1
1452 same time, the parents will get a rest from the heavy responsibility which the care of such children entails. IRRIGATION FOR PERITONITIS An interesting case report is to be found in the annual report of the medical department of the United Fruit Company for 1931. Dr. R. Aguilar tells how a man, 27 years old, was sent into hospital from a town 60 miles away with an acute abdomen Laparotomy disclosed a ruptured appendix, the gangrenous tip being separated and adherent behind the caecum. There was general peritonitis. The abdominal cavity was irrigated with normal saline and closed with three drainage-tubes. On the second night after operation the patient continued to vomit coffee-coloured fluid and had hiccup. On the third day the pulse was poor, the vomit had a faecal odour, and no gas or faecal matter could be passed per rectum. At this stage the surgeon passed 2000 c.cm. of warm normal saline into the abdomen through the upper drainage-tube, the other two being kept closed. When the abdomen was distended with this fluid, it was gently massaged, and after a few minutes the saline solution was allowed to escape. This treatment was given three times during the day. That night the patient passed some gas and a small stool. On the next (fourth) day two more treatments of irrigation and massage were given. Pituitrin and cardiac tonics were administered. On the fifth day the temperature fell to normal and recovery was thereafter uneventful. It is difficult to resist the conclusion that without this heroic but quite rational treatment the patient would have died. MEDICINE AND THE LAW Miscarriage Caused by Noise A CASE of interest to medical practitioners and students was tried last week before Mr. Justice Horridge and a common jury. The facts were as follows. At about 4 o’clock in the morning a motorist skidded ; his car crashed through a private hedge and through a lattice fence and then collided with the wall of a house. A lady who was three months’ pregnant was asleep in an upstairs room of the house. The noise awoke her and she and her husband helped the motorist and his companion, neither of whom was seriously injured. Next day the lady had a mis- carriage. She and her husband sued the motorist. The husband’s claim was for special damages to recompense him for the money paid in connexion with the accident to his wife ; the wife’s claim was for general damages for her pain and suffering. Medical evidence on behalf of the wife was given by her own doctor, who was clearly of opinion that the shock resulting from hearing a noise was enough to cause a miscarriage. The defence was first that there was no negligence since the car accident was unavoidable, and secondly that the miscarriage could not have resulted from merely hearing a noise. Evidence on behalf of the defence was given by Mr. John Ellison, F.R.C.S. The defendant also sought to establish that from the condition of the lady after the miscarriage it was clear that before the miscarriage she was suffering from endometritis, and that that was the cause of the accident. The jury found a verdict for the plaintiffs ; the husband recovered what he had paid on his wife’s behalf and the wife was awarded Y,175. It is now no longer possible for a defendant to contend that the lady’s injuries were too remotely connected with the defendant’s act to justify the recovery of damages. There need not be physical impact. Nervous shock, the law recognises, can create physical injury. Nervous shock resulting from reasonable apprehension of injury to one’s self will justify a claim for damages- as in the case of a person on the pavement faced by a runaway tram-car. In the case of shock due to fear for another person the law is not so clear, but apparently a mother can recover damages for shock due to reasonable fear of immediate injury to her child. Pins in a Pie A woman who bought some pork pies at a butcher’s shop in Chingford found that one of them contained two drawing-pins. One pin she extracted from the back of her throat after feeling sharply pricked by the point of it. The other she had swallowed already. The defendant firm of butchers explained the unfortunate occurrence by saying that the pins, used to keep linoleum in place on a table top, had somehow become loose without being noticed by persons preparing the ingredients of the pies on the table. When the plaintiff’s claim was heard, there was medical evidence of inflammation of the throat, loss of weight, nervous debility, and dyspepsia. It was suggested that the plaintiff’s recovery would be accelerated when the legal proceedings were over. Mr. Justice Macnaghten observed that so uncomfort- able an experience as swallowing a drawing-pin was not the kind of incident a patient could immediately forget. The plaintiff had got into a nervous condition as the result of the accident and she was entitled to be compensated for that. He awarded 200. The defendants had admitted liability. This was indeed one of those cases where the plaintiff is hardly troubled to prove negligence. In the legal phrase res ipsa loquitur. If the established facts are such that the proper and natural inference is that a plaintiff’s injuries happened through the defendant’s negligence, the thing speaks for itself. The text-books usually cite in this connexion the old case of Byrne v. Boadle where a flour-barrel hurtled out of the upper floor of a warehouse and descended violently upon the plaintiff in the street below. Barrels would not behave thus unless some- body in charge of them had been careless. Another range of cases to which the like principle applies is that of injuries in railway collisions when the railway company has allowed two trains to be upon the same set of rails ; here again the thing speaks for itself. There was a reasonably close parallel to the pork-pie case in 1905 (Chaproniere v. Mason) where plaintiff bit on a stone in a bun supplied by the defendant. Jelf J. told the jury it was for the plaintiff to make out negligence in the first place. The Court of Appeal corrected him ; the defendant knew all about the manufacturing of his buns, the plaintiff knew nothing. Stones ought not to be in buns nor drawing-pins in pork pies. ROYAL EYE HOSPITAL, LONDON.-A dinner in in celebration of the seventy-fifth anniversary of the founding of this hospital was held on Dec. 9th at the Frascati Restaurant, with Lord Elibank, the president, in the chair. A message from the King expressing his interest in the hospital was read. Lord Elibank spoke of the plans for an appeal for jS150,000 for a much-needed extension, and Mr. L. V. Cargill, chairman of the hospital. gave a sketch of its history and development. Mrs. Germaine responded to the toast proposed by Mr. Arnold Sorsby to the memory of her father, John Zachariah Laurence, the founder of the hospital. The Rev. E. H. Griffiths proposed the health of the guests, and Mr. F. A. Williamson-Noble responded. The evening concluded with a speech of Mr. A. D. Griffith, the senior surgeon, proposing the health of the chairman.

