Second report of the Departmental Committee appointed to inquire into the law relating to coroners and coroners' inquests, and into the practice in coroners' courts.

  • Great Britain. Committee on Coroners.
Date:
1909
Catalogue details

Licence: Public Domain Mark

Credit: Second report of the Departmental Committee appointed to inquire into the law relating to coroners and coroners' inquests, and into the practice in coroners' courts. Source: Wellcome Collection.

    221/232 (page 191)
    191; 19 November 1909. ] die than females. The suggestion that I make is that it is in males that the most cases of accidents occur. 11,400. (Sir Malcolm Morris.) A greater proportion of alcohol, and so on ?—Yes. 11,401. (Chairman.) And tobacco possibly ’—Yes, and diseases generally. 11,402. (Str Malcolm Morris.) Are your statistics from private practice or from hospital ?>—Both. 11,403. (Sir Horatio Shephard.) The one is adminis- trations and the other is deaths?—Yes, but it is curious that the Registrar-General’s returns of deaths do not agree with the relative proportions of males and females to whom anesthetics are administered. In 1907, for instance, the deaths from anesthetics in males are registered as 102 and in females 84; whereas in my figures, extending over nearly 10,000 cases, they are as 3 to 5. 11,404. (Chairman.) Is there anything, do you think, in this fact, that anesthetics are administered more freely to women because they are less able to bear pain ?—That may be; but if they are administered for any reason to women there ought to be some relation between the proportion of deaths. I think it rather tends to show that these returns must be taken with a very large grain of salt. 11,405. Then another point arises on these returns. We have no figures whatever to show the ratio between the number of deaths and the number of operations P— None whatever. 11,406. Can you help us in that matter?—In a letter that I wrote to the papers I made a very rough approximation. I first of all took the number of administrations in two hospitals—King’s College Hos- pital and the London—in one year. I then went through the Medical Directory, and looked out all the public hospitals in England alone where operations were likely to be performed, with the number of beds that they had, and I made an approximate estimate on that basis. The conclusion that I then came to was, that in England alone the administrations were very many more than I had anticipated; I put them down at half a million a year. But even that is very much under-estimated, because I did not take into account nitrous oxide cases. According to Mr. Matheson, who gave evidence here, he ‘put the latter at not less than 2,000,000 per annum for dentists alone. But that is a very rough estimate, and it is merely an indication of what an enormous number of administrations there must be. 11,407. Of the longer anesthetics, such as chloro- form and ether ?—Yes, a very large number. 11,408. Have you any means of telling us whether, looking at Dr. Hewitt’s table, the number of operations has increased in anything like the same proportion, or the number of severe operations P—It is very difficult to say that, but looking at that table, I suppose that 1887 is just about the time when this increase com- menced. 11,409. In abdominal and brain surgery ? — Of course, the jump since 1887 has been very enormous indeed. I should not like to say that it is im propor- tion to the increased death rate, I think something must be due to altered methods of registration of the latter, but since 1887 I am quite sure the jump has been enormous. 11,410. (Sir Malcolm Morris.) Has it been larger in the last decade. I mean is it in geometrical progres- sion ?—I think it is, for this reason, that there are such a very much larger number of young men doing the work now than there were 10 or 15 years ago. Then it was in the hands of comparatively few, but now there are a very large number of highly qualified, highly trained, highly skilled men who operate, and the public place themselves in the hands of the younger men very much more than they did. 11,411. (Chairman.) And I suppose since 1887 a great many more of what you may call capital opera- tions are done. Abdominal surgery has almost entirely arisen since then ?—TI should think so. 11,412. (Sir Malcolm Morris.) And all these liver operations for. gall stones and brain operations and kidney and prostate and any number of new things P— Feeds -3 [ Continued, 11,413. (Chairman.) So that an enormous number - of lives are saved although a certain number of lives are lost ?>—Yes, I think that is without question. I should like to emphasise the fact with regard to the difficulties of figures that it is not only difficult to arrive at the number of administrations, but it is absolutely impossible to arrive at any idea of what number, if any, of deaths are due to what I may call unqualified agencies. We have absolutely no information upon the point. Allusion has been made to 138 cases in 21 years; 13 cases in 21 years I consider practically negligible. 11,414. (Sz Malcolm Morris.) Out of millions and millions of administrations ?—Yes, you cannot put them at less than 10 millions. 11,415. (Chairman.) If, then, Mr. Matheson’s figures go over the same number of years, as they ~ probably do, at least as many people have been killed by falling downstairs?—Yes. With regard to that again, it seems to me that if you are going to take the Registrar-General’s figures as the basis of the » increase in the number of deaths, I should like. to - point out that most of the figures registered by him® are derived from registered practitioners. The un- registered practitioner does not, as a rule, approach the Registrar-General in any way; so that the increase in the number of deaths is due to an increase at the hands of qualified administrators, not of unqualified persons. ; 11,416. What is your remedy. Would you allow absolutely unqualified persons to administer anesthetics if you could stop it ?—I should be very glad indeed to stop it. 11,417. Would you draw no distinction between other forms of unqualified practice and the administra- tion of anasthetics P—Certainly not. It is suggested that if a bone-setter can call in his butler to give an anzesthetic, you should prosecute the butler, prosecute the servant, penalise the servant, but not the bone- setter. I cannot see why the distinction is made. 11,418. I cannot quite follow that. (Str Horatio Shephard.) One is giving a direct poison and the other may be doing some operation. (Str Malcolm Morris.) But the one is giving it under compulsion. 11,419. (Chairman.) Let me put it in this way. If I, being a! lawyer, recommend my friend, Sir Horatio Shephard, to take a particular pill, that is unqualified practice, but there is a very great differ- ence between my doing that, saying you will find these pulls excellent, and my giving him an anesthetic and performing an operation upon him ?—But with all due deference, your friend could not refuse to pay you your wages if your pill failed to act. That is the position. The bone-setter says to his butler, “ You come and give an anesthetic.” ‘No,’ says the man, “T will not.” Then the bone-setter says, “ You must leave my service.” 11,420. In that particular case. But surely there is a great difference between a man simply prescribing a drug—I am taking an unqualified practitioner—a chemist, say, who, when a woman comes with a bad cough and asks for a prescription, gives her a cough mixture and a man who gives her an anesthetic and performs an operation upon her?—It is a question of degree; he is equally culpable. He may administer morphine or cocaine, cyanide of potassium, or some of the most poisonous drugs. 11,421. But surely putting a person into a state of absolute unconsciousness is a serious power to entrust to anybody who does not belong to a recognised profession and has had no training in the profession 2. —But you have no guarantee that he is more qualified to give anesthetics if he is qualified. Sir Malcolm Morris’s inquiries, I take it, were directed to elicit my opinion as to whether I thought it was a personal element came in in giving anesthetics. I do think so. I think that many qualified practitioners are much less capable of giving anesthetics than a man who is perhaps nominally unqualified. 11,422. That shows that you must legislate for general cases and not, special ones ?—Exactly. There.