the inquest,1 it appears that the anaesthetist administered ether to the girl. The surgeon had informed the anæsthetist that it was his intention to use the electrical cautery ; when he asked if there were any precautions to be taken,he understood the anaesthetist to say " No." He did not ask what anaesthetic had been given. He was nearing the end of the operation when the explosion occurred, there being a. flash and a flame in the girl’s throat. The coroner said that he was satisfied on the evidence that there was no criminal negligence. A verdict of death by misadventure was recorded.
Parliament Medical and Health Services in the Colonies SPEAKING in a debate in the House of Commons on June 21, Mr. HENRY HopKrrrsoON, Minister of State for Colonial Affairs, said that, though we still had a long way to go in providing medical services in the Colonies, the recent Report on the Colonial Territories showed that the medical and health services had been not only maintained but considerably expanded. There was growing evidence of mastery over some of the preventable diseases and of the increasing consciousness among the public in theColonies as to the causes of these diseases and their willingness to take measures to deal with them. In particular more and more attention was being paid to tuberculosis, as was shown by the appointment of Prof. F. R. G. Heaf as consultant on tuberculosis. The Government had realised that it was better to have doctors from overseas, whether they were expatriate or local, whether from the Far East or Africa, or from other dependencies, and to have them trained in the treatment of tuberculosis in this country. There was a steady stream of medical officers coming over to study for the diploma in tuberculosis diseases at Cardiff. Many of these doctors went back to their territories and carried out work of a high order. ’ In many overseas territories tuberculosis hospitals were now being built, and small tuberculosis annexes were being set up in rural areas to meet local needs. Surveys had been made, and people found to be tuber1. Manchester
Daily Dispatch, June 18, 1955.
greatest possible precautions, not only to avoid the danger when it was known, but also to find out whether there was danger or not. The employers ought to have suspected it until it was proved harmless. They were starting what they had called an experimental process." It behoved them not only to call in their research chemists "
to tell them how to make it, but also their medical officers to advise them whether it was safe for their workers to handle. It did not seem right that a great concern should exploit a new process at the risk of their workers without a word to them of the dangers it entailed. He would allow the appeal. LORD JUSTICE BIRKETT said that the only question before the Court was whether the defendants ought to have known. For the plaintiff it was said that a literature The question was : search should have been made. When ? Before they began to use powders purchased from other concerns ? Or in 1943, when they began using beryllium oxide for radio valves ? Or when they first began making the powder themselves in 1945 or 1946 ? The growth of knowledge as to the nature of beryllium compounds was not rapid. Even the paper published in the United States in July, 1947, which first really
the industry, contained the significant words that " the case against beryllium is not clear cut." His Lordship could not think that the employers were under a duty of care so stringent as to amount practically to a guarantee of safety when they had no knowledge of the danger and all their experience was to the contrary. He would dismiss the appeal. LORD JUSTICE PARKER, agreeing with Lord Justice Birkett, said that little was yet known of the disease contracted by the plaintiff, save that it was of a delayedaction type. The intensity of the disease bore no direct relation to the concentration of the exposure. While most people were unaffected, there were those in whom the inhalation of but one speck of the powder would set up the disease. On the question of duty, if there were any reason to suspect that a substance was likely to be toxic, a reasonable and prudent employer should make a search such as had been suggested, particularly if the substance had not been used or manufactured before on a commercial scale. But if there were no reason to suppose it was toxic, and it had been used and manufactured for some time by others without ill effects, there was no reason why an employer should do more than act in accordance with the general principles of hygiene observed where a dusty process was involved. His Lordship could not believe that if any of the companies which had supplied the powders to the defendants had been aware of the danger, their knowledge would not have been available in the trade generally. He agreed with the Judge that the plaintiff had not proved any breach of duty in the failure to make an exhaustive search for any literature concerned with these substances. Leave was given to appeal to the House of Lords. HARMAN r. MITCHAM WORKS LTD.-Court of Appeal: Denning, Birkett, and Parker L..T.J.:June 21, 1955. Counsel and Solicitors : Tristram Beresford, Q.c., and Peter H. Ripman (Lewis, Holman, and
enlightened
.
