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SOUTHERN v. LYNN THOMAS AND SKYRME.
HOUTHTBRN
v.
LYNN THOMAS AND SKYRME.
871
result not always to be averted by the highest degree stovaine we have, of course, one of several such drugs. of skill and care. Or, again, such a case as one of In Mr. DEAN’S opinion the avoidance of shock and the in
an elderly person with intestinal much distended abdomen hampering the diaphragm. In the latter case the danger is mainly from pneumonia after anaesthesia and it may be is not entirely removed by the use of spinal injection, particularly if any intercostal paralysis should follow. But in the case of diabetes the risk is probably reduced by the
acute bronchitis
obstruction and
a
absence of the risk of evil after-eflects should lead us to choose spinal in preference to general anaesthesia in many cases of severe and acute abdominal disease. In cases of
persons in ordinary health he thinks the choice less important and one to be made rather in accordance with the preferences of the patient. There are, of course, persons who dread the idea of losing consciousness, just as there are many others whose one wish in the matter is expressed in the words, "Don’t let me know anything at all about it." The former would probably choose spinal injection, whilst nothing but general anaesthetics can meet the desires or the minds of the latter class.
It may be granted avoidance of general anaesthesia. then that a surgeon might find himself confronted with circumstances in which spinal injection offered particular advantages. Such circumstances would be the impossibility of having the help of a skilled anaesthetist or the presence of complications of the kind which we have just described. The question arises then whether surgeons would find it desirable to master the technique of spinal injec. tion for the sake of these rare instances. For one thing I Ne quid nimis." appears quite certain-viz., that good results cannot be obtained with this method of anaesthesia except by those SOUTHERN v. LYNN THOMAS AND SKYRME. who have acquired considerable experience in the matter. WE publish in another column an appeal from a repreOn this point Mr. BARKER, to quote only one authority, is sentative body of medical men to the profession at large in very clear and we may repeat his words that lumbar favour of a fund to reimburse Mr. J. Lynn Thomas and Mr. anaesthesia claims a very close study and those who employ it H. E. Skyrme the enormous sum of money which has been casually without this incur grave responsibility." This spent in defending the action for malpraxis which was surgeon’s views on the way in which the analgesia is pro- decided rather over a year ago. The facts may be fresh in the of our readers, but if not they will find a ’l’éS1lméduced differ from those held by the followers of BIER. memory of the circumstances prefixed to the letter of appeal. The latter believe that diffusion plays a part and that the We trust that the fund, the objects of which receive such drug is brought into contact with nerve roots by movement splendid support in the medical profession and the inauguraof the spinal fluid. They do not believe that gravity plays tion of which has been so happy, will in a brief space of any part in the matter. Mr. BARKER uses a fluid of heavier time amount to the sum appealed for, large as that sum is. specific gravity than the liquor spinalis and maintains that We shall report in our columns the progress that is made in subscriptions and hope that before many issues of by using the influence of gravity obtained through altera- collecting THE LANCET have been published we may be able to tions of the patient’s posture he can accurately localise the I announce the welcome tidings that the fund is closed. Many action of his injected fluid. The fluid which he recommends of our readers have no doubt already received a statement contains 5 per cent. stovaine and 5 per cent. glucose. This of the case in which the pertinent question is asked, "Is observer reports 14 failures to produce adequate analgesia a surgeon to be held culpable if after careful investigation he in his first 100 cases and only six in his second 100, advises treatment which he considers the best even if different from all other methods previously adopted ?" The answer to bearing out his contention that the greater the experience this question is loudly and clearly "No." Such a surgeon of the operator the larger will be his proportion of sucmust be held blameless whatever the issue. Every method cesses. That is to say, apparently during the acquisition of of treatment embodying an advance must differ from methods experience the presence of someone who can administer either in usual practice or recommended in text-books, and a general anaesthetic, if necessary, is essential. We have to punish the surgeon for intelligent and thoughtful modifiof several in which such a cases necessity cations of existing routine, or traditional technique, is knowledge has arisen and it was remarkable with how little of simply to punish him for making progress in his science. We are not surprised to learn that the protests from the the general anaesthesia a perfect result was secured medical profession against the reactionary process described This use after the spinal injection had been made. the statement which has been circulated have been of the combined anmsthesias leads to the question already numerous and emphatic and we anticipate that the whether the spinal method might not be sometimes publication to our readers of a full account of the facts employed in conjunction with general anaesthetics for will result in many more such protests couched in the the prevention of surgical shock. It is largely from practical form of a subscription to the fund. We publish in another column in addition to the facts of the case and the point of view of its efficiency in eliminating the appeal for subscriptions an interesting letter from shock that Mr. H. PERCY DEAN has advocated the use Mr. Robert Jones, surgeon to the Royal Southern Hosof spinal injection. It must be said, however, that pital, Liverpool, which deals with many of the technical Mr. DEAN takes up the position which many will dispute aspects of the diagnosis and treatment of such injuries as that shock is not materially diminished by the use of were discussed in the case of Southern v. Lynn Thomas
quiet
Annotations.
in
general anaesthetics. The abolition of shock can, however, and Skyrme. Our readers will learn from this letter how a common-sense aspect of the matter agrees with accepted be procured, he maintains, by the use of such drugs as scientific knowledge. It may occur to them at the same act upon the peripheral part of the nervous system in such time that the ordinary judicial processes of this country are a way that stimuli are prevented from passing from the not best calculated for the threshing out right from wrong field
of
operation upwards
to
the
vital
centre.
