THE AUSTRALIAN
MEDICAL JOURNAL.
NOVEMBER, 1876.
MEDICAL SOCIETY OF VICTORIA.
ORDINARY MONTHLY MEETING.
WEDNESDAY, NOVEMBER 8, 1876.
(117 Collins Street East.)
Present : Dr. McMillan, Dr. Peacock, Dr. Blair, Mr. Gray, Dr. Kennedy, Mr. W. Barker, Dr. Talbot, Mr. Girdlestone, Baron von Mueller, Dr. P. Smith, Dr. Allen, Mr. R. Robertson, Dr. Martin, Dr. Williams, Dr. Nicholson, Dr. Molloy, Dr. Neild, Mr. Fitzgerald, Dr. W. Molloy, Dr. Barrett, Dr. W. H. Hinchcliff, Dr. Singleton, Dr. Rowan, Mr. Cooke, and Dr. Pinnock. Dr. Syme, of Stawell, was present as a visitor.
The president, Dr. McMillan, in the chair.
CORRESPONDENCE.
The honorary secretary read an acknowledgment from the Solicitor- General, of the copy of the resolution passed at the last meeting, relative to the bill for abolishing coroners. Also the following letter on the subject from the hon. Dr. Madden, solicitor-general :
" October 16th, 1876.
" J. E. Neild, Esq., M.D., &c.
" Dear Sir,—I have the honour to reply to your letter conveying to me the resolution arrived at by the Medical Society in relation to the Inquests Bill, and to point out that your Society labours under a mistake. There is no such distinctive office as a medical coroner under the present law. There is no coroner, save Dr. Youl, who is a medical man ; and of the deputy-coroners, not more than, I think, one-third are medical men, the remainder being persons of every variety of profession or calling. Therefore, without entering upon the question whether or not the holder of inquests' should be a.
medical man, it is clear that the bill now before the house does not, as your Society appears to think, reverse an already existing state of things which throws this office on medical men, for there is non&
such.
" I have the honour to be, Sir, faithfully yours,
" JOHN MADDEN. "
VOL. XXI. A A
342 Medical Society of Victoria. [Nov.
PRESENTATION OF BOOKS.
The following books were presented to the library : " Abstract of Specifications of Patents" (" Metals," p. ii.), by the Registrar- General. " Forest Culture," and " Eucalyptus Trees," works by Baron von Mueller, collected by Ellwood Cooper, San Francisco, presented by Baron von Mueller.
NOTICE OF MOTION.
The following notices of motion were given by Dr. Neild : 1. That Rule 22 be rescinded.
2. That the following addition be made to Rule 4, after the words " Register of Victoria :" and he shall have resided not less than two years in Victoria.
NEW MEMBERS.
Dr. A. Shields of Hotham, and Dr. J. Grant Black of Carlton, were elected members.
EXHIBITS.
The hon. secretary, Dr. Neild, exhibited a sample of Dr. Lelievre's Iceland Moss Instantaneous Poultice, and submitted the following description of it by the inventor :
" The Iceland moss poultice is exempt from all the incon- venience inseparable from poultices made from linseed, which soil the bedding, rapidly ferment, give out a most unpleasant odour, and are almost invariably prepared from rancid and adulterated meal
" To use the new poultice it is only requsite to submit it to the action of a small quantity of water, either boiling, lukewarm or cold until it becomes thoroughly distended, and then to apply it to the part affected, covering it with either gutta-percha tissue, or gold- beater's skin, or waxed linen. It thus supersedes the use of linen, which is often very scarce among single persons and in humble households.
" The chief advantages of the new poultice are these :
" 1st. It is unchangeable, the same poultice can be applied for many days to the skin without undergoing the slightest deterioration.
" 2nd It will receive and keep upon its surface the most varied medical substances, and will facilitate their application and effect.
From this point of view alone, this poultice is calculated to render the greatest services to the medical art. In the course of an experience acquired during more than one year in the hospitals of Paris and from which the most favourable results have been obtained, they have been prepared with Sydenham laudanum, extract of saturne, phenic acid, arnica, morphine, with perchloride of iron, etc.
, " 3rd From a surgical point of view they are equally capable of rendering great services. As a matter of fact, saturated with water or any astringent liquid, they can most easily be moulded upon the 'contused or otherwise affected place and protect it against friction from clothes, etc., and, when left to themselves, they slowly dry, and can then, under certain circumstances, act as a retaining bandage, remarkable both for its lightness and its homogeneity.
J 876.] Case of Resection of the Shoulder-Joint. 343
" In fact, the Iceland moss instantaneous poultice is essentially safe and can render real service to practitioners ; finally, it offers to travellers and persons living alone, advantages which the ambulance and marine services have quickly utilized, inasmuch as the Minister of War (in France) has just adopted it for the military ambulance and hospital services."
Dr. MARTIN exhibited Dr. Lawson Tait's }Ether Inhaler, a de- scription of which he stated would be found in The Practitioner
for March 1876. Its advantage consisted principally in the possibility of its being used with less risk to the bronchial mucous membrane, on account of the vapour being raised to a high temperature. There being no evaporation was an additional recommendation to those who disliked the smell of nether.
Dr. NEILD exhibited samples of Tually's new Compound of Phosphates, for warded by the inventor, and read the following description of the composition : each tablet consists of phosph. of lime, 10 grains ; phosph. of iron, 2 grains ; phosph. of sod., 2 grains ; opheline (chiretta), 1 grain ; extr. carnis (kreatine) and sugar, q. s. Each tablet is subdivided into four doses.
Dr. BLAIR exhibited for Dr. Peacock the stomach of a man who had been poisoned by swallowing chloroform. As a pathological specimen it was valueless, in consequence of its having been some time in spirit.
CASE OF RESECTION OF THE SHOULDER-JOINT.
Mr. GIRDLESTONE, after Dr. Molloy had questioned the desira- bility of re-opening the discussion upon this case, said, that as Dr. Blair had exhibited the patient without notice, and as it had, since the last meeting, been partially debated in the public news- papers, he thought it only right to re-introduce it in the Society, for those who knew most of the history of the case, had had no opportunity of speaking upon it. It was, he thought, always most desirable, that all subjects likely to evoke discussion in the Society should be first submitted to the committee, so that all members could have a proper notice of them. But he (Mr. Girdlestone) had been publicly attacked by Dr. Blair, on account of what he had said respecting the case, and he therefore conceived that he had a right of explanation. Consequently, he had felt himself quite justified in giving notice of his intention to say something more respecting it. He preferred to do so in the Society, rather than to write to the newspapers. The patient, Timothy O'Hara, had been, and probably was then, in the Alfred Hospital. He had been seen by Mr. Fitzgerald and others capable of judging, and Dr. Blair had said that he (Mr. Girdlestone) had committed an error in diagnosis.