Ross and Son, Horley); E. Ryder Richardson, Q.C., Hopkins (Carpenters). M. M. HILL Barrister-at-law.
Lawrence for and Ronald
Electroconvulsant Treatment hope 1 will not have to consider any case in the future in which there is therapy involving loss of consciousness and a cessation of breathing, however short, on the part of the patient, where only one doctor is present to administer the therapy and look after the patient in an unconscious state." These remarks were made by the North Bedfordshire coroner at the inquest 1 on a man who had died during electroconvulsant treatment. The patient had recently "
I
1.
Bedford Times, June 10, 1955.
37
undergone
an
operation
on
one
lung
and afterwards
suffered from acute melancholia. He was admitted to the Three Counties Hospital, Arlesey, where it was decided to administer a modified form of electroconvulsant therapy evolved at the hospital a year ago and now adopted by a dozen other hospitals in the country. The treatment was administered by a registrar with the assistance of four of the nursing staff. Evidence was also given by an assistant psychiatrist at the hospital who had originated the treatment and the machine by which it was given. He agreed that everything ought to be done to protect a patient, but between 4000 and 5000 such treatments were given every year at the hospital and it would be impossible to have a trained anaesthetist present on every occasion in addition to the doctor giving the therapy. The coroner suggested that in a case such as this, where the patient had recently had an operation for lung trouble, a second doctor might well have been present to provide controlled respiration. He recorded a verdict that the patient had died from spontaneous pneumothorax and chronic pulmonary tuberculosis and that he died by misadventure after electroconvulsant therapy
Explosion during Electrical Cauterisation A girl, aged 11, was undergoing an operation for the removal of her adenoids by electrical cauterisation when an explosion occurred in her mouth. Artificial respiration was applied, after which the patient’s ’.heartbeat became normal, but she died some days later. Death was stated to be due to toxaemia and bronchopneumonia caused by burning of the lung, mouth, and tongue. From the evidence given at the inquest,1 it appears that the anaesthetist administered ether to the girl. The surgeon had informed the anæsthetist that it was his intention to use the electrical cautery ; when he asked if there were any precautions to be taken,he understood the anaesthetist to say " No." He did not ask what anaesthetic had been given. He was nearing the end of the operation when the explosion occurred, there being a. flash and a flame in the girl’s throat. The coroner said that he was satisfied on the evidence that there was no criminal negligence. A verdict of death by misadventure was recorded.
Parliament Medical and Health Services in the Colonies SPEAKING in a debate in the House of Commons on June 21, Mr. HENRY HopKrrrsoON, Minister of State for Colonial Affairs, said that, though we still had a long way to go in providing medical services in the Colonies, the recent Report on the Colonial Territories showed that the medical and health services had been not only maintained but considerably expanded. There was growing evidence of mastery over some of the preventable diseases and of the increasing consciousness among the public in theColonies as to the causes of these diseases and their willingness to take measures to deal with them. In particular more and more attention was being paid to tuberculosis, as was shown by the appointment of Prof. F. R. G. Heaf as consultant on tuberculosis. The Government had realised that it was better to have doctors from overseas, whether they were expatriate or local, whether from the Far East or Africa, or from other dependencies, and to have them trained in the treatment of tuberculosis in this country. There was a steady stream of medical officers coming over to study for the diploma in tuberculosis diseases at Cardiff. Many of these doctors went back to their territories and carried out work of a high order. ’ In many overseas territories tuberculosis hospitals were now being built, and small tuberculosis annexes were being set up in rural areas to meet local needs. Surveys had been made, and people found to be tuber1. Manchester
Daily Dispatch, June 18, 1955.