A DOCTOR'S REPUTATION.

Auckland Star, Volume XLII, Issue 193, 15 August 1911, Page 5

A DOCTOR'S REPUTATION.

. , » ALLEGED UNSKILFUL TREATMENT. CLAIM FOR DAMAGES. The action in which Alice Beatrice Shortland and Frederick William Sliorlland, of Taumarunui, are suing Dr. Stanley Arthur Bull, of Auckland, for the sum of £598 10/ as special and general damages for alleged negligent and unskilful treatment, was continued before Mr Justice Edwards and a common jury of twelve at the Auckland Supreme Court yesterday afternoon. Mr Moss appearing for plaintiffs, ana Messrs McVeigh auu Singer for defendant. .the plaintiffs allege that in performing an operation on Mrs Shortland in November of ISO 9, Dr Bull through negligence left ti piece of ragged gauze m the wound, causing further trouble, medical attention and expense, till February of this year it was extracted in an opera tion performed by Dr Douglas at t'.i" Hamilton Hospital, since when she has revovered. Dr. S. Douglas, surgeon in charge of the Hamilton Hospital, said he operated on Mrs Shortland in February of this year for anal fistula, and her general health at the time was satisfactory. Ho excised the fistula, and in cutting into it found ?ome gauze packing at the base of the sinus. The packing was ragged, not ribbon gauze, and was double cyanide, and an inch or an inch and a half long when stretched out. It was located half way between the amis and the coccyx, in front of the latter, and there was an opening from the fistula to the bowel, not necessarily a perforation caused by the gauze, which was in contact neither with the coccyx nor th? bowel. It could not be ascertains! how long the gauze had been in tho sinus, but there was a suppuration area aroung where the gauze was located. After the operation, Mrs Shortland made a good recovery, and the wound healed well. Questioned by Mr McVeagh the witness stated that ribbon gauze would always be used by a doctor for packing in preference to ragged gauze. With the

rairged gauze pieces were liable to break. of! in parkin" and remain in a wound. ! His Honor: A piece about an inch, long? ! Dr. Douglaf: I am only guessing at the length. Tl>" piece of gauze was moist and rolled u > into a small ball. ] Ills Hono': I suppose the gauze had no business being in the woman's body? —None at all. ' Mr M-cVeagh: We are all agreed on that point. j Continuing, the witness said Mrs Shortland him the full history of, the case, and said that included in those who had dressed the wound were Dr Bull, nurses at Auckland, Dr Howard, Dr Monfries, and either herself or her husband. In his opinion it -was extremely unlikely that the presence of the gauze in the body was the cause of the einu*. or of the perforation between the sinus and the bowel. That trouble was caused by the* suppuration area bursting, and was proba'bly due to the action of tuber - culosis—tubercular fistula being recuri rent. He had treated several cases of ! tubercular fistula in ■which two or three' ! operations had previously been perfonuj ed. What he saw and heard were con-' sistent with a local tubercular condition,, I but it was difficult to tell by examina- i i tion if tuberculosis were present or not. ! j The history of the t?ase, and the ulcera- : : tion to the bowel suggested tubercular j trouble, as also did the fluctuation of | temperature noted while the patient was! | in the Hamilton Hospital. j His Honor: Was it the right state of things that the gauze should be there?; The woman was unwell continuously i after the operation by Dr. Bull, but when you removed everything she recovered. Does not that suggest the gauze had something to do with the trouble? —Not necessarily. Was your operation more drastic than Dr. Bull's?—I don't know what Dr. Bull j did, but the operation I performed was I I drastic, and I can't promise she won't j have a recurrence. j Dr Douglas further said that physical'

