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UNITED STATES OF AMERICA
281
MEDICINE AND THE LAW More Problems of Damages ON July 10th, in noticing the decisions in Rose v. Ford and Roach v. Yates, comment was made upon the difficulty of assessing damages where, by the defendant’s negligence, a healthy and athletic man has been turned into a permanent invalid or where a figure must be placed upon the diminished expectancy of life. Further instances have since occurred. Dr. D. J. C. Mangan was killed in a motoring accident He was 32 years of age ; he was a year ago. unmarried ; he held a post on the staff of an institution for mental defectives. How were the lost prospects of his career to be valuedAccording to Lord Atkin’s judgment in Rose v. Ford, damages for diminished expectancy of life could be computed and ought to be computed. The Lord Chief Justice awarded 1500 to Dr. Mangan’s mother (to whose support the dead man had contributed 130 a year), E57 for funeral expenses, and JE2000 for the diminished expectation of Dr. lZangan’s life. This novel element of increased damages for shortened prospect of living is causing no little perturbation to insurance companies. If the awards continue to increase, the companies will doubtless find means of distributing part of the burden of the additional liability among the members of the public who insure themselves. There is likely to be an appeal over the figure of ?000 awarded in Dr. Mangan’s case. The Court of Appeal, of course, can increase as well as reduce an award. In Roach v. Yates the damages were more than doubled on appeal. And last week, in Coates v. Rawtenstall Corporation, an award of 1300 at Manchester assizes was increased to :E3000 in the Court of Appeal. A child had been injured while sliding down a chute in a recreation ground, a chain having been negligently left fastened across the lower end of the slide. The child broke his thigh and paralysis supervened. It would be foolish to suggest that awards of this kind could be standardised ; but, if Dr. Mangan’s case reaches the Court of Appeal, it will be interesting to see what value the judges place upon the loss of professional prospects.
Septicaemia or Agranulocytosis ? At an inquest in Manchester, reported in the lTanchestea Guardian of July 15th, the death of a woman, aged 59, was attributed by some witnesses to septicaemia and by others to agranulocytosis following the taking of doses of amidopyrine in tablets of Yeast-Vite. Her husband said that his wife’s health had always been good. She had taken Yeast-Vite occasionally since 1931. She took two tablets on each of the three days before June 6th. At the beginning of June she scratched her finger. On June 5th, when she felt definitely ill, her doctor found that her temperature was 102° F. There was a red swelling on the finger and he incised it. Next day he ordered her removal to the Royal Infirmary, apparently telling the hospital authorities that he thought she was suffering from blood-poisoning. The Manchester city analyst, called at the inquest, expressed the view that the drugs amidopyrine and phenacetin contributed to the cause of death, though in cross-examination it was suggested that his opinion could scarcely outweigh that of a qualified medical practitioner who, after seeing the patient, had diagnosed septicaemia. Dr. David Lloyd Griffiths, who also gave evidence, considered that death was accelerated by the Yeast-Vite. The inquest was adjourned in order to enable the manufacturers to be represented.
The retailer who had sold the tablets to the deceased said that he had never received any notice from the manufacturers to the effect that a new formula had been substituted or that there were any restrictions on the sale of the patent medicine. He was the manager of the local branch of the Cooperative Society. Another witness said that a notice calling in all Yeast-Vite stocks was contained in the weekly price list sent to all branches of the society in May, 1936. For the manufacturers it was stated that for many years Yeast-Vite had been sold at the rate of 80,000,000 tablets a year, and it had never been suggested that anybody was any the worse for taking them. There was one case only, that of a young woman in 1935, who died, it was said, as the result of sepsis of the teeth. Amidopyrine was omitted from the tablets after that date. The medical evidence was conflicting. On the one side Dr. Griffiths attributed death to agranulocytosis caused by the doses of amidopyrine and not to septicaemia. He was convinced that death was not due to septicaemia because bacteriological examination of the patient’s blood did not reveal any micro-organism. On the other side Sir William Willcox was equally positive that death must be due to septicaemia caused by the wound in the finger and could not be due to amidopyrine. He had, he said, prescribed the drug thousands of times. He thought it absolutely inconceivable that two doses of 42 grains of amidopyrine, taken on June 3rd and June 4th, could have caused those dramatically acute symptoms ; with this dose taken only two days consecutively, it was impossible that agranulocytosis could have resulted. He ruled out the suggestion of idiosyncrasy. The patient had been taking the drug for years ; had there been any special susceptibility, it would have shown itself some time before. The coroner told the jury that there were three possible verdicts. Death could be found due to septicaemia or to agranulocytosis, or to a toxic condition of which there was insufficient evidence to indicate the cause. The jury returned an open verdict, choosing the third course.