In
in such matters.
v.
LYNN THOMAS AND SKYRME.
871
result not always to be averted by the highest degree stovaine we have, of course, one of several such drugs. of skill and care. Or, again, such a case as one of In Mr. DEAN’S opinion the avoidance of shock and the in
an elderly person with intestinal much distended abdomen hampering the diaphragm. In the latter case the danger is mainly from pneumonia after anaesthesia and it may be is not entirely removed by the use of spinal injection, particularly if any intercostal paralysis should follow. But in the case of diabetes the risk is probably reduced by the
acute bronchitis
obstruction and
a
absence of the risk of evil after-eflects should lead us to choose spinal in preference to general anaesthesia in many cases of severe and acute abdominal disease. In cases of
persons in ordinary health he thinks the choice less important and one to be made rather in accordance with the preferences of the patient. There are, of course, persons who dread the idea of losing consciousness, just as there are many others whose one wish in the matter is expressed in the words, "Don’t let me know anything at all about it." The former would probably choose spinal injection, whilst nothing but general anaesthetics can meet the desires or the minds of the latter class.
It may be granted avoidance of general anaesthesia. then that a surgeon might find himself confronted with circumstances in which spinal injection offered particular advantages. Such circumstances would be the impossibility of having the help of a skilled anaesthetist or the presence of complications of the kind which we have just described. The question arises then whether surgeons would find it desirable to master the technique of spinal injec. tion for the sake of these rare instances. For one thing I Ne quid nimis." appears quite certain-viz., that good results cannot be obtained with this method of anaesthesia except by those SOUTHERN v. LYNN THOMAS AND SKYRME. who have acquired considerable experience in the matter. WE publish in another column an appeal from a repreOn this point Mr. BARKER, to quote only one authority, is sentative body of medical men to the profession at large in very clear and we may repeat his words that lumbar favour of a fund to reimburse Mr. J. Lynn Thomas and Mr. anaesthesia claims a very close study and those who employ it H. E. Skyrme the enormous sum of money which has been casually without this incur grave responsibility." This spent in defending the action for malpraxis which was surgeon’s views on the way in which the analgesia is pro- decided rather over a year ago. The facts may be fresh in the of our readers, but if not they will find a ’l’éS1lméduced differ from those held by the followers of BIER. memory of the circumstances prefixed to the letter of appeal. The latter believe that diffusion plays a part and that the We trust that the fund, the objects of which receive such drug is brought into contact with nerve roots by movement splendid support in the medical profession and the inauguraof the spinal fluid. They do not believe that gravity plays tion of which has been so happy, will in a brief space of any part in the matter. Mr. BARKER uses a fluid of heavier time amount to the sum appealed for, large as that sum is. specific gravity than the liquor spinalis and maintains that We shall report in our columns the progress that is made in subscriptions and hope that before many issues of by using the influence of gravity obtained through altera- collecting THE LANCET have been published we may be able to tions of the patient’s posture he can accurately localise the I announce the welcome tidings that the fund is closed. Many action of his injected fluid. The fluid which he recommends of our readers have no doubt already received a statement contains 5 per cent. stovaine and 5 per cent. glucose. This of the case in which the pertinent question is asked, "Is observer reports 14 failures to produce adequate analgesia a surgeon to be held culpable if after careful investigation he in his first 100 cases and only six in his second 100, advises treatment which he considers the best even if different from all other methods previously adopted ?" The answer to bearing out his contention that the greater the experience this question is loudly and clearly "No." Such a surgeon of the operator the larger will be his proportion of sucmust be held blameless whatever the issue. Every method cesses. That is to say, apparently during the acquisition of of treatment embodying an advance must differ from methods experience the presence of someone who can administer either in usual practice or recommended in text-books, and a general anaesthetic, if necessary, is essential. We have to punish the surgeon for intelligent and thoughtful modifiof several in which such a cases necessity cations of existing routine, or traditional technique, is knowledge has arisen and it was remarkable with how little of simply to punish him for making progress in his science. We are not surprised to learn that the protests from the the general anaesthesia a perfect result was secured medical profession against the reactionary process described This use after the spinal injection had been made. the statement which has been circulated have been of the combined anmsthesias leads to the question already numerous and emphatic and we anticipate that the whether the spinal method might not be sometimes publication to our readers of a full account of the facts employed in conjunction with general anaesthetics for will result in many more such protests couched in the the prevention of surgical shock. It is largely from practical form of a subscription to the fund. We publish in another column in addition to the facts of the case and the point of view of its efficiency in eliminating the appeal for subscriptions an interesting letter from shock that Mr. H. PERCY DEAN has advocated the use Mr. Robert Jones, surgeon to the Royal Southern Hosof spinal injection. It must be said, however, that pital, Liverpool, which deals with many of the technical Mr. DEAN takes up the position which many will dispute aspects of the diagnosis and treatment of such injuries as that shock is not materially diminished by the use of were discussed in the case of Southern v. Lynn Thomas
quiet
Annotations.
in
general anaesthetics. The abolition of shock can, however, and Skyrme. Our readers will learn from this letter how a common-sense aspect of the matter agrees with accepted be procured, he maintains, by the use of such drugs as scientific knowledge. It may occur to them at the same act upon the peripheral part of the nervous system in such time that the ordinary judicial processes of this country are a way that stimuli are prevented from passing from the not best calculated for the threshing out right from wrong field
of
operation upwards
to
the
vital
centre.
In
in such matters.