Hospitals and Operations on Children.

1217 this purpose fairly well. The measure of protection afforded by pharmaceutical legislation, however inadequate, has been sufficient to enable the Pharmaceutical Society to maintain its high educational standard and to foster the spirit of progress in those who years ago the means of communication between chemists and druggists for the purpose of exchanging views and suggesting improvements in methods of preparing drugs can hardly be said to Those were the days of the unsightly and have existed.

non-performance have been given. Farther, an opera tion, to speak generally, must not go further than that

or

to which the

practise pharmacy. Seventy

draught, and the uncoated pill. To-day we have the cachet, the capsule, and, what is more important than all, the standardised galenical preparation. By its encouragement of pharmaceutical research the society has exercised, indirectly, an important influence on therapeutics, for failing products whose strength could be exactly determined, pharmacological research would lose

unpalatable bolus,

the black

patient

has consented.

In

some

circum-

it may be necessary that it should do this, and in many it may be very advisable, but the onus of deciding how far he shall exceed the permission given to him forms part of the responsibility imposed by his

stances

upon the operating surgeon. In some cases it is clear that the consent must be given by some one more or less intimately connected with the patient, who will take the

position

responsibility

his behalf

(for convenience we speak of the patient as a male throughout) because, through an accident or from some other cause, the patient may not himself be in a

on

condition in which his consent

can

be

obtained, while

the

urgent need for operation may preclude the possibility of waiting. This is likely more frequently to be the case in

private practice, and in them instances an operation is absolutely and urgently needed to save life, when the patient is incapable of consequence. Without danger of giving praise where it is not due, consenting and no one competent to give consent on his it may be said that the Pharmaceutical Society has either behalf is present, while there is no time to call any directly or indirectly, through its members or through those relatives into counsel. When this is the case it is whom it has educated or encouraged, laid the foundation for plainly the moral duty of surgeons to take upon themmany of the most important improvements in pharmaceutical selves the responsibility of operating, and we are not methods that have taken place during the 70 years of its aware that any blame has ever been imputed to them for existence. With the nature of the work which the society or so doing by the patient whose life or limb has been saved its members have done in connexion with the Pharmacopoeia by their prompt attention. In the event, however, of the most readers are familiar. Until 1864 there were different operation not proving successful, the surgeon may have to pharmacopoeias for England, Scotland, and Ireland, and in face the recriminations of the patient upon whose limb he 1845, at a pharmaceutical meeting, Mr. PETER SQUIRE, one has ineffectually operated without his consent ; while his of the society’s early presidents, pointed out the evils which friends, should he succumb, may feel that had their opinion would result from the discrepancies in the formulas of the been asked the sad issue would have been avoided. In the three codes. Thus the hydrocyanic acid of the London case of children the consent on the child’s behalf of the pharmacopoeia was 2 per cent. in strength, and of the parent, or some other adult person competent to give it, must Edinburgh pharmacopoeia 3} per cent. The solution of be obtained whenever it is possible to do so ; but children, morphine hydrochloride of the London volume contained like grown-up persons, must sometimes need to have an 8 grains to the ounce, and of the Edinburgh pharmacopoeia operation performed upon them without waiting to find out 4 grains. It was not, however, until 1864 that the first who is the father or mother and what views they may hold. British Pharmacopoeia was published, and in connexion with In such cases the conscientious has no alternative surgeon the compilation of this and subsequent editions the Pharma- but to assume the responsibility, whatever may be the copoeia Committee of the General Medical Council received consequences. In the case to which reference has been important assistance from the Pharmaceutical Society. Of the made Dr. F. J. WALDO held an inquest upon a child who purposes for which its charter was granted, the advancement; was stated to have been run over by a van and to have had of pharmacy, by which is meant the science of pharmacy, his leg injured. The precise injury is not material nor the must ever remain the most important if the Pharmaceutical precise nature of the operation which it was proposed to Society is to retain the high esteem in which it is held, andl perform when upon a subsequent day the father took the its present efforts to improve the existing system of pharmachild to the hospital. It was a case, not for deciding in the ceutical education give reason to believe that the society is absence of parental consent to operate, but of operating in of the same opinion. direct opposition to the parental wish; the father, having brought the child to the hospital, refused his consent at first and on to the proposed operation, and only gave way to persuasion Hospitals Operations and advice after delay had taken place. After the deferred Children. IN an inquest at Southwark recently an interesting question1 operation had been performed the child died, and the was raised with regard to the performance of operationss question whether in this particular instance life would have upon children and the necessity for first obtaining, wheneverr been saved if there had been no waiting need not be conpossible, the consent of the parents or custodians of thee sidered here. It must be obvious that in easily conceivable child. The general attitude of the law towards surgical.1 cases delay would be responsible for subsequent death, and operations-a very wide term-is that the consent of thee also that it is in the power of a parent to cause such delay patient must be obtained after explanations of the reason forr or to deprive the child altogether of the benefit of suitable

much of its usefulness and medical science would suffer

hospitals

than in

must arise in which

as a

i

’

the operation and of the

probable results

of its

performancee surgical aid.

