TWO RECENT MEDICO-LEGAL CASES IN THE MEDICAL COLLEGE HOSPITAL. TO THE EDITOR OF
THE
"
INDIAN MEDICAL
GAZETTE."
Sir,?Two medico-legal cases in which I am concerned have lately been the subject of unintentional misrepresentation in the daily newspapers, and I therefore beg you will allow me to lay before the profession a short statement, in order to remove any erroneous impressions that may exist regarding them. that of a young man who was brought to tho of the 11th September, with a severe contusion over the left eye, and what appeared to be a simple abrasion of the skin of the left lower eyelid, which his friends said had been caused by a morah that had been thrown at his head during a fight. There was no sign of injury to the eye itself, and the patient was perfectly sensible. He did not wish to stay in hospital, but the house surgeon persuaded him to do In the course of the next twenty-four Lours he became so. gradually unconscious ; this state soon passed into one of violent delirium, with a high temperature and other symptoms of cerebral inflammation, and he died on the 17th September. The postmortem examination revealed a punctured wound penetrating the left lower eyelid, and passing into the brain through the roof of the orbit; and it appeared afterwards that this had been caused by a broken rattan, which was sticking out of the morah at the time it was flung at the patient's head. The first
hospital
on
was
the
night
At the examination before the magistrate the house surgeon gave evidence, which was very severely commented on, because he stated that the punctured wound had not been diagnosed, and that at the time of the patient's admission into hospital there was no aperture visible in the left eyelid : and the magistrate remarked that "the death might have been caused by the house surgeon's negligence, he not having paid attention to the
November 1,
MEDICAL NEWS.
1876.]
diagnosis. If the injury had been carefully attended to, the result might have been otherwise." This was perhaps a natural conclusion for a non-professional person to arrive at, on hearing that an injury so severe in its consequences had escaped detection; but surgeons are aware that punctured wounds, in lax tissues like those surrounding the eye, very often give rise to no other mark than a mere superficial trace. There was nothing in the history of the case, or in the appearance of the patient to lead to the supposition that he was mortally injured, and it was only when grave symptoms shewed themselves that we were made aware that some injury which was not apparent was the Even had the exact nature of the injury cause of the mischief. been plain from the first however, the treatment would have been precisely the same as that which was adopted throughout the progress of the case. So far then from the house surgeon's conduct having been deserving of censure, it is evident that he is to be congratulated on having admitted the man into hospital, and kept him there in opposition to the wishes of himself and his friends, as it shews that he recognised the soundness of the principle that every injury of the head should be treated as if it were of a serious nature, until there is decided evidence that it is not.
The second case was that of a woman who was brought to the hospital on the evening of the 5th October, about two hours after having swallowed a quantity of white arsenic, with a view to committing suicide. The poison had been taken in the solid form on an empty stomach. The woman had vomited twice before she arrived at the hospital, and at the time of her admission was vomiting and purging incessantly. The house surgeon encouraged the vomiting by the administration of hot water and diluents, and treated the case otherwise with skill and care; but notwithstanding this, the patient died about five hours after her arrival in hospital. At the coroner's inquest the house surgeon " was taken to task by the coroner for not having used the stomach-pump, which appeared to him one of the most essential remedies in cases of poisoning" ; and because he had not done so, the coroner observed in his charge to the jury that the house surgeon was a perfectly incompetent person. It is just as absurd, however, for the coroner to assume that the use of the stomach-pump is imperative in every case of arsenic poisoning, as it would be for him to lay down the law that every fracture of the thigh should be treated with splints, there being many cases of this injury which do not admit of their application at all. As a matter of fact, in the case in question, the woman had taken solid white arsenic on an empty stomach, and there is no doubt this must have acted almost like a caustic on those parts of the stomach with which it came in contact. In addition to this, the patient had vomited so freely both in and out of the hospital that there was every reason to believe the stomach was thoroughly cleared out; and this view was confirmed by the post-mortem examination, which shewed that there was no loose, arsenic in that organ, but only a few fragments adherent to, and imbedded in the mucous membrane. On these imbedded fragments tho and it is stomach-pump could not have had the slightest effect, that the house therefore clear from all the facts of the case The in not using it. surgeon acted with sound judgment seen two similar cases of patient died, it is true, but I have in this hospital, arsenic poisoning under the care of Dr. Chevers in which, as in this case, it was not thought advisable to use the stomach-pump, and both recovered. From this statement the opinion of the profession will prothat bably be that the coroner's remarks were uncalled-for, and for not no blame can possibly attach to the house surgeon employed the stomach-pump in a case in which its use
having decidedly
was
contra-indicated.
I am, Sir, Yours truly, JJlMV
Aiiw XJ/i. >V -IV
Resident Medical College Hospital, 24th October, 1876.
