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1. Those cases in which an anæsthetic has been used in medicine, lawfully.
2. Those cases in which an anæsthetic has been used criminally.
The second division may be again divided: (a), cases in medieine where it was used criminally; (b), cases where it was used as a means for suicide; (c), cases where it was used for the purpose of robbery, rape, murder, or other crime.
There may also be other cases, in which medico-legal questions might arise; for instance, where a person had administered an anæsthetic to himself for its intoxicating effects; and where it had been administered for the detection of crime.
We will first briefly consider that division of the subject including those cases in which the anæsthetic has been used in medicine lawfully.
It cannot be expected that agents with qualities which render a person so completely insensible, mentally and physically, to all external impressions, can be used incautiously; or that the person using, or administering them, does not assume the most serious responsibility.
The physician administering an anæsthetic, or responsible for the same, runs the same risk of a suit for malpractice that the doctor does in prescribing, or the surgeon in operating.
In case an operation is to be performed, the person giving the anæsthetic should be legally and actually as well qualified for his duty as the operator himself. Often, however, in an emergency, and especially in the country, a skilled anæsthetist cannot be got, and the physician has to trust the sponge to the most intelligent layman at hand. In such case the physician in charge would not be liable, to the same degree, should accident occur. But if possible, a responsible assistant should always be obtained to give the anæsthetic.
If injury or death follow the administration of an anesthetic by a legally qualified physician, or by a person not legally qualified, while giving an anæsthetic by invitation of, and under the direction of a qualified physician, the first question to be decided would be, what was the cause of death? Was it the anæsthetic, or some coincident cause? If by careful inquiry,
by post-mortem examination and otherwise, it should be decided that the anesthetic was the cause, the question would then be asked, Did the administrator use "ordinary skill?”
What do we here mean by “ordinary skill?” The person using the anæsthetic agent, being legally qualified, must know the action to be expected from the agent employed, on a person both in a state of health and of disease. He must be competent to decide whether it be safe to administer any anæsthetic to the person presented for anæsthesia, and if so, which is the suitable agent to use. He must know how to give it in the manner recognized as correct, and so give it. In case of accident, he must know and have at hand, and skillfully apply, the proper remedies. In case of accident he will be interrogated on these points, and the law will hold him responsible for the use of "ordinary skill."
The question may come up, as to whether a given operation was of sufficient gravity to justify the use of the particular anesthetic administered. As when death had resulted from chloroform, given for tooth extraction, when the nitrous oxide might have been used.
In case of a person found dead, under circumstances which prove that he died from chloroform, or other anesthetic, administered to himself, the question—and an important one it is-would arise, did he take it with suicidal intent, or to relieve pain, or to produce sleep, or for the silly purpose of producing intoxication or exhilaration from partial anasthesia?
It is possible that anesthesia may sometimes be produced to aid in criminal abortion, or to conceal the same. The woman might testify that the anæsthetic was given for a different purpose; and she would not be able to swear as to what was done; or possibly even to identify the operator. Of course her wish would be to conceal the crime, and shield the criminal.
If she die under suspicious circumstances, an inquest and thorough investigation would disclose the cause of death, even though the criminal might not be brought to justice.
It is now known that an anæsthetic cannot be used as an aid in the commission of crime, to the extent formerly believed.
Chloroform is the anesthetic generally used for criminal pur- ,
poses, as it can be given without any special apparatus, and being quicker in its action and less disturbing to the victim, than ether. But it is not the instantly overpowering agent which it was once popularly thought to be. A criminal would nów hardly attempt to anæsthetize a person by waving a chloroform saturated handkerchief before his face. Nor would a person dare to claim he had been rendered insensible in such a way. Nor would one attempt to chloroform a waking person of nearly equal strength, for the crime could probably be committed as easily as the chloroform given.
It was once a much debated question whether a person could be anæsthetized while asleep. But it was long since settled in the affirmative. Yet, it is not always, or often, easy to do this, unless the administrator is an expert, and then the attempt often fails. But if the person is sleeping very soundly, and the criminal is an adept, the victim may be anæsthetized, and robbery, rape or any crime committed.
The crime most often declared to have been committed by the aid of an anæsthetic is, undoubtedly, rape. It is a question of the greatest interest both legally and medically. But having nothing new to present it is unnecessary to consider the subject at length.
It may however be safely asserted, that it is hardly within the bounds of possibility that a woman should have sufficient consciousness to have knowledge of the crime at the time of its commission and at the same time be unable to resist or make outcry.
The following summary from Wharton and Stille's "Medical Jurisprudence,” 1884, may well be quoted here:
“1. That the consciousness or perception of external objects and impressions is impaired in the early and lost in the final stage of etherization.
"2. That during the time the mind remains susceptible to external impressions at all, these reach it in a feeble or perverted manner.
“3. That the emotions, and especially those of an erotic character, are excited by the inhalation of ether.
“4. That voluntary muscular movement is not paralyzed
until the state of perfect narcotism is produced, at which time, however, all outward consciousness is extinct.
“5. That the memory of what has passed during the state of etherization is either of events wholly unreal, or of real occurrences perverted from their actual nature.
“6. That there is reason to believe that the impressions left by the dreams occasioned by ether may remain permanently fixed in the memory with all the vividness of real events."
That a woman often bas erotic sensations while anæsthetized, and caused by the anesthetic is without doubt true. And the impressions left are so vivid, so real, that only the strongest proof can dispel them. For this reason the invariable rule should be, never to give a woman an anæsthetic unless the most trustworthy witnesses are present. Charges of this nature are often brought against the physician or dentist by women who are perfectly honest and respected by all.
The question of the propriety of diagnosis of feigned or hysterical disease by means of anæsthesia is an important one. If the patient willingly consents to take the anæsthetic, it would be lawful to give it, provided there was a necessity for a more certain diagnosis. But in cases where the parties decline to take the anæsthetic, each case would have to be settled by itself.
In regard to insanity following anæsthesia, we quote the following, written by Dr. Lyman of Chicago, from the “Annual of the Universal Medical Sciences:” “Insanity following the use of anæsthetics has been noticed. Bull mentions such a
The well known alienist, Savage, of London, read a valuable paper on this subject, at the fifty-fifth annual meeting of the British Medical Association. He calls attention to the fact that, in persons who are predisposed to insanity, intoxication with vegetable, mineral, or organic poisons, and the use of alcholic or anesthetic inhalations, may be followed by acute delirious mania, from which the patient may recover, or lapse into dementia, or even into the progressive paralysis of the insane.
“These conclusions are based upon a number of interesting observations which agree with the facts recorded by Crothers
and others who have written upon inebriety. Savage utters a word of caution against the use of chloroform during childbirth, when a predisposition to insanity exists, for in this way puerperal insanity may be excited. He also records a case of mania, followed by dementia, after nitrous oxide, thus agreeing with the opinions of Bropley, previously noted.”
AN IMPORTANT COURT DECISION.-Some time ago, a man livin West Virginia, was convicted in the supreme court of the State for practicing medicine in violation of the Medical Practice Act of the State.
The case was appealed to the Supreme Court of the United States, which gave the following important decision, rendered by Justice Field:
“The power of the State to provide for the general welfare of its people, authorizes it to prescribe all such regulations as in its judgment will secure, or tend to secure them against the consequences of ignorance and incapacity, as well as deception and fraud. Few professions require more careful preparation than that of medicine, and no one has a right to practice it without the necessary qualifications. The Statute only requires that whoever assumes, by offering his services to the community, that he possesses the requisite qualifications, shall present evidences of them from a body designated by the State as competent to judge of his fitness to practice medicine."