77

H.—22a

Gastric ulcers could also be termed emergency cases under certain conditions. Peake's case was an emergency operation. Certain classes of cases which Dr. Collins specified would be considered major operations. Dr. Collins : There was a surgeon on the honorary staff, was there not, who systematically cut his telephone off at night?—l do not know. Has the staff not tacitly agreed until the last few days with the interpretation put upon the term "emergency"? — I have always thought that when death was threatening the operation should be performed. Then, I was not contravening Rule 21 in performing these operations?—lf life was in danger, you were not. Witness said he considered more buildings for infectious diseases should have been erected in years past. He had formerly thought that for minor infectious diseases the building could have been erected in the Hospital grounds. Now that the number of infectious cases had increased so much he thought it would be better to have the Hospitaf farther away. Dr. Scott stated that he was an honorary surgeon on the Hospital staff. He had occupied the position of chairman of the honorary staff for some time. He pointed out some defects in the Hospital buildings and the old operating-theatre. "There was," he said, "really no operating-theatre in tho Hospital at present." The staff had expressed the opinion that better facilities should be provided, and the Board had followed out this advice by erecting the new operating-theatre. The modern trend was in the direction of having separate theatres for septic and aseptic cases. He considered that there should be two, if not three, theatres at the Auckland Hospital. As honorary surgeon, he considered he should treat only the poor. Have you found any difficulty in getting people to go into the Hospital?— Yes. There are two classes who do not mind going in— the very poor and the fairly rich. The former know that they cannot possibly lose any money, and the latter did not mind when they knew they could get fifty pounds' worth of operation for £5 or £10. Those who fear to go in—and their fear is very bitter—are the comparatively poor, who by being provident have got a roof of their own over their heads. I have known cases of people of sixty years of age say, " I will have to mortgage my property if I go into the Hospital, and if I do that I shall never have a chance of lifting the mortgage." Then, when these people do go into the Hospital, they often have a terrible dread of remaining there owing to the expense. Witness considered members of the honorary staff should be appointed for a longer period. When the question of the appointment of the Senior Medical Officer came up the intention of the Board, he believed, was that they should get a man specially qualified for emergency work. He had been very much surprised to hear the view expressed that the Senior Medical Officer should not perform major surgical work. He did not think the Senior Medical Officer had performed any operations not in conformity with the rule. The honorary staff had discussed the question as to who was to use the discretion as to the advisability of performing operations, and they decided on the person on the premises. The Chairman: The question is whether the rule authorises him to do it. Dr. Scott: The rule does authorise him. Tho Chairman : We will form our own opinion of the rules. Continuing, Dr. Scott said it would be advisable to have a uniform system of hospital-management throughout the colony, arranged according to the size of the institutions. It would give an opportunity for the promotion of deserving residents to higher posts, and would avoid trouble between Board and staffs. He favoured the appointment of assistant surgeons to the honorary surgeons. As an ex-Mayor of Onehunga, he could say that the representative of that district on the Hospital Board was elected from a financial standpoint— one who would see that as little levy as possible would be made on the local authority in the upkeep of the Hospital. He estimated that the monetary value of the services rendered by the honorary staff to the Hospital at £3,600 a year, reckoning on two guineas a visit, with four visits a week. The honorary staff were thus, ipso facto, contributors to the maintenance of the Hospital. Mr. Reed cross-examined the witness as to the White operation. He said he was visiting surgeon that w-eek, and was communicated with by Dr. Collins. Witness was in bed, suffering from influenza, and could not attend, so requested Dr. Collins to operate, as he had the fullest confidence in his capabilities. He said he was conversant with the particulars of the case and the operation, and stated he had known in a similar case it was necessary to evacuate the bowels. Mr. Reed: It has been suggested that the shock of the opening of the bowels is likely to accelerate the death of the patient?— That is half of the truth. The other half is that a surgeon who feared shock was perfunctory about the cleansing of the bowels, and he would have a larger proportion of deaths than one who disregards shock and thoroughly cleanses the peritoneal cavity. It was more surgical to lisk deaths by shock than to have certain deaths following peritonitis. It would cause delay, but the results were much superior. Opening the bowels takes time and causes shock, but it is safer than closing up the wound without relieving the bowels?—ln many instances that would be the case. In reply to Dr. Collins, the witness said he did not think Dr. Collins had arrogated his position, but had not overstepped the position granted him by the Board.