He (Mr. Girdlestone) wished to know, had there been disease in the head of the bone sufficient to justify Dr. Blair resorting to
•excision, or, on the other hand, was it a case only of disease of the scapula ? There had certainly been this question of the condition
,of the bone, and Dr. Blair had brought the case to the Society, and
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344 Medical Society of Victoria. [Nov..
paraded it as a cure. In very bad taste he had congratulated.
society at large that there were two hospitals, and that a patient who had not been operated on at the Melbourne Hospital, had been successfully so treated at the Alfred. Very naturally, Dr. Blair had been taken to task by Mr. James for this violation of a well- understood rule of professional good manners. Dr. Blair had also written to The Argus about the case, and although the word
" cure " might not have been used, the impression obviously desired to be conveyed was, that the patient was cured. Mr. Rudall, the value of whose opinion no one would gainsay, had declared the operation to have been premature, and certainly, considering that the man could not move his arm, and that a number of sinuses were discharging pus, there had been a questionable eagerness to exhibit the case. He (Mr. Girdlestone) repeated that there has been no disease of the head of the os humeri, and that there was disease of the scapula, and that the operation did no good. The excised head of the bone had been exhibited, covered with dried blood, and broken in with a gouge. This gave a wrong impression to those who saw it. It gave a notion of disease which did not exist. There was no proper history of the case, which there ought to have been, and now he (Mr. Girdlestone) understood no one was allowed to see the case.
When a consultation was held, he (Mr. Girdlestone) had objected to the operation being done; Mr. Robertson had simply said " operate,"
and Mr. Rankin had given no opinion. Those present at the operation had not been able to see any disease. There was certainly no caries, and unquestionably no necrosis, and therefore no need for the operation.
Mr. FITZGERALD knew something of the case which at first, in the Melbourne Hospital, had been under the care of Mr. Howitt, who treated it for disease of the scapula. The man was sent out and re-admitted under him (Mr. Fitzgerald). There was then no disease of the joint, but cloacae leading to the scapula, which was in the first stage of necrosis. He had pointed out to the students that no educated surgeon would consider himself justified in operating.
Dr. BLAIR wished Mr. Rankin were present to speak as to what he knew of the case. Mr. Girdlestone did not see the operation, and therefore could hardly say anything of that part of it. He- (Dr. Blair) asserted that there was disease of the joint.
Mr. FITZGERALD.—Not such as to justify operation.
Dr. BLAIR.—He had used no gouge. He had simply cut down to the joint, and a quantity of pus immediately poured out. This pus had found its way through the supra-spinatus and infra- spinatus muscles. Certainly relief followed upon the operation ; the man slept well, he had some power of motion, and the sinuses had closed. He appealed to anyone who knew anything of surgery if the bone was not diseased I But besides the head of the os humeri, the glenoid cavity was also diseased.
Mr. GIRDLESTONE re-asserted that the hole in the head of the bone had been made with a gouge or chisel.
1876.] Case of Resection of the Shoulder-Joint. 345 Mr. ROBERTSON had been present at the operation and he was
•satisfied Dr. Blair was wrong to operate. His gouge had certainly gone into the head of the bone, which he believed to be sound, as also the glenoid cavity.
Mr. FITZGERALD would be glad to know how the pus could go 'up into the supra-spinatus and infra-spinatus, as spoken of by Dr. Blaid There had been a little periostitis, but nothing more. The instruments had caused the appearance of disorganization presented by the bone on exhibition. The joint had been excised for disease, not within it, but only above and below it.
Dr BLAIR explained that capillary attraction would account for the passage of the pus into the supra-spinatus and infra-spinatus muscles. He had refused to let the man be seen, because the ,continual examination would only have done him harm.
Mr. COOKE, who had had charge of the case in the Alfred Hospital, expressed his belief there had been no disease of the joint.
Mr. KENNEDY, who had had charge of it in the Melbourne Hospital, was equally clear there was no joint-lesion when the man went out of the Melbourne Hospital.
Mr. GIRDLESTONE observed that for Dr. Blair to say he did not make the hole in the head of the bone with the finger or the gouge, was only an evasion of the question. The hole had been made, and Dr. Blair himself could not deny it. It was mere subterfuge to say it was not a healthy bone. The fact was the man had no healthy bones, and any other of his joints might have been excised with quite as much justification as this shoulder-joint had been, and no more. The joint was suffering from disease. It was a light bone in a strumous subject.
Dr. BARRETT had seen Dr. Blair at the operation pass his finger into the bone.
Dr. McMILLAN thought there had probably been inflammation of the cancellous structure.
RESUMPTION OF THE DISCUSSION UPON DR. SINGLETON'S PAPER.
Dr. SINGLETON gave a resume of the paper upon " Phthisis in Victoria," which he had read at a former meeting.
Dr. MARTIN had been struck with astonishment at the industry shown by Dr. Singleton in the compilation of the tables prepared by him ; at the same time he could not accept without question all that was asserted by Dr. Singleton. The truth as to the mortality of phthisis in Victoria probably lay between the assertions of Mr. Thomson on the one hand, and Dr. Singleton on the other. It was certainly not desirable to increase the influx of consumptive patients into this colony from Europe. His (Dr. M.'s) experience had been that for consumptive patients to come to this colony in winter was in many instances beneficial, but the summer season certainly did them harm. The hot winds exhausted what little of
346 Medical Society of Victoria. [Nov.
vitality was left in them. He therefore had always recommended them to go away to a cooler latitude when the hot winds began to blow.
Dr. BLAIR said it was a matter of altitude rather than latitude, and that Victoria presented every variety of climate in this way.
BARON VON MUELLER remarked: Having come nearly thirty years ago to Australia to save my life, while in danger of being carried off in the cold clime of Scandinavia by phthisis, of which both my parents died, I was grateful to Australia for the prolongation of my life, and should like therefore to offer a few remarks on this occasion.
In reference to Dr. Singleton's paper, I am eager to draw particular attention to that passage which laid stress on placing phthisical patients on mountainous elevations, having experienced in my own_
explorations the sanitary effect of the lightness of the air at con- siderable altitudes. When, in 1853, 1854, and 1855, I was the first to traverse many parts of the Australian Alps, and carried on triangulations there, I felt inexpressibly easy and delighted in inhaling the air of lofty heights, my inspirations being free of the oppressions of the lowlands. I had to determine the zones of vegetation at the time, which I did by testing the boiling-water point ; and it may readily be imagined that, as at every thousand feet ascent nearly two degrees Fahrenheit less are needed to boil water, a great facility was experienced at six or seven thousand feet high, where about a dozen degrees of heat less are required to change water into steam vapour. In our latitudes, however, such altitudes are too trying for patients in danger of pulmonary consump- tion, because the climate in our higher ranges becomes too cold for them. Yet, in the summer months, the best chance for recovery would here be attained by placing consumptive people at some moderate elevations, particularly under the favourable influence of an equable forest temperature, instead of keeping the poor sufferers- in towns, or indeed any where in low lands, subject to sudden changes Of the air, often far too dry and too cold, or again, too hot.
I deem it also injudicious to subject such patients, in an advanced stage of the disease, to a voyage half around the globe, and have often been advising that far less distant localities should be sought by European patients—for instance, the high mountains of Ceylon.
or Venezuela, which can be easily reached even by much-suffering invalids, being near the harbours, and where precisely the tempera- ture most salutary at any particular season can be chosen, the- distance being only half that to Australia ; or, much nearer still, Tenerife offers every inducement for choosing it for a stay, under the advantage of easily respirable pure mountain air. People with very slender means may prefer the benefit of a long sea-voyage,.
which is comparatively inexpensive ; but such patients should not have passed from the first already to the second stage of the disease.
