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Complete Exoneration of Dr. Stewart.

Nearly three weeks ago, John MacLauchlin, a man residing at Tinwald, met with an accident while chopping rails for a fence. The , adze he was using slipped in its descent on a black birch rail, glanced off the wood, and struck the inner side of his right leg, wounding him severely, and cutting one or two arteries. The man was attended to within an hour afterwards by Dr. Stewart, and for a week or more the wound appeared to be doing well, and healing up wonderfully. _ It then began to burst out bleeding again,’ doing so several times, and finally the limb mortified, and the patient died. Dr. Stewart brought in the other two medical men in the township to see the patient and to consult with himself on the case. The decision arrived at waft to amputate the leg in the hope of saving the man’s life. It was decided, however, by the patient and his friends not to have the operation performed at the time the doctors meant to do it if MacLauchlin were strong enough, and the patient died on the 22nd inst. Rumors, from some cause or other, went abroad that the patient had been unskillfully treated, and in the interests of the public an inquest was held yesterday, which resulted in the full exoneration of Dr. Stewart from aIP suspicion of either neglect, nnskillfulness, or professional ignorance. It is a matter of great importance, : especially in a district like this, that the medical men practising within it should have the fullest confidence of those who employ them, and, having this in view, we devote more space to the inquest than in ordinary circumstances such a proceeding would obtain.

, The inquest was held yesterday, in the Tinwald Hotel, Mr. Guinness, R.M., being coroner, and Mr. J. C. Bell foreman of a jury of fourteen men. After the jury had - been sworn and viewed the body, • • • Sergeant .Felton said, that, in justice to Dr. Stewart,, it should be stated that rumors as to unskilful treatment by him in this Case had been abroad.’ The Coroner said the doctor would have full iiberty to’ put any questions to the witnesses he chose through the coroner. The "following evidence was then taken -

AgheS Travers—l am a daughter of the the deceased John MacLauchlin. I remember Thursday, the 7th of October. My father was chopping a rail on that day, and got cut with an adze (produced). The cut was on the right leg on the outside, just above the ancle. I think it was on the outside. I got cloths, and tried to stop'thc bipod, and also sent for Mr. Lewis. Dr. Stewart came to deceased about, an hour after the accident. He dressed the wound, and he-was in attendance on my father till he died. Dr. Stewart was several times sent for after the 7th October —on occasions when the wound burst out bleeding. My father was perfectly satisfied with Dr. : Stewart’s treatment of him. My father died on Friday, the 22nd, at 25 minutes to 12 in the forenoon. My father said the accident happened by the slipping of the adze while he was cutting the rail.