! injury predisposed to tubercular trouble, j I and in this case there was a connection j 1 between the fistula and the injury susI tamed by Mrs Shortland some years pre-1 I viously. A wound was not likely to j i heal with the presence of a bit of gauze; ! as found in the sinus. A recurrence of | the trouble would suggest- tubercular i mischief. Mr Moss: You have communicated with i the other side? j Mr McYeaph objected to the questiou | as an improper one. His Honor: It is quite proper. Dr. Douglas admitted that he had discussed the matter with the other side. Mr Moss: Yet you declined to give me some information I asked for on behalf; of Mrs Shortland until you were sworn j in the witness box. I At the request of hie Honor Mr Moss j submitted a letter he had written to Dr. : Douglas asking for information respect- j ing the gauze found in the wound and the reply sent by the doctor declining, in view of the fact that au action would be ' brought against someone, to give any in-' formation til! put on oath in the witness; box. ! "X have no hesitation in saying," re i marked bis Honor, "that a doctor is not entitled to take up that attitude with a j | patient. Xo matter what litigation is] | pending, it is the right of every patient; I to have from her doctor «Tn exact and. j clear statement, as to what he is prepared to swear to regarding the condition of; the patient. 1 don't care two straws about medical etiquette, that is between ' the doctors themselves, but when it is between the doctors and the public it i is not a matter of etiquette, but the j rights of the patient, and one right is | to have a clear statement. In this case you received a very proper and candid ; letter as to why the information was I wanted, and the plaintiff was entitled to l a candid reply. I Dr Douglas: It was not a matter of medical etiquette, tout being dragged into legal matters. His Honor: You can't live in this world without being dragged into legal matters. Mrs Shortland said she was one of a family of eleven, and tuberculosis had i not made its appearance amongst them. | Her parents recently celebrated their j golden wedding, and her father, though I over 70, was still working as a watchmaker. She stated that after the operation was performed, Dr. Bull expressed j dissatisfaction with the slow healing of | the wound, and the sinus was specially treated. When she left the private hospital six weeks after the operation, the wound had not healed, and she continued to go to Dr. Bull, suffering a good deal all the time. Ten days after her return to Taumarunui a blood blister formed on the partly healed woimd, and caused intense agony till it burst. Although she again saw Dr. Bull, the same thing was repeated, and the wound con-, tinned -to discharge. After, the opera- ]

tion at the Hamilton Hospital she had! no further trouble, and tlie pain hat j gone. Dr. E. H. Howard, of Taurnarunui, said he first examined Mrs Shortland in Feb-1 ruary, 1910, when she was suffering from a sinus on her back, and he first treated her in August, after her return from a holiday visit to the South Island. Witness suggested that the wound should be opened up to get away what appeared to be an irritating cause at the base of the sinus, which was not more than an inch jor an inch and a quarter deep. There j might have been an opening a little deeper, which the probe would not enter. He , opened and cnrrettcd the sinus, bnt fail- ! Ed to trace any irritation, and continued ■ for some months to lightly pack the : wound for some time with iodoform; , gauze, and later with double cyanide | , gauze. A secondary sinus broke out,, slightly lower than the cr.ie being healed, j indicating that there were sinuses bur- I rowing in other directions. It did not j develop into a fistula, nor was there nny I perforation to the bowels, till the last

j ten days. Witness then arranged for I 'Mrs Shortland to go to the Hamilton Hospital, and undergo a mor,' thorough | examination. She m-ade a sood recovery j after the operation at the K?spital. Wit-1 ; ness was inclined to think that the j ' sourer of irritation, while he was treating Mrs Shortland. wn.s more than an < I inch from the skin surface. It was necessary for a doctor to report any eise of tuberculosis. , Cross-examined by Mr McYeazh. Dr.: Howard said he attended Mrs S'hortlaml j daily, with the exception of some date* j on which Drs. Monf ries and Wheeler I visited the patient, and continued pack- i ,ing each day, right up to the time *he was sent to the Hamilton Hospital. The | | ourretting he did would not have been I deeper than an inch and a-quarter, but : had there been a piece of gauze in the i j sinus within the area •covered it would have been removed in the op'ration. .Where the mischief was of a tubercular character, a recurrence of sinuses in dif ferent parts could be expected, and in this case some symptoms suggested tubercular trouble, while olhers vYore i against it. 1 The doctor further s'.'te.l that he did not think Dr. Mon-frics p.ic'..e.l the wound on the three days he attended tin patient, nor to his knowledge did the. j nurse do any packir.g. Xoth of the indications of tubercular troubl~ vere present in the case save that some co-noi-tions were consistent, and th? fart that there had been no recurrence in the kist

