THE WELLINGTON " EVENING PRESS" LIBEL ACTION.

Timaru Herald, Volume XLIII, Issue 3585, 27 March 1886, Page 3

THE WELLINGTON " EVENING PRESS" LIBEL ACTION.

STEWART r. BOYDHOUSB AND ANOTHEB. [Condensed from the. Lyttelton Times.'] (At the Supremo Court, Dunedin, Thursday, March 25th, before Mr Justico ■Williams and a special jury of twelve) The case was rpsumod yesterday morning at 10 o'clock, when Dr MieUe's cross-examination was continued. He said : — The, sac was opened before tho first ligature was applied. There wcro broad bands of adhesion which attached tlio bowol to tho sac. I have not said that there was no large pieco of omentum, and it would be perhaps more correct wero I to say that at this date I don't remember whether there was. The ligatures wero applied on two or three occasions during the operation. Dr Nedwill said something about the spermatic reins. In tho dissection of the sac thero was necessarily manipulation j it was absolutely necessary to twist it Blightly. Some person at tho enquiry used tho term "a' coil of twisted tisane," but I don't think I used it. A slight twist would not make any difference. To the be=t of my recollection the sac waß divided so closo to tho ligature that part of it escaped, and the ligature was not effective. That would account for tho sharp hremonv huge described by Brown. I will not contradict Dr Nedwjll if he says that it was at this juncture that he suggested putting it on. If a tenaculum had been put m we would not have been able to have pulled tho ligaturo tighter ; it would not have prevented the slipping. It was after this that the second ligature was applied. I can't account for tho extensive haemorrhage. If my ligature was sufficient to arrest bleeding for two

days, it would bo impossible," m my opinion, for thero to havo been extensive hemorrhage from the wound. Tho application of the ligature would not prevent the stump with the ligature on being pushed up within tho canal. I do not see how the needlo could pa? 3 through .without transfixing the stump. The Operator himself could not sco it; he must feel it. I have heard tho cn-;e of Henry M'Kegncy discussed a litUe. There was a ease of distended bladder m tho female ward, which I BawJ It was found out that it wa3 not a case of tumour. I don't think that the general body of " practitioners have much discussed Hospital matters, but this special case wo are now trying' has been discussed. Tho doctors havo token sides about tho hospital matters generally, but thero has been practical unanimity about this case, with the exception of one or two. Mr Stout: How could there bo a decided majority if there wa9 suoh a division as you told ub of? Witness: Well, if you always had such a decided majority bohind you, you would bo vory well contfnt. (Great Laughter.) Do you think it wiso for a medical man to have performed a dangerous operation of this kind, which lie had nevor seen performed, nor performed himself, without consulting with liia colleagues ? . I think it very unwise, and I have expressed that opinion myself before. .Are you m favor of vivisection ? Yes, m competent hands. Not on tho human, I suppose, — only on rabbits? Certainly not on. the human boing; but what do you moan by vivisection ? All operations are vivisection m a sense. I mean m a popular sense. Well, m a popular sense, I am m favor of it if carried out m competent hands. Would yon not teroi it vivisection, m tho ordinary eeuse, if a surgeon attompts to perform n, most dangerous operation, which ho has never performed himself before and nover seen performed? I would not. If he had carefully prepared himself by a study of the subject, that would havo boen a sufficient reason for me. In Wood's oporation the sac is cut for irreducible hernia. The text-books are necessarily behind date. This operation for irreduciblo hernia (Annandalo's) has only been performed within the last five years, but has been rouch used m that time. The opinions of tho surgeons who say that this operation is dangerous may be altered. Great experienco has been gained since 1883. Tho best surgeons advocate Annandalo's method, and practice it as much as they can. It is more favourably regarded now than over. Professor Wood says it is a successful and safe operation. Tho state of tho patient's health and his constitution should bo oarofully considered. " Bud constitution "is a broad term, but you certainly have to consider it. It wan not v matter of the doctors rofusing to attend the consultations at the Hospital, it was inconvenient, because they are all m busy practise. Did you form an opinion beforo you left the operating room as to tho chances of tho man's recovery ? At this date I cannot say. Would it be correct, tlicu, to saj that you loft tho room under the impression that tho man would not recover ? I cannot s.»y that it would bo correct. Would it be incorrect ? Probably ; but I have no recollection that tho man was m such a bud state that his recovery was impossible. He certaiuly seemed prostrated. liy Mr Stringer : Was