Part 4
It is usual when a consulting surgeon is called in, to allow him to perform the manipulation, but in this case Dr. Bell himself passed the sound—I stood by while he attempted to pass it, which in my opinion was of a very objectionable form, and such a one as he would be likely to experience difficulty in introducing, and not calculated to detect the stone when in. On passing it down to the commencement of membranous portion of the urethra, he came to the check which I had anticipated; he then made forcible attempts to pass the instrument, despite my advice not to do so, conveyed in the words “Oh do not use force; pray do not use force—force will do no good, you will do harm.” That instrument was withdrawn, but not until force had been used. Another and smaller instrument was tried by him, when the nurse suggested that he had better use some warm water, as she thought the instrument might be cold, and she brought some. A further attempt was made to pass the instrument, and more force was applied, and Swann cried out “Oh! sir, you have hurt me, it has gone somewhere, I think it has gone wrong,” of which, I myself, entertained no doubt. The instrument was then partially withdrawn, and I seeing where the difficulty existed, recommended that this sound (producing it {49}) should be passed instead, for it had never fallen to my lot to see such unskilful manipulation as was exhibited by Dr. Bell, whose hand shook considerably at the time. He then turned the instrument and effected an entrance into the bladder. He said he felt the stone, and requested me to take the instrument, I did so, and felt a grating, but not being satisfied, I requested him to withdraw his instrument and I would introduce mine. I have no doubt that the urethra had been lacerated, for on his withdrawing his instrument, blood dropped on my boot. I do not say there was any great quantity, nor was it likely there would be, because it became extravasated; therefore, I adopted my usual plan in such cases, which was to introduce an instrument as large as the passage. I passed the instrument into the bladder and struck the stone, and I believe the sound was audible to the nurse, who is accustomed to such cases. Dr. Bell not being satisfied, on this, I withdrew the sound, and proceeded to inject into the bladder tepid water, as no surgeon in his senses would do what Dr. Bell states I did—use _hot_ water, and if he would, he could not, for the patient would not let him. I then handed the instrument to Dr. Bell and turned the stop cock, allowing water to run out, so that the stone might fall on the end of it which it did, and was heard distinctly by those present, and Dr. Bell having assured me he felt it distinctly, it was withdrawn. During the progress of the examination, I asked the man whether he felt any serious pain, and he said, “I hope you have done, for I am getting very faint.” As he was very deaf, I put the question to him again, and asked him, did the last instrument hurt you? and he said “No; the last instrument did not hurt me.” All this was done openly. Dr. Bell said he was going to treat the man homæopathically; I said “he might do as he pleased, he might humbug the patient, but that he should not humbug me, and I would have nothing to do with such treatment.” Dr. Bell then mixed some medicine in some water in a tumbler glass; it did not readily dissolve, and he called for another tumbler, and in order to dissolve it, he poured the contents of one tumbler into another several times, and in the process, spilled one half of it. Thus showing how important _these medicines_ are in their _integrity_. It was arranged that if the man was not benefitted at the end of a month, he should pass into my hands to be operated upon. I remarked to him that that time would afford no criterion of the value of his treatment, as patients had what is called fits of the stone, and if the fit went off, he would take the credit of curing the man, when in fact he had done no such thing. Dr. Bell states that I saw the man on Wednesday, the 18th, but that is not correct, as on that day I was called to and attended a patient in Cambridgeshire. On the following Sunday, (the 22nd,) he came to me and asked me if I had seen the man again, I replied certainly not—he asked me if I would come and look at him, because said he, “my treatment does not appear to succeed with him, I have no great confidence in its success.” I went with him to nurse Phillips’, and never in my life did I behold a man so changed—his condition was that of a man suffering under acute inflammation. I immediately turned up the bed clothes, or rather the sheet, and placing my hand lightly on the body, I was about to examine the state of the bladder, when he shrieked violently, saying “Oh! take away your hand, sir—I cannot bear it—you will kill me!” I had used no pressure. I then turned round and said, “Dr. Bell, how comes this about? Why the man has