taking the heart out of the oncometer ments. Thus, so long as the functional capacity of the heart is unknown, there will always be danger of sudden cardiac failure. A heart may be able to meet all ordinary requirements, and may seem normal, and yet these ordinary requirements may demand all that the heart is able to give; when an extraordinary occasion arises such a heart is unable to respond, and is forced into fibrillation and diastolic

and handling it very gently) produced
fibrillation and death. Neither the
blood pressure nor the volume changes
of the heart form a safe guide with
the alkaline solution. The injection
of salvarsan seems to bring out any
inherent cardiac weakness, and the
contention of Ehrlich and others that
myocarditis should be regarded as a
contra-indication for its intravenous
use finds support thru Auer's experi- stoppage.

Medico-Legal
Department

UNDER CHARGE OF WILLIAM E. BUTLER, B.S., M.D., JUR. D.,

Member of the New York Bar; Professor of Medical Jurisprudence at Dartmouth.

In opening a Department in a medical journal for the elucidation of questions affecting the relationship of the physician and surgeon to the law, it is well to have clearly understood at the outset the obligation which the doctor assumes toward his patient, and, as well, the duties taken up by the patient when he accepts the services of the physician or surgeon. For we shall have to bear this relationship clearly in our minds thruout the series of discussions that will appear in this Department, else we shall fail to profit by them.

This relationship is based entirely upon the legal significance of contracts, and perhaps a few words on this subject will clear the air and allow a broader discussion as to the effect of this law of contracts on the physician or surgeon and on his patient.

A contract is an agreement enforcable at law made between two or more persons by which rights are acquired by one or more acts or forbearances on the part of the other or others.

An analysis of the law shows that to make a valid and binding contract we must have all of the following ele

ments:

I.

An offer and its acceptance.

2. Reality of the assent expressed in the offer and acceptance.

3.

4.

5

Legal capacity of the parties.
A consideration.

Legality of the object which the contract proposes to effect.

There is a meeting of the minds of the parties to a contract when the first element is effectuated. This offer and acceptance may take place in any one of three ways:

I.

In the offer of an act for a promise.

act.

2. In the offer of a promise for an

3. That he will exercise reasonable care in the management and treatment of the case.

4. That he will always act accord

3. In the offer of a promise for a ing to his best judgment. promise.

The doctor is affected by the first where the act is the giving of services on his part in return for the promise of the patient to fulfil certain duties on his part, as for instance the payment for those services when completed.

Now this offer and acceptance may be either expressed or implied. They are expressed when a definite arrangement is made either in writing or orally in the presence usually of witnesses. An express contract is entered into when a physician or surgeon undertakes to treat a patient for a certain time or for a certain disease and the patient agrees to pay a certain, definite sum for such services.

Usually the contract is implied and no special time for treatment is specified or amount of payment definitely named.

5. That he will not leave a patient without the consent of the patient or relatives unless he gives reasonable notice or furnishes the services of another physician.

6. That he will not experiment on his patient but will always consider the welfare of that patient exclusively.

7. That he will not disclose any communication received from the patient or discovered in his examinations during the course of treatment.

The patient on his part contracts: I. That he will give the physician all information concerning the facts and circumstances of his case and full opportunity to treat him properly.

2.

That he will obey his instructions and follow his directions. 3. That he will pay the doctor the reasonable worth and value of his services.

All of the different elements enter

The practitioner, then, implies, when ing into the contract have been litihe undertakes a case:

gated and from time to time cases will be cited in these columns and explained and their bearings on the practitioner gone into. An endeavor will be made to steer the physician and surgeon clear of the legal difficulties that lie in his path and to show him where he may enforce his rights.

163 Journal of Missouri State Medical Asso- 207 Medical World. Philadelphia. M., $1-
ciation. St. Louis. M., $2-20c.
Journal of Nervous and Mental Diseases.
New York. M., $5-50c.