Calcutta,
Surgeon.
THE
"
INDIAN MEDICAL
GAZETTE."
Sir,?Two medico-legal cases in which I am concerned have lately been the subject of unintentional misrepresentation in the daily newspapers, and I therefore beg you will allow me to lay before the profession a short statement, in order to remove any erroneous impressions that may exist regarding them. that of a young man who was brought to tho of the 11th September, with a severe contusion over the left eye, and what appeared to be a simple abrasion of the skin of the left lower eyelid, which his friends said had been caused by a morah that had been thrown at his head during a fight. There was no sign of injury to the eye itself, and the patient was perfectly sensible. He did not wish to stay in hospital, but the house surgeon persuaded him to do In the course of the next twenty-four Lours he became so. gradually unconscious ; this state soon passed into one of violent delirium, with a high temperature and other symptoms of cerebral inflammation, and he died on the 17th September. The postmortem examination revealed a punctured wound penetrating the left lower eyelid, and passing into the brain through the roof of the orbit; and it appeared afterwards that this had been caused by a broken rattan, which was sticking out of the morah at the time it was flung at the patient's head. The first
hospital
on
was
the
night
At the examination before the magistrate the house surgeon gave evidence, which was very severely commented on, because he stated that the punctured wound had not been diagnosed, and that at the time of the patient's admission into hospital there was no aperture visible in the left eyelid : and the magistrate remarked that "the death might have been caused by the house surgeon's negligence, he not having paid attention to the
November 1,
MEDICAL NEWS.
1876.]
diagnosis. If the injury had been carefully attended to, the result might have been otherwise." This was perhaps a natural conclusion for a non-professional person to arrive at, on hearing that an injury so severe in its consequences had escaped detection; but surgeons are aware that punctured wounds, in lax tissues like those surrounding the eye, very often give rise to no other mark than a mere superficial trace. There was nothing in the history of the case, or in the appearance of the patient to lead to the supposition that he was mortally injured, and it was only when grave symptoms shewed themselves that we were made aware that some injury which was not apparent was the Even had the exact nature of the injury cause of the mischief. been plain from the first however, the treatment would have been precisely the same as that which was adopted throughout the progress of the case. So far then from the house surgeon's conduct having been deserving of censure, it is evident that he is to be congratulated on having admitted the man into hospital, and kept him there in opposition to the wishes of himself and his friends, as it shews that he recognised the soundness of the principle that every injury of the head should be treated as if it were of a serious nature, until there is decided evidence that it is not.
The second case was that of a woman who was brought to the hospital on the evening of the 5th October, about two hours after having swallowed a quantity of white arsenic, with a view to committing suicide. The poison had been taken in the solid form on an empty stomach. The woman had vomited twice before she arrived at the hospital, and at the time of her admission was vomiting and purging incessantly. The house surgeon encouraged the vomiting by the administration of hot water and diluents, and treated the case otherwise with skill and care; but notwithstanding this, the patient died about five hours after her arrival in hospital. At the coroner's inquest the house surgeon " was taken to task by the coroner for not having used the stomach-pump, which appeared to him one of the most essential remedies in cases of poisoning" ; and because he had not done so, the coroner observed in his charge to the jury that the house surgeon was a perfectly incompetent person. It is just as absurd, however, for the coroner to assume that the use of the stomach-pump is imperative in every case of arsenic poisoning, as it would be for him to lay down the law that every fracture of the thigh should be treated with splints, there being many cases of this injury which do not admit of their application at all. As a matter of fact, in the case in question, the woman had taken solid white arsenic on an empty stomach, and there is no doubt this must have acted almost like a caustic on those parts of the stomach with which it came in contact. In addition to this, the patient had vomited so freely both in and out of the hospital that there was every reason to believe the stomach was thoroughly cleared out; and this view was confirmed by the post-mortem examination, which shewed that there was no loose, arsenic in that organ, but only a few fragments adherent to, and imbedded in the mucous membrane. On these imbedded fragments tho and it is stomach-pump could not have had the slightest effect, that the house therefore clear from all the facts of the case The in not using it. surgeon acted with sound judgment seen two similar cases of patient died, it is true, but I have in this hospital, arsenic poisoning under the care of Dr. Chevers in which, as in this case, it was not thought advisable to use the stomach-pump, and both recovered. From this statement the opinion of the profession will prothat bably be that the coroner's remarks were uncalled-for, and for not no blame can possibly attach to the house surgeon employed the stomach-pump in a case in which its use
having decidedly
was
contra-indicated.
I am, Sir, Yours truly, JJlMV
Aiiw XJ/i. >V -IV
Resident Medical College Hospital, 24th October, 1876.
Calcutta,
Surgeon.
