HOSPITAL INQUIRY.

Auckland Star, Volume XXXV, Issue 250, 19 October 1904, Page 3

HOSPITAL INQUIRY.

j . THIS AFTERNOON'S SITTING. I .When-the Comaiission resumed a; 2.30, Mr McYeagh-mentioned that hi: next witness woulr"be Dr. Savage (wh< was present at -the exhumation- o White_ body on behalf vi t_e--Healtl Department). Mr Beed intimated that as Dr. Nei would be again p-it in tlie box whei other charges were dealt with, he wotdc not cross-examine him further. A PERSONAL EXPLANATION. Dr. Neil asked leave to make a per sonal explanation. Mr Keed, he said jin his cross-examination . of. him thai I morning, had. insinuated that he lefi I Dunedin Hospital ori account" of sonii I disturbance. Producing a gold chain ;Dr. Neil said: "That was given to "im on the day.l left the university. Ther< j was no disturbance, and they 'were al [friends of mine. I think it is ver'-i j wrong to make insinuations which wefi | absolutelj- false." Judge Ward: Tt was a question Mi Reed had a right to ask in eross-exami | nation, and we fully accept your denia of it. Besides, it is. not as, if the. eorh missioners were ordinary jurymen. Tha sort of thing „iigkt carry some weiglii with ordinary jvrymen, 'but not vvitl us. Mr Reed: I do not suppose even thai to ordinary jurymen, where the ques t4pn was asked in the negative, i; would cai-ry weight. Judge Ward: Ordinary jvrrvmen an apt to go by the question; and not t_ the answer.. The cross-examination of Dr. Neil b"< Dr. Collins then proceeded. DR .COLLINS CROSS-EXA_IINES DR. NEIL. .Dr. CoUins: Did you see Clarence Walters when he came to the hospital?— I first saw him on the operating table.' What was his condition?— General peritonitis and its effects. It was an emergency case, was it not' -—An emergency abdominal case. "iou said yesterday you were at the post-mortem ?—Of course I was. What made you come there ? Did I ask you to come? —r don't believe you did. Did anyone tell you the boy was dead? —I.can't say who told, mc: The boy was dead. There was ,»o question about that. You swear he was dead the nexi morning?— That, is the impression on mi mind; that he was dead next day. Dr. Collins: He came in on the 17th and died on the 18th. How can yot say it was, a few hours after? Dr. Neil: What time on the 19th? Dr. Collins: Four-o'clock. Br. Neil: Morning or afternoon? Dr. Collins: I am not here to answei your questions. Dr. Neil: You must show the re cords. I can't take your statement otherwise. Dr. Collius: Do you remember sayinc everything possible was done for the boy?— Not in regard to the pus in the appendix. Do you remember there was great dif Acuity in finding the boy's appendix?— No. Do you remember what came out of the appendix—What, do you .mean ? Do you rember an orange pippin coming out,, and you trying to cut it with a knife,?—-I. temembex. no orange pippin. But there was a concretion which I cut to show you it was not an orange pippin. It is a very common occurrence with such, easQS.- ■-,•.-- v■u■ •-. ■ t ... - ...-,,,-. In acute peritonitis and strangulation of. the bowels which that man had, do you not get adhesions to the pelvis? Dr. Neii: Do you mean acute or chronic adhesions? Dr. Collins was repeating the question, emphasising the words with a raised finger, when Dr. Neil remarked, "Don't point to mc, Collins." In a case of appendix with septic peritonitis are there any adhesions in the abdomen?— Recent or chronic? How can they be chronic if the ease is one of acute appendicitis?— Then that would be recent. Is it wise to break down those ad-hesions?—-No, certainly not. Where was I operating?—l think over the appendix. Dr. Collins: Dr. Neil, I was operating on the middle line. Continuing the examination. Dr. Collins asked: You were not present at the end of the operation?— No. And you do not know what steps I took to remove pus?—l saw it present a - ihe post-mortem. (Proceeding.)

BR, NEIL'S ALLBBATIONS. EVIDENCE TAKEN ,'. ir royal commission.