Francis Lewis, sworn, said —I am a veterinary surgeon, residing at Tinwald. 1 remember on Thursday, the 7th of October, .a daughter of John MacLauchlin came for mo, and I. wept to John MacLauchlin’s house. - I found him sitting'in a. chair, so weak and faint from loss of: Mood that he could not speak. There was much blood on the floor. I saw a wound inside MacLauchlin’s right leg. It. was a deep cut, and 1 put a ligature ‘ of tape round the leg, below the knee. I had to tear the trousers to do so. I also put a lump of tow over the wound, and a bandage. I advised them to send for a doctor, as the ■wound was a serious one, and Dr. Stewart came in about half an hour.. Dr. Stewart opened the wound again, and did something to it. Dr. Stewart told me to take the bandage off. I could not" say what the Dr. did to the wound while it was open, as I did not see, but after the wound had been opened Dr. Stewart sewed it up again. Dr. Stewart was sent for again on the 14th, and on the 17th I was sent for. The wound was bleeding, and had bled very much. The blood was oozing out of the bandages. I did not disturb the bandage, but put a ligature below the knee, with a pad in the hollow of the knee for the purpose of a compress. Dr. Stewart came while I wss there. He put two needles—one above and one below the wound. Dr. Stewart said the man was very weak, and if the bleeding broke out again the liklihood was that the man would not live. Previously to this day the Dr. said. he could not account for the wound breaking out bleeding in this way after it had been healing up so well for a week. Francis Macbean Stewart, sworn, said —I am a duly qualified medical practitioner, and reside in Ashburton. On the 7th of October last, I went to the house of deceased, John MacLauchlin. I found MacLauchlin sitting on a chair with his right leg bandaged up, and at his foot a large clot of blood, and a number of cloths thoroughly saturated with blood. I proceeded to remove the bandages with the help of Lewis, to see what state the wound was in, and if it was still bleeding. Blood was oozing out from one or two small arteries. I took them up with the forceps and twisted them—called torsion in medical language—which stopped the bleeding. I then sowed up the wound and put on water dressings, and a small bandage. By the time this was done, after putting MacLauchlin on the sofa, he fainted, but was easily brought to by giving him a little brandy and water, and sprinkling water in his face. After he recovered a little bit and came to, I left him, giving those in the house instructions what to do. The wound apparently healed up beautifully, and for a whole week it appeared as if- he were never to have a bad symptom. About a week after the accident occurred he had an attack of cramp, which jerked the leg, and when that was done the bleeding came on. They sent for me, but when I got there the bleeding had stopped. I took the bandage off, and the blood oozing began again. I applied the perchlorido of iron, which stopped the bleeding. There was very little bleeding after this till the Sunday after the accident, the 17th. They then sent over to tell me the wound was bleeding again. I went and found the bleeding had stopped, blit to prevent a recurrence, I used what is called acupressure. There was no bleeding after that for two days but what could be stopped by using a little perchloride of; iron. On Tuesday, 19th, Dr. Trevor saw the patient with me. On the Thursday (21st) I saw the patient, when gangrene arid mortification had set in. The same day both Drs. Trevor and Ross saw the patient. It was then decided that if the patient continued strong, and the friends were willing, the leg should be amputated next morning. Daring the night, -however* his friends made up their minds not to have the leg amputated. He died next day, about 12 o’clock noon. After he was dead I opened the wound, and found that it had mortified up towards the knee for five or six inches. By Sergeant Felton—The process of torsion is the proper one to use in such cases, to stop the bleeding of such arteries as were cut in this case, and the wound afterward to be sewn .up. The patient attributed the bursting but of the bleeding to an attack of cramp, which caused the l o ,v to jerk violently. I attribute the death of the patient to the ; mortification and excessive bleeding that followed the wound. I also have reason to believe that the wound had been probably poisoned by black birch. I have reason to believe that cases of blood-poisoning have arisen from black birch, and a leading surgeoh

in Canterbury bears out this opinion. The posterior tibial and possibly the peroneal artery, had been cut, but of this I am not certain. I attribute the bleeding on the 17th possibly to the mortification of the arteries. If mortification had taken place in the wound, of course it could not heal. There was no outward indication of mortification till the day before he died. In reference to Lewis’ evidence, and the remark he attributes to me, it is perfectly correct. I did think it was a remarkable thing for the bleeding to break out after doing so well for a whole week. MacLauchlin was a spare man, and temperate ; but I am told that on a previous occasion when his toe was wounded great difficulty had been experienced in stopping the bleeding. Dr. Trevor saw the patient at my request, with the object of gaining further advice. My belief then was that the patient’s chances were not so bright as they had been. ~ Dr. Trevor recommended the use of tincture of iron internally, and suggested that amputation might be necessary if the bleeding continued. On the 21st. Dr. Trevor, Dr. Ross, and myself saw MacLauchlin together, and we determined that if he did not mend the leg would be amputated. MacLauchlin was informed of this decision. Amputation might have saved life, but it was doubtful. The information that amputation was necessary as a last resource seemed to have a very depressing effect upon the patient. His friends consented, but ultimately withdrew their consent. When I used acupressure, I did so because it was simpler, and because opening the wound to examine the arteries would have been fatal to the patient. As it was, the simpler process was sufficiently trying to him to endanger his life. Nothing that Lewis did could have been hurtful to the wound, but was beneficial. But for the precautions taken by Lewis, the probability is that MacLauchlin would have bled to death. I first saw deceased in broad daylight. By Mr. J. 0. Bell—Mortification does not always progress at the same degree of rapidity. The extent of mortification at the time of death was not sufficient to cause death without the previous hemorrhage, but the mortification that was seen after death may have produced bloodpoisoning sufficient to cause death. By a Juror —MacLauchlin was 54 or 56 years of age. Had he been much younger his chances would have been better.