got inflammation of his bladder, what have you been doing?” The man was rather deaf, but he caught the last words, and looking at Dr. Bell, said “you have done it; you have given me poison.” Dr. Bell remarked, “I have merely given him nux, {52} because his bowels were confined.” I then said “there is no time to be lost; I fear the man will die; you had better put on leeches, as soon as you can, and have recourse to fomentation, and the sooner the better,” when Dr. Bell remarked “Can we not go some where else and talk?” I said “No, sir, whatever I do every body is welcome to see and hear, I will be a party to nothing in the dark, and I will tell you, unless you stop this inflammation soon, it will soon stop the man.” Dr. Bell said “that he would not take a drop of blood from the man, and he mentioned the names of several persons who, he said, _knew_ the cause of inflammation, and that it could be stopped without it.” Being called into that neighbourhood on the evening of the same day to attend a patient of my own; and being anxious about the poor fellow, I called again at Mrs. Phillips’, but did _not_ see the deceased. The nurse said that she had used fomentation, but the man was in great pain; I asked if Dr. Bell was there, and on her replying that he was not, I said I would write to him, (and hence the letter which Dr. Bell has thought proper to produce in his defence.) I then took my leave—Dr. Bell continued to attend him, on the Monday and Tuesday, and on the Wednesday, I received a note from him, asking me when I could attend, but I did not immediately answer it, as I saw his motive for writing in such a way. After this, Swann’s wife called upon me and I did attend, and I found the man discharging mucous from every mucous surface. Mr. Crickmay who happened to be in my house at the time went with me, and also saw the deceased, and he enquired as to the remedies that had been adopted; we both thought the man was sinking—his pulse was almost imperceptible at the wrist—his eye was vacant—the surface of his skin was clammy, and there were other indications of that general decline of power which frequently precedes death. I naturally inquired what the man had been taking, but before the nurse could answer, he said “he has been giving me more poison, I know it was arsenic, because I have mixed arsenic and lime with wheat, and know the smell and taste too.” This is the condition I found him in—I prescribed for him, directing such treatment as I conceived to be required to meet the exigencies of the case. He continued much in the same state for four or five days, the principal symptoms being diarrhoea, and a discharge of a small quantity of urine, mixed with bloody mucous and pus, which he had great difficulty in voiding. He then rallied somewhat, but relapsed in a day or two, and fearing the threatened result, and being influenced by the remarks being made out of doors, which were loud and condemnatory of the treatment the man had received from Dr. Bell, I thought it necessary to call in Mr. Gibson, a medical man, with whom I was not intimate. On the evening on which Mr. Gibson saw the man, he supported him while I drew off his water, and after Mr. Gibson had examined him, he came to the same conclusion as myself, that abscesses were forming in the neck of the bladder, and in the tissues connecting that organ with the adjacent structures. Mr. Gibson said that he had nothing to suggest in addition to my treatment. He saw the man the next day, and he said there was evidence of abscesses having burst, both in the rectum and in the urethra, for a great deal of pus had escaped. For a few days the man rallied again, but we had no hope for him at that time; and those who understand these cases, will tell you, that when abscesses form, as the result of injury and irritation in structures adjacent to the bladder and its connections, they will, by a continuous irritation in the absence of controul, lead to the perpetuation or encroachment of similar action in similar tissues, as for instance, an abscess in the capsule of the kidney, which has been attested to by Mr. John Coleby as the proximate cause of death. {55} From that time however, the man gradually progressed, and thanks to good watching, good nursing, and a generous diet, he recovered sufficiently to be removed home, not with my consent, but from frequent importunities I submitted to his going home, and he having improved, to a certain extent, I told him that he was at liberty to please himself, as to the future; he could either be under Mr. Coleby’s care, or he might return to me, and he went home on the 30th of March. I heard no more of him for a fortnight, when he sent word to me he was going on well, and that he hoped to return to undergo the operation. From the cause before mentioned, and possibly owing to the less nutritious diet, another abscess formed—after this, it appears the vital powers began to sink.”