gel Mr Me\ eagh. • ADDITIONAL CHARGES. yesterday afternoon, Dr. J. Hardie nut in tiie following enargcs m ad- • Sn P la those published yesterday: ' AGAINST DR. COLLINS. i Itet one John Donald[ McLeod vue i k-ttPtl as a patient to the Auckland •■■g£Sohor U>u t February 20, 1904 SffiS from a fractured thigh, and & Olive Collins, senior raed.----i offiper of the Hospital, did not sea ! fitfwf attended to on admission, 'IS fa-t"being that the said John Donm iffcLeod was not seen by any doctor Sou? 40 hours after hb admission he admitted to the J -id James Clive Collins! '.iwtontly and unskilfully removed S- IkiDg-plaster from the leg of th: BoMldMcLeod was so unskiltully treated thai his leg i≤ now permanently injured. ■\GACvST DR. COLLINS AND THE • • BOARD. 1 That patients suffering from cancer consumption. deUrium tremens, and were kept with other paLts in the same ward, and that sufSnt lavatory and places ot conveni«Unot provided for the purpose -f spwmthig such of the said cases as to° have been kept apart and as to have been kept separate from the other patients. . • 2 That patients are refused admission to the said Hospital unless they Yoduce at trie same time as their reL.t to be admitted a recommendation from a medical man, even though tne <a«e may be such as to require lmmedi- ' " 'ate attention, and that this practice is lad. AGAINST THE BOAHD. 1 That in the month of March, 1904, I was appointed by the said Board lion. ear nose, and throat surgeon to tne Auckland Hospital under the control of the said Board. , •2. That on August 29 the-said Boar-l dismissed mc- from my said office -Without any just cause or excuse. - 3 That -the ef.'fte said Hospital during the r.m^ it has':bcen:. under the cnarge oi Dr. James CUve' CoUins, senior medical \ <ficef, has been excessive. Speikißg of the preliminary inquiry teldbj-Br. HacGregor, Dr. Neil- said the inquiry had reference Xo his case generally, and Dr. MaeGregor went intc 'the White-case a* heing the bone ol contention. Dr. M*-?Gregor took Dr Collins' st-tement «. tins c&ac. Speak ingof the'tecisionsiSk the intestines, Dr Coffins sa& it was not true that, he lad made two incisions in the large in testinc.' Dr. Craig, who had been pre sent- the operation, corroborated Dr Collins' statement. Drs. Parke≤ aur King, who were also present at sornc part of the operation, also gave cvi dence which generally corroborated tin statements of.Dr. Collins. Dr. Tarke said he was out of the room when th indsions were made, and also ■whei they were closed. He (witness said t\vincisions were made. Dr. Collins fur ther on said he took ont thiec ulcersone measuring abont l.|in.. and tin ' others being of ordinary size. Di Parkes said he saw two ukers. H< ■ 'vrpnld.not go the length of saying ther ■were three. The stomach v> as so iri • able (Dr. Parked said) that no soone was one perforation sewn up than ano titer appeared. Dr. Craig said then ■ were three ulcers—one Uin. in length 1 and two others of average siz-e (presuni »% ahont half an inch). llr ifcVeagh: I think you were pre ■sent at the exhumation' of White' body!— I was. lien it was .shown tiiat your state •meats were- correct?— Yes. ■ ' You stated that wheu the abdomina ! nemon -was made at the time of th operation there was an escape of <:as?_Wkt .did that portend to v doctor *- ibat there was a pe.rforation in th tttetmal track somewhere. • What '.vould a careful surgeon do- ,- ---• look for the perforation. - He.. Wo md not defer it till after h Cjad-removed the foecal concretions?ytttainly not. ■tiS* -IT Dr - irer S«=o,,- S duties a tt^ho spitol?-Look after the medic l"t lo ° k f fter the infectious diseas !rS~on: the Post-mortem exam " parity ■ be - ri « ht «iat/he should tak 'ft llfJu- Sur S ical operations ?-N, ' for W" to kee Yes. P 6d On of -*eptii- infoction?- ---! OF WAUDS 3 Of h * e C h ar g e - alle ? in * th, r^«qu?ri n S. Co . nsta nt3y broken tl • > ta.iHpt ,1 t0 V,Sit Awards, 1 f r ; Xeil said h " hi rVr 011 h ° urs of t] r a PPfear in £ °mS ° ften did n - -iimseU f rPn ,,i +i He witness) w + ac anaesthetis • k t U yD£CoU& tOEpeakof^^u: • : From, your «Jl" . 1 >- ■ »,»M the amomits

Si dressings required, signing up requisitions for dressings, etc., peaking to £he nurses on administrative points, inspecting the lavatories, signing discharge sheets. Was that the routine adopted when you were engaged at the Hospital in Dr. Baldwin's time?— Yes. Witness added that the visits of the honorary staff would take place about ten o'clock, they being accompanied through the wards by the resident staff, who, if an operation were performed, would render any assistance required. POST MORTEM WORK. With reference to post mortem work, have you any knowledge of this being done by the senior medical officer?— Yγ-. I have sren him doing it more than nm-p, but cannot say how many times. Is it usual that a senior medical offi-i cer performing abdominal work should ■ do post mortem work also?—No; the risk of septic infection is too great. Have you ascertained the length of time between a post mortem pertormed by the senior medical officer and an abdominal operation performed by him? — Yes. On one occasion T found Dr. Collins in the deadhouse with Drs. James and Sterling, of Melbourne, doing an operation in the abdomen of a corpse and explaining the details to those with him. Four days later I saw him operate on Martha Gordon, who ha.d been admitted suffering from internal hemorrhage. Was Dr. Collins working with a book? —Yes. He had a book there, referring to it. What was the book?