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1452

same time, the parents will get a rest from the heavyresponsibility which the care of such children entails.

IRRIGATION FOR PERITONITIS

An interesting case report is to be found in theannual report of the medical department of theUnited Fruit Company for 1931. Dr. R. Aguilar tellshow a man, 27 years old, was sent into hospital froma town 60 miles away with an acute abdomenLaparotomy disclosed a ruptured appendix, the

gangrenous tip being separated and adherent behindthe caecum. There was general peritonitis. Theabdominal cavity was irrigated with normal salineand closed with three drainage-tubes. On the secondnight after operation the patient continued to vomitcoffee-coloured fluid and had hiccup. On the thirdday the pulse was poor, the vomit had a faecal odour,and no gas or faecal matter could be passed per rectum.At this stage the surgeon passed 2000 c.cm. of warmnormal saline into the abdomen through the upperdrainage-tube, the other two being kept closed. Whenthe abdomen was distended with this fluid, it wasgently massaged, and after a few minutes the salinesolution was allowed to escape. This treatment was

given three times during the day. That night thepatient passed some gas and a small stool. On thenext (fourth) day two more treatments of irrigationand massage were given. Pituitrin and cardiactonics were administered. On the fifth day thetemperature fell to normal and recovery was thereafteruneventful.

It is difficult to resist the conclusion that withoutthis heroic but quite rational treatment the patientwould have died.

MEDICINE AND THE LAW

Miscarriage Caused by NoiseA CASE of interest to medical practitioners and

students was tried last week before Mr. JusticeHorridge and a common jury. The facts were asfollows. At about 4 o’clock in the morning a motoristskidded ; his car crashed through a private hedgeand through a lattice fence and then collided withthe wall of a house. A lady who was three months’pregnant was asleep in an upstairs room of the house.The noise awoke her and she and her husband helpedthe motorist and his companion, neither of whom wasseriously injured. Next day the lady had a mis-carriage. She and her husband sued the motorist.The husband’s claim was for special damages to