UNITED STATES OF AMERICA
(FROM
AN OCCASIONAL
CORRESPONDENT)
GROUP HEALTH ASSOCIATION
SEMI-OFFICIAL blessing on health insurance is in the announcement that a Group Health Association is being established in Washington D.C., for the employees of two federal agencies-viz.,. the Home Owners Loan Corporation and the Federal Home Loan Bank Board. Some 2000 employees are said to have enrolled already at a semi-monthly rate of$1.10 per person or$1.65 per family, regardless of the size of the family. A total revenue from subscriptions of$60,000 is anticipated. This is to be supplemented by grants from the federal agencies in the belief that the scheme will promote efficiency and lessen absence on account of sickness. Subscribers will be entitled to medical care by Dr. William Rolfe Brown, former chief of the tuberculosis division of the Veterans Administration, and a corps of assistants ; also to special examinations and to hospital care. For the latter, the association is contracting under the existing Washington hospital insurance plan described in the American Foundation’s "American Medicine" as follow We have now about 27,000 subscribers in the Group
implied
Hospitalisation, Inc. in Washington. To take a recent period as an example, the organisation paid the hospitals
282 from
let to June 30th, 1936, over$50,000 for This would indicate that our plan is certainly of value to the hospitals. We also know now that our average stay in the hospital is about eight days, but the organisation has been able to set up adequate reserves to protect the subscribers for the full period of 21 days if necessary, and even to absorb three or four times the expectancy in case an epidemic or catastrophe or contingency of any sort required it...."
January
hospitalisation.
Group health insurance through commercial insurance companies has already been established in this country ; for example, the 7000 employees of the firm of McKesson and Robins, drug manufacturers, of Fairfield, Connecticut, are covered by a$12,000,000 group insurance policy that provides life, accident, and sickness benefits to the insured employees. But the foundation of the Group Health Association is, so far as I know, the first venture of government into the field of health insurance in this country. SCOTLAND
(FROM
OUR OWN
CORRESPONDENT)
The preventive side of medicine had not future." been neglected either in teaching or in research in the past, but in the future the aim must be more and more to stress its importance.
THE
SERVICES_____
ROYAL NAVAL MEDICAL SERVICE Surg. Comdrs. E. B. Pollard to Pembroke for R.N.B., Chatham; and W. E. Heath to Victory for R.N.B., Portsmouth. Surg. Lt.-Comdrs. C. H. Birt to Victory for R.N.B., Portsmouth; and E. E. Malone to Pembroke for R.N.B., Chatham. Surg. Lts. W. S. Miller to Victory for R.N.B., Portsmouth ; J. F. Meynell to Peterel W. S. Parker to Penzanceand W. B. Teasey to York. The following have been appointed Admiralty Surgeons and Agents : Mr. S. M. Lawrence, Buckingham; Mr. F. T. Hill, Caterham ; Mr. S. E. Kilner, Bury St. Edmunds; Mr. F. McVean, Castle Cary; Mr. W. T. Briscoe, Chippenham ; and Surg. Lt.-Comdr. D. W. Bawtree, R.N.V.R., Tunbridge Wells. ROYAL NAVAL VOLUNTEER RESERVE
Surg. Lt.-Comdrs R. B.