Iloiise Surgeon at the Christchurch Hospital for a year. On tho first occasion of ouo being held I was told that tho post moil cms were hold m tho morning, nnd the practice was to hold them early m I lie morning before breakfast, the object being not to allow the patients to fre one £oi»g to tin 1 niwrguc, sis it had a bad effect on the piticni.i. 1 conc-urre I with tho resolution of tho JJospitil Sliiff, bocauso I thought that if an oper.it ion was to be performed, aud the surgeon operating was to bo charged with malpractice, there would bo no safety for us. Our hands would bo tied considerably, and many operations that ought to be performed would be left undone. The meeting was unanimous m considering that this libel was a most unjust attick on Dr Stewart, and th.it there was really no foundation whatever for the libel. As a rule, a stout man is not so good a subject for operating on as a thin one The putting on of a tenaculum, as suggested by Dr Nedwill, would not have prevented the slipping of the ligature. In giving a certificate of death for a case like Strickland's, I should have written "irreduciblo hernia and hii>inorrli':go " I never used a chimp while 1 was m the Hospital. It would be absolutely incorrect to describo the operation for the radical cure of hernia as "speculative, rare, and dangerous." To Mr Stout : I cannot say who proposed the resolution at the meeting of tho Hospital staff. If a aurgeon caw the operator doing anything improper, he ought not, aud would not, remain quiet. Unless it is a very well known oporation, the operator tells his assistants what tho nature of the intended operation is but there is no compulsion about it. This operation on Strickland was not a very well known. Dr Stewart, plaintiff, faid: I havo been m practice m Scotland and the Colony between 22 and 2^J years. I mil now, anil have been for some timo past, one of the honorary stuff of the ClirUtvhiirvh Hospital. [ have been on the stall' as one of the surgeons eineo the beginning of ISB3. In December, 183 1, Dr Bobinsou brought under my notico tho caso of William Strickland, ' for hernia. I saw him at the Hospitil about a week before his admission, mid had an interview with him m tho out-patients' room. 1 l;iiew, from what Dr Robinson told mo, that, he wu3 suffering from hernia. I also oxamined tho condition of tho hernia he was suffering from — a largo serotal hernia. I tried to reduce it, and reduced tho great bulk of it, but thero was a Email portion which I could not return. It was an irroduciblo hernia. He Baid ' he had been Buffering from it for years; ' that he had tried trusses, which were no good for him. I told him that m that case thero was nothing I knew of which would do him any good except an operation, if he was willing to undergo it. He said ho was quite willing to take tho risk. Ho also said his life was getting a burden to him ; that ho could not earn his living ; that ho suffered great dragging at times, nnd many times had to stop m tho street from pain. 'flic impression left on my mind was that ho know ho was m a daugerous position. I pointed out to him the danger of strangulation, and ho appeared to understand that ho was subject to it. I informed him several times that there was a risk. in having tho operation performed, and he then said ho waa quite willing to take any blame on himself if thero was any risk m the operation. I then asked tho House Surgeon to admit him as a house patient, and a week later he was co admitted. . I then partially examined him. I forget whether ho told mo where ho came from. From tho time of admission ho was under my charge ; was dieted, had baths, had his bowels and kidneys attended to. He was a fat, short man with q florid faoo, and. had evidently been fond of his glass, lionce tho nocessity of troatment for getting him into good coudition. I ordered the dispenser to. prepare catgut ligatures, according to.MqEwen's method. This would be about the time of his admission ; and I saw to their preparation. On December 10th the operation was performed. I did not call a consultation of tho staff. I had so veral reasons for not doing so, In the first place, tho man came m for tho distinct purposo of having this oporation done ; and as there was no other than tho particular niodo of operating, I did not see what I should gain by a consultation. The operation for tho radical euro was tho only ono possible m the circumstances. The usual-notices of tho operation were Bent out m the ordinary course. The patient was put on tjje table, and chloroform administered to him by the House Surgeon. When he was thoroughly under chloroform, I made an. inoieion. m tfje skin — I suppose about four inohes long. I then carefully, and as quickly as I could, cut down until I came to the Bao of tho hernia. AH the bleeding vessels were carefully secured by ligaturo or torson previous to tho sac being opened. I then dissected partly round the sac to see what I was doing. I then opened the sac and found that it contained a considerable quantity of intestine.