—"Cowpers Surgery"—a new edition that he has. Where is that book ordinarily kept?— He keeps it in his room. Is that a hook which otheT surgeons would occasionally refer, to?— They have access to it. Do you remember where the book was when you saw him in the mortuary?— I saw ifc near the legs of the body. I presume it would not be at all an unlikely thing for a visiting surgeon a.t the Hospital to take it down and examine it and work from it?—lt 'was constantly referred to at one time, I know. It is a well-known book?— Yes. "Coopers Surgery 7, is the standard textbook. Would there be any risk in a surgeon who had been using that hook performing an abdominal operation? —I should say so. certainly. What risk? —Risk of direct carriage of septic matter from £he dead-house to the book, from the book to the surgeon's hands, and from his hands to the patient, unless he properly cleansed himself, and that would be v difficult matter. Witness added that he had seen" Dr. Collins working in the dead-house with gloves on, but on one occasion, working at the arteries of a leg, he wore no gloves. BACTERIOLOGICAL WORK. Do you know anything personally about Dr. Collins' bacteriological work? —I know he has worked in the bacteriological laboratory. I have seen him there. Do you know how long he has worked there?—At one period at the beginning of the year, near March last, he was pretty constantly in the laboratory; in fact, you woufd oftener find him if you went down there. At that time was there an honorary bacteriologist attached to the staff?— Yes. Dr. Frost. Do you happen to know if Dr. "Cofe lins was engaged in cultures? —Htnvas' engaged in some experiments in ■ connection with anthrax microbes. Did you know the nature of the experiments? — Well, he showed mc a glass smear with some of these microbes, and I understood at the time he was operating with a guinea-pig. As a surgeon, would you approve of that? Mr Reed: Did he say he saw him inoculate a guinea-pig? Dr. Neil: I never saw Dr. Collins inoculate a guinea-pig. Mr McVeagh: As a surgeon, would you approve of the inoculation of a guinea-pig with malignant microbes being carried on in such an institution as the Hospital? Dr. Neil: No; I certainly would not. You consider the practice a dangerous one ?—Yes. Is it one which any reasonable careful surgeon,, having regard to the safety of his patients, would adopt?—He would not adopt such a practice. CONSULTATION S. Questioned as to the consultations held in the hospital, witness said the method of holding these had been unsatisfactory to him. In Dr. Baldwin's time the hon. staff attended, and after consulting a case, the junior speaking first, a decision was come to. and entered in a book and signed by the members of the staff. Sometimes a member who objected would record a contrary opinion. Has that practice been followed by j Dr. Collins?—No, it h;is been neglected. Do you attach importance to the consultations being entered?— Yes. They are records of the fact of the staff being consulted, and they are records of opinions expressed. The ordinary consultations now sometimes have to do with cases which really do not require consultations, and a resolution to obviate thi* was recently adopted by the staff. This provided that no consultation should be held without previous consultation with the hon. surgeon hi charge of the case. Was that adhered to?— : For a short time, and then it lapsed, and the staff was again summoned for consultation on cases where such consultations were not necessary. The result has been that iv some cases where prolonged consultations happened to be needed the members of the hon. medical staff have uot always taken the trouble to attend. Dr. Collins, witness added, had often told him he was not much interested in the medical side, but more in the surgery. THE CASE OF MARTHA GORDON. Witness Mas then examined into the details of the ease of Martha Gordon. The case, he said, was oue of internal bleeding, and he was called to it as an urgent abdominal operation. He found Dr. Collins operating in the stomach, with Dr. Inelis administering the anaesthetic. Witness said to Dr. Collins: "'Why don r t you go down to the pelvis, doctor:" Dr. Collins cut down to the pelvis, and found a considerable quantity of blood there, filling the pelvis. At I witness' suggestion a sponge was used, land then Dr. Collins exposed a small j portion ■ of one of the fallopian tubes, land remarked that it was normal. This was, however, only cursorily examined, and Dr. Collins returned to the stomach, and finished his operation. Finally, the woman died from internal hemorrhage. He arrived at the right moment to see the post mortem, and saw the cause of the death. There was a small perforation of one of the fallopian tubes, which had been overlooked in tlie operation. Would a careful surgeon have discovered it?— Tee. That operation was a major one, I suppose?— Yes; Eroy'operation open-

