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1919 Journal of the American Medical Association  
In this book are collected the results of an exceptionally wide experience of neuroses developing in the British army. Throughout it presents the appearance of a collection of notes hastily thrown together, owing, no doubt, to the need for such a source of information on the part of medical officers engaged in the work of reconstruction. The material shows a lack of grouping, and there is a somewhat confusing transition from one topic to another. Part of this is due to the fact that Dr. Mott,
more » ... ct that Dr. Mott, before the war, interested himself almost wholly in pathologic histology and anatomy, and he evidently finds it difficult to feel quite at home in discussing disorders which he recognizes as psychogenic in nature. Unfortunately, the author also has repeated the views which he published in 1916 on the nature and causation of shell shock, although he admits that he has been obliged since then to change them. He makes it quite clear that he recognizes two types of cases: the one due to real structural dam¬ age to the nervous system, for which he uses the term "commotional shock," and the other, by far the more frequent, which is functional in character and which he calls "emo¬ tional shock." Obviously the two are quite distinct, although they may occasionally be present in the same case. To call them both shock, therefore, is simply to perpetuate the grave errors which belong to the title shell shock, long since dis¬ carded by the British army. In the text these two types of disorder are perplexingly mixed at times. The cases of structural lesion due to the effects of high explosives are admirably described and discussed. Excellent illustrations of the histologie changes are given and com¬ parisons made with the effects of carbon monoxid poisoning, on which Mott had previously done much work. The descrip¬ tions of the various form of functional disorder are excellent and well illustrated by cases. No essential difference between the war neuroses and psychoses and those of peace times were discovered, although the symptomatology was found to be colored by the military nature of the conflicts and experiences that called them forth. The views expressed as to their pathogenesis are entirely sound, though not given with the same detail as is done in the case of histologie changes. The differentiation from malingering is discussed briefly but helpfully. In an appendix is a valuable and well illustrated account of the methods of study and examination of patients. In spite of its minor drawbacks, the book is a decided contribution which will be found helpful to the general practitioner, and which the neurologist cannot afford to be without. The Supreme Court of Michigan, in affirming an award of $189 made against the defendant by the state industrial accident board, in favor of the plaintiff for medical, surgical and hospital expenses incurred by him as the result of an accidental injury which he sustained while in the defendant's employ, holds that cases may arise in which the employer will be liable for such expenses although not given an oppor¬ tunity to furnish needed medical and hospital services as required by the workmen's compensation act. The court says that in this case the plaintiff, in attempting to lift or carry some material, experienced an injury, the nature of which he did not then apparently understand or localize, but which caused him to suspend work, telling his "boss," who was the superintendent, that he was sick and had to go home, which he did, arriving there between 9 and 10 o'clock, as his wife testified, not yet knowing what ailed him. Shortly before noon he discovered that he was suffering from a hernia. During the day he experienced increasing pain and grew weaker. His wife summoned their family physician, who called shortly after supper, and found the plaintiff suffering with a strangulated femoral hernia, which in the physician's opinion, demanded prompt surgical action, and he at once called in for consultation a surgeon in whom he had confidence, and an immediate operation was deemed by them necessary to save the patient's life. He was thereupon taken in an ambulance to the city hospital before dark that evenin, and operated on almost immediately, remaining in the hospital nineteen days. Was the defendant employer liable for the expenses thus incurred? It appeared undisputed that within twenty-four hours after the accident the defendant was fully notified of it, and told where the plaintiff then was, by his wife, who requested aid in his behalf. After such notice, request, and reasonable opportunity to furnish or offer the required treatment, and failure to act, the defendant was clearly liable for the plaintiff's reasonable expenses in securing them during the remainder of the three weeks after the injury. The more serious question was that of the expenses incurred in the claimed emergency prior to notice. In this case there was, as the result of prompt and efficient action after the plaintiff's critical condition was discovered, an early and full recovery, at small expense to the defendant compared with a death loss, which was threatened and would have been the result of delay until the' following morning, as the undisputed medical testimony showed. It was indicated that the plaintiff, after his return home and his distress increased, was not in a physical or mental condition to judge or act in the matter. His wife was not shown to have then known he had sustained an accidental injury. She knew he was sick, and, when his condition indicated the need, called in their family physician, who recognized the emergency. Broadly considered the statute as to medical service to be paid for by the employer involves the combined interests of both parties. What services were actually and reasonably necessary to that end, and what is a fair compensation there¬ for, are the vital inquiries. Unquestionably that construction of the statute is logical, and the adopted rule sound, which requires notice and oppor¬ tunity to the employer to select the physician and furnish the needed service during the prescribed three weeks before the injured party can secure it at the employer's expense; but in the many complications which arise in industrial activities it is not an unreasonable or strained construction of the statute, in view of its purpose, to recognize as inferable exceptions in extraordinary cases when the surrounding circumstances and critical condition of the injured party present emergencies, or exigencies demanding prompt action, which reasonably warrant the injured party in securing the then needed service at the employer's expense without first
doi:10.1001/jama.1919.02610510036033 fatcat:mtex5ksthfcntjqm3kogbrazjy