ON COMPENSATION FOR RAILWAY INJURIES.

2 of

success

which may well be attributed to

auspicious.

beginnings

so

That, however, which most concerns me now to dilate upon is proper conduct to the sick, especially of those who are now entering on their studies in the wards. 1 should like to insist on the almost solemn obligation which young men, with youth and health qnd high spirits, are under, to adopt manners covrtAoit-9, I might almost say 7-everential, towards the suffering inmates ; especially to cultivate the great virtue of modest treatment in all personal examinations. Many of you will hardly conceive to what extent the sense of delicacy is keen amongst persons who might be called, comparatively, of the lower orders. There are a hundred little ways in which this delicacy may be considered, and many rough, incautious acts may de avoided without the least approach to anything like effeminate prudery: which last fault is, perhaps, as oppressive to a patient as a want of proper delicacy. True feeling and acquired tact will point out the proper medium ; and the value of perfect manners towards the sick, which may be obtained in t-he wards of an hospital, will be felt by you continually in after-life, contributing in no small degree to your success in practice. Not only in the mode of examining, but the very language used, especially in the female wards, ought to be studied and nicely adapted to each particular case. To learn in your time of pupilage the nice distinction between coarseand affectation will be well worthy of your serious attention. It is due to your character as gentlemen, and to your principles of humanity. It will also be of great consequence to you as to your future popularity. I remember long ago an instance in which a most worthy practitioner lost the attendance for ever of one of the most important families in his nehbourhooJ. by a single vulgar and expression. may mention, as a minor inducement to you to adopt that ’Clir:-,,’3t, and pure line of conduct, joined with that polished lll,’,;,’B"1’ which ought to distinguish the medical above all other profession.--, that these are the qualities that will first bear fruit in your future course of life. A reputation for scientific .knowledge and for successful practice must be gained by degrees whilst you are actually at work-its acquisition must be a work of time ; whilst your first acceptance by the public P2-c,E,t depend chiefly on personal qualifications of which all can wl. 1-1=;e alverted only, so far, to your conduct towards the patients. There is another class towards whom a very strict and well-re6ulated tone of manners is imperatively necessary. It is a, difficulty peculiar to the wards of an hospital, and one that is unavoidable, that young men have to work in conjunction with young persons of the other sex; and it rather increases the difficulty that the young men are, in most ca.sF, ia a superior social position to the nurses, so that a certain í’.,’1Y"lTt of respect and reticence is gracefully appropriate to regulate the conduct of the superior towards the inferior class. Tt Is impassible to lay down minute rules for the commllnÎcdion between pupil and nurse, but I trust the hint may not bo unavailing to you, and that a habit of gentlemanly selfrestra,ir..t will be cultivated by all of you, especially by those whoare us yet strangers to the customs and manners of a great 1-,it..:l. 1 am. not myself by any means the advocate of taki&bgr;g the great and useful work of nursing out of the hands o-f CLBS of women by whom it has always been supplied. ’Employ !it0ut is washed by that class; they can sympathise more, they can understand better the wants and feelings of the sick, who belong more nearly to their own condition ; and it is my opinion that we are doing better in educating these people to a more complete knowledge of their duty, than in encouraging members of a higher class to accept work which does not naturally belong to them. In the wards of St. Mary’s you meet chiefly the genuine hired nurse ; and you will consult not only the formation of your own manners, but the improvement of the nurse, by avoiding any possible approach to levity or familiarity. The observations with which I began this lecture, as to the vahe of intensely concentrated observation, cannot find more important topic than that which the unhappy epidemic now present immediately affords. You are called at the very out39t to’the study of the gravest and most difficult of all diseases, a disease which is still the humiliation of medical science, the most earnest study of which has as yet been baffled in trving to discover the cause and in applying remedies. One thing is certain, thab mere tentative remedies have all failed equally. It is also certain that we have arrived at a few facts in regard to the morbid change, and to a knowledge of many of the elements which favour the development of the disease; whilst speculations as to the exciting cause in each locality have

abrupt

altogether

proved, in their turns, to be signal failures. All that can be made out is, that that which depresses the system, which induces a low state of vitality, affords liability to attack, and even this, when we come closely to investigate it, requires some modification. I think we are in a position, in regard to this difficult subject, to attempt some further plans based, not as heretofore on the poor system of "trying plans,"but upon reasoning drawn from the few facts which we have been able to realise. I shall continue this subject at my next lecture. In the meantime we have only, both students and teachers, to go on in the course of investigation. There has been a painful uniformity in the symptoms, but still some new lights may be afforded by very keen observa. tion. So far as to the morbid changes as seen after death there has been a similar uniformity in allcases, as I shall hope to prove to you on the next occasion. It is into this source of information that we must be especially anxious to inquire. The two inspections which I have already had with you have been full of interest, and before we meet again possibly some further evidence may be afforded to us, which we may hope to turn to good account.

of treatment,

ON

COMPENSATION FOR RAILWAY INJURIES. BY JAMES

SYME, ESQ., F.R.S.E.,

PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF EDINBURGH.