ing the abdominal cavity is a major operation, requiring a consultation. Was a eonsultatidn held? —No. OPERATION OX A BOY. ' Dr. Neil then referred to a boy named Clarence Waiters, suffering from acute appendicitis. He found Dr. Collins, assisted by a resident officer operating for what he called intestinal obstruction. Witness said he thought it a case of appendicitis, vrith intestinal obstruction similar to a case he had been reading about. He suggested a simple "way of ascertaining, but Dr. Collins did not art on hie suggestion. The boy died. Next morning he paw the post mortem examination, and the indications which he had suggested looking for were | found. Among these indications were a quantity of pus, which, ought to have been removed at the operation, although be did not say that it would have saved the boy"s life, as he was very bad. AN EMERGENCY CASE. Reference was next made to those cases of emergency which Dr. Collins was authorised to operate on. Dr. Neil said there were eases that needed treatment without Tvaiting for consultation with the staff, such as bleedings, dislocations and fractures—such cases as required instant treatment to save a patient's life and avoid the after effects Df delay. Mr. McVeagh: flow long does it generally take the staff to arrive?— From 20 minutes to haif-an-hour. They are all rery keen to get there, and they are ill on the telephone. Some preparations are necessary for ibdominal cases?— Yes. The patient has to be put to bed, his mouth cleaned out, his bowels relieved by an enema, bis temperature taken, and other things ione. A chart has to be put over the bed, and rough notes for the guidance of the honorary staff. The patient's Friends have'to be fully informed of the facts of the case, a.nd that takes up considerable time. The operating theatre has to be got ready, a staff of nurses arranged, and others instructed to take their places in the wards. In Dr. Ba-ld-erin's time the urgent abdominal operations were generally done by the honsrary staff, and dono well. 1 can recollect no rase in which the patient sufiered irotn f his rule. THE CASE OF DONALD McLEOD. Dr. Neil was then asked concerning the case of John Donald MeLeod, who had beeu treated in the. hospital for fractures, etc. Witness said he examined the nian last Sunday, and found the left thigh permanently deformed, and a £nee and aside stiff. To Dr. Roberton: Concerning those emergency cases where delay might produce serious after effects, he included fractures so far only as temporary measures -were ooncerned, pending the arrival of the hon. staff. TO-DAY'S PROcsSDIISG*. THE RIGHT TO QUESTION THE NURSES. When the proceedings opened this mornings Mr McVeagh drew the Commission's attention to a rule existing at the hospital forbidding employees from making statements prejudicial to the hospital to outside persons. He asked the Commission to decide that so far as matters relating to the eases under consideration were concerned thi? rule should not bo set up so as> to prevent him from interviewing the nurses or migftir- bc^.tfble,^o deincr.—hi short, that they shouTttbe at. perfect liberty; to make any communications to him regarding anything falling within the scope of the inquiry. Judge Ward: They a»"3 bouml to do that. Mr McVeagU: I desire to interview some of the ?tafl\ and fear I might be fettered by the existence of that iule. Mr Reed said the Board while wishing to afford every reasonable, facility, felt that it would be subversive of discipline if Mr MeVeagh were allowed to go round looking for someone who could srfvc evidence. He had already said that all witnesses desired would be produced. Judge Ward: The trouble is they don't know what persons can give evidence. How are they to know without making inquiries ? Mr Reed: They are hardly justified in making charges without already having evidence to support them. Those "hargca have.been published in the newspapers. which Mas quite wTong unless Iliey already had evidence Lo support them. Judge Ward: Undoubtedly the.ru has been evidence already given to substantiate them. I don't say what evidence will be given on the other side: but at present a prinia facie case has been made out. Of course, when a employee comes before the Commission he shall be held harmless for anything he may say. The question is which employees arc to be summoned to give evidence* Mr McVeagh said he" proposed to call some of the nwscs, but he wished to aspert am what evidence of tlreirs ho should lay before the Commission, and how. Judge. Ward: When witnesses are summoned it is usual for counsel to interview thcui. Mr McVeaah: That is what I want. But at present they are under restraint. Judge Ward; That is got over to some extent by summoning the whole of the nursing "staff. They could then all be interviewed. Mr Reed: Of course. But still it is an unheard of thing that the persons who really are affected —because I suppose all these nurses are moTe or less affected —should be interviewed to practically make complaints against themselves. Judge Ward: There is no charge against any nurse. Mr Reed: Still they arc the Board's hospital staff, and the charge is against the stall. Judge Ward: There is no charge against the hospital staff. The question is how the hospital is conducted; and how the commissioners are to ascertain that without cabling the staff here I don't know. Mr Heed said he presumed the interviews would be restricted to those nurses who were engaged at the cases specified. Judge Ward remarked that some of the charges wuro so general that they would justify any of the nurses being, called. ' Mr Reed said the Board would have no objection to the whole staff of nurses being called if necessary. Judge Ward. Very likely they will be. Mr Reed said he supposed they would j be justifiedt without any disrespect to the Commission, in telling the nurses there was no necessity for them to give any evidence until they were examined before the Commission. Judge Ward: It would be very rash for you to do that. It would prejudice the j case against the hospital to tell the! staff proposed to be summoned, they are not to make wuy statements till they I appear before the Commission. His Honor said he must rule that when the witnesses had been subpoenaed the counsel ou the other side had a. right to interview them to ascertain what evidence they .could, give, and to decide whether to call them or net, ■ ." '. . ", i