Dr. P. SMITH agreed with Dr. Martin as to the truth being midway between Mr. Thomson and Dr. Singleton. He disagreed'
1876.] Casualties and Hospitals. 347 with Mr. Thomson when he said that climate had no effect in influencing the progress of phthisis. For those who could obtain change of climate, it could easily enough be had in this colony.
But the advantage of Victoria, as a residence for comsumptive invalids, depended also upon the stage of the disease, and in some measure upon the social condition of the patient. If a phthisical patient who came to Victoria to be benefited, had to sit every day at work in an office he would certainly derive no advantage from.
coming here. We ought therefore to do our best to stop such a class from coming. And yet, now, people were recommended to go to Greenland to be benefited in the first stage of consumption, so that the treatment was not altogether so much a matter of climate:
His personal testimony, however, was in favour of the climate of Victoria. It had certainly saved his life.
Dr. MARTIN said that although the Gipps Land mountains .were very well, so far as temperature was concerned, the absence of residence-accommodation limited their advantages.
Dr. SINGLETON, in reply, said he did not think his statements could be challenged, and they fully refuted Mr. Thomson's state- ments, that the mortality from phthisis in Melbourne was excessive.
He reasserted that in dry climates phthisis was unknown, so that this fact ought to be accepted as a sufficient reply to the statement that climate had no concern in influencing the disease, and remem- bering that by means of elevation we could choose any climate in this colony, the advantages of Victoria as a residence were, he thought, fully established. All the facts went to show that phthisis was not increasing here. Certainly not among those native born.
gl,ustralian #aurnal.
NOVEMBER 1876.
CASUALTIES AND HOSPITALS.
The abuse of hospitals is a subject so worn, that the mention of it is very likely to at once suggest the avoidance of any discussion upon it. Generally, it seems impossible entirely to prevent it, and in the case of ordinary patients, its repression is surrounded with many difficulties, the chief of these being that of having no adequate means of getting at a knowledge of the circumstances of those who present themselves for treatment. But there is less difficulty in the ease of casualties, since the very nature of the circumstances under which persons who have suffered accidents are taken to the hospital, is of a kind to furnish a knowledge of their ability to pay or not for surgical treatment. Frequently,
iy
r.
348 The University of Melbourne. [Nov.
persons injured by accidents are taken to the hospital by the police, and it would add but little to the duties of the force if they were instructed in such emergencies to inquire into and report upon the social condition and kind of livelihood of those whom they take to the hospital in this way. But the authorities could go further. They might make it compulsory upon all persons desiring for themselves or others such attention as the casualty-room supplies, to be accompanied to the hospital by a constable, and that no one should be attended to unless so accompanied. It is easy to say that a constable is often difficult to find, and assistance is sometimes required without delay. But in such exceptional instances it would be easy to impose a further condition of reporting such accidents at the police-station. In this way, a host of minor accidents would be prevented coming to the hospital, and the double injustice of imposing upon the charity, and defrauding the profession, would at any rate be lessened if not entirely remedied.
Perhaps the pharmaceutical chemist would have to deal with some of the cases so refused, but this alternative would not always, and probably not as a rule, present itself Medical men would begin to get their share of minor surgery which now they do not, and the public would, in time, fall into the habit of paying for that which now they look to obtain, almost as a matter of right, for nothing.
A further mode of dealing with such examples of casual relief, might be to exact payment at the hospital itself. As a matter of principle, the paying patient method in hospitals is a mistaken one, but the exception to the rule of gratuitous relief appears to lie in the direction of casualties, and considering how much medical men are continually doing for nothing, it would be an act of justice as well as a novelty, to distribute the fees received for casualties among the (too long) honorary staff.
gtrt ainiVersitg of atelbournt.
OCTOBER TERM, 1876.
the following is the result of the examinations in medicine : FIRST YEAR : A. Adam, J. B. Backhouse, F. D. Bird, F. H.
Eastwood, R. R. Harvey, F. H. Meyer, F. W. W. Morton, C. W.
l'ardey, J. J. Prendergast, A. Sutherland.
SECOND YEAR : W. Armstrong, F. J. Newman, J. W. Springthorpe, J. D. Thomas, C. J. Trood, T. R. H. Willis, S. E. A. Z. Woinarski.
1876.] Melbourne Hospital Chronicles. 349 THIRD YEAR : P. B. Bennie, R. Fitzgerald, H. B. Forster, H. L.
liarris, H. S. Lyons, J. R. M. Thomson, H. S. Wood.
FOURTH YEAR : A. Murray, C. H. Scott, R. Sides, R. A. Stirling.
FIFTH YEAR : J. P. Fitzgerald, T. A. Garlick, J. A. Kennison, A. Munro, F. Haley.
SINGLE SUBJECTS.
DESCRIPTIVE AND SURGICAL ANATOMY : H. M. Curtayne.
SURGERY : G. F. Wickens.
THEORY AND PRACTICE OF MEDICINE : G. F. Wickens.
PRACTICAL CHEMISTRY : J. F. Donaldson, M. J. Ryan.
HONOUR LIST.
FIRST YEAR : 1st class, none ; 2nd class, F. H. Meyer, C. W.
Pardey ; 3rd class, J. J. Prendergast, J. B. Backhouse, R. R. Harvey.
DEGREES CONFERRED.
The following degrees in medicine were conferred at a meeting of the Council on the 2nd December :
BACHELORS OF MEDICINE : John Patrick Fitzgerald, Thomas Augustine Garlick, John Alexander Kennison, Angus Munro.
MELBOURNE HOSPITAL CHRONICLES.
November 14.—Committee Meeting : Dr. Lewellin offered to postpone his holiday, so that the vacancy caused by the resignation of Dr. Williams should not cause inconvenience. His offer was accepted, and the term of his leave of absence when he should take it, was increased from three to four weeks.
Attention was drawn by the chairman to a remark by Dr. Youl, the city coroner, in connexion with the inquest on Mrs. Conley, that " he knew the effect of the inquiry at the Melbourne Hospital in the case of the man Berth had been to cause a perfect stampede
•of patients who were afraid of having operations performed on them." It was thereupon resolved that a report from the medical officers be obtained in explanation of this statement.
Mr. T. M. Girdlestone being the only candidate for the vacant appointment of assistant-surgeon who had produced the required .qualifications, was declared duly elected.
November 21.—Committee Meeting : The secretary reported, in reference to the statement made by the city coroner, that, after the inquest upon the man Berth last December, there had been a stampede of patients from the hospital, he had searched the books and could not find any evidence of patients having left the hospital to avoid operation from fear of its results. Inquiry among the
•employ6s was to the same effect, and although there was a rumour that one man had left at the time of the Berth inquest from this cause, there was no record of it, nor was any information forth- coming thereon from other sources.
350 Melbourne Hospital Chronicles. [Nov.
A discussion ensued, and eventually the following resolution was adopted :—" That the attention of the coroner be called to the report contained in The Argus
of the 9th inst., of certain observa- tions addressed by him to the jury in the inquest on the body of Mrs. Conley, to the following effect : ' He knew that the effect of an inquiry he had held at the Melbourne Hospital some time ago, was to cause a perfect stampede of patients who were afraid to submit to operations,' and that the attention of the coroner be called to the report of the secretary of the hospital of November 21, 1876."