EXTENDING THE CURRICULUM
IN his address as promoter at a graduation ceremony in the University of Edinburgh last week, Prof. Sydney Smith, dean of the faculty of medicine, referred to proposals for extending the course of study. The curriculum, he said, had been the target for much criticism, but this was to be expected of a course of study that was always advancing. It had been said that the education of medical students was entirely vocational and devoid of cultural value. This was but a phase of the age-long battle between science - and the humanities in which the latter, knowing little, feared much ; whereas a little understanding would remove all cause for antagonism. It was doubtful if the study of the classics, or of anything else, could do more than foster an appreciation of truth. There could be no doubt that the study of medicine offered as ample a field for thought as any other. The whole of the recent advances in medicine and cognate sciences has had to be incorporated into the curriculum of study without adding to the time taken in the process. Prof. Sydney Smith said that the senatus are now deliberating the advisability of extending the course of study to five full years after the study of the fundamental sciences-that is to say, five years from the beginning of anatomy and physiology. They are also considering the desirability of keeping students at school until they are eighteen years of age. After acquiring the standard of proficiency of the Leaving Certificate, the student would continue at school for a further period of about a year, during which the sciences would be treated as special subjects, associated with one or more subjects of general education. He would then pass to the University, prepared to undertake the study of biology and enter the medical curriculum proper. Among the many other changes under consideration, Prof.’Sydney Smith said that they hoped to increase greatly the amount of clinical work, and through the close association with the municipal hospitals arrangements will be made to give all the students a period of living-in at hospital. It is hoped also to extend the dispensary system which is a unique feature of the Edinburgh School. " A considerable amount of money is required to give effect to our programme, but we have every confidence that when our needs are known it will be forthcoming. About half a million pounds would enable us to do all we want to do in the immediate
Roberts to Revolutionand J. A. Kerr and J. L. Cox to Victory. Surg. Lt.-Comdr. (D) A. C. Bloomer to Victory. Surg. Lts. R. D. Jenkins to Drapeand C. P. Nicholas and J. N. Matthews to Pembroke. Surg. Sub-Lts. J. B. W. Hayward and W. H. Osborne promoted to Surg. Lts. Proby. Surg. Lt. R. M. Littledale to be Surg. Lt.
ARMY MEDICAL SERVICES Sir Harold Gillies, C.B.E., F.R.C.S., has been appointed Honorary Consulting Surgeon in Plastic Surgery to the Queen Alexandra Military Hospital, Millbank, London. ROYAL ARMY MEDICAL CORPS of Maj. H. Alcock has been brought to notice in recognition of distinguished services rendered in Palestine, April-Oct., 1936. (See also under Royal Air Force for further names.) The
name
TERRITORIAL ARMY
E. G. Oastler to be Maj. Lts. W. G. Garrow, from 9th Bn. H.L.I., and S. Gifford to be Capts. To be Lts. : M. S.Holman (late Offr. Cadet, Univ. of Lond. Contgt. (Med. Unit), Sen. Div., O.T.C.) ; J. M. Dewar (late Offr, Cadet, St. Andrews Univ. Contgt., Sen. Div., O.T.C.) ; J MacM. Macfie (late Cadet Corpl., Edinburgh Academy Contgt., Jun. Div., O.T.C.) ; J. C. Buckley (late Cadet Serjt., Eastbourne Coll. Contgt., Jun. Div., O.T.C.); N. G. Clements; and A. Chambers.
Capt.
TERRITORIAL ARMY RESERVE OF OFFICERS
Capt.
W. R. Nash, from Active List, to be
Capt.
ROYAL AIR FORCE of the following have been brought to notice by the Air Officer formerly Commanding and the General Officer Commanding the British Forces in Palestine and Trans-Jordan in recognition of distinguished services rendered in Palestine, April-Oct., 1936 : Group Capt. K. Biggs, M.C. ; Squadron Leader (now Wing Comdr.) G. P. O’Connell ; Squadron Leader G. E. Church ; and Flight Lt. C. A. Rumball. Squadron Leaders F. D. Barling to No. 3 Flying Training School, Grantham, for duty as Medical Officer ; and H. Penman to Princess Mary’s R.A.F. Hospital, Halton, for duty as Medical Officer. Flight Lts. T. D. L. Bolan to R.A.F. Station, Feltwell; J. F. Dales to R.A.F. Station, Finningley ; and D. J. Sheehan to Central Medical Establishment, London. Dentul Branch.-Flight Lt. A. Maben to R.A.F. Station, Cardington. Flying Offr. B. Blackburne to No. 1 School of Technical Training (Apprentices), Halton. The
names
RESERVE OF AIR FORCE OFFICERS
Flight Lt. J. Twohill relinquishes his commission on completion of service and is permitted to retain his rank.