Dr. Collins said the rule was passed on. his appointment because. ;a/Junior niiiW brought, charges of malj*r?i.ctict! against a sursreon. "it was to a repetition of " this that the rule, was passedl , ■-~", _ A BELATED WITNESS. WSlHani Moir, a seaman v>. "!O nad as&isted to take White from the steamer Gael to the hospital, and who had not put in an appearance when called yesterday, gave his evidence ivben the Commission resumed this morning, before the cross-examination oi Dr. Neil was commenced. Mbir stated that it was ahout four o'clock in the afternoon when they got to the hospital. He told a man i n the hall that he had a sick man. Witness was asked if he had a certificate from » doctor. The reply wan "No." and the man stated he would not take Ihe patient in without, a eertitieate unless it was a case of a limb broken. Moir stated tiiat he then returned to the ambulance, where he waited for half-nn-hour. Then a man came 'down. He did not know whether the latter was ft doctor. Mr. MeVeagh. What was White's condition then*—He was groaning with pain all the time. The witness proceeded to state that the man who came out of the institution asked White where he felt the pain, and the paiient was then la-ken into (he hospital. Mr. MoVeagu: Do you know when he wa. j operai-ed upon?— No. Examined by Mr. Heed, the witness said it was the same man who came nut in half-an-hour as the one who met; them when they first went to the hospital. DR. NEII/S EVIDENCE. CROSS-EXAMINED BY MR, REED. Dr. Neil "was then cross-examined by Mr. J. R. Reed, representing the Hospital Board. Had you formed an absolute opinion that it-was not appendicitis in the case of White after the. consultation at his bedside?—So, I had not. Was it not doubtful *—There was some doubt owing to the scarcity of clinical notes. There was v.cry .Httle chance <?f its being appendicitis , .'—-That is so. What did you diagnose it as?—ln my own mind f thought it was some mischief, probably ou the left side of the groin. Did you indicate those views to Dr. Collius?— Yes. I did. Had you a iixed opinion on that point ? —Certainly not. No man should hare a, fixed opinion in five minutes. Do you say it was unreasonable from a surgical point of view? —It was, after live minutes' diagnosis.' Did .you know what clinical history he had?—Ho told mc some facts. Was the diagnosis of appendicitis unwarranted?—fl« had very little grounds to so upon. There was the very slightest~possib.ility of its being appendicitis. In your own mind, from a surgical point of view, do you say that Dr. Collins should not have performed the operation for appendicitis? —He should have taken the middle line. Do you consider that Dr. Collins was doing * wrong in opening over the appendix?—He may have opened over the appendix and closed it up. and still have been acting surgically, but be rvent further. Do you consider, iir bis deciding; to open rover tb'c nppeiiditf'and- nnt- 6vat the centre lino, he was doing wrong?—He was acting without taking the fullest consideration of all the fa-rts. Was it surgically wrong to have dealt with it in that, way?—He dealt with the ca.se without taking the full clinical notes and history. He had "appendix operation' iixed in his mind before he got to the bedside. He would have been justified in cutting over it, then? —I consider it wrong, because he hadn't enough information to go upon. Dr. Collins informed you that the man had felt pain over the right aide?— Yes. Iβ it not, then, your experience that a patient would be doubtful where the pain was- —After two or three examinations you will find that the man will generally lix it. Dr. Craig? Dr. Parkes, Dr. Ferguson, and Dr. King were present at the operation?— Yes. . Do yon know whether there was any consultation? —There was no consultation in the room. Prior to your arrival? —It could not have been, because Dr. Parkes was making a cursory tap on the abdomen. Had htf consulted in the case, why should he top the abdomen? Having the flews you had, did you communicate your views to the other doctors present?—l was not asked, and no consultation was held. Do you say you had strong views on the subject?— Yes; there was no ground for diagnosing appendicitis. Did you consider it necessary to communicate to the other members of the hononnry staif? They were present, and you were a luember of the honorary staff?—Ye?, they were member?. You have had some experience as an anaesthetist ?—Yes. What did you administer? —Chloroform. What was the patients condition before the operation? Was he dying?— Xo. but he was when he left the table. He was in a lo>v condition? —Yes. Well, was it not necessary, then, to pay very close attention to t-hc patient aiid not watch the operation? —Such patients are the easiest to look after. Did he not come out of the anaesthetic twice? —No. He moved twice, but thai is not uncommon. An abdominal operation is vpry serious, and the main danger is collapse and death from shoirk?