Evening star., 1881-12-28

Medical Jurisprudence" has the following bear
ing upon it:
''In case of this kind. what becomes of the
responsibility of the party who inflicted the
original wound? No decision. 50 far Is know,
has ever been given on this point. Was the
administration of the chloroform vapOr, in a
professional view, necessary part Of the treat
ment? Was it skillfully and properly admin
istered? Could the diseased condition of the
heart, which rendered the effects of the vapor
more fatal than usual, have been detected by
the operator? so as to show the improperly OF
administering it in this case? These questions
should receive satisfactory answers before the
aggressor is rendered responsible for death
under these peculiar circumstances
Should the prisoner be acquitted by jury in
one of these cases. would an faction lie against
physician who had administered the chloro-
form and who had been the unwilling cause OF
death! This is question Of great importance
to surgeons connected with our large institu-
tiOns, where injuries and wOundings of every
kind are continually brought in and when, to
save life, surgeon must often act promptly.
where he knows nothing previously of the
patient and perhaps can learn little now. either
from the exhausted or intoxicated condition of
the patient. and yet must give his immediate
and best attention. If physician, under those
circumstances, does that that seems best to his
enlightened judgment, is he responsible should
the result prove unfortunate? The tendency
to draw more strictly
THE LINE OF RESPONSIBILITY
Is shown each year. Should patient die from
chloroform inhaled in sitting position in q
dentists chair it could no longer be urged in
behalf of the surgeon, whose patient had been
chloroformed out of existence, as it was sue
cessfully argued in behalf of the young Partisan
surgeon. in 1858, who had been imprisoned for
the death of patient under chlOroform, on
whom he was operating without assistance, that
there were no fixed rules for the administration
OF chlOrOfOrm. The English chlorOfOrm COM
mittee appointed by the Royal Medico Chirurgi-
cal Society laid down in 1864 the rule that anes-
thetics should always be given in the recum-
bent position and never in the erect position.
The reason of this rule is evident. In natural
respiration the rising and falling of the ribs is
produced by the intercostal muscles, and the
respiration is called thoracic. AS the patient
comes under the influence of the anesthetic
these intercostal muscles become paralyzed and
cease their action. The respiration is then kept
up by the action of the diaphragm or abdominal
respiration. Those who have seen much of the
patients under the influence of anesthetics in
our large hospitals must have noticed how
quickly patient stopped breathing at this
stage if an assistant pressed against the abdo-
men, to watch the operation or to pass an instru-
ment. Now. as soon as the patient comes
fnlly under the influence of an anesthetic she
slips down in tine dentists chair. The weight
the abdomen-preventing the diaphragm from
acting. think with the present knowledge of
ansesthetics that a surgeon who should adminis-
ter chloroform to patient in the erect position
in the dentists chair, with her clothes tight
around her waist, and the patient should die. he
would justly be held for manslaughter. During
the early ages of anesthethics. the knowledge of
the profession was only experimental. That age
has passed. The most distinguished men in the
profession, as long ago as 1864. published this
rule and the reasons for it. Subsequent expert
mentaton has demonstrated the justice of it
1t has been adopted by all our modern writer's
on the subject. The courts have held over and
over again that a physician must practice ac-
cording to the well known rules of his profess
sOn and if he departs from them it is at his
peril Now if he has read any Of the medical
authorities issued in the last fifteen years, he
must have seen this warning; if he neglects it.
and life is lost by his neglect, what escape is
there from the charge of manslaughter? Next
to deaths in The dentists chair come the fire.
quency of deaths from operations for piles and
other operations of this kind about the rectum
When we recall the fact of the ano genital region
beng the last to give up its senstiveness, we can
well understand this result, because the bound
ary line between danger and death is so slight
that before the anus ceases to respond the patient
is across the line OF fatal narcOsis. Again, the
patient is rolled over very frequently for the sur
geons benefit, and thus there is danger of inter-
ierlng with the abdominal respiration. Anes-
thetlcs should never be used for these cases so
as to produce full loss of sensibity. Anesthetics
should not be used at all unless the patient is
very nervous, and only enough to blunt the
susceptibility of the parts. With the knowledge
OF this popularity of the anO genital region
given the profession by Anstie, and so thor
ou@hly the property Of the profession, failure to
observe these precautions will eventuate in the
surgeon being held on serious charge. should
death follow, unless ne could show that the ope-
ration was OF sufficient gravity to call for this
unusually dangerous use of anesthetics. That
it was not merely his Individual opinion, but
thaf 1t was the JOINT opinion of a consultation:
that the anesth hetc was administered by a per-
son skilled in the business and not by medical
student. and that the person that administered
the anesthetic had no other part OF the opera
ton to attend to to distract his attention from
the effect the anesthetic was having on his pa
tlent. This is point the surgeons should well
consider, for it is an established principle of law
that physician or surgeon. in the performance
of his professional Duties is liable for injuries
resulting from his want of ordinary diligence
skill and care GIandon VS.. Carter, 8 Conn, 2O9)
Already in England. according to the last edi-
ton OF Taylor's Medical Jurisprudence" cases
of this kind have been brought before the
courts, suits for damages for deaths from chlo-
rCform-and. although they broke down from
failure OF the proof-still the courts held the
same principle of law was applicable to these
cases as to other civil suits against physicians
CHLORoFORM TO DETECT FRAUD.
Another question Of interest is whether it is
justifiable to use chloroform against the persons
will to detect fraud. During the war soldiers
would initiate the curvature of the spine or
stiffness of joint, or some other disease as
deafness this malingering could always be de-
tected by putting the patient under the effects
of chlorOform The same trick is frequently done
now by persons arrested under some criminal
charge, who often simulate deafness or some
other defect to conceal their identity 1t is an
interesting fact that no matter how much YOU
may inculcate upon patient that he shall not
speak, he will Invariably answer when coming
from under the effects of chlorOform. The stiff
knee, apparently permanently anchylosed. will
bend, and the curved spine that they have
learned to simulate so well that it will remain
curved in sleep, becomes straight. and there is
not simulated disease but can be discovered
by chlorofOrm. Has the surgeon any right to
make use of this means with the arrested party?
think decidedly not. Every party is to be pre-
sumed innocent till proved guilty. and the law
Will not compel person to crmnate himself
1t would seem that the old opinion holds that a
prisoners person was sacred, and evidence OBJ
tanned in that way would be ruled out by the
courts ii obtained against the will of
the party. So far has this principle been
carried that the court of appeals has decided
that judge cannot even make a pris-
oner stand upin his seat for the purpose of hay
ing witness on the stand identify him. As for
enlisted persons, the army officer would proba-
tyr ont, Ola