I did not cut tho bowel. The sac also contained a small piece of omentum, which was glued on by a little point to tho intestine. I found that tho bowel was not freo, but wns attached by adhesions. It was necessary to break down these adhesions, and I did that, partly by my fingers and partly by the aid of tho handle bf the scalpel. There' was a pavt which I thought it .would bo risky to break down, and I put a ligature round it and cut it off cloao to the sac. I think it is the generally approved method. The nest Btcp was to try and reduco tho bowel. I found Bomo difficulty, and then pulled down a small amount of tho bowel to see if there wore any adhesions. I then got the bowel fully returnod after a certain amount of manipulation and coaxing. I then proceeded, with the aid of my finger and tho blado of the scalpel, to aeparate the sac from tho adhesions. After they were carefully separated I held tho sac up and askod Dt Mickle to put a ligature round it. When he did that I gave him tho. sac to hold, and I tied it m the ordinary surgical method with a specially prepared catgut ligature. I then cut the sac below the ligature till that was free. I tied the ligature as close to the abdominal wall as I could get it. I went rather close to the ligature m cutting, and a corner or neck of the sac had slipped out. Bleeding ensued. I took hold of the stump with a pair of forceps, and asked Dr Mickle to put a second ligature round, which he did; that suppressed the hemorrhage. Just before tho second ligature was put on Dr Nedwill suggested putting on a clamp, but I diil not ; do so, beciiuso it was a most unsurgicnl proceeding, and dangerous besides. The clump would require to elough olt. He also suggested the use of a tenaculum. I consider that likewise an unsuigieal proceeding. Tho first ligature was there to hold it. It had not been cut short. It is also a good sound surgical rule that so long a3 you can use your fingers, you ought not to usri instruments. Previous to passing the ligature round, I gavo the sac a twist purposely, m order to form a Btrong barrier against tho return of the hornia. I had authority for doing that, itbeing recommended by Ball, an Trish surgeon

of eminence. Tho bleeding having been stopped and the parts sponged,- 1 took a curved needle, threaded it with catgut ligature, nnd passed it deeply through the abdominal ■wollb close to the ring and through the Btump and out through the opposito side of the abdominal wall. I next tied the ligature, and bo olosed tho outer wound. I guided the needle with my finger, which retained the stump m tho position I wanted it. I dressed the wound over with the usual antiseptic precautions. We had only to ligature two or three small blood vessels ; there are no largeBized vessels there. Proper bandages were next applied, nnd the man was removed to lia bed, where I saw him twice a day, if not oftener. Ihe day after the operation he was Tory nice, and seemed as i' he were going to do well. On the morning of the second day he was fairly well, but m the afternoon he •was not so well. I never Baw him again, and he died on tho morning of the third day. I oxamined tho dressing, but there was no . liermorrhage from the wound. I remember Dr Nedwill returning to the operating-room and saying to Dr Mickle, who was helping me becauso he (Nedwill) was absent, ".You had bettor go on with it," or something to that effect. Dr Nedwill made no objection to my going on with tho operation, and never said anything good, bad, or indifferent about it, though he was present all the time it was going on. I asked Brown to out tho sutures and open the wound. There were a few clots of blood between the walls of the abdomen, and I asked him to wash them out m order that I might see the appearance of the parts. I saw the stump. I asked Brown to cut the ligatures m order to Bee if there had been any sign of healing m the stump. I found that there was practically no healing- I took the forceps and scaljel m order to open the mouth of the stump. Thoro was nothing to be seen — a few small clots of blood m the centre and edges of the wound were noticeable, but these wore of no consequence. There wbb a good deal of effusion of blood to the softer tissues. The postmortem had nothing whatever to do with the certificate of death, which has to bo given by the House Surgeon. The House Surgeon said " What do you think is the cause of death ? ' and I replied " Oh, I think hemorrhage is one of the causes j" but I did not give tho matter any consideration. 3he House Surgeon, as a matter of fact, differed from me, saying " Oil no ; there's no hemorrhage sufficient to cause death ;" but I said, m an offhand way, "Oh ■ it does not matter j you can put m hemorr hage as one of the causes." Up to that time I had not the slightest idea that Dr Nedwili ■was making any oharge ngninet me. I first heard of a charge on the afternoon that tin etaff meeting was called. When the Boar.li enquiry took place Dr Nedwill made furthei charges against me, and then I examined thi temperature chart, which indicated a higl state of temperature, which would be incon sistent with any great hemorrhage. By Mr Stout : Dr Robinson informed m< that Dr Nedwill wished the post morten postponed until the staff hud met, notwith standing that I consented to tho post morteu being held. In making the post mortem ] did not look for the cause of death. Its onli object