Medicolegal

1920 Journal of the American Medical Association (JAMA)  
This is an instructive guide for the dietetic management of gastro-intestinal diseases. A chapter on general dietetic requirements emphasizes the importance of every physician's knowing not only the value of particular foods, but also the manner of their preparation for the invalid. The patient's desires and taste should be frequently a guide as to which foods are best suited to his individual case, especially in the gastro-intestinal conditions in psychoneuroses. The chapters on hyperacidity,
more » ... s on hyperacidity, reflex and organic, on duodenal and gastric ulcer, and on obstipation, colitis and chronic diarrheas are complete and well worth perusal by the practitioner. In several chapters on the dietetic management of preoperative and postoperative conditions, Kelling of Dresden lays particular stress on preparing the patient by dietetic measures, in order that his resistance may be at a maximum before every operation. War conditions have shown that protein loss is not necessarily associated with a lowered resistance to infection. There is a chapter on the preparation of a diabetic patient for operation. No mention is made of the Allen management. In fact, starvation days were not found necessary. These volumes consist mainly of a republication of a number of papers published by Head and his co-workers in Brain over a period extending from 1905 to 1918. No material change has been made in their arrangement. Each paper contained an account of the methods employed in testing sensation. These have been omitted, and a fresh chapter in which they have been combined has been added. An introduction and an epilogue dealing with the common aims which underlie these various researches have been added. Finally, some of the most serious criticisms of their researches have been considered in an appendix. The first volume consists of three papers on the peripheral nervous system. The profound studies herein described resulted in a new conception of the physiology of sensation. They led Head, Rivers and Sherren to conclude that the sensory mechanism in the peripheral nerves consists of three systems: deep sensibility, protopathic sensibility and epicritic sensibility. In addition to the sensory studies there are found some illuminating observations on changes in the skin and nails, and comments on paralysis, emphasizing the effect of supplementary motility. In the second volume the grouping of afferent impulses is described. After showing that afferent impulses which reach the central nervous system by way of the peripheral nerves undergo rearrangement within the spinal cord, so that each tract is devoted to the conduction of one of the specific impulses, such as pain, the authors attempt to trace the course of the impulses upward. They show that painful, thermal and tactile impulses ultimately pass from the point of entry to the opposite side of the spinal cord, having undergone recom¬ bination on the side into which they enter. A lamellar arrangement of fibers as they course upward is pointed out. Continuing their researches to the brain, there are exhaustive studies on the grouping of afferent impulses in the brain stem, and sensory disturbances from lesions of the optic thalami and· the cerebral cortex. These volumes will be of interest to the physiologist and all clinicians. They permit a comprehensive view of the newer conceptions of the physiol¬ ogy of sensation, and should tend to stimulate further interest in this subject, which has so great a bearing on clinical neurology. The clinician will be especially edified by the full case reports and numerous illustrations. The Supreme Court of New York, Appellate Division, Third Department, in affirming an award under the workmen's com¬ pensation law, says that the claimant sustained an injury to his right eye, which made its removal by operation necessary. Simultaneously with the operation, the sight of the left eye became affected,· and was almost wholly lost. No injury appeared to have been done to the eyeball, the optic nerve or any physical thing constituting a part of the organ of sight. Yet distinguished physicians were agreed that the claimant was not simulating blindness, and in fact did not see. Am neurologist said that the claimant could not see at all, and diagnosed the trouble as "traumatic neurosis" or "hysterical blindness," stating that "this psychic shock, the surgical operation which produced the shock, was the primary means of producing that hysterical blindness." It was not important that the claimant had an uninjured physical equipment with which he should, but could not, see. After all, a man sees with his brain, not with his eyeball or his optic nerve, and if an operation performed on an eye so affects the mind, the nerves or even the imagination that a man genuinely loses vision with his other eye, then the faculty of sight has been more directly attacked than when assailed through the mechanical contrivances by which it functions. The work¬ men's compensation law of New York provides that every employer shall pay or provide compensation for the disability or death of his employee resulting from an accidental per¬ sonal injury. All the consequential results of an accidental injury are thus made compensable. The operation of this section is not in the least limited by the provision which merely makes certain that conditions consequent on disease following accidental injury shall be regarded as themselves the consequence of such injury. This was perhaps a neces¬ sary provision, for the reason that, strictly speaking, disease is never caused by injury, but is merely provided with oppor¬ tunity thereby. If an injury requires an operation, and the operation deranges the mind or nerves, clearly disabilities resulting frorn the derangement "result from the injury. In negligence cases involving railroad disaster, nothing is more common than recoveries for nervous and hysterical disorders due to shock. If a neurasthenic condition consequent on accidental injury is compensable, as it clearly is, then surely a disorder, such as hysterical blindness, which forms a con¬ stituent part of that condition, must also be compensable. Care Required of Private Hospitals (Davis v. Springfield ¿¡ospitai (Mo.), 218 S. W. R. 696) The Springfield (Mo.) Court of Appeals says that the plaintiff's former husband was a pay patient at the defendant hospital, which was not claimed to have been a charitable institution, but was conducted on the theory of charging and receiving adequate compensation for the services rendered. That it was liable for its negligent acts was not controverted. Two trials were had of this case, the second one being on the theory that this patient, being delirious and unconscious of his acts and danger, left his room on the third floor of the hospital, between 12 and 1 o'clock at night, in the absence of any nurse or attendant, and went into the hallway, opened a door leading to a fire escape, and fell down the steps of the fire escape to the ground, receiving injuries from which he died a few hours later. A judgment for damages, for an amount not stated by the court, was rendered in favor of the plaintiff, and is affirmed. But it was with some hesitation that the court came to the conclusion that there were suffi¬ cient facts to carry to the jury the question that the defendant could and should have anticipated that the patient was likely to receive injuries unless more closely watched and guarded. There was no queslion but that his mental condition and conduct were such as reasonably to warn the hospital atten¬ dants that unless watched he was likely at any time to leave Downloaded From: http://jama.jamanetwork.com/ by a RYERSON UNIVERSITY LIBRARY User on 06/18/2015
doi:10.1001/jama.1920.02620440052033 fatcat:oua7647pbbhvfp3ynklmyk3ada