November 28 .—Committee Meeting : The following letter was read from Dr. Youl, the city coroner :
" Melbourne, 26th November, 1876.
" I do myself the honour to acknowledge the receipt of your letter of the 21st inst., calling my attention to some remarks I had made at an inquest at the Alfred Hospital, and informing me that an inquiry had been made ; that the hospital books had been searched ; and that no foundation could be found for my statement.
I can quite understand that in a set of books kept for quite a different purpose, such information would not likely be found. I have, however, examined the consultation book, and I find recorded in it that in April and May of this year, and immediately after the holding of the inquests upon which I was commenting, no less than five patients left the hospital, refusing to have operations performed which had been determined upon at consultations held upon them. I would specially call the attention of the committee to two cases of the 3rd of April. They will find, I think, upon inquiry, that the operating surgeon, attended by a member of the committee, was in the theatre ; but when he ordered the patient to be brought he was told There are none, they have bolted.' Judging by these cases, I think it only fair to infer that patients left the hospital to avoid operations, before even a consultation was held ; these are not, therefore recorded in the consultation book. In making the remarks I did, I merely give expression to a wide-spread report which had, from my own knowledge, a substantial foundation in ,
truth. Having answered your letter, I would now beg to call the attention of the committee to the case of two patients, of whom it is recorded that they died upon the operating table. I take it for•
granted that these two persons died from some sudden and unfore- seen cause, but which I find is not set forth in the information furnished to the deputy-registrar of deaths. You will be good enough to point out to the committee, that I am the only officer appointed by law who can deal with deaths occurring under such circumstances in this city, and that both these cases should have been reported to me.
" I have the honour, &c.,
" (Signed) RICHARD YOUL."
It was resolved, after some discussion : That Messrs. Hart;
1876.] The Alfred Hospital. 351 Bailliere, Phillips, Anderson, and the mover, be appointed a sub- committee to investigate the statements made by the city coroner in his letter of the 26th inst., and his original statement at the inquest upon the body of Mrs. Conley.
ALFRED HOSPITAL.
CASE OF MRS. CONLEY.
At the Meeting of the Alfred Hospital Committee, on November 3, 1876, the following business took place :—Report of the Medical Committee of the Alfred Hospital, held on Wednesday, 1st November, 1876. Present : Mr. Girdlestone (in the chair), and Drs. Blair, Balls-Headley, Barrett, Haig, Rockett, Dempster, and Malcolmson, and Messrs. Robertson and Rankin. Your committee- have the honour to report having taken into consideration a message from the managers, respecting an operation lately performed on a patient named Charlotte Conley, the managers having desired the medical committee to report the circumstances of the case. Your committee unanimously decided to confine their inquiry to the following questions, viz. :-1. Were any foreign substances found in the body by the gentleman (Dr. Glendinning) who made the post-mortem examination ? 2. Did the presence of any foreign substances accelerate the patient's death ? 3. Was any distinct inquiry made towards the conclusion of the operation about the number of the sponges 4. Was a search made for the missing forceps during the operation ? After careful inquiry, your committee- have the honour to report as follows, viz. :—This committee is unanimously of opinion that the presence of the said foreign substance did not accelerate the death of the patient. Search was.
made for the missing forceps towards the conclusion of the operation, but their small size and peculiar position (being doubled in outside the cavity of the belly, between the peritoneum and the muscles) accounted for their not being found. Some of the staff present did not know they were missing. The nurse was asked before the conclusion of the operation whether she had all her sponges right.
She was heard to say, "Yes, sir ; they are all right." The nurse- who had charge of the case, and who was asked about the sponges, was not in the hospital at the time of the inquiry. Drs. Martin;
Fetherston, Smith, Knaggs, Pinnock, and Cooke were invited to attend, but, with the exception of Mr. Cooke, did not do so.
Mr. Robertson was present at the meeting, but did not vote.—
T. M. Girdlestone, chairman of medical committee, Alfred Hospital, 1st November, 1876.
In connection with the above report, the following evidence ; taken by the medical committee on the inquiry, was also read :- Dr. Glendinning, resident-surgeon, stated as follows : I made the post-mortem on Sunday, 24th September. After prolonging the incision, found about three quarts of bloody fluid, and a
352 The Alfred Hospital. [Nov.
sponge about two and a half inches in diameter, semi-floating near the upper end of the incision. I then felt about with my hand, and got the bull-dog forceps outside the peritoneum. They were situated between the muscles and the peritoneum, secured to the blood-vessel to which they had been originally attached. The vessel was detached from the surrounding tissue, so that the forceps hung by a strip of fascia. They were on the right side, near the right iliac region, two or three inches from the edge of the first incision. On removing the blood, I saw flocculent masses of cancer in the situation of each ovary. That on the right side was broken down, and was easily lifted out in pieces. That on the left side was entire, and I removed it along with the uterus. On the left lateral posterior surface of the uterus, there was a wound, the mark of where the tumour had been removed, which presented no points of bleeding, and had an ordinarily healthy appearance. I found a small solid fibroid tumour, the size of a marble, imbedded in the wall of the uterus, at the fundus. It did not encroach upon the cavity of the uterus. The vessels of the peritoneum were red and congested ; there was a dull red appearance, the first stage of peritonitis. The body was considerably emaciated, nothing remark- able about the liver and kidneys, except that the liver showed more fat than usual, and there were no special marks of inflammation where the foreign bodies were found. The cause of death was
• exhaustion from hmmorrhage, and shock with peritonitis. I do not think the foreign bodies accelerated death in the slightest. I had a pretty strong suspicion that the forceps were there, because I had seen them on the lip of the wound at the operation, and knew they were missing I saw a very complete search made for them. From the post-mortem appearance, I do not wonder they were not found.
There may have been an inquiry about the sponges. I did not hear any. I was out of the room part of the time.
Dr. Hearn agreed with the statements made by Dr. Glendinning.
He had heard Mr. Robertson ask the nurse about the sponges. His words, if he remembered right, were, " Nurse, have you counted the sponges 1" She replied, " Yes, sir ; they are all right." Witness thought it was the nurse specially engaged for the occasion who gave this answer. At the end of the operation the patient was in a sinking condition, getting cold, and pulse feeble. He did not think that the foreign substance being there accelerated her death.
Dr. Rockett heard an inquiry made about the sponges.
Dr. Blair heard the inquiry made.
Dr. Malcolmson also heard the inquiry made.
Mr. Cooke was present at the operation, and arrived late at the post-mortem. Haemorrhage, in his opinion, caused her death. There was commencing peritonitis, but not sufficiently advanced to cause death. The forceps and sponge had nothing to do with it. There was a superficial search for the forceps, which it was not desirable to continue, as the patient was in a state of collapse. Was not
1876.] Tie Alfred Hospital. 353 aware that the patient ever applied for admission into any other institution.
The chairman thought it desirable, as a coronial inquiry was to be held in the matter, that the consideration of the report should be deferred until after the inquiry had taken place, and a resolution was passed to that effect. Mr. Knaggs forwarded a letter to the secretary of the institution, declining to attend the meeting of the medical committee, and stating as his reasons that probably some future inquiry of a more stringent and judicial character might be- instituted, and, if so, it would be more in accordance with the rules of propriety, and for the best interests of those most concerned in the result, that the evidence of persons who were present at the operation might be thoroughly unfettered, and free from all suspicion of any ex parte bearing.