SINCE the passing of Lord Campbell’s Act-a most unjust piece of legislation as it has always seemed to me, which established the principle of regulating the amount of damages for personal injuries in accordance with the value of individuals to society and to their families, -claims of this kind have become very frequent, under circumstances which seriously call for consideration. For instance, at this time last year a trial took place at Guildhall in the Court of Common Pleas, on the part of a commercial traveller, who prosecuted the Great Northern Railway Company for compensation on account of an injury alleged to have been sustained from a collision on their line. In this case Sir Wm. Fergusson, Mr. Erichsen, and Dr. Russell Reynolds declared that there was organic disease of the spine, which in all probability would soon prove fatal; while, on the other hand, Mr. Borlase Childs, Mr. Pollock, of St. George’s Hospital, Mr. Cock, of Guy’s Hospital, Dr. Risdon Bennett, of St. Thomas’s Hospital, Dr. Dunsmure, President of the Edinburgh College of Surgeons, and myself, no less confidently expressed theconviction that there was no organic disease whatever, and no reason why the claimant should not enjoy good health. The jury, instead of the j612,000 asked, gave .E4700 of damages; and before the end of many months, the plaintiff, who had been rapidly recovering, admitted that he was quite well, as he still continues to be. The truth is, that when juries find the medical evidence so conflicting, not being able to judge for themselves as to the merits of the case, they almost always decide in favour of the claimant, so that there is thus great encouragement afforded to unfounded or exaggerated demands for redress. Indeed any man who travels by railway may easily obtain a competency by stumbling on the platform after the door of his carriage has been opened by a servant of the company, but before the train has ceased to move. He has then merely to go to bed, call in a couple of sympathizing doctors, diligently peruse Mr. Erichsen’s lately published work on Railway Iujuries, go into court on crutches, and give a doleful account of the distress experienced by his wife and children through his personal sufferings, which have resulted from the culpable negligence that allowed him to leave his seat prematurely. Who can doubt that in such circumstances the jury would give large damages. This system ought certainly to be put down, and as one means of doing so, I beg to suggest the publication of cases exhibiting an entire discrepancy between tbmedical evidence, in order that regard for professional character may tend to check the reckless advocacy of one-sided views. The results of such cases in regard to the claimant’s speedy recovery of health would also be worthy of attention for the same purpose;

3

and, having given one of these, I may add a diversity that has just occurred here.

case

of medical

ON A CASE

’

On the 27th of April last a commercial traveller drove out in the evening to my residence in the neighbourhood of Edin-

