Civil Practice Research Articles

The medicolegal implications and status of fluoroscopy.

Fluoroscopy is apparently becoming of great medicolegal importance because of the augmentation of the number in the field of radiology, through the entrance into this specialty of many physicians who made use of the fluoroscope in the Army and Navy during the Second World War. As an old timer in this field of medicine, I consider it both my duty and privilege to warn my younger colleagues against the indiscriminate use of fluoroscopy in civil practice. During the past few months, I have seen several cases of roentgen dermatitis following and unquestionably due to fluoroscopy, all the result of overexposure and all produced by recently returned veterans who had had little experience with x-rays before their induction into the Armed Services. Because of the limitations of fluoroscopy and the dangers incident to its careless use, its medicolegal status demands careful consideration. With the present methods, perfected apparatus, and advanced knowledge of the effects of the roentgen rays, there is little or no excuse for accidental overdosage during a series of fluoroscopic or film examinations sufficient for complete study of the human body. No qualified radiologist will deny that such examinations may be made with safety if the operator knows his apparatus and technic. That every physician, when he enters the practice of medicine, shall possess an ordinary and reasonable degree of knowledge and skill, and apply that knowledge and skill with ordinary care and diligence, is the rightful expectation of the public, and the courts of our country have learned to demand this. Physicians in smaller towns and cities, away from the larger centers of population and medical education, are not expected to possess and exercise as high a degree of knowledge and skill as specialists from the large cities or centers of medical education. Indeed, it is pretty well established that the degree of knowledge and skill which practitioners of medicine are required by law to possess and apply is that degree of knowledge and skill ordinarily possessed and applied by members of their profession in the same line of practice, in the same or similar locations and at the same time. While we as physicians are not expected to be guarantors of results from our ministrations, we do guarantee that we possess the ordinary degree of knowledge and skill and that we will exercise ordinary care and dihgence in the appUcation of that knowledge and skill as applied under similar circumstances and conditions in the same or similar localities. But, it should be indelibly impressed upon us that, while knowledge and skill may vary somewhat in different geographical localities, the amount of radiation which may properly and safely he applied does not vary with the locality.

Procedure. Impleader. Cross-Claim against Co-Defendant Who May Be Liable over under Section 264 of New York Civil Practice Act

Procedure. Impleader. Cross-Claim against Co-Defendant Who May Be Liable over under Section 264 of New York Civil Practice Act

SOCIAL VALUE OF WAR-TIME MEDICAL RESEARCH

SIR ALEXANDER BIGGAM has published a valuable paper on “War-time Advances in Medicine which might be translated into Civil Practice” (Edin. Med. J., 53, 413 ; Aug. 1946). In a world war, he says, some medical problems become so important that solutions of them must be found at all costs and, during the Second World War, the attacks upon these problems led to important advances in our knowledge, especially in the practice of preventive medicine.

Wartime advances in medicine which might be translated into civil practice.

Wartime advances in medicine which might be translated into civil practice.

OBSTRUCTION OF THE NASOPHARYNX SECONDARY TO CHOANAL POLYP OF ANTRAL ORIGIN: Report of Three Cases

CHOANAL polyp of antral origin while not a rare condition occurs relatively infrequently. Three cases are reported, of which 2 were found in a military practice which included more than twentyfive thousand ear, nose and throat examinations over a period of three years. The third case was seen in civil practice just prior to my entrance into the service. The development of this type of growth has been well described by Goldsmith¹: The antral lining is but a continuation of the nasal mucosa; it is obvious that whenever the nasal mucosa becomes markedly inflamed, a similar process takes place in the antrum, and if the inflammation is severe persistent swelling of the mucous membrane at the ostium completely shuts off the antrum from the nose. In this manner, an acute rhinopharyngeal inflammation may initiate an acute inflammatory process in the antrum of Highmore. The air space of the antrum is

THE DOCTOR AS A WITNESS

Excerpt THE DIFFERENT CAPACITIES IN WHICH THE DOCTOR MAY BE CALLED TO TESTIFY There are three different sets of circumstances under which a doctor may be called as a witness and the rights, privile...

EXPERIENCES WITH THE PHARMACOLOGIC SHOCK THERAPIES IN THE "PSYCHOSES" IN MILITARY PERSONNEL

1. The case histories of psychotics in the military personnel, and the effect of the shock therapies was reviewed and analyzed. The response to treatment was found to differ markedly from the response observed in civil practice. 2. Various modifications of technique were described and illustrated.

Physical Medicine in the Army: Its Effect on Civil Practice. [Abstract.

Physical Medicine in the Army: Its Effect on Civil Practice. [<i>Abstract</i>.