was to Bee what repair had taker place. I have given certificates of death ir my private practice, and know that it is ai important matter. I ought to have allowec Dr Robinson to have given it as he pleased This is not the first occasion on which I havi given an account of tho operation, but I don'i think the account I have just givei differs one iota from that I gave at tin Board's enquiry. I deny that 1 then statec what you read as my ovidence at the Board'i enquiry. I am there mado to say what ] never said. It was physically impossible. ] signed the evidence a week or two afterwards but I never read it, or h:id it read over. 3lk fact is, I was co heartily tick of the thing tiial I signed it right off. The witness was cross examined at lengtl: as to the number of liga 1 ures, and said then were two on the Btump. and the third went right through the abdominnl wall, and through the Btump. I now think it was wrong to say that the man suffered from hemorrhage. I was misled m Baying that there ha t been extensive hemorrhage beforo death. At the staff meet ing I gavo a reason why thero had beer hemorrhage, the reason being that a ligature had slipped. This statement was made bj me after the poßt mortem. Another rcasoi: why the ligature had apparently slipped was that tho tissues had softened. At the enquiry I stated that I was wrong m the opinion 1 had previously expressed. The term " shock ' ia not generally used by surgeons when thej cannot account for death. The man's stomach was swollen, and if Brown swore to the contrary he was certainly mistaken Dr Colquhon, lecturer on medicino m the Otago University, said : I am pretty conversant with hernia, and know of the operation for the radical cure of hernia," but I have never performed it or seen it performed. The operation is a comparatively rare one, but it is not hazardous, nor is it speculative. It has decidedly passed out of tho region of experimental surgery. In the sac you find the bowel, and the matter or adhesions which have prevented the reduction. A skilful surgeon performing the operation would break down tho adhesions where possiblo with his finger or a blunt instrument, and if these were not practicable, he would use tho scalpel In the operation of radical cure for hernia, the methods of stopping hemorrhage aro pressure of the small venels, twisting by forceps, by the application of ligatures, or by the use of the clamp. If the hemorrhage occurred nt the stump, I should think the application of a ligature is the generally accepted method. The clamp would be quite as effectual an operation if it were properly applied. There are, however, disadvantages from the use of the clamps retarding the healing of tho external wound and tending to drag the string down and prevent tho ultimate closure of the opening. Hemorrhage cannot bo absolutely prevented m such an operation, nor after it. A prudent and skilful surgeon operating m this cose would endeavour to return the bowol by gentle pressure If he failed he would draw the bowel gently down and try again. I know tho operation for strangulated hernia. Tlio operation must be performed promptly. By Mr Stout : I htivo operated for the radical cure of hernia. I had no occasion to cut tho sack. My patient recovered. I think it would be the correct thing to say that the primary cause of death, m tho case suggested, was hernia, and not the operation following. By Mr Fitohett : No Bpecial knowledge is required to stop hemorrhage. John Barti's evidence was that he made arrangements with defendants f.jr being supplied with their paper. He received a copy, which he handed to Dr Stewart, who marked it. [Mr Wilding admits thai a copy of the 'Evening Press of May 21st, 1885, containing articlo complained of, was sent by the defendants to Mr Baxter, and received by him m Christchurch.] William Deamer : I am a duly qualified medical practitioner, carrying on business m Christchurch for the lost 23 years. Supposing a patient m tho Hospital suffering from an irreducible hernia ; that he had expressed himself as unable to earn a living as he was ; that he had had tho nature and risks of tho operation explained to him ; and that he had expressed himself as willing to undorgo those risks — what could you, as a medical man, advise to be done ? (Question asked by Mr Stringer). I should advise an operation to be performed for the relief of the hernia. In cases m which the staff had decided upon an operation, the operating surgeon would decide as to the modus operandi. The staff merely decide as to the necessity of an operation. I know nothing personally of Strickland's case. At the meeting of the staff on December 23rd, Dr Nedwill preferred two charges against Dr Stewart ; first as to tho breach of tho rules, second as to the mode m -which the oporation had been performed by Dr Stowart. There was a discussion as to the mode of tho operation between Drs Stowart and Nedwill. Dr Stowart gave it a3 his opinion that death had resulted from hemorrhage, arising from something being wrong with tho ligature. At tho meeting of the staff, they, after hearing Dr Stewart's explanation, and hia promise not to infringo the rules again, completely exonerated him from blame. At the meeting of the 3taff, m the discussion between Drs Nedwill and Stewart, I think Dr Nedwill objected to the way m which the ligature had been tied, and said something about a clamp pot having been used.