burgh,

and informed

me

that he had been shaken the

night

OF

POPLITEAL ANEURISM TREATED BY TEM-

PORARY METALLIC COMPRESSION before in a railway collision near Berwick-on-Tweed. He had walked immediately afterwards a mile and a half to see Dr. OF THE FEMORAL ARTERY. Maclagan, of Berwick, and having been assured by him that there was no local injury or occasion for confinement, had come BY T. PRIDGIN TEALE, JUN., M.A. OXON. on to Edinburgh. Finding that there was no local complaint, I desired him to call next morning at my house in Rutlandstreet, and tell me if he felt anything wrong. He accordingly IN the Medical Times and Gazette of Dec. 30th, 1865, p. 717, did so, and then exhibiting the most perfect freedom in all his Mr. John Dix, of Hull, refers, in a short note, to a case of movements, without any sign of local injury, I concluded that carotid aneurism which he had treated successfully by a terait if he felt any uneasiness, must be more mental than bodily. the wire being withdrawn on the sixth I to was rather surthis wire-compress, effect, my opinion Having expressed prised by being asked to recommend a law-agent, and, it is i day, as soon as the aneurism had become solid, and all pulsahardly necessary to say, declined to do so. tion had ceased-that is, as soon as the objects aimed at by On the same day, the 28th of April, it appears that this compression of the artery were obtained. Through the kindperson, having procured an accomplished agent, applied to a ness of Mr. Dix I had the opportunity of examining his patient surgeon of experience in cases like his own, who discovered that he had sustained a "severe wrench of the spine and sacro- a few months ago, at the annual meeting, in Hull, of the East iliac synchondrosis," put him to bed, called in a trustworthy York Branch of the British Medical Association. The case coadjutor, and visited his interesting patient at least once a was perfect. The result of this operation, and the prospect day for months. On the 12th of June Dr. Dunsmure re- thereby held out of somewhat diminishing the risk of secondary quested me to see the claimant, as he had now become. We haemorrhage after ligature of the larger arteries, prompted me found him lying upon a sofa, from which he rose and walked with vigour and flexibility of body. There was not the slight- to adopt this plan in treating the following case of popliteal est swelling, discoloration, or rigidity of the spine, and, on the aneurism. contrary, every appearance of good health so far as we could Although my own case did not terminate successfully, it judge from our own observation. will, nevertheless, contribute some evidence which may assist On the 29th of July, the trial being about to take place, the us in forming a judgment as to the value of the operation. For claimant desired to be examined by a commission; and his the notes of the case I am indebted to my dresser, Mr. George ordinary attendant having given a certificate on " soul and Fisher. conscience" that he was unable to appear in the witness-box Frederick W-, a collier, aged thirty-four, was admitted without serious injury to his health, I was requested along into the Leeds Infirmary on Dec. 29th, 1865. In the right ham with Dr. Dunsmure to report as to this for the information of there was a pulsating tumour, of the size of a small orange, the Court. We found the claimant lying, or rather lolling, on very soft (especially on the inner side), and without any evitwo chairs in a garden, to and from which he walked in dence of consolidation of its contents. He suffered also from leaving and returning to his room, which was up a stair on severe neuralgic pains in the leg. He first noticed the tumour the drawing-room floor. He told us that he sat at his meals, two weeks -before admission, but he had been for three months and, on the whole, he had no appearance whatever of bad laid up with rheumatism, brought on by working a whole day health. We reported our opinion that he could safely appear in wet clothes. The rheumatism affected all his joints, and in Court, and the trial was ordered to proceed. But the had disabled him during the whole three months, with the exclaimant’s legal advisers applied for delay. ception of one week. The only history of accident was, that On the 14th of December Dr. Dunsmure and I were again four years ago he fell down a cellar when drunk and sprained requested to see the claimant, as the trial was to take place the right knee, returning to his work in a fortnight, not any on the 24th. We found that he was not at home, but after a worse for the accident. little while saw him walking stoutly along the street from a ’, Treatment by nkle &y flexion. public bathing establishment, which it appeared he had freankle was firmly bound to the thigh until Dec. 30th.-The quented for several months. He walked up the stair of his the residence before me, and neither then nor afterwards, when pulsation in the tumour became almost imperceptible. more particularly examined, showed any sign of spinal or During the rest of the day the neuralgic pains in the leg were other disease. At the trial, after the plaintiff had been ex- considerably relieved. Jan. 2nd, 1866 (fourth day of flexion). -The leg was unamined, sitting in a chair, as he was not able to go into the witness-box ! his counsel agreed to accept .61000, instead of bound, in order to ascertain whether any improvement was the JE3000 which had been demanded. taking place in the aneurism, and to relieve him from the disI deem it unnecessary to offer any observations on this comfort of the constrained position. There was no sign of consolidation. Flexion was resumed in the evening. case, but would suggest the following questions :— 4th (sixth day).-Treatment by flexion was abandoned, as 1. Could anyone who had sustained a severe wrench of the was no appearance of improvement, and the circumferspine and sacro-iliac synchondrosis immediately afterwards there walk a mile and a half, or on the two following days travel ence of the knee had increased from 16in. to 16 7/8in. The sixty miles by railway, drive about in cabs, and make visits pulsation was quite as distinct as before the employment of flexion. without local complaint ?‘’ Treatment by u;ire compress. (First period.) 2. Could serious disease of the spine resulting from external violence exist for eight months without presenting some sign Jan. 4th.-The feiioral artery having been reached in the of its presence in the patient’s gait, flexibility of trunk, or usual way at the apex of Scarpa’s triangle, a silver wire was general appearance ? passed behind the vessel, instead of the ordinary ligature of Edinburgh, Dec. 26th, 1866. silk or hemp. Each end of the wire was then threaded on needle, and by this means carried obliquely outwards through THE BRITISH WORKMAN.—A most seasonable addi- athe sartorius until it was out through the skin at the of St. a tion to the funds Mary’s Hospital was made few days distance of an inch and a brought half from the wound. The two ends ago, when a deputation of working men waited on the com- of the wire, being about one-third of an inch apart, were then mittee and handed in a cheque for z327 19s. 9zd. to the chair- tied over a small piece of cork, and were tightened so as to man, as the contribution from the various lodges of Foresters the artery and stop the pulsation of the aneurism. compress of the district. Altogether £ 1500 have been subscribed and Thus the wire formed a bridle passing from the skin round the presented to the hospital by the Foresters. artery, which could be made tight or slack at pleasure, and LONGEVITY. On Tuesday last the obituary of could eventually be withdrawn when no longer needed for The Times contained the deaths of four ladies and two gentle- compressing the artery. The pulsation of the aneurism having been completely arrested, the wire was fixed over the cork, men whose united ages amounted to 517 years, giving an average of exactly eighty-six years and two months to each. and the wound was closed by wire sutures. The operation The ladies, as usual, took the lead; the oldest being ninety-six, was followed by great diminution of the neuralgia of the leg. Second day.-Slight pulsation in the aneurism. and the youngest seventy-nine. Our contemporary of WednesThird day.-Pulsation arrested by the insertion of a small day recorded similar illustrations of longevity.

porary

Dec. 30th - T a

-

firmly bound