The chairman then stated that Mr. Robertson should be informed of the manner in which the committee had dealt with the report, and be allowed, if he thought proper, to make any statement in reply. Mr. Robertson was accordingly called in, and, in answer to Mr. Service, said that he desired to make a statement of the whole facts of the case to the committee. He then read the following statement :—
St. Kilda, 3rd November, 1876.—Gentlemen,—You have received a report from the medical committee relative to the death of a woman named Charlotte Conley, who died in this institution on 24th September, 1876, after being operated upon by me for ovarian tumour. The circumstances of the case being looked upon by some as suspicious, have given rise to much talking and newspaper writing. I beg, therefore, to be allowed to briefly state my version of the affair for your satisfaction and mine.
The case was handed over to me from the medical side of the house, and a consultation having been held, it was decided by all the gentlemen who saw the case—save one —that it was desirable to perform an exploratory operation. The danger of the case having been fully explained to the patient, she willingly consented to undergo the operation, which was performed in the presence of about twenty medical gentlemen, on the 22nd September. I think I need not enter into the details of the operation here ; suffice it to say, that when the incision was made, there was a small artery bleeding on one side, which was seized by a pair of, what from their nature, and not their size, are termed bulldog forceps, and during the continuance of the operation, these were missed.
I removed two tumours from the womb which just presented themselves, and then it was found that there was cancerous disease of both ovaries. On endeavouring to remove these, free haemorrhage from numberless points set in, and it was at once seen that nothing further to ensure the patient's recovery could be done. It was resolved to close up the wound, deciding that the woman's fate was inevitable. Before doing so, however, I called out to the nurse to inquire if the number of sponges was correct. I received an
354 The Alfred Hospital. [Nov.
answer in the affirmative. Several gentlemen present can corroborate this statement.
I then made search for the missing forceps, as also did the gentleman who was immediately assisting me. The medical report will convey the reason for their not being found, as also the fact of our being aware of the loss. Failing to find them, and having received intimation from those who were superintending the after due consultation, it was decided to sew up the wound, which administration of ether, that the patient was getting weak and cold, was accordingly done, and the patient placed in bed, being then in a state of collapse. She became weaker, incessant vomiting having set in, and she died twenty-one hours after the operation.
I have been asked by outside medical men, why I allowed three others besides myself to pass their hands into the part of the abdomen. My answer is, that on finding the true and malignant state of affairs, it did not matter if one or twenty had passed in their hands, but had the case been one likely to terminate favourably, no hand but mine would have explored the disease ; and, further, with reaard to the forceps—had this latter, the favourable, been the case—I°should not have sewn up the woman until the forceps had been found.
I do not think it necessary to enter into any further details here.
They will be made public shortly, for I am glad to find that the Crown has taken the matter in hand. And while on this point, I desire to assure you, gentlemen and the public, that had I imagined the case from the first would have caused so much public discussion, and resulting in so much professional injury to myself, apart from the personal annoyance and anxiety, I would have demanded the strictest inquiry, for I have never attempted to conceal or suppress any investigation that might be thought desirable. And I am glad to find, as I have before stated, that the Crown has taken the matter in hand, and whatever may be the result, I trust you and the public will be satisfied that whatever I did in the cause of charity, whether right or wrong, I did for the best, and that inuendos and mis- statements, circulated by a very few, I am glad to say, of my medical brethren, will hereafter be treated in the manner of their worth, and that your confidence in me as one of the staff of the Alfred Hospital, and that of the public as a medical man, may be re-established.—I am, gentlemen, your obedient servant,
ROBERT ROBERTSON.
The inquest upon the exhumed body of Mrs. Conley was held on the 6th and 8th of November.
Dr. Youl, in opening the proceedings, mentioned that a few days previously he had received a letter from Henry Conley, the husband of the deceased, in which the writer insisted upon an inquest being held. At that time, the body having been interred, it was out of his power to hold an inquest without a special order from the Minister of Justice permitting the exhumation of the body. On inquiring egarding the case at the hospital, he was informed that it presented
1876.] The Alfred Hospital. 355 no unusual features, and the suppression of some of the facts he considered very reprehensible.
HENRY CONLEY said : The deceased, Charlotte Conley, was my wife. She was 46 years of age at the time of her death. She was ill for sixteen months. She told me on one occasion that Mr. Robertson said she had twelve or fourteen pounds of cancerous matter inside. There was a consultation as to the advisability of performing an operation on the deceased. I believe eleven doctors consulted on the matter. Mr. Rankin told me that he thought the operation would kill the deceased. I did not give my consent to the operation, but my wife was determined to have it performed.
I was at the hospital after the operation had been performed. Mr.
Rankin came out of the room first. He said the doctors had not discovered what they expected ; that they had found an ovarian tumour which had been handed round for inspection. The medical men could never agree as to the disease from which the deceased suffered. I wrote the letter because I was not satisfied. I had not heard at that time anything about the sponge and forceps.
Dr. GLENDINNING said : I am one of the resident surgeons at the Alfred Hospital. I remember the operation being performed on the deceased. It was performed for ovarian disease. A consulta- tion took place regarding her case prior to the operation. I produce the consultation book. The date of the consultation is not given in the book. It should be given. The operation was performed by Mr. Robertson on the 22nd September. Mr. Girdle- stone assisted. I was present during the operation. The deceased was on the operating table for about an hour and a half. She was much exhausted when it was over, and never rallied afterwards.
She died the following day. I made a post-mortem examination of the deceased in the presence of Mr. Robertson. Other doctors came in and out during the post-mortem. I found a sponge about 2in.
in diameter in the body. It was about 2in. above the surgical wound. I found the forceps produced in the wall of the abdomen.
I knew the forceps were in the body, because a search was made for them unsuccessfully at the time of the operation. I did not know the sponge was there. The doctors present at the consultation were Messrs. Robertson, Haig, Rankin, Girdlestone, Rockett, and Headley. They all concurred that an operation would be judicious.
I do not think that the sponge caused peritonitis, or in any way expedited the woman's death. I did not mention anything about the sponge or forceps being found in the body in reporting the case to the police. It was not the peritonitis alone that caused death.
It was the whole shock resulting from the operation, from which she never rallied. I do not know whether any search was made for the sponges. It is usually' the duty of the nurse to count the sponges after the operation.
Dr. Youl.—I think it is your duty also.
Witness.—I counted them before the operation, and told the nurse and operator how many there were. It was when I was out of the room that they were counted—at the close of the operation.
356 The Alfred Hospital. rNov..
The patient had not to be hurriedly removed from the operating- table. At the time the wound was sewn up, I heard no remark from the nurse or any one else regarding the sponge. The sponge was in such a position as to be concealed from the observation of the medical men engaged in the operation. There were thirteen sponges used in the operation altogether.
To Mr. Robertson.—The sponge was not in view when I first opened the body.
To the Coroner.—I did not include the sponge and forceps in the written account of the post-mortem, because I did not consider they had anything to do with the cause of death.
The Coroner.—You mentioned several things that had nothing to do with the cause of death, and it seems strange in a record that should be correct, you should not have mentioned these things.