Dr. Bell declined cross-examining Mr. Webber, and no other evidence being called, the room was then cleared of strangers and witnesses, and the jury proceeded to consider their verdict; after deliberating about 20 minutes, the foreman returned the following verdict:—“_That William Swann died from an abscess in the capsule of the left bladder_,” but on the suggestion of Mr. Crickmay, the coroner substituted the word “kidney” for “bladder,” remarking that, that was what the jury intended. One of the jury said that the foreman had not given the verdict exactly as agreed upon; and the foreman then added the words “_and we are of opinion that deceased’s death was accelerated by improper treatment_.” {56} Mr. Crickmay said, by whom do you consider improper treatment was used? The coroner observed “_as for that_, _you and the public are to form your own judgment_.”
Thus terminated a painful enquiry, on which a large volume might be written in behalf of humanity, expressing regret, for the sufferings of the unfortunate deceased—expressing regret that his care, his counsel, and his regard shown to his wife and children should be so untimely lost—expressing regret that the good intentions of Mrs. Shirley should apparently, through misplaced confidence, be frustrated—expressing regret, that a professional gentleman standing in this case in an awkward position, should make a more awkward defence, in apparently endeavouring to cast the blame on others, who wholly undeserved it—expressing regret that a member of the Royal College of Surgeons, in Ireland, {57a} who is supposed to possess an acquaintance with the tissues and structures of the human body, apparently forgot that the larger an instrument, called a sound, can enter a canal at a given part, the less danger there is of rupturing a tube, or wounding a delicate membrane. But above all, expressing regret, that having apparently neglected the precaution given by Mr. Webber not to use force; having witnessed the agony accompanying inflammatory action which followed, he persisted to combat it by such apparently vague medical treatment. {57b} For this it appears was nearly sending Swann to a still earlier grave. His life, however was for a time preserved through the skill and perseverance of Mr. Webber, and the great attention Mrs. Phillips, the nurse, paid to the deceased. But the days of the poor agricultural labourer were numbered; and his earthly sufferings having ceased, an earnest hope may be expressed that his ethereal spirit—his soul, may be now slumbering in the bosom of his Father, and his God.
The cases narrated, plainly demonstrate that care, tact, delicacy, and discernment, are required at coroners’ inquests—for a two-fold object must be kept in view:—the one to ascertain the proximate cause of death, whether arising from natural or mechanical events, and the other, whether the law can take cognizance of, and bring to justice the incautious, the ill-disposed, and possibly the gross offender against the laws of his country.
To the departed, these duties are of little moment, but to the living, they demand the greatest attention, not the less owing to the voice of humanity towards the friends of the deceased than to individuals, who innocent or guilty, may be directly or indirectly, suspected or implicated, in conniving or hastening, the death of a fellow creature.
It may be inferred, that jurymen {58} ought to assert their right {59a} (whilst the memories of learned coroners are sleeping) to ask questions, necessary to obtain evidence, that their minds may be so enlightened, as to record just and complete verdicts, even in Mala Praxis, for why should truth be withheld, when the Science of Medicine, with sound surgery for its helpmate, are being sullied in glory?