MEDICINE AND THE LAW More Problems of Damages ON July 10th, in noticing the decisions in Rose v. Ford and Roach v. Yates, comment was made upon the difficulty of assessing damages where, by the defendant’s negligence, a healthy and athletic man has been turned into a permanent invalid or where a figure must be placed upon the diminished expectancy of life. Further instances have since occurred. Dr. D. J. C. Mangan was killed in a motoring accident He was 32 years of age ; he was a year ago. unmarried ; he held a post on the staff of an institution for mental defectives. How were the lost prospects of his career to be valuedAccording to Lord Atkin’s judgment in Rose v. Ford, damages for diminished expectancy of life could be computed and ought to be computed. The Lord Chief Justice awarded 1500 to Dr. Mangan’s mother (to whose support the dead man had contributed 130 a year), E57 for funeral expenses, and JE2000 for the diminished expectation of Dr. lZangan’s life. This novel element of increased damages for shortened prospect of living is causing no little perturbation to insurance companies. If the awards continue to increase, the companies will doubtless find means of distributing part of the burden of the additional liability among the members of the public who insure themselves. There is likely to be an appeal over the figure of ?000 awarded in Dr. Mangan’s case. The Court of Appeal, of course, can increase as well as reduce an award. In Roach v. Yates the damages were more than doubled on appeal. And last week, in Coates v. Rawtenstall Corporation, an award of 1300 at Manchester assizes was increased to :E3000 in the Court of Appeal. A child had been injured while sliding down a chute in a recreation ground, a chain having been negligently left fastened across the lower end of the slide. The child broke his thigh and paralysis supervened. It would be foolish to suggest that awards of this kind could be standardised ; but, if Dr. Mangan’s case reaches the Court of Appeal, it will be interesting to see what value the judges place upon the loss of professional prospects.
Septicaemia or Agranulocytosis ? At an inquest in Manchester, reported in the lTanchestea Guardian of July 15th, the death of a woman, aged 59, was attributed by some witnesses to septicaemia and by others to agranulocytosis following the taking of doses of amidopyrine in tablets of Yeast-Vite. Her husband said that his wife’s health had always been good. She had taken Yeast-Vite occasionally since 1931. She took two tablets on each of the three days before June 6th. At the beginning of June she scratched her finger. On June 5th, when she felt definitely ill, her doctor found that her temperature was 102° F. There was a red swelling on the finger and he incised it. Next day he ordered her removal to the Royal Infirmary, apparently telling the hospital authorities that he thought she was suffering from blood-poisoning. The Manchester city analyst, called at the inquest, expressed the view that the drugs amidopyrine and phenacetin contributed to the cause of death, though in cross-examination it was suggested that his opinion could scarcely outweigh that of a qualified medical practitioner who, after seeing the patient, had diagnosed septicaemia. Dr. David Lloyd Griffiths, who also gave evidence, considered that death was accelerated by the Yeast-Vite. The inquest was adjourned in order to enable the manufacturers to be represented.
The retailer who had sold the tablets to the deceased said that he had never received any notice from the manufacturers to the effect that a new formula had been substituted or that there were any restrictions on the sale of the patent medicine. He was the manager of the local branch of the Cooperative Society. Another witness said that a notice calling in all Yeast-Vite stocks was contained in the weekly price list sent to all branches of the society in May, 1936. For the manufacturers it was stated that for many years Yeast-Vite had been sold at the rate of 80,000,000 tablets a year, and it had never been suggested that anybody was any the worse for taking them. There was one case only, that of a young woman in 1935, who died, it was said, as the result of sepsis of the teeth. Amidopyrine was omitted from the tablets after that date. The medical evidence was conflicting. On the one side Dr. Griffiths attributed death to agranulocytosis caused by the doses of amidopyrine and not to septicaemia. He was convinced that death was not due to septicaemia because bacteriological examination of the patient’s blood did not reveal any micro-organism. On the other side Sir William Willcox was equally positive that death must be due to septicaemia caused by the wound in the finger and could not be due to amidopyrine. He had, he said, prescribed the drug thousands of times. He thought it absolutely inconceivable that two doses of 42 grains of amidopyrine, taken on June 3rd and June 4th, could have caused those dramatically acute symptoms ; with this dose taken only two days consecutively, it was impossible that agranulocytosis could have resulted. He ruled out the suggestion of idiosyncrasy. The patient had been taking the drug for years ; had there been any special susceptibility, it would have shown itself some time before. The coroner told the jury that there were three possible verdicts. Death could be found due to septicaemia or to agranulocytosis, or to a toxic condition of which there was insufficient evidence to indicate the cause. The jury returned an open verdict, choosing the third course.