(The birch rail deceased had been cutting was brought in, and examined by the Jury.) ... By the Coroner —A full nourishing diet was ordered for the patient, with brandy and port wine, to enable him to recover from the loss of blood he had sustained. James Ebeneze.r Trevor, sworn, said — I am a legally qualified medical man, and reside in Ashburton. Recognise the body of deceased as that of John MacLauchlin. Saw deceased on Tuesday, the 19th, with Dr. Stewart. There was a wound on the inside of deceased’s right leg, but I could only see a very little of it, as it was covered over with coagulated blood. From one corner, however, hemorrhage was stated to have taken place. The'patient was suffering from the loss of blood, and was generally depressed. Nothing was done while I was there because there was. no bleeding at the time. In certain cases torsion is a recognised surgical proceeding for injured arteries, but I really cannot say whether it w r as the proper course to follow in this case as I do not know’ what arteries were cut. Torsion is sufficient for small arteries, and where torsion is sufficient to stop hemorrhage, the wound may be sewn up. I could not tell the extent of the wound, nor how far across the leg, nor how deep. By a present examination of the wound, I would be uncertain in any evidence required of me as to whether the proper practice had been used. Secondary hemorrhage is liable to break out in any case when a vessel is cut, and is one of the great dangers in all cases of amputation, &c. Acupressure is a method used for stopping hemorhage from arteries, also tying. On the 21st I saw the wound ; it was then shown to its entire extent. It would be such a wound as an adze would produce. I should think the wound w r as a clean cut, but cannot say .possibly. I advised amputation, in consultation with Drs. Stewart and Ross. It w’as the only possible chance of saving the man’s life, as mortification of the limb had taken place, probably caused by the supply of blood being stopped. Mortification is a common result when the vessels of the leg are injured, and more likely to result in the leg than in the arm. In torsion a clot of blood is supposed to form within the vessel but would not mortify if the blood were in a healthy state. A deep wound in the part of the leg where MacLauchlin was wounded would be a serious wound. By the Foreman —Small vessels will sometimes cause a very large amount of blood to be lost. By Mr. Corrigan—lf I were called in to see a person with a similar wound to that received by MacLauchlin, I should ascertain how many arteries had besn severed. If it were two inches deep two large arteries would probably be severed. The second hemorrhage, seven days after the accident, referred to by Dr. Stewart was not an indication that mortification had taken place. When I first saw the wound, there was no mortification, but the wound looked so unhealthy, I was of opinion if hemorrhage occurred again amputation would be necessary. By the Foreman—Had there been then a tendency to mortification, nothing could have been done to arrest it. By a Juror—Secondary hemorrhage is always serious. By Dr. Stewart—Torsion has been successfully applied to one of the largest arteries in the arm. If I were assured that the arteries to which torsion had been applied were small, and that there had been no hemorrhage for a week, 1 should conclude that the operation had been successful. There would be less irritation from torsion than from tying—the silk itself would produce some irritation. Ligatures from small arteries often come away within seven days. Torsion is a perfectly right surgical practice applied to cutaneous arteries near the surface. I should consider it my duty to stop all the arteries I found bleeding : and having satisfied myself that all the injured arteries were attended to, I would be justified in proceeding to sew up the wound. It would be no good to look in a mortified wound for a bleeding artery. I would consider Ericson as high a authority on surgery, and would respect his opinion when he says that when bleeding has ceased, a wound is not to be irritated by searching for wounded arteries. I have had no practice in the use of acupressure. By Sergeant Felton—Splinters of black birch cause wounds that are very difficult to heal. William Graham Ross, sworn, said—l ani a legally qualified medical practitioner, ■residing in Ashburton. On the 27th inst. I visited John MacLauchlin, in company with Drs. Stewart and Trevor. On the inner side of the right leg there was a wound, at the junction of the middle and lower third. The superficial extent of the wound was taken notice of by me. A largo artery was secured by two needles, and that was how I knew that a large artery had been severed. It was the posterior tibial. It is the prinicpal artery of the leg in that part of the leg. 1 have no knowledge as to the depth of the wound, which was necessarily below the skin. The lower end of the cut was not closed, but two-thirds of the cut had the skin united mortification had taken place where the wound was not closed. A. consultation between us resulted in an opinion that amputation was the only thing that would give the man any chance at all for his life, because the probability was that the hemorrhage would