Evidence taken on Commission, March, 13th, 1886. Elizabeth Medlam : I am head nurse m No. 6 ward of tho Christchnrch Hospital. I have been a nurse there for 11 years. I remember the operation on Strickland. He was under my care. I always attend operations on patients m ward, and attended the operation on Strickland. Dr Stewart is always careful and attentive, and most successful m most of his operations. The operation on Strickland was performed m his usual way. He was cool and collected, and nothing different to usual. Charles Morton Anderson : lam a duly qualified medical practitioner, and am a member of tho Hospital Staff. The operation for the radical euro of hernia is (m my opinion), at tho present day, a perfectly legitimate one. There aro various methods of performing the oporation. I believe I heard Dr Patrick state at tho Hospital Board onquiry, " After the opening of tho sac I was unable to follow the operation." I understood him to say that ho could not toll what was cut off by Dr Stewart. I believe he said words to tho effect that " the tissues became so mingled and covered by blood that I could not distinguish one part from another." I should not have performed such an operation as that on Strickland, either within or out of the Hospital, without a previous consultation. James Somervillo Turnbull (for plaintiff) : I am a duly qualified medical practitioner, and have been practising at Christchurch for 27 years. I have been on the Hospital staff both as physician and surgeon at various times, amounting m the whole to about eight years. I remember Strickland's case. I am acquainted with the rules of tho Hospital, and was Chairman of the staff which prepared them. With reference to consultations held under the rules, my opinion is that such consultations are for tho purpose of getting as much information ns possible from the profession, and to give satisfaction to the patient and his family. The consultation is for the purpose of deciding whether or not an operation is justifiable. The method of carrying out the proposed operation would be decided on by the operator, and would not be uffocted by the consultation. Q. Supposing a patient m tho Hospital was suffering from an irreducible hernia ; that he had expressed himself unable to earn his living as he was ; that he had had the nature and risk of the operation explained to him ; and that he had expressed himself willing to undergo those risks, what would you as a medical man advise p I would advise an operation, and perform it myself, without reference to tho Hospital staff. I have done so before m major operations, and would do so again. I have done so m spite of the opinion of the staff that thoro should not be an operation, and with success. I have no personal knowledge of the operation, but it is accepted as a safe and justifiable operation at the present day. The staff, as I have since hoard, entirely exonerated Dr Stewart from blnnie. I was present at a meeting of tho medical profession of Canterbury, which was held to consider the article tho subject of this action. Dr Stewart was present. It was decided at the meeting that Dr Stewart ought to bring an action against the newspaper for libel. I considered at that time, and consider so now, that Dr Nedwill wa3 the virtual author of the libel. I am not on speaking terms with Dr Nedwill, and have not been since the commencement of this action. Rawdon Briggs Robinson, formerly house surgeon, described tho operation performed on Strickland. Witness administered the chloroform. Dr Stewart seemed to operate carefully and with steadiness. He was mno flurry, and there were no objections raised by anyone watching the operation to lead witness to believe that anything wrong was going on. He did not think death had resulted from hemorrhage, but had put that cause m the certificate m deference to Dr Stewart's opinion. The cross-examination of the witness extended to great length, but from a very large part of it nothing of much importance was elicited. He believed ho had BUggesled to Dr Stewart the advisability of having a consultation prior to the operation. Tho witnoss's opinion the cauee of death was " shock," that is that the gravity of the operation affected the heart and the nervous system generally. At 5.30 p.m. tho Court adjourned until next morning.