UNITED STATES OF AMERICA
(FROM
AN OCCASIONAL
CORRESPONDENT)
GROUP HEALTH ASSOCIATION
SEMI-OFFICIAL blessing on health insurance is in the announcement that a Group Health Association is being established in Washington D.C., for the employees of two federal agencies-viz.,. the Home Owners Loan Corporation and the Federal Home Loan Bank Board. Some 2000 employees are said to have enrolled already at a semi-monthly rate of$1.10 per person or$1.65 per family, regardless of the size of the family. A total revenue from subscriptions of$60,000 is anticipated. This is to be supplemented by grants from the federal agencies in the belief that the scheme will promote efficiency and lessen absence on account of sickness. Subscribers will be entitled to medical care by Dr. William Rolfe Brown, former chief of the tuberculosis division of the Veterans Administration, and a corps of assistants ; also to special examinations and to hospital care. For the latter, the association is contracting under the existing Washington hospital insurance plan described in the American Foundation’s "American Medicine" as follow We have now about 27,000 subscribers in the Group
implied
Hospitalisation, Inc. in Washington. To take a recent period as an example, the organisation paid the hospitals
282 from
let to June 30th, 1936, over$50,000 for This would indicate that our plan is certainly of value to the hospitals. We also know now that our average stay in the hospital is about eight days, but the organisation has been able to set up adequate reserves to protect the subscribers for the full period of 21 days if necessary, and even to absorb three or four times the expectancy in case an epidemic or catastrophe or contingency of any sort required it...."
January
hospitalisation.
Group health insurance through commercial insurance companies has already been established in this country ; for example, the 7000 employees of the firm of McKesson and Robins, drug manufacturers, of Fairfield, Connecticut, are covered by a$12,000,000 group insurance policy that provides life, accident, and sickness benefits to the insured employees. But the foundation of the Group Health Association is, so far as I know, the first venture of government into the field of health insurance in this country. SCOTLAND
(FROM
OUR OWN
CORRESPONDENT)
The preventive side of medicine had not future." been neglected either in teaching or in research in the past, but in the future the aim must be more and more to stress its importance.
THE
SERVICES_____
ROYAL NAVAL MEDICAL SERVICE Surg. Comdrs. E. B. Pollard to Pembroke for R.N.B., Chatham; and W. E. Heath to Victory for R.N.B., Portsmouth. Surg. Lt.-Comdrs. C. H. Birt to Victory for R.N.B., Portsmouth; and E. E. Malone to Pembroke for R.N.B., Chatham. Surg. Lts. W. S. Miller to Victory for R.N.B., Portsmouth ; J. F. Meynell to Peterel W. S. Parker to Penzanceand W. B. Teasey to York. The following have been appointed Admiralty Surgeons and Agents : Mr. S. M. Lawrence, Buckingham; Mr. F. T. Hill, Caterham ; Mr. S. E. Kilner, Bury St. Edmunds; Mr. F. McVean, Castle Cary; Mr. W. T. Briscoe, Chippenham ; and Surg. Lt.-Comdr. D. W. Bawtree, R.N.V.R., Tunbridge Wells. ROYAL NAVAL VOLUNTEER RESERVE
Surg. Lt.-Comdrs R. B.
