H.—22a

36

You did not know his opinion and he did not know yours?—No; until the Commission sat no one had seen my report, except Dr. MacGregor. Dr. Bull, who performed the autopsy, would be able to say what took place, but it would be impossible for a man who was looking over my shoulders, at a distance of 2 yards, to speak. 1 am prepared to prove my statements. Probably you could produce the specimens?—l have them here, but it might be offensive to produce them in the room. They might be examined outside in the corridor, or on the lawn. The Chairman: An examination of the specimens would show how many ulcers there are. It is a simple question. Mr. Savage (reading from Dr. Bedford's report): He says, "The walls of the stomach were not watertight." That is not so. There was no leakage from the stomach, except a dripping on the outside, which might fall from any wet, smooth surface. Mr. McV r eagh: If there is going to be a contest like that, there should be other medical witnesses. Mr. Reed: There is no contest. Mr. Savage said that if he demonstrated the specimens to the Commissioners they would be able to observe for themselves. Mr. Savage (again reading from Dr. Bedford's report) : He says, " On raising the intestines adjiesions were found to exist between the coils." There were no such adhesions. He also says, " The scrotum could not be seen," but I raised the scrotum myself, and showed it to Dr. Bull. He also says, " There were minute points through which a general leakage took place over the whole gastric sac." I do not admit that. The Chairman: We expect that the stomach will make it plain, even to us, how many perforations there are. Mr. Savage (once more quoting from Dr. Bedford's report) : He says again, "The peritoneum was friable; it broke away readily from the stitched edges on the slightest movement." I do not admit that. He also says, " The gastric ulcer was the longer of the two ulcers," but I can say that the state of the mucous membrane of the stomach was such as to enable me to say that there had been no ulceration whatever in the stomach. Dr. Bedford speaks of the first incision in the colon being 3 in. from the root of the appendix. Its actual distance was li in. I may remark here that I think it fair to Dr. Bedford that he did not use a rule, and that he only measured with the eye. I do not suppose his measurements are intended to be minutely accurate. I was the only person present who used a measure of any kind. Dr. Bedford's description of the second incision in the colon as being of such a size as would be made by the blade of a scalpel I cannot admit. It was not less certainly than i in. Mr. Reed: Can you say, from your experience, whether it is difficult to diagnose between perforated gastric ulcer and perforated appendicitis? —I w-ould say that no expert surgeon need feel ashamed it, after opening for appendicitis, he found the case to be one of duodenal or gastric ulcer. You have known an expert surgeon to make that mistake?—l have. Supposing you cannot get at the appendix owing to a distension of the bowel?— That never occurs without adhesions, and in this case there were no adhesions. What would be the percentage of mortality in cases of gastric ulcers operated upon at seventeen hours after perforation?—Up to twelve hours the average mortality is 28 or 29 per cent., twelve to twenty-four hours between 60 and 64 per cent. It increases very rapidly after twelve hours. Could you say whether incisions such as were made in this case would get longer or shorter after death?—lf the caecum were distended with gas at the time, naturally the incisions would become shorter when the gas escaped. If you make a cut in the length of an elastic band when it is stretched, when the band is relaxed the cut becomes shorter. Therefore these incisions could not have been smaller when made. The Chairman: How should White's case, in your opinion, have been treated ?-—lt is difficult to definitely decide between appendicitis and gastric ulcer. I have seen exactly the same thing occur with one of the expert surgeons at Home. An incision w-as made over the appendix, which was found to be normal. This was sewn up and immediately an opening was made in the abdomen over the stomach, and a perforated ulcer found. Did the patient die?— Yes. What effect would the incisions in the intestines have on the patient? Would they militate against his chances of recovery?— They must to some extent. The question of time would be a serious matter, and every incision in the intestine or stomach conduces to grave shock, and makes more perforations in the bowel which have to heal. Mr. McCarthy: Ought the knowledge you have detailed to be possessed by the average practitioner?— That is too difficult to answer. The Chairman: I do not think there is any more to ask you. Dr. Collins did not cross-examine the witness. It w-as agreed that Mr. Savage should arrange for an examination of the exhibits in the presence of the Commissioners, Drs. Neil and Collins, and other doctors. Nurse Bell, who was present at the operation on White, was called to answer one or two questions concerning the patient, but these were not of any general interest. Dr. Gore Gillon, consulting surgeon, of Auckland, said he had been for three years Superintendent of the Wellington Hospital, and for three successive periods of three years each elected a visiting surgeon. Authorities differed, he said, as to the mortality in perforated-gastric-