—Tes. Is tint danger increased by the patient coming out of the anaesthetic?—l do not think so. It has compensating advantages, because the pulsn is increased. Did you purposely allow this man to come round?—l kept him lightly under. Did that require constant attention? — I could give him attention quite well. Was it want of attention that led to him coming around? —No, certainly not. Was it accidental, then? —Yes, but the better term would be "incidental." It was not a mistake, then —it was done with intention?—lt was an incident. I cannot understand you.—You don't understand anything about anaesthetics. It was not done intentionally. I kept, the patient slightly under, and if he made a slight move he was put under again. Does any movement stop the;operation? —Yes. but it is only a matter of a few seconds. If you had been solely watching the patient, could you nave prevented him coming round ?—lt all depends on wbat the operator did. Do you distinctly state that tfoe -ap« penarc could be found without reducing the distension of the towelsS-eTEes,. it could, and vfss found. . '' V; ;

T "put that to you because there are, other medical men who will- distinctly state it had to be removed. Mr Reed: Is there a-difference from a surgical point of view between an incision and a puncture? —I should say i there ia a difference. An incision implies a cut. does it not? —Yes, a cut of ~omc length. If a pcalpel is inserted straight down, j is that a cut or a puncture? —It would j depend on the width of the blade, of the ] scalpel. It might make an incision an j inch wide. Do you say that, surgeons describing j a ease Would make no distinction be- j tween an incision and a cut except to drscrilx>" the length of it:—Witness re-j plied this wa? splitting hairs. Do you say that foecal matter was taken out of both the incisions in the lars'e intestine?—l swear that ertiphatjeally. The incisions were of different length? —Yes. Mr Beet ham hero suggested that a diagram w">uld greatly help .the "Coin- | missioners. Mr MeVeagh said Dr. N*>il bar! pro-1 vided a blackboard and chalk, and would make diagrams if desired. Continuing his questions, Mr Reed asked: The cut through the peritoneum, was that longer tiiau the width of the SL-alpol?—Yon. Would a cut expand or contract lifter death?— Witness replied That it. would depend on conditions. If the appendix could not bo reached owing to Ihe distension of the bowel b t y gas, would it be right for a surgeon to puncture it? —No, certainly not. He should if necessary enlarge the cut. J Would not that increase the distension?—'No; why should it? ■ If it did, would it be justifiable surgery to puncture the intestine? —, If absolutely necessary a small punc- ! t-ure might he made, hut not an incision ] 2 inches wide to take out two pieces of j foeees. Did he do that?—Ye?. Have you ever performed an abdominal operation?— Yes. Once, on the battlefield, I opened an appendix. Id that- your' only abdominal operation ?—Yes.' But 1 have assisted at many. ■ % ■-/ • " ~ To furiher . questions D.ty. ..Neil said tie bolieve-.I Dr. Collius and Dr. Parkes had both performed many abdominal operation-;.■ After the operation he had coffee with Drs. Collins and Parked and the matron, but did not then complain of or .discuss the operatioti in the matron's presence, but he did subsequently .both to Dr. Pnrkcs and Dr. Collins; Dr. Parkea said "Yts. Wasn't it sickening." It was not nuprofessional to speak to the chairman of the Board about, the breach of jr. rule by another doctor before speaking to the doctor himself. It was only a question of a brief time, and ho subsequently spoke to Dr. Collins on it. At this operation on White was there not an tilcer in the duodenum in addition to the ulcef in the stomach?— There was only one ulcer, and this was close to the duodennm. It is quite impossible there could have been two ulcers?— Dr. -Cell replied that he saw only one, and added, "I saw the exhumation." Mr Reed: Yes; I know you saw the exhumation. MEDICAL DIAGRAMS. At this stage there was a brief respite while Dr. Savage, explained to the Commissioners a number. -jf diagrams of an abdomen. Resuming. Mr Reed asked: What vras used for the sutures? —Witness replied he recollected silk and tish-gut being used. How long was the patient on the table, altogether?— About two hours. You- spoke yesterday about this man bavin" & 50 per cent, chance of life. What did you mean? —I spoke from statistic:?- of gastric ulcer operations by skilled operators. You sa-vv Mr Garland next day. You are aware that. Mr Garl?nd said you charged Dr. Collins with converting the operating theatre into a '■damned shambles"? —I remember him saying that, and I denied, using the word? in t-H€ way he stated. At the inquiry by the Board, did you state what you really did say?—No; I did not. Had you at any time before yesterday made the explanation you have made now!— Yes: several times to my solicitor aud other persons. Why did you no£ say so at the. Hospital Board inquiry? —Because that vras not the proper way to go rnto the matter. But. what Mr Garland said was untrue?— Yes. Why should he say what rras untrue? —I cannot tell what was in Mr Garland's mind. Mr Reed then examined witness upon his statements respecting his conversation with Dr. Collins after the operation. What did you nreau by going nearer to him? This wats nearly a scene, was it not, ami did you nearly' come to blows r—l felt very iudignaut. Whose were the "doz.si.is of unfriendly eyes" -i you referred to? —Many of the doctors outside. Were yours unfriendly- eye* at the operation?