recompense him for the money paid in connexionwith the accident to his wife ; the wife’s claim wasfor general damages for her pain and suffering.Medical evidence on behalf of the wife was given byher own doctor, who was clearly of opinion that theshock resulting from hearing a noise was enoughto cause a miscarriage. The defence was first thatthere was no negligence since the car accident wasunavoidable, and secondly that the miscarriagecould not have resulted from merely hearing a noise.Evidence on behalf of the defence was given byMr. John Ellison, F.R.C.S. The defendant also

sought to establish that from the condition of thelady after the miscarriage it was clear that beforethe miscarriage she was suffering from endometritis,and that that was the cause of the accident.The jury found a verdict for the plaintiffs ; the

husband recovered what he had paid on his wife’sbehalf and the wife was awarded Y,175. It is nowno longer possible for a defendant to contend thatthe lady’s injuries were too remotely connected with

the defendant’s act to justify the recovery of damages.There need not be physical impact. Nervous shock,the law recognises, can create physical injury.Nervous shock resulting from reasonable apprehensionof injury to one’s self will justify a claim for damages-as in the case of a person on the pavement faced bya runaway tram-car. In the case of shock due tofear for another person the law is not so clear, butapparently a mother can recover damages for shockdue to reasonable fear of immediate injury to herchild.

Pins in a PieA woman who bought some pork pies at a butcher’s

shop in Chingford found that one of them containedtwo drawing-pins. One pin she extracted from theback of her throat after feeling sharply prickedby the point of it. The other she had swallowedalready. The defendant firm of butchers explainedthe unfortunate occurrence by saying that the pins,used to keep linoleum in place on a table top, hadsomehow become loose without being noticed bypersons preparing the ingredients of the pies on thetable. When the plaintiff’s claim was heard, therewas medical evidence of inflammation of the throat,loss of weight, nervous debility, and dyspepsia. Itwas suggested that the plaintiff’s recovery would beaccelerated when the legal proceedings were over.Mr. Justice Macnaghten observed that so uncomfort-able an experience as swallowing a drawing-pin wasnot the kind of incident a patient could immediatelyforget. The plaintiff had got into a nervous conditionas the result of the accident and she was entitled tobe compensated for that. He awarded 200.The defendants had admitted liability. This

was indeed one of those cases where the plaintiffis hardly troubled to prove negligence. In the legalphrase res ipsa loquitur. If the established factsare such that the proper and natural inference isthat a plaintiff’s injuries happened through thedefendant’s negligence, the thing speaks for itself.The text-books usually cite in this connexion theold case of Byrne v. Boadle where a flour-barrelhurtled out of the upper floor of a warehouse anddescended violently upon the plaintiff in the streetbelow. Barrels would not behave thus unless some-body in charge of them had been careless. Anotherrange of cases to which the like principle applies isthat of injuries in railway collisions when the railwaycompany has allowed two trains to be upon the sameset of rails ; here again the thing speaks for itself.There was a reasonably close parallel to the pork-piecase in 1905 (Chaproniere v. Mason) where plaintiffbit on a stone in a bun supplied by the defendant.Jelf J. told the jury it was for the plaintiff to makeout negligence in the first place. The Court of Appealcorrected him ; the defendant knew all about themanufacturing of his buns, the plaintiff knew nothing.Stones ought not to be in buns nor drawing-pins in

pork pies.ROYAL EYE HOSPITAL, LONDON.-A dinner in

in celebration of the seventy-fifth anniversary of thefounding of this hospital was held on Dec. 9th at theFrascati Restaurant, with Lord Elibank, the president,in the chair. A message from the King expressing hisinterest in the hospital was read. Lord Elibank spoke ofthe plans for an appeal for jS150,000 for a much-neededextension, and Mr. L. V. Cargill, chairman of the hospital.gave a sketch of its history and development. Mrs. Germaineresponded to the toast proposed by Mr. Arnold Sorsby to thememory of her father, John Zachariah Laurence, the founderof the hospital. The Rev. E. H. Griffiths proposed the healthof the guests, and Mr. F. A. Williamson-Noble responded.The evening concluded with a speech of Mr. A. D. Griffith,the senior surgeon, proposing the health of the chairman.