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EL—22a

The Chairman read Rule 72 (adopted in 1902), as follows: "He (the Senior Medical Officer) shall be responsible for the treatment of all cases of emergency, and all surgical operations connected therewith, after the visiting surgeon, under whose care the case was admitted, shall have been notified of the urgency of the case, and he shall be authorised to use his discretion as to the advisability of immediate operation prior to the arrival of the honorary surgeon." Mr. Savage: Is there not a resolution that if the surgeon for the week is not present within one hour he shall proceed with the operation ? Supposing the surgeon for the week was ill? The Chairman : Another should be summoned. Mr. Savage: That is not the rule, but it should be so. Mr. McVeagh: I think Rule 11 provides for illness. The Chairman (referring to the rule) : Rule 11 reads, " In case of illness or other cause of absence on the part of any member of the honorary visiting staff, he must arrange with the Senior Medical Officer that the patients under his care be attended by one of his colleagues, with the consent of the Chairman of the Board"?— Yes; but I do not know what the Chairman of the Board has got to do with it. Mr. Beetham : If the resident Medical Officer were prohibited from performing such operations, can you conceive of any abdominal case coming into the Hospital which would suffer from the interregnum of time which would elapse after the patient had been prepared for the operation before any honorary surgeon could be obtained?— Not if satisfactory rules were enforced. In the London Hospital there is a rule providing that the honorary surgeon for the week shall be within half an hour's call of the Hospital during the whole of the week. If he has engagements which will take him away beyond that distance the regulations distinctly state that he shall notify the next man in rotation on the honorary staff, and arrange with him to do the work if any such case should arise. You do not think that any danger would arise from such a rule?- - No. If the surgeon for the week could not come within, say, an hour, lie ought to arrange for another man to come. It is extremely unlikely that the three or four surgeons would all be away at the same time. Mr. Reed: You say that you consider that at present the resident Medical Officer is practically compelled under the rules to do these operations?— No. What I said was that by the interpretation lately put on the rules it had been customary for him to perform them. Mr. Reed read the following extract from a letter dated the 11th May, written by Dr. Inglis, as secretary of the honorary staff: " Owing to advances made in the science and art of surgery, most of the more important operative work, especially on the head and abdomen, falls under the heading of emergency work." I think, continued Mr. Reed, that the most serious operations are emergency operations?— Yes; the serious emergency operations which the honorary staff should do. Mr. Beetham : You say that no operation of any magnitude can be done within an hour, and that all emergency work should be done by the honorary staff?— Yes. Dr. Robeiton: Can you tell us where the definition of "emergency work" is the same in London as here?—l cannot exactly say, but emergency work is generally understood to be such cases as come in suddenly, needing serious operative treatment of some magnitude within a short time—that is, within two or three hours. This would include abdominal operations or compound fractured limbs, which should be attended to by the honorary staff. Generally, " emergency " oases are those which require quick surgical treatment. Mr. Beetham: How would you deal with fractures, compound or otherwise?— Ordinary fractures should be attended to by the resident staff, and should be inspected by a member of the honorary staff next day. Compound fracture of the less serious character could be similarly dealt with. In more serious cases, such as those requiring the remove' of bone, and possibly amputation, the members of the resident staff should render treatment on the principles of first aid, and a member of the honorary staff should be sent for. Apart from the interest of the patient, I do not think it fair to expect the resident staff to undertake such work, when it could be done by more responsible men, who are in constant practice. There are many unjustifiable complaints made against hospitals which would not be made if the patients were treated by more responsible men who are in working practice. Dr. Bull, who performed the autopsy of the remains of the late Wallis White after the exhumation, said that he had been a member of the honorary staff, but had lately resisined. In describing the examination of the exhumed remains, he said there were two incisions in the caecum, the first being about 1-5- in. and the second rather less than 1J in. in length. Apart from this, the caecum, colon, and appendix were healthy. There were no signs of ulcerations in the stomach. An oval ulcer, measuring i in. by about J in., was found in the duodenum. The rest of the duodenum was healthy. The Chairman: There was no ulceration in the stomach itself? —No. The Chairman: We could see this morning that there was no perforation in the stomach. Mr. McVeagh: Did Mr. Savage show you the scrotum?—l do not remember him doing so, but I saw the scrotum. Wore there any indications of a drainage-tube having been inserted?— There were indications which went to show that a drainagetube might have been used. Were there any adhesions?— No. It has been suggested that the peritoneum was friable? — Not markedly so.