—No, 1 was one of his friends. At, .the special meeting of the Hospital Board was tbere not a scene between yourself and Dr. Collins? —We talked -over the table a hit. Did you not. give the chairman the lie direct with regard to the —- shambles" statement ?—Yes. Can you suggest how the hospital could have been carried on with the iIJ-feeling between Dr. Collins and yourself while he was medical superintendent and you on the honorary staff? —No answer. Recollect you are charging the Board ■with having dismissed you. What cou'Jti the Board have done, dismissed Dr. Collins or yourself?— Dr. Collins, 1 understand, handed in his • resignation aud asked Mr Garland to suspend mc, and I consider that Mr Garland has no right to be domineered by the • senior medical superintendent. How do you suggest the Board should have acted?— They should not have taken it as a "matter of hostile criticism. What do you say was the cause of the suspension ?—lt was because I got the rule' altered .about emergency operations. On August 0 I got this rule altered, and on August 10 I was suspended. What could, the Board have done but suspend you?—' Hie Board should have disagreed with the chairman's action. Would the work at the hospital have gone on satisfactorily if you had been working tbera with .Dr. Collins*—Yes. If Dr. Collins bad kept his right place it wou|d have been all right. That is' subordinate to you?—So he should' be—--subordinate to the honorary staff. • - : Were yon satisfied up to a certain date, ■with i>r. Collins , surgery?—l was .satisfied •' that he did the emergency ■ easaialty work fairly well, and I wrote * letter to the Board to that effect.

Mr Reed read the letter referred *to, which stated that the honorary staff ■was of opinion that the suggestion in regard to .emergency surgical work was excellent. For some time past, the letter continued, the emergency work had been carried out. in the absence of the honorary superintendent, to the entire satisfaction of the honorary staff, by the senior medk-al officer, Dr. Collins. Dr. Neil: That was in reference to the emergency casualty work. Witness was questioned at some length on this letter, and Mr Reed also put in a letter which had been published in a newspaper by Mr Garland (chairman of the Board), to which Dr. Neil's- letter from the. honorary staff to the Board was to some extent a reply. Cross-examination on this was deferred. Mr Heed then asked: Were you in the Dnnedin Hospital?— Yes. Did you have a similar dispute to this before leaving there ? —No. Was not your leaving Dunedin Hospital due to a dispute of this kind?— No. Nothing of the kind. The honorary staff gave mc a testimonial. Dr. Neil said this question implied that there was something, and it vras Mr Heed's place to state what it was. •Mr Reed: I am not lier<» to make statements. I am instructed it wag the ease.—Dr. Neil: It. is tot-ally untrue. Did you start an office in Auckland to receive complaints against the liospital?—Yes. And were you responsible for this advertisement: '"Hospital Reform Committee.—All persons having information throwing light on the management of the Auckland Hospital are invited to communicate with the Hospital Reform Office. Coombes' Arcade"?— Yes, and I was quite entitled to do that. ■ You engaged an office and a clerk?— The clerk came there of his own free will. From your experience of hospitals, would you not expect, with 2000 patients a year, to have a number of dissatisfied persons —It varies with the management. You had no difficulty in getting persons with grievances ?—More than I' wanted. ■ Were thoy-told that if it was not against Dr. Collins ;they were net wanted ?—No. Do you recollect the .man named Hulst? —Yep. Was it not a complaint against the honorary staff, and as he had no charge against Dr. Coll ins, -he was of no use ? Do you recollect telling him so?— No. I don't recollect. Will you say you did not tell him so?— I do not recollect. Still, that was the general conduct. It had to be complaints against Dr. Collins?—lt Was not. I listened to his complaints, and said there, was no ground for his statements in regard to the honorary staff. Was the same procedure followed when you were resident sursreon, as now. in regard to cancer cases being treated in the general ward?— Yes: but some attempt was made to isolate them. How was consumption dealt with in your time?—ln a very unsatisfactory manner. How is it now?— The same. | Delirium tremens? —The same as now: but I don' think we kept delirium tremen eases for a , fortnight in the typhoid ward, disturbing them. That is a wicked thing. Where should the delirium tremens cases be put, with the accommodation .they have at the Hospital-?—T-hey khould certainly be Ts , there room?—I could have -found place? to put them. It is necessary they should be downstairs for fear of jumping oufe-of the , windows ?—Yesi Did you in your time put the delirium tremens cases in the typhoid ward?