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SERVICES AT HEALTH CENTRES

Certain services will probably be included in one or more of thethree main centres :-Administration Cardio-rheumatism Backward childrenTraining school Speech Other special clinicsMass radiography Child guidance

building and precincts, and also allow for enlargement." Temporary " forms of construction could be employedat small centres so that the capital outlay need not militateagainst reconstruction when, with the progress of servicesand ideas, this becomes desirable.The present health centres in Bristol are :

1. One central health clinic.2. Four district health centres, built specially for the purpose.3. Four adapted clinics.Infant-welfare and antenatal clinics are still being heldin church halls and school-rooms, but a number of siteshave been acquired for the erection of modern healthcentres to replace these premises.

Medicine and the Law

Charges of Professional Negligence FailIN Holt v. Davies and the Nottingham General

Hospital, decided at the Notts assizes earlier in March,allegations of professional negligence and unskilful treat-ment failed entirely. Miss Holt, a governess, claimeddamages from the surgeon who had performed an opera-tion for haemorrhoids, and from the hospital, on theground that a 15-in. swab of cotton-wool had been leftin her body and that her health had been ruined thereby.The operation, it was said, had been performed at thehospital on Jan. 30, 1941 ; she had been dischargedfrom hospital on Feb. 12, though she had fainted frompain on the previous day. On the 26th her sister hadcalled in the surgeon because of the patient’s suffering.He did not visit her till March 22, when, it was alleged,he made an examination and declared that the painswere imaginary. On March 24 her own medicalattendant called in the district nurse and ordered anenema to be administered. Thereafter the swab camefrom her ; it was shown to the defendant surgeon whowas said to have asked the patient and her family notto talk about it. According to her counsel, she re-enteredthe hospital and was given massage and X-ray treatment ;she had been a healthy and athletic woman of 27 beforethe operation, but was now a complete wreck who hadto be carried into court.The defendant surgeon’s evidence was that, during

the original examination, the plaintiff wept and behavedhysterically ; she then refused the operation but waslater admitted to the pay-bed wing where it was per-

formed. Having made the excision, he introduced thetail end of a piece of gauze ; its maximum distance insidewould be 1 in. ; the remainder he folded over as thefirst layer of the external dressing ; cotton-wool wasplaced outside this. The surgeon said that he did allthis himself ; it was utterly ridiculous to suggest that heput in 15 in. of cotton-wool; it would be the wrongmaterial to use ; it would tend to come to pieces. Nonurses, he said, would have to insert a swab or pack ; -,the nurses concerned were highly competent and haddone nothing amiss. Sisters from the pay-bed wingtestified that external dressings were properly appliedand that cotton-wool was never used for internal dressingsat the hospital. Medical witnesses gave evidence thatthe plaintiff suffered from hysteria and was an anxious,restless, and neurotic type of patient.

Mr. Justice Charles said that the defendant surgeonwas of the very highest experience and reputation ; itwould have been the act of a very unskilful beginner tohave done what was alleged. The judge was satisfiedthat the cotton-wool, however it found its way into thepail, was not introduced into the plaintiff’s body bythe surgeon ; " of that I am quite certain ; I have nodoubt of it at all." After mentioning the evidence of therecords of bowel movement in the hospital books, andthe care of the nursing staff night and day, he declaredhimself satisfied that the swab was not introduced by theservants of the hospital; how it came into the patient’sbody he did not know. The plaintiff’s case, he con-cluded, had broken down in the face of the extremelycareful evidence of the surgeon and of every nurse whohad been in charge of the patient. Judgment was givenfor both defendants and leave to appeal was refused.It was unfortunate, said the judge, that the case hadtaken so long to come into court ; the delay was veryunfair to the defendants.

Mr. Llewellyn Davies was represented by Messrs.le Brasseur and Oakley acting for the London & CountiesMedical Protection Society.

Liability of Radiological DepartmentsThe British Journal of Radiology (1946, 19, 45) has use-

fully reproduced Dr. W. M. Levitt’s presidential address tothe section of radiology of the Royal Society of Medicineon the legal responsibility for accidents in radiologicaldepartments. The address covered the respective respon-sibilities of hospital authorities, radiologists, and radio-graphers and showed in particular how important wasthe decision in Gold v. Essex County Council in 1942.Previously public hospitals could still shelter them-selves under the classic ruling in Hillyer v. St. Bartholo-mew’s Hospital, delivered in 1909. Applying the prin-ciple of that famous case, the judges have in effectdeclared that no liability attaches to a hospital whichgives gratuitous services to patients for any negligenceon the part of the professional staff, whether medical ornursing, provided that the hospital authorities havetaken reasonable care to choose or appoint staff properlyqualified to carry out the duties concerned. In Gold’scase a child, being given Grenz-ray treatment for wartson her face, was severely burned. The treatment hadbeen ordered by the visiting radiologist and was givenby the radiographer whom the defendants employed. Thedefendants pleaded the decision in the Hillyer case in vain.

Readers may be referred to Dr. Levitt’s exposition for thesignificance of the Gold case. In a final section of hisaddress he deals with the liability of manufacturers ofapparatus. Lord Atkin’s opinions indonoghuev. Stevenson(1932) made clear that, if a maker sells his products in such aform as to show that he means them to reach the con-sumer without any chance of intermediate examination,he owes the consumer the duty to take reasonable care intheir preparation so as not to injure him. That was thecase where the purchaser of a bottle of ginger-beer founda snail where no snail should be ; the manufacturer,though he had no contractual relationship with the con-sumer, had to pay for the want of care. Dr. Levitt pointsout that this principle has been applied to the fitting of aside-car to a motor-cycle ; the side-car came loose, thepassenger was injured, and the person who fitted it wasmade liable. So also, in 1940, the purchaser of a recon-ditioned motor-car obtained damages when a wheel cameoff next day and he was injured. In the same way, saysDr. Levitt, a supplier of X-ray apparatus or high-tensionapparatus will be liable if a defective machine is supplied.