H.—22a.

2

after the admission of the patient. From that period the fracture appears to have been properly attended to. The result of the case is that the fractured limb is crooked, and is 1J in. shorter than its fellow. William Peake's case : William Peake was admitted into the Hospital on the 31st January, 1903, suffering from a fracture of both legs and a fractured jaw. The case was admittedly a serious one. The broken jaw, which appears to have given much trouble, was set by a junior resident (Dr. Horsfall), the Senior Medical Officer ordering the charge nurse of the ward to tell Dr. Horsfall to put the jaw in splints. The patient was in the Hospital for six months, when, being dissatisfied with his treatment, he left and went into a private institution. He states that a short time before leaving the Hospital he was informed by the Senior Medical Officer that the fractured limb was uniting, and that he proposed to put the leg into plaster-of-paris. On his entering a private hospital it was found necessary to remove a quantity of dead bone before the fracture could possibly unite. This appears to be one of those cases where an immediate operation was absolutely necessary, and one in which every effort should have been made to procure the attendance of some member or members of the honorary staff to operate. We are by no means satisfied that such steps were taken. The operation was performed by the Senior Medical Officer, assisted by the junior residents, Drs. Bennett and Horsfall. The case should, under Rule 73, have been placed under the charge of the honorary staff. It was a case requiring serious operative interference, and as such the sole treatment and responsibility did not under that rule rest with the Senior Medical Officer. The patient complained of the food served to him, and also states that the visits of the Senior Medical Officer were irregular and infrequent. It is perfectly clear to us from the evidence that the operation for the removal of dead bone, which was performed at the private hospital, should have been performed at the public Hospital three months before the patient left it. The Wallis A. White Case. It is now our duty to report upon a most serious charge against the Senior Medical Officer, Dr. Collins, made respecting the treatment and subsequent death of a patient named Wallis A. White. We find the facts proved before us to be the following : — On the 17th May last White was brought to the Hospital dangerously ill. He was put to bed, and examined by Drs. Collins and Neil. On being questioned, he indicated the left side as the seat of pain, but Dr. Collins, in spite of a remonstrance from Dr. Neil, determined to perform the operation for appendicitis, in which the incision is made on the right side. That incision was made accordingly, and the appendix was found to be normal. Dr. Collins then manipulated the large intestine adjacent to the appendix. He found the intestine distended with gas, and certain faecal concretions were also present. He then made two incisions in the bowel; the upper incision was the smaller of the two, and was apparently made with a view of getting rid of the gas contained in the intestines ; the lower incision was situated about 1J in. above the place where the appendix leaves the bowel, and from this orifice he extracted two faecal concretions each about the size of a walnut. He stated in his examination before Dr. MacGregor that these concretions were not sufficient to cause obstruction of the bowel. After suturing these two incisions and the incision over the appendicular region he made the median incision in order to ascertain the position of any perforation that existed, the existence of a perforation somewhere being at that stage of the proceedings apparent. He also stated in his examination before Dr. MacGregor at the departmental inquiry that he found the anterior wall of the stomach very friable and having three perforations in it, and that he had great difficulty in uniting them. The post-mortem examination disclosed the fact that there was only one perforated ulcer in the duodenum. After suturing that ulcer he then proceeded to put a line of stitches or sutures in a portion of the stomach-wall where no ulcer existed ; this line of sutures was situated near the small curvature of the stomach, and apparently the sutures included a portion of the small omentum. The sutures were put in the stomach-wall at a point where it is clearly proved no ulcer could have existed; the post-mortem examination showing that the stomach was an unulcerated one, and that there was no evidence of any ulceration except the one perforated ulcer in the duodenum, which is not, strictly speaking, a portion of the stomach. The median incision was then closed, and the patient carried upstairs to bed after having been two hours on the operating-table. He died two days afterwards. We are unanimously of opinion that the reliable evidence before us shows, — 1. That the incision for appendicitis ought not to have been made. That, however, is stated to have been a mistake which even a skilful surgeon might make. 2. That the two incisions in the intestines near the appendix were both of them most dangerous and unnecessary. 3. That the sutures above referred to, put by Dr. Collins in a stomach, which was proved to be an unulcerated one, can only be characterized as wanton and uncalled-for surgery, without any justification whatever, and that the time taken up by that portion of the operation apparently lessened the patient's chances of life. 4. That, though the patient on his admission to the Hospital was in a very serious condition owing to the perforated ulcer in the duodenum, he had a chance of life which was seriously diminished by the malpractice of Dr. Collins. 5. That, in order to conceal his malpractice, he falsely stated to Dr. MacGregor at the departmental inquiry that he found the anterior wall of the stomach very friable and having three perforations in it, and that he had great difficutly in uniting them. Dr. Craig at the same inquiry stated that Dr. Collins " explored the stomach, which presented three ruptured ulcers )s| one of which was \\ in. long ; the edges were of such a friable nature that it could not hold the sutures." Dr. Parkes stated at the same inquiry, " Here in the stomach 1 saw two