recur. Only the superficial mortification had taken place, but I could not, as a matter of fact, state how far it had extended. Torsion is a recognised surgical practice for small arteries —only for small arteries in my experience. The posterior tibial artery is not one to which I would apply torsion. Beyond looking at the wound and touching one of the needles I made no other examination of it. I examined the man himself as to his general condition. Dr. Stewart did not explain to me the nature of the wound. When arteries have been secured by torsion, and are of a size to which that process can be applied, they do not usually break out, unless the shock applied to them is unusually severe, when they will break out no matter how they are secured. Why amputation did not take place I was not told. The man seemed very much agitated when he heard he would have to lose his leg in order to save his life. From the appearance of the deceased I concluded he had suffered extreme hemorrhage. The depth of the posterior artery from the skin would be from an inch to an inch and a half. The two needles I saw secured the ends of the artery. By Dr. Stewart —I was informed of the nature of the case by Dr. Trevor. I have no personal experience of acupressure, but have seen it applied by good surgeons. Tension is a safe practice in small superficial arteries. The absorption of the clot that plugs up the end of a severed artery would possibly cause secondary hemorrhage. There is such a thing as hemorrhagic diathesis, and a person will often bleed quite profusely from a small wound. I have no experience of poisoning from black birch. I am a licentiate of the Royal College of Surgeons, Loudon. There is a difference between the teaching of that college on the subject of securing large arteries and that of the Edinburgh College. I have seen the Scotch practice. Dr. Stewart said that, in regard to this practice of torsion, he had seen Syme practice torsion on very large arteries, and this great surgeon practised both torsion and acupressure in connection with all his amputations ; and in ail the important amputations that he (Dr. Stewart) had seen performed within a wide radius of Edinburgh, both torsion and acupressure had been regularly used. The jury having expressed their desire to hear no more evidence, alleging that sufficient had been given to enable them to form a verdict, The Coroner addressed them, explaining the law in relation to manslaughter, pointing out that if the facts, as brought out in the evidence were sufficient to show that the medical man had been guilty of any culpable neglect, unskillfulness, ignorance, or any other malpractice whatsoever in the treatment of the patient, a verdict of manslaughter ought to be brought in. If on the contrary the evishowed no such thing, then the verdict should be a complete exoneration of the medical attendant from any suspicion of blame, and they should pronounce very distinctly on the subject. After a short deliberation, the jury returned a verdict to the effect “ That deceased died from the effects of a cut in the leg, accidentally inflicted by himself, and there is no evidence to show that he received improper treatment, surgical or otherwise. ”

Previous to the closing of the evidence, Dx\ Stewart testified to the care and attention bestowed on the patient by those in the house with him, and Mr. Low, a relative of deceased, stated that the Dr. had been unremitting in his attention to the wound.

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INQUEST AT TINWALD. Ashburton Guardian, Volume 2, Issue 177, 27 October 1880

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