218 At the inquest in question Mr. F. KAHLENBURG, who called as a witness from Guy’s Hospital as to what had taken place there, drew attention to the difficulty which had arisen, and to the position in which surgeons were placed by the lack of authority to operate according to their He suggested as a remedy that operations own discretion. should be performed after consultation held by two or three members of the surgical staff of the hospital without waiting to obtain parental approval, and he dwelt upon the fact that, in the case of children inj ured in the streets, and brought in "?{2,Q

by policemen or neighbours, consent often took a long time to obtain, apart from any question of its being deliberately withheld. He referred obviously to such operations

as may be delayed for a few hours without immediate and certain danger to life, for no one will gainsay that

where immediate steps are necessary they must be taken. Commenting upon Mr. KAHLENBURG’S suggestion, which he had courteously invited, Dr. WALDO remarked that the change in the law proposed by Mr. KAHLENBURG serious one, but that it was one which fittingly engage the attention of Parliament if

was

might

a

some

Member could be found to take the matter in hand. With regard to the seriousness of the alteration which would be effected if

an

Act of Parliament

were

to authorise

a

committee or combination of surgeons to sanction an operation upon a child without waiting for parental consent, or in the teeth of parental opposition, the innovation will appear Itss serious in principle if we take into consideration that the Children Act, 1908, while embodying provisions already existing in previous statutes, makes it criminal

neglect in a parent or guardian to fail to provide medical If the father or surgical aid for a child or young person. who withheld consent to a certain operation after he had brought his son to Guy’s Hospital had neither taken him there nor called in a medical man, although he had been told that the child had been run over and could see that he was suffering pain, he would clearly have been guilty of neglect under that Act. Nevertheless, as far as we are aware, he committed

such offence in refusing an operation recommended by the surgeons whom he himself was consulting, for it seems illogical to suggest as matters stand that a parent’s consent is necessary to a certain course

being

no

taken and that at the

same

time the law

can

punish

him if he withholds such consent.

It would not, however, involve any great extension of the principle contained in the section of the Children Act already referred to (Section 12) if it were to be enacted in express terms that to refuse the recommendation of a surgical operation might be deemed in certain circumstances to be

neglect.

It would be necessary to define the nature of by providing that it should be made by

the recommendation a

surgeon

surgeons of a position calculated to command and also that there should be facilities within

or

confidence, parents’ reach for having

the

the

operation performed.

The

provision, moreover, would have to be so framed that it would be capable of general application in appropriate cases.

To

give to surgeons in hospitals power

to insist

in these matters, which is not possessed by them in private practices, would be to impose upon the poor conditions from which their richer neighbours would be their

to be made a special feature of hospitals be performed in them without the could operations consent or against the will of parents, recourse would not

free

and if it

were

that

be had to them in many

operations

are

cases

where now, under advice,

duly performed.

Annotations. II

" N8 quid nimis.

SPRING "FEVER." WE are not aware that any authoritative opinion has ever been offered in explanation of a curious phenomenon which sometimes quite consciously, and at other times unconsciously, affects most people about this time of year. It has been variously described as"a sort of restlessness," or"aa feeling of recklessness and adventure." Some people assert that they experience an added piquancy in life and a general quickening of perception. Others, again, feel an unwonted depression ; to the majority, however, the spring season is certainly felt as giving fresh buoyancy and a feeling of hopefulness in life. Making due allowance for those whose imagination merely may be stirred by the creative power of spring, as evidenced in the almost imperceptible stirring of all animal life, by the arrival of those most desirable of aliens, the tribe of bird immigrants, or by the tender green of leaf and bud,-these sensations, we venture to think, must surely be the natural expression of a definite physiological state which recurs annually at this time of year. Man, to our knowledge, has never actually hibernated. He has had to seek his food the year round or pay forfeit with his life. Before the introduction of artificial light, was but a matter of yesterday in the history of which the human race, it is probable that for long ages he must have lain in a kind of slumberous lassitude during the dark winter days and long nights, waiting for the sun’s brief reign to enable him to seek his food. During this period of the year all his functions would be depressed; his blood pressure would be low. Only when the sun strengthened and the days lengthened would there be a rise in blood pressure, and this, we think, may be, in some measure at least, an explanation of therestlessness " so many of us feel at this season of the year. The sap in the tree rises more quickly in the spring than at any other time, and so far, perhaps, the analogy may be pressed. The reproductive organs naturally share in the increased blood pressure, and an enhanced sexual activity results. Although the poets delight in describing Spring as a fickle and sportive young maid, there is at least no mistaking Nature’s seriousness in her arrangements for wooing and wedding. The fierce and unconquerable note of the nightingale, the madness of the March hare, all bear witness to Nature’s intensity of purpose in one direction-reproduction. DANTE AND

HIS SCIENCE.

MEDICAL men in practice have as a rule but little time for the cultivation of the arts, but such of them as do find the leisure pursue their subject with enthusiasm, and we need only mention the names of Greenhill and Payne among those who have passed away as examples. Among the living we may cite Dr. D. Lloyd Roberts, who recently delivered a lecture upon the wisdom of Dante before the Dante Society of Manchester. In the Middle Ages the acquirement of encyclopredic knowledge was more easy than now, for the simple reason that a knowledge of Aristotle practically meant the knowledge of all that there was to be known. And as regards