Witness.—It is not the custom for the house surgeon to take note of such things in the written account of the post-mortem examination.
To Mr. Robertson.—I saw the forceps applied during the opera- tion. They were in the lower end of the wound at the right side.
When I made the post-mortem they were attached to the same- vessel, but pushed down more to the right side.
To a Juryman.—I took charge of the instruments after the operation. The forceps were missed during the operation, and search was made for them.
To Mr. Robertson.—There might have been no ill effect from leaving them in the body. never heard you making the state- ment that the deceased had 12 or 14 pounds of cancerous matter.
I always accompanied you in your visits to the ward. The deceased.
woman consented to the operation.
To a Juror.—It was not suggested to me by any one that it was unnecessary to mention the sponge and forceps in the account of the post-mortem examination.
At the request of a juror, the sponge was immersed in water, and then appeared to be about three inches in diameter.
Dr. WALTER BALLS-HEADLEY.--I am one of the honorary visiting physicians to the Alfred Hospital. The deceased woman was under me in the hospital. I explained to the woman that she must die very shortly if left as she was, and that her only chance of life consisted in the success of an operation, and that if not successful she would die from its effects. She preferred to take the chance of an operation. She was transferred to the surgical side for the purpose of undergoing an operation. I was not present at the consultation. I wrote my opinion of the case in favour of an operation in the medical case-book. I administered the ether to the woman during the operation, and consequently I saw nothing of the operation. I did not know that a forceps and sponge had been left in the body. I knew they were looking for the missing forceps.
I was not at the post-mortem examination, as the notice did not reach me until the following day. I have seen the uterus since and the ovary. There was nothing from their appearance to prevent.
1876.] The Alfred Hospital. 357 them being removed. I think the woman would probably have had a better chance if that had been done. I did not feel certain that the woman would die when she left the operating table, nor was there any general feeling to that effect expressed in my hearing.
She was, however, very weak. There was not a great quantity of blood lost during the operation.
To Mr. Robertson.—I think the tumours could have been removed, because they appeared to be unattached.
To Inspector Burton.—I think that a greater search for the missing forceps at the time of the operation would have only led to the more speedy death of the woman. I think the deceased died from the shock of the operation, and haemorrhage. Peritonitis is the usual cause of death after such operations.
To a Juryman.—The woman might probably have lived for three months if no operation had been performed, but certainly not longer.
To Mr. Robertson.—I do not think that the woman was an hour and a half on the operating table, but I cannot say accurately.
The time for such operations varies very much. I have heard of two cases in which a sponge was left in the body, but I never was present at such a case.
In reply to the Coroner, the witness stated that he had written his opinion in the consultation book in favour of an exploratory operation, after the operation had taken place, but he had written what he had before expressed, verbally, to the other medical men.
Dr. Youl. —That proceeding seems a most irregular one, and I think that the consultation book not being dated, is another grave irregularity which ought not to be permitted.
SARAH BRYCE.-I was nurse at the Alfred Hospital. I was engaged to specially attend the deceased woman. I attended her for two days before the operation. She appeared cheerful and in good general health, considering her condition. I was present at the operation. I could not say how long it lasted. I had the whole charge of the sponges. The house surgeon told me there were 13 sponges, and that he expected me to give him 13 back. I counted them after the operation, and there were then only twelve.
That was after the wound was sewn up. I reported the fact to Nurse Miller, but not to the house-surgeon, because I did not see him. No one asked me whether I had the sponges all right. I returned the sponges to Nurse Miller, and not to the house-surgeon..
I knew the forceps were missing, but I did not know they. had been left in the body. Mr. Robertson told me they were in the bucket or soiled linen, and I searched for them, but could not find them.
I remained with the woman until she died. She suffered a good deal before she died. She had a pain all over the stomach. She got very little rest, and died on the following day.
To Inspector Burton—.I have been 13 years a nurse. At the operations I have attended, the sponges were counted by the house- surgeon and operating-surgeon, and not by the nurse.
To Mr. Robertson.—I am quite sure that no question was put tO,
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358 The Alfred Hospital. [Nov.
me regarding the number of sponges. There were two assistant- nurses present at the operation, and also the matron.
To a Juror.—The deceased was visited during the night both by the house-surgeon and Mr. Robertson.
To the Coroner.—The object of counting the sponges was not explained to me, and I thought it was only to make sure of their safety.
Mr. T. M. GIRDLESTONE.-I saw the deceased a few days before the operation, together with Dr. Balls-Headley and Mr. Robertson.
I examined the woman then, after hearing the history of the case.
I wrote my opinion in the book immediately before the operation.
I wrote the word " operate " with the full understanding that the operation was to be an exploratory one in the first instance, to be continued, if deemed advisable. I was present at the operation, and assisting. From what I saw, I believe that the cause of the disease could not be successfully removed, and therefore I advised that the wound should be sewn up. Other gentlemen then examined the parts of the patient, and gave their opinion, and Mr. Robertson determined to go on, believing that the operation could be success- fully performed. He removed the tumour from the uterus. Some further examination was afterwards made of the cancer, and the attempt to remove it was relinquished. There was a good deal of hmmorrhage at the time, and it had to be sponged out. Before the wound was closed search was made for a pair of forceps.
The sponging out of the hmmorrhage was done by Mr. Robertson himself. I saw him looking for the forceps before the wound was closed. They were applied during the first part of the operation, and left hanging on to a vessel. We could not find them when we looked for them. I could only look along the edge of the wound, because the woman was suffering chiefly from hmmorrhage and it was not possible to search in the belly. To secure the safety of the woman, I advised Mr. Robertson not to search any longer for the forceps, and said that wherever they were they should be left. Exposing the belly to the air was doing the woman harm every moment. I heard nothing whatever about the sponge. I do not think that leaving the forceps in the wound would be necessarily fatal. I do not think that, considering where they were, they had anything whatever to do with the cause of death. I do not think that the sponge had any effect either.
The sponge was the most dangerous, but there were other causes of a stronger character at work, sufficient to procure the woman's death.
She died from hmmorrhage and the shock. The operation, on account of the numerous difficulties connected with it, was rather a lengthy one. I think there were too many hands passing over the body of the woman, although of course the surgeons were assisting with the best possible object. It is a very easy thing to leave a sponge in the wound, because once in it gets covered with blood, and cannot be seen. Such accidents have occurred in operations conducted by the most skilful operators. I did not hear any one speaking about the sponges. The woman was bound to die if no
1876.] The Alfred Hospital. 359 operation had been performed. Dr. Blair and Dr. Rankin examined the belly as well as myself. They put their hands inside the wound and necessarily caused hmorrhage. There was no hinorrhage before. Mr. Robertson and myself had our shirt-sleeves turned up.
I expressed the opinion that if the operation were solely mine I would not permit so much inteference.
The Coroner.—Do the honorary staff work harmoniously ? Witness.—Some of them do, but we are always ready to assist each other in an operation, whatever may be our differences. I do not think that the house surgeon is to blame for not entering the circumstance of the sponge and forceps in the post-mortem book, because it is not pleasant to have to mention the mistakes of your superior officers. The duty should be performed by some person independent of the honorary staff. I think such facts ought to be recorded.