EXTENDING THE CURRICULUM
IN his address as promoter at a graduation ceremony in the University of Edinburgh last week, Prof. Sydney Smith, dean of the faculty of medicine, referred to proposals for extending the course of study. The curriculum, he said, had been the target for much criticism, but this was to be expected of a course of study that was always advancing. It had been said that the education of medical students was entirely vocational and devoid of cultural value. This was but a phase of the age-long battle between science - and the humanities in which the latter, knowing little, feared much ; whereas a little understanding would remove all cause for antagonism. It was doubtful if the study of the classics, or of anything else, could do more than foster an appreciation of truth. There could be no doubt that the study of medicine offered as ample a field for thought as any other. The whole of the recent advances in medicine and cognate sciences has had to be incorporated into the curriculum of study without adding to the time taken in the process. Prof. Sydney Smith said that the senatus are now deliberating the advisability of extending the course of study to five full years after the study of the fundamental sciences-that is to say, five years from the beginning of anatomy and physiology. They are also considering the desirability of keeping students at school until they are eighteen years of age. After acquiring the standard of proficiency of the Leaving Certificate, the student would continue at school for a further period of about a year, during which the sciences would be treated as special subjects, associated with one or more subjects of general education. He would then pass to the University, prepared to undertake the study of biology and enter the medical curriculum proper. Among the many other changes under consideration, Prof.’Sydney Smith said that they hoped to increase greatly the amount of clinical work, and through the close association with the municipal hospitals arrangements will be made to give all the students a period of living-in at hospital. It is hoped also to extend the dispensary system which is a unique feature of the Edinburgh School. " A considerable amount of money is required to give effect to our programme, but we have every confidence that when our needs are known it will be forthcoming. About half a million pounds would enable us to do all we want to do in the immediate
Roberts to Revolutionand J. A. Kerr and J. L. Cox to Victory. Surg. Lt.-Comdr. (D) A. C. Bloomer to Victory. Surg. Lts. R. D. Jenkins to Drapeand C. P. Nicholas and J. N. Matthews to Pembroke. Surg. Sub-Lts. J. B. W. Hayward and W. H. Osborne promoted to Surg. Lts. Proby. Surg. Lt. R. M. Littledale to be Surg. Lt.
ARMY MEDICAL SERVICES Sir Harold Gillies, C.B.E., F.R.C.S., has been appointed Honorary Consulting Surgeon in Plastic Surgery to the Queen Alexandra Military Hospital, Millbank, London. ROYAL ARMY MEDICAL CORPS of Maj. H. Alcock has been brought to notice in recognition of distinguished services rendered in Palestine, April-Oct., 1936. (See also under Royal Air Force for further names.) The
name
TERRITORIAL ARMY
E. G. Oastler to be Maj. Lts. W. G. Garrow, from 9th Bn. H.L.I., and S. Gifford to be Capts. To be Lts. : M. S.Holman (late Offr. Cadet, Univ. of Lond. Contgt. (Med. Unit), Sen. Div., O.T.C.) ; J. M. Dewar (late Offr, Cadet, St. Andrews Univ. Contgt., Sen. Div., O.T.C.) ; J MacM. Macfie (late Cadet Corpl., Edinburgh Academy Contgt., Jun. Div., O.T.C.) ; J. C. Buckley (late Cadet Serjt., Eastbourne Coll. Contgt., Jun. Div., O.T.C.); N. G. Clements; and A. Chambers.
Capt.
TERRITORIAL ARMY RESERVE OF OFFICERS
Capt.
W. R. Nash, from Active List, to be
Capt.
ROYAL AIR FORCE of the following have been brought to notice by the Air Officer formerly Commanding and the General Officer Commanding the British Forces in Palestine and Trans-Jordan in recognition of distinguished services rendered in Palestine, April-Oct., 1936 : Group Capt. K. Biggs, M.C. ; Squadron Leader (now Wing Comdr.) G. P. O’Connell ; Squadron Leader G. E. Church ; and Flight Lt. C. A. Rumball. Squadron Leaders F. D. Barling to No. 3 Flying Training School, Grantham, for duty as Medical Officer ; and H. Penman to Princess Mary’s R.A.F. Hospital, Halton, for duty as Medical Officer. Flight Lts. T. D. L. Bolan to R.A.F. Station, Feltwell; J. F. Dales to R.A.F. Station, Finningley ; and D. J. Sheehan to Central Medical Establishment, London. Dentul Branch.-Flight Lt. A. Maben to R.A.F. Station, Cardington. Flying Offr. B. Blackburne to No. 1 School of Technical Training (Apprentices), Halton. The
names
RESERVE OF AIR FORCE OFFICERS
Flight Lt. J. Twohill relinquishes his commission on completion of service and is permitted to retain his rank.