Journal of the American Medical Association (JAMA)
The Supreme Court of Kansas says that, in this action to recover damages for alleged malpractice, the plaintiff intro¬ duced evidence which tended to prove that she was pregnant and in ill health, and had consulted one of the defendants, a local physician, on a number of occasions. He made examina¬ tions from time to time, and first informed the plaintiff that she had a tumor in the mouth of the uterus ; and later, after the plaintiff had informed him she was pregnant" said that her condition
... hat her condition was not due to natural pregnancy, but that, if she was pregnant, the fetus was in the fallopian tube, and must be removed by an operation or the condition would result in death. He requested her to go with him to the other defendant in Kansas City for a roentgen-ray examina¬ tion, which would reveal the cause of her trouble. She went with him to Kansas City for that purpose, and they consulted the other defendant, who made a digital examination, and said that a roentgen-ray was unnecessary; that a blind physi¬ cian could tell what was the matter; that the ailment was pregnancy outside of the uterus ; and that it was necessary to have an operation at once. No roentgen-ray examination was made. A few days afterward, the plaintiff went to a hospital in Kansas City, where an operation was performed and it was discovered that the plaintiff was pregnant, but that the fetus was in the uterus and not in the fallopian tube. The incision was closed and in a short time the plaintiff returned to her home. Afterward she gave birth to a normal, healthy child. After the operation, the defendants reported to her that they had discovered a number of tumors in and about the uterus, and that after the birth of the child they must be removed. When the child was born, a hernia developed in the incision that had been made. Some months later, the plaintiff returned to the hospital and was operated on by another sur¬ geon for the purpose of reducing the hernia. He made an incision, examined the abdominal viscera, and found that the fallopian tubes and the appendix were in bad condition. They, together with the ovaries, were removed by him. He dis¬ covered no tumors about the uterus, but did discover some scars and adhesions on the omentum, some of which might be called tumors. The defendants said, in their brief, that is was conceded that if they made a wrong diagnosis, they did not operate in pursuance to such diagnosis, but so far as the hazy evidence of the plaintiff threw any light on the subject, it appeared that they made an explorative operation, on account of the seriousness of the plaintiff's condition, a method which is approved by the best surgeons according to the testimony of a physician who was a witness for the plaintiff. On the trial, the court sustained a demurrer of the defendants to the plaintiff's evidence. But that judgment is here reversed, and a new trial directed. It is unnecessary, the supreme court says, to make any extended comment concerning the manner in which the defendants treated the plaintiff as their patient. It is enough to say that they made a serious mistake in their diagnosis, and that the evidence tended to show that they were negligent in not making a roentgen-ray examination. The demurrer should have been overruled, and the" evidence should have been submitted to the jury. It is the rule in Kansas that negligence of a physician or surgeon must be proved by expert evidence. That rule, how¬ ever, was satisfied by the testimony of a physician that he thought a six months' fetus would show a shadow on a roentgenogram ; that if he diagnosed a case by an abdominal condition and felt positive, without a roentgenogram, that it was a serious case, and one for immediate surgical treatment, he wouldn't bother with a roentgenogram ; that there are pregnancies where unusual, extraordinary symptoms appear, which are hard to diagnose, but it is not hard to ascertain whether the condition is a serious one ; and that an explora¬ tory operation was not justified if the case was so clear and the diagnosis so plain that, to use the language of the man diagnosing it, a "blind physician could tell what was the mat'.er." There are three age periods of bone: (1) the growing period, from 1 to 20 years ; (2) the period of maximal health, from 20 to 40 years, and (3) the period of decline, after 40. Different lesions affect different age periods. Injuries to bone are according to the age of the bone. Take, for instance, the hip : in the first period fracture occurs at the epiphysis, which is the weakest part. In the second period, the epiphysis is united to the neck of the femur and synovial membrane ; the syno¬ vial membrane slips. In the third period, the bone is more brittle, owing to absorption of calcium salts, and fracture of the neck of the femur occurs. In childhood, the bones are much more flexible and greenstick fractures occur. In older people long oblique fractures occur. In the elderly and aged, comminuted, transverse fractures occur. Disease of the bone is also in relation to age periods. The origin of the lesion is important. By determination of the origin, certain lesions can be ruled out. Bone lesions in children show three age periods: from 1 to 3; from 3 to 6, and from 6 to 14. In the first period the common diseases are scurvy, syphilis and rickets. From 3 to 6 years, tuberculous lesions of the joints are common. From 6 to 14, Perthes' disease is most oftenŝ een. There are also laws relating to sex : from 1 to 5 years, lesions are as common in girls as in boys. After 6 years, boys play more dangerous games and suffer a higher pro¬ portion of fractures. In men, the heavier trades show a larger percentage of bone lesions. After 50 the two sexes again become equal in this respect. In regard to neoplasms, carcinomatous métastases are more common in the female, following carcinoma of the breast. The most common cause of bone cancer in the male is carcinoma of the prostate, metastasizing into the pelvis and the lumbar spine. Operative Treatment of Idiopathic Scoliosis Dr. Armitage Whitman, New York : These cases exclude scoliosis from well known causes and postural deformities.