I six months was strop: cv.'drnec in opposition to the viev/ of tuberculosis. | Replying further to Mr .Moss the wit- ! ness said he fniled to - diagnose the complaint, and it was a puzz!e to him all through. At tiir.es the wound apparently healed, but broke out again in a few days. The symptoms could have been caused by the presence of a foreign object, such as a piece of gauze. I This closed the ease for the plaintiff. I In outlining the defence to be set up to the action, Mr M-cVeagh stated that ] the evidence of Dr. Bull and nurses pre , sent at the operation would show that the gauze then used consisted of ribbon gauze, and not the double cyanide gauze found in the wound by Dr. Dougias; and if that point was established it could not bo held that defendant was responsible for the gauze in the sinus. In performing the operation, Dr. Bull cut im a depth of about three inches with the object of removing all mischievous material, leaving a fairly large cavity, which obviously should be healed from the , base. The fact that the wound healed and was right for five weeks afterwards was against the allegation that the gauze was left in at that operation. j Dr. Bull, the defendant, described the i condition of the mischief as existing ; when he performed the operation on Mrs Shortland, and what he removed in the ■presence of Dr. Williams, anaesthetist, and nurses Thompson and Taylor. At | the time he remarked that the appearances suggested tubercular trouble. Rib- • hon gauze was used for packing the \ wound after it was cleansed. The fol--1 lowing day he removed the packing and ■ treated the wound with an iodoform i lotion as a disinfectant for possible tubercular trouble. His Honor remarked that it was not necessary to review the whole of the i treatment, because the doctor's skill was j not impeached, but it was alleged that j by some mischance a piece of gauze was left in the wound. It -was admitted that I the treatment from day to day was skil-

1 fill, and that defendant's reputation was I not assailed. Mr McVeagh: The doctor will be glad I to hear you say that, your Honor. j His Honor: The plaintiffs have con- ! ducted the case very fa irly. They have made no unnecessary attack on the doctor's reputation, but Mr Moss will, no doubt, say that accident* will happen. T>r. Bull stated that at no time did he use double cyanide gauze in packing the wound. When Mrs Sbortland left the hospital a small sinus remained and practically healed, though the process was slow. Dr. Williams attended th" case for about a fortnight. Had there I been any foreign substance in the wound ! the sinus would have regained open to j the point where it was located, but that ! did not happen in the present case. After i the operation, Mr Shortland saw witness I and expressed some anxiety as to his I wife's suffering from consumption, but . he gave an optimistic report in the interests of the patient, and the hu'lnnr' ! who naturally worried. He saw Mrs ! Shortland again at the beginning of Feb- ! ruary. 1010, and she then said she was ' all right, and paid a portion of the ae--1 count. Under cross-examination Dr. Bull said : he treated the case as one of local tuber - | culosis, and nothing but a bacteriological ' examination would have assisted in proving anything. Whatever resulted, there r would not have been any material charge l in the treatment. Swabs of cotton wool • were used, but it was not commonly th<> practic e to wrap the wool in gaure, sava ■in abdominal operations. It would be ; an absolute impossibilitv for a bit of i ragged gauze to get introduced with the \ ribbon gauze on the cotton-wool. It was ! possible but not probable for a cavity I to'hcal up with a bit of gauze leit at the ibase; his opinion was that the wound I would refuse to heal, and that the gauze would come away with the inevitable discharge resulting. i Annie C. G. Taylor, surgical nurse at 'lErinholme Hospital, who was present at j the operation performed by Dr. Bull, said | iodoform ribbon gauze was used for • ' packing, but no other gauze was us?d. ' The witness remembered the operation ■ distinctly, though nearly two years ago, and because the doctor said he was 1 afraid of tubercular mischief, and would ' ■ use iodoform gauze. [! Maud E. Bovd, certificated nurse, who nursed Mrs. Shortland at Taumarunui , in September of last said both Drs. , Howard and Monfries dressed the wound ' i with cvanide gauze, and witness herself 'fixed the packing on one °<*asion. " Dr W E Williams stated that he baa ! attended slrs. Shortland for Dr. Bull, . and used only the iodoform ribbon gauze I ; in the wound. I Dr. Milsom gave evidence relative to ', I the difficulty experienced, even by bacteriologists, in tracing tubercular bacilli. I The case is proceeding.