IMMEDIATE CARE OF THE WOUNDED THORAX

The experience which has been gained in the early preoperative care of severe thoracic battle casualties can, in large measure, be applied to the primary management of thoracic injuries in civil life as well. As far as this is true the following presentation may help to place such therapy on a firmly established basis in civil practice. The discussion is based on work in the Mediterranean and European theaters over a period of two and one-half years by us and our colleagues of an auxiliary surgical group. First aid treatment of the thoracic casualty is initiated on the battlefield by company aid men. These soldiers are taught that sucking wounds should be closed with a dressing large enough to stop the sucking noise, that a "stove-in" chest should be bandaged snugly, that the wounded man should be urged to cough if he has a rattle in his windpipe and that

Surgical Lessons of War applied to Civil Practice

Surgical Lessons of War applied to Civil Practice

Judicial Mediation: How It Works through Pre-Trial Conference

T THE I94I session of the Illinois General Assembly, Section 582 was added to the Civil Practice Act. It reads as follows: Subject to such rules as the Supreme Court may promulgate the court in any action may in its discretion direct the attorneys for the parties to appear before it for a pre-trial conference to consider any matter as may aid in the disposition of the action.' This simple permissive statute is not so feeble as it appears to be at first glance. True, it is not mandatory, and only emphasizes a discretion inherent in the courts, but it does achieve the following objectives: (i) by giving legislative sanction to pre-trial conferences the practice became clothed with a garb of respectability; (2) responsibility for non-action is placed upon the courts; and (3) the courts which desire to promote the practice are enabled to do it effectively. No such legislative action was necessary to authorize holding pre-trial conferences. Each court could by rule provide for them, and each judge could with or without rules hold a pre-trial conference in any case. In fact, some judges have for many years followed the practice of calling the contending lawyers into chambers for an informal discussion of the case before proceeding with the formal trial. But without legislation the practice would not have reached the position of importance it now holds, primarily for these reasons: (i) the bar is slow to accept change, and the courts were powerless to compel attendance of representatives authorized to act for the mere purpose of conferring; (2) the courts were without power to bind the parties to the results of any conference; and above all (3) many judges scoffed at the procedure, looked upon it as lacking legal sanction, and regarded it as something beneath the dignity of the court. Even long after the practice had gained acceptance in other jurisdictions and received the blessings of the Federal Rules of Civil Procedure,2 many judges in Illinois took (and some still take) the position that participation

THE PROBLEMS OF THE INTERNIST IN THE NAVY

Excerpt Most of the problems which are to be discussed will seem commonplace and in civil practice they would probably be routine matters. However, when considered in the light of the requirements ...

Civil Practice. Examination before Trial of Defendant in Negligence Action. N. Y. C. P. A. Section 292-a

Civil Practice. Examination before Trial of Defendant in Negligence Action. N. Y. C. P. A. Section 292-a

PRIVILEGED COMMUNICATIONS: IS JUSTICE SERVED OR OBSTRUCTED BY CLOSING THE DOCTOR'S MOUTH ON THE WITNESS STAND?

Excerpt Physicians and surgeons are required by the ethics of their profession to preserve the secrets of their patients which have been communicated to them or learned from the inspection of sympt...

Book Review Wounds and Fractures: A clinical guide to civil and military practice . By H. Winnett Orr, M.D. 4°, cloth, 227 pp. Springfield, Illinois: Charles C Thomas, 1941. $5.00.

Book Review Wounds and Fractures: A clinical guide to civil and military practice . By H. Winnett Orr, M.D. 4°, cloth, 227 pp. Springfield, Illinois: Charles C Thomas, 1941. $5.00.

GUNSHOT WOUNDS OF THE CHEST

Gunshot wounds of the chest are a common problem of the military surgeon in active warfare, but they are frequently seen also in civil practice in large municipal hospitals. The same principles of therapy apply in both instances, but certain differences are at once apparent. During warfare, more emergency operations are performed; the septic complications are more frequent, and the mortality rate is somewhat greater. In civil practice, gunshot wounds are usually small; there is only a small amount of tissue damage; septic complications are uncommon; recovery is prompt, and the mortality rate is low provided the great vessels are not penetrated (if they are, rapid or immediate death is the rule). These differences are due largely to the penetrating missile. Penetration of the thorax as seen in patients admitted to large municipal hospitals is usually caused by plain or jacketed bullets. In warfare, on the other hand, penetration is

Wounds and Fractures: A Clinical Guide to Civil and Military Practice

Wounds and Fractures: A Clinical Guide to Civil and Military Practice

WOUNDS AND FRACTURES. A Clinical Guide to Civil and Military Practice

WOUNDS AND FRACTURES. A Clinical Guide to Civil and Military Practice

Procedure. Illinois Civil Practice Act. Power of Appellate Court to Consider Evidence Not Offered at Trial

Procedure. Illinois Civil Practice Act. Power of Appellate Court to Consider Evidence Not Offered at Trial

Treatment of Burns by Envelope Irrigation

While no single method for the local treatment of burns has been found universally satisfactory and acceptable, the technique described by Bunyan (1940) of sealing the affected part in a coated silk envelope and irrigating with electrolytic sodium hypochlorite merits a thorough and critical trial. In the past six months 16 cases have been treated by this means at the London Hospital and 8 by . other methods. Two were caused by electricity; the rest were due to the commoner agents encountered in civil practice and to wartime incendiary bombs. When the burns were multiple, as was often the case, different methods were used on the separate lesions and comparisons made between them.