Mr. RANKIN.-I am one of the visiting-surgeons at the Alfred Hospital. I saw the deceased woman, and was in favour of an exploratory operation being performed. I expressed that opinion to the other medical men. I wrote my opinion in the consultation book, I think, after the operation was performed. I was present at the operation, but left some time before it was concluded. I did not attend any general consultation on the case. I think it would have been wiser for Mr. Robertson to have followed the advice given by Mr. Girdlestone, and not have proceeded with the operation.
I told the woman that the case was not suitable for an operation, but I concurred with the majority, that it was advisable to explore
—that is, to make an exploratory operation. I do not think that the sponge or forceps had anything to do with the woman's death. It is possible that the deceased might have lived a few months without an operation.
Dr. JOHN BLAIR.-I am one of the visiting-surgeons of the Alfred Hospital. I was not at the consultation that took place on the deceased. I was informed that a woman was to be operated upon for ovarian tumour, but as I heard the belly was much distended with fluid from dropsy, I did not sign the book in favour of an operation, not wishing to risk my reputation in a matter about which I was not certain. I did not give any opinion on the case at all. I was present at the operation, but simply as a spectator, and did not interfere in any way, thinking it better to leave the operation alone. There being some doubt as to the nature of the tumour, I inserted two fingers in the wound for the purpose of ascertaining whether it was ovarian or malignant. I remarked that the tumour I felt was not ovarian. I saw it was cancer. I did not advise the discontinuance of the operation. I thought that, it being a malignant tumour, it was all up with the woman. I heard Mr. Robertson say to the nurse before the wound was closed,
" Nurse, have you got your sponges I" I did not know that the forceps were in the wound. I saw them applied. I am quite certain they were not pushed in by anyone. A great amount of :Wood was lost. My cuffs could not have come in contact with the
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360 The Alfred Hospital. [Nov.
forceps. I did not hear the nurse reply to the doctor's question regarding the sponges. At the Lying-in-Hospital, the nurse is held responsible for the sponges, when operations of a similar kind take place.
To Mr. Robertson.—Nothing more could have been done for the woman than was done.
Dr. FETHERSTON.-I am one of the visiting-surgeons of the Lying-in-Hospital. I was present at the operation on the deceased woman. The first incisions were performed slowly and carefully by Mr. Robertson. The bulldog forceps were applied to a small artery that commenced to bleed at the right side of the wound. I saw that Mr. Robertson had mistaken the peritoneum for the cyst-wall, and I looked at Dr. Martin to call his attention to the matter. He apparently understood my meaning, and came round and said, " On what footing do we stand here l" I said, " We can only stand by and keep our mouths shut." He said, " We ought to interfere for humanity's sake." I turned to Dr. Blair, and told him that Mr. Robertson was dissecting the peritoneum, and that he ought to be told. Dr. Blair replied, " I don't speak to him." I said, " For- the woman's sake, some one ought to interfere." Dr. Blair said,
" Mr. Robertson ought to know his business." I think some one did speak to Mr. Robertson, and the dissection of the peritoneum ceased. The rule of the Lying-in-Hospital is to make the resident- surgeon responsible for the sponges, but the practice is to give the charge of them to the nurse. If a nurse is made responsible for them, she ought to be told the reason for counting them. I don't remember any case in which a sponge was left in the body during an operation of this kind. The late Dr. Tracy never did so.
During one of his operations, on one occasion a sponge was lost, and he searched for half an hour, until it was found amongst some hot flannels used to keep up the temperature over the wound. He was in the habit, in his lectures to students, to inculcate the necesssity of attending to the sponges, and alluded to the case I have mentioned as an illustration. I do not think that the operation was unskilfully performed by Mr. Robertson. I think it is right in all cases for a medical man to write his opinion in the consulta- tion book before the operation takes place. The mistake about the peritoneum could have been made by any operator. It was not so dangerous in this case as it might be in some cases.
ELIZABETH DOWNIE.-I was an assistant-nurse at the Alfred. Hospital. Was present at the operation on the deceased woman, and was employed washing the sponges. At the commencement of the operation I was told by Dr. Glendinning to count the sponges.
I counted them, and found thirteen. I did not count them again until after the operation was concluded, and the patient was in bed.
I did not hear anyone ask if the sponges were all right. After the deceased was put to bed, I told Nurse Bryce that one was missing.
The Coroner then summed up. He said the fact was clear that all the surgeons concurred in the advisability of making an exploratory operation. The evidence went to show that the consultation book.
1 876.] The Alfred Hospital. 361 was very badly kept, and the omission of all mention of the finding of the sponge and forceps in the body of the deceased, in the 'written record of the post-mortem, deserved grave censure. He also -adverted to the attempt to conceal the circumstances attending the death from him, when he sent to make inquiry, and he hoped that the inquest would, at all events, prevent such irregularities from occurring in future. He was always very loth to hold inquiries touching cases of this kind, because they had a most painful effect, tending as they did to create nervousness amongst hospital patients, and rendering them unwilling to undergo operation at all. He knew that the effect of an inquiry he had held at the Melbourne Hospital some time ago, was to cause a perfect stampede of patients, who were afraid to submit to operations. If, however, the true circumstances of this case had been told to him, he would certainly have represented to the Minister at once the necessity for an inquest, and thrown upon him the responsibility of holding an inquest or not. It appeared to him that the case was an illustration of the apparent mania prevailing amongst surgeons for performing opera- tions. He had heard that so great was this mania, that some surgeons had written into the country, asking practitioners to send them down something to operate upon. It would be much better if 'operations were not attempted in many cases in which they were now carried out. It was clear that this case was not one of emergency, and he thought that if it had not been for the present rage for operations, it would not have been attempted.
The jury returned a verdict that the deceased died from shock, .exhaustion, and hwmorrhage, from a surgical operation, and that there was no blame attaching to the operator, Mr. Robertson. They also begged that attention should be called to the way in which the consultation-book of the hospital was kept, and the manner in which consultations were held in that institution.
DR. BLAIR'S LITHOTOMY CASE.
A meeting of the Medical Committee of the Alfred Hospital was 'held in the board-room of the institution on November 21st, for the purpose of considering " Certain circumstances connected with an operation of lithotomy performed at the hospital on a person named Cole, on the 25th ult., by Dr. Blair," a charge having been made by
-" A Vagabond," in The Argus, that the operation was performed
with a pocket-knife.
Mr. GIRDLESTONE, the chairman of the committee, presided.
There were also present Drs. Blair, Barrett, Rockett, Haig, and Balls-Headley, and Messrs. Rankin and Robertson.
Dr. BLAIR intimated to the reporters that they were not to be admitted, as the meeting was quite private. The latter, however, submitted the question to the chairman.
Mr. GIRDLESTONE signified that he himself was desirous of the press being admitted, and put the question to the meeting.
Dr. BLAIR objected, and contended that the meeting itself was irregular. He quoted rule 11 of the hospital regulations, which ran
1
362 The Alfred Hospital. [Nov.
as follows :—" The non-resident medical staff shall meet as often as may be necessary as a committee to advise the weekly committee respecting the purchase of drugs and instruments, and on all medical questions or other matters that may be referred to them bearing on the welfare of the institution." He argued that, according to that rule, the chairman had gone beyond his power in calling the present meeting. There were many kinds of lithotomy knives, including Erichsen's, Liston's, Blizard's, Brodie's, Wormald's, Thompson's, Web- ber's, dze. Blizard's was the longest, its blade measuring about 2/in., and handle about 4 in. The knife that he had used was a modifica- tion of Brodie's and Liston's, and had the advantage of being long, and pointed so that it could cut upwards without being turned.