— Not in the typhoid season. In regard to reference to a number of semi-lunacy cases which doctors would not certify to being insane, Judge Ward said if they were insane they ought to go to the asylum. If they wore not they had no light to be at the Hospital. Dr. Collins said there were cases in which the patients' friends bad to go out to work and leave semi-lunatic persons at home unattended. These were sent to the Hospital. Judge Ward: They ought not to be sent to the Hospital. Dr. Roberton:> There .is a want of accommodation for cases of this kind. Judge Ward: Either a patient, is in- ' sane and fit for the asylum, or he is not. Dr. Roberton said there Was the question of differences of opinion. This was one of those points on which they hoped to get assistance from the Commission. Dr. Neil: Instead of spending £~l'COo> for a useless doctor's house the money should be spent in building a refractory ward. . Mr Reed (to Dr. Neil): Were'medical certificates required in your time ior persons applying for admission?—No; they were welcomed. Dr. Neil produced an old book or rules, which stated "accidents and urgent cases will be received at all hours, day and night." Judge Ward said that the sending poor people away to get a medical certificate was simply monstrous. Rule 13 was read, providing Cor patients being admitted upon producing a certificate from a member of the honorary staff. Judge Ward: A man might he kept groaning outside the Hospital, waiting for the honorary staff to take him in. Absurd. Mr Reed: Ar.d in the same way a man might be groaning in pain, and someone objects because the medical superintendent operates at once. Judge Ward: We are looking for a rule which would keep White outside the Hospital while he was groaning iv pain. Mr Reed: I understand there is jio rule, but that it is simply the practice. Judge Ward: A monstrous practice! OPERATIVE PRECAUTIONS. Mr Reed: Do you know if demonstrators of. anatomy elsewhere who perform post-mortems also operate in surgical leases? —No. ' But can precautions be taken to eni able this to be done?—lt is almost imj possible. i But it can Le done?—lt is carrying it J to extremes. j Have, you done so yourself?— Not 1 major operations or abdominal operations. Perhaps minor things like an in growing toe-nail. Do you suggest, -that Martha Gordon showed any ill effects by being operated upon within four days of Dr. Collins peri forming a post-mortem?— She «iid not I live long enough for suppuration to sec ! in. I took that as an incident. ; How is the charge brought against Dr. ! Collins that he inoculated guinea pigs iwith anthrax? —I can bring evidence to i show that he did so. j Did anthrax show itself in Auckland Hospital?— The case of the boy Brown, who brought it into the Hospital. Concerning operations by the senior medical" officer, Mr. Reed read a letter from Dr. Ingiis (secretary to the ton. staff.)', written, on 'August 11, the day after Dr. Neffs suspension, which stated

that the hon. staff were not quite satistied with the working of rule 72, defiitiug some of the duties of the senior medical officer. Most of the more important operative work, especially to the head and abdomen, falls under the heading of emergency operations. Dr. Neil: Who wrote that? Mr. Reed: Dr. Inglis, secretary to the hen. staff. Dr. Neil: He must explain the emergency work he is speaking of for hi'nself. Tbe hon. staff, were broken up then owing to the opposition Mr. Reed: So that really most of the serious operations are iv a great measure emergency ones. Mr. Reed then proceeded to read the. letter in full. ' .Judge Ward: Do you think those sug- I gestions good?— With your permission I would like to make my suggestions later on. LETTERS TO THE NEWSPAPERS. Mr. Reed: Since your disagreement, with Dr. Collins and the Hospital Board you have been writing to the newspapers? —Yes. In one of your letters you stated that the rules of the hospital had been altered, you did not know how?— When I came' back from London I found that urgent abdominal operations were being done by the senior medical officer. Have you ascertained since that these rules were altered at the request of the honorary staff?—l have the statement of Dr. Collins. THE CASE OF CLARENCE WALTERS. In connection with the case of Clarence Walters, you made a charge that the abdomen was not properly sponged out? —Pus was not removed. Did you observejjpus at the operation? —-I requested Dr. Collins to examine the pelvis, which he did not do. This was ■where the pus was. . How long after the operation did the boy die?—A few hours afterwards. I)id pus go on forming? —Pus is a reaction of the body, and would not be formed exclusively when a person was j dying. ,( At the post mortem, was a large quan-.j tity of pus observed in the pelvis?----' Yes, I called the attention of the surgeons present to it. Did you suggest, at the operation, that it should be drained in any way?— I told them that it was the recognised, principle to drain per the rectum; . That would require, an incision ' from the rectum in order to drain it? —-Yes. Upon pus being shown at the post mortem you made your indictment"? —My charge is that he did not sponge it out. Did this cause death?—lf the boy liad a chance of living the pus. being there reduced it to nil. Would he have died in any case l-r-Yes, he would. The principal point, continued Dr. Neil, is that I object to the resident staff performing these operations when patients' lives arc thus placed in danger. Mr. Reed: You suggest they should 1 wait till they have rung up tor the hon. staff?— Yes. There is more danger in performing a hasty operation than in waiting till you have got the honorary staff together. With, a good staff it;is far better to wait for them than to in-dulge-iu senseless operations. The Commission adjourned at' one j o'clock until 2.30 p.m.