The blade, when opened, became fastened with a spring lock, so that it could not move during the operation ; and it measured n in. in length, while the handle was about 4 in. long.
Mr. GIRDLESToNE maintained that he was quite justified in calling the meeting, and that in doing so he had simply followed the former practice of the committee. He pointed out that but recently they had met and taken evidence in Mrs. Conley's case, in which Mr. Robertson was concerned, and asked why a public report should be made of Mr. Robertson's actions and not of Dr. Blair's. In the present case he simply asked that the committee should give an opinion as to the operation in question. He wanted to know if Dr. Blair ever made a boast that he would perform the operation with a spoon and pen-knife, and if so, whether the committee approved of such conduct. He would also request Dr. Blair to show the knife lie used in the operation to the committee.
Dr BLAIR said that in performing lithotomy the great object was to do it with as simple operations as possible. He objected in , a great measure to the elaborate and obsolete staffs and other instruments which were used, whereby a species of tunnelling into the body was carried on.
Mr. GIRDLESTONE requested Dr. Blair to say distinctly whether or not he ever made the boast alluded to.
Dr. BLAIR.—I never in any way made such a boast. I have declared that the simpler the instruments the better would the operation be.
Mr. GIRDLESTONE.—Did you never say that you could perform a lithotomy operation with a pocket-knife and a spoon ?
Dr. BLAIR.—I never said I would do so. I am not aware that I ever said so.
Mr. GIRDLEsTONE.—But you may have said so.
Dr. BLAIR. —No ; I do not say that.
Dr. BALLS -HEADLEY said that if the question was to be gone into, and if Dr. Blair chose to show the knife with which he performed the operation, it would be desirable that he did so, but in his (Dr. Balls-Headley's) opinion it was most undesirable that a mere question of gossip should be investigated by the committee.
If the operation was performed with a proper knife, then the matter would be of no importance.
1876.] The Alfred Hospital. 363 Dr. BARRETT held that there was no analogy between the cases of Mr. Robertson and Dr. Blair, and that every surgeon had a right to choose his own instruments.
Mr. GIRDLESTONE said he simply desired to know whether the officers on the staff held themselves responsible for choice of instru- ments, made by their colleagues in performing operations ?
Dr. HAIG also held that there was no analogy between the cases of Mr. Robertson and Dr. Blair, as the meeting to investigate the former case was convened at the request of the Managing Committee.
Dr. BALLS-HEADLEY said he had seen the knife used by Dr. Blair, and thought it suitable for the operation.
Mr. RANKIN moved—" That this meeting is uncalled for, and that it is beyond the power of any member of the staff to call such a meeting."
Dr. HAIL seconded the motion, which was carried by 5 to 3.
Those who voted for the motion were—Drs. Haig, Barrett, Balls- Headley, and Blair, and Mr. Rankin ; and against it—Messrs.
Girdlestone and Robertson, and Dr. Rockett.
The meeting then broke up, and several of the members of committee withdrew ; but in a few minutes they returned with Dr. Blair, who produced the knife he had used (a narrow-bladed clasp knife, three inches long in the blade) to the representatives of the press, in the presence of Mr. Girdlestone, and offered the followinc,
t' explanation :—There are a number of knives used in the performance of the operation of lithotomy—Erichsen's, Liston's, Blizard's, Brodie's, Wormald's, Thompson's, Webber's, Ferguson's, and Key's. Blizard's is two inches and a half long in the blade, and the knife used is a modification of Brodie's and Liston's. It has the advantage of being pointed upwards, so that it can cut upwards without being turned ; and it being locked at the root of the blade, prevents it from closing during the operation of cutting.
Including the handle, it is seven inches and a quarter in length.
Some surgeons prefer a smooth handle, but this knife has a rough handle, which keeps the hand from slipping over it.
Mr. GIRDLESTONE (taking the knife in his hand, and feeling the edge of the blade): " I hope it was a little sharper than this."
Dr. BLAIR : " It was just out of Jones's hand—the instrument maker—the day I used it."
At the meeting of the hospital committee on the 24th, the following letter was read :
" No. 101 Collins-street east, 23rd November, 1876.
" To the Chairman of the Committee of Management of the Alfred Hospital.
" Sir,—I enclose heron a copy of a notice of meeting which was sent to the honorary medical staff by the instruction of Mr. Girdle- stone, and shall feel obliged if the committee will inform me whether Mr. Girdlestone was justified in calling a meeting, inviting the press to be present, and attempting to hold a quasi-judicial
364 An Error in Diagnosis. [Nov.
inquiry upon a member of your staff without having received any authority from the committee of management to do so. In connec- tion with the sensational writings about the knife used by me in a recent lithotomy case, I enclose for the satisfaction of the committee a written statement signed by every medical man connected with the institution (except Mr. Girdlestone). Mr. Girdlestone's motives in giving a half-and-half countenance to an insinuation which he had not the courage to endorse, were so transparent that I would have felt myself demeaned by crossing swords with him. I can afford to treat his ill-natured discourtesies with the contempt they deserve ; but it is to be regretted that any one connected with the institution so long should be so disregardful of its interests as to gratify his personal spite at its expense.
" I have the honor to be, Sir, your most obedient servant,
" JonN BLAIR, M.B., F.R.C.S. Edin."
The "written statement" referred to was the following :
" Alfred Hospital, 21st November, 1876.
" I have seen the instrument with which Dr. Blair performed lithotomy on Charles Cole, and consider it perfectly suitable in every respect for the purpose.
" WILLIAM E. L. HEARN, M.B., Res. Physician Alfred Hospital.
" W. B. RANKIN, F.R.C.S. Edin.
" W. BALLS-HEADLEY, M D. Cambridge.
" ROBERT ROBERTSON, M.R.C.S. Eng.
" J. HILDRETH ROCKETT, M.D., L.R.C.P., L.R.C.S.
" RICHARD MALCOLMSON, Physician and Surgeon Edin.
" JAMES BARRETT, M.D., M.R.C.S.
" WILLIAM HAIG, M.D.
" GEO. GLENDINNING, M.B. Edin., Res. Surg. Alfred Hospital."
After a conversational discussion, the following resolutions were passed : " That an intimation be sent to Mr. Girdlestone to the effect that if in his opinion there were any circumstances connected with the lithotomy operation, performed upon a patient named Charles Cole, which still call for an inquiry by the medical com- mittee, the general committee will be glad to hear the grounds upon which such opinion has been based." Also, " That the secretary communicate to Dr. Blair the satisfaction of the committee at receiving the certificate signed by the medical officers, and that the same be ordered to be published, and that Dr. Blair be requested to withdraw the latter part of his letter, as not being pertinent to the matter between himself and the general committee."
AN ERROR IN DIAGNOSIS.
The following is from the Maryborough4and Dunolly Advertiser :
" It was reported to the physician of one of our Melbourne hospitals the other day, that there was a man lying in one of the wards in a comatose condition. The nurse declared that he had been insensible for twenty-four hours, and she had tried in vain to