But it must be borne in mind, that a jury of men labouring in other vocations, living in a remote village, seldom attending coroners’ inquests, whose education is so limited, as not to be competent to seek for information, which the knowledge of medical jurisprudence inculcates, are the reasons why they must and do rely on the coroner to extract the evidence required; that their ideas of right and wrong may rest on the solid foundation of truth itself, which cannot be effected, unless the judge on obtaining evidence, explains the law bearing on the question, and introduces both, suitably to their comprehension. {59b}
Unless this object is realized, coroners’ inquests are perfectly useless, and evidently prove there must be something “rotten in the state of Denmark,” which if enquired into, will be found to prevail in many instances even where gentlemen in the legal profession are coroners. But how can it be otherwise? Their knowledge of medical jurisprudence, if to a certain extent comprehended, must be far too limited to conduct enquiries of grave importance. The want of sound medical knowledge must prove the hindrance, because it is frequently observed when medical gentlemen give evidence, they use technicalities employed in the profession, and by stepping into details, they bewilder their hearers, and sometimes themselves also. {60} Therefore it may be assumed, that great tact and discrimination is required in the examination in any case where medical evidence is of paramount importance, and consequently it may be believed, that unless gentlemen are properly educated, so as to be able to elicit important truths connected with the science of medicine in all its branches, as well as the legal points in coronership, they cannot be capable of conducting inquiries, in all the integrity, which these solemn occasions demand.
In conclusion, the following queries may not be deemed impertinent or superfluous:—
Is it customary for coroners to be petulant, irascible, and over desirous to close their enquiries?
Is it customary for witnesses to omit signing the depositions of their evidences?
Is it customary for coroners to allow disputations to exist in their presence, which do not appear to harmonize with the solemn character of coroners’ courts?
Is it customary with coroners to omit calling evidence that might be material towards corroborating testimonies where conflicting evidences arise, or links in the chain of evidence are broken?
Is it customary for coroners previous to summing up, to order their courts to be cleared of witnesses, strangers, and reporters, who had been admitted to hear the evidence?
Is it customary for coroners to summon witnesses _in person_, especially in cases of adjournment, where grave evidence has previously been given on oath?
Is it customary for coroners at adjourned inquests, to call upon parties, in person, suspected of felony, to inform them of it?
Is it customary for coroners to allow suspected parties present at inquests, to hold earnest conversation with jurymen, during enquiry?
In inquests of grave importance, is it advisable for coroners to summon jurymen all of one parish, especially if the jurymen are directly or indirectly connected with parties accessory before the facts, in cases of suspected felony?
If coroners doubt the veracity of a medical witness, and they state their reasons for doing so, are they not bound to suggest to the jury the propriety of calling other medical witnesses?
Is it customary for coroners to omit to recapitulate the evidence at the summing up, and neglect to explain the bearings of the law upon the various issues?
Is it customary for coroners to dictate verdicts, instead of leaving juries to come to their own unbiassed, deliberate, and honest conclusions?
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[Picture: Decorative graphic ‘finis’]
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S. DAYNES, PRINTER, NORWICH.
ADVERTISEMENT.
BY THE SAME AUTHOR: ABOUT TO BE PUBLISHED BY SUBSCRIPTION, UNDER DISTINGUISHED PATRONAGE.
Revised and considerably enlarged, a Second Edition of
AN ESSAY ON THE ENCROACHMENTS OF THE GERMAN OCEAN, WITH A Design to arrest its further depredations, applicable to the Norfolk and other Coasts, by taking every particular respecting them into consideration.
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THE Work will be interspersed with elaborate drawings of Cromer, Hasborough, &c., accompanied with diagrams, showing the full extent and meaning of the author, who, owing to repeated solicitation to introduce another Edition, and having obtained valuable and more ample information, announces his intention to comply, believing that this important subject may yet become, as it ought to do, a matter for national attention, and national expense.
The interested therefore are respectfully informed, that if they coincide in the desire they expressed, and the offer proposed, orders must be sent as early as possible, direct to the author, North Walsham, Norfolk.
The Work will be published in Royal quarto.
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Price to Subscribers, £1 1s. 0d.—Non Subscribers, £2 2s. 0d.
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OPINIONS of the PRESS on the FIRST EDITION.
“The work is another interesting addition to Norfolk literature, and the plan for the conservation of our Northern shores, is worthy attention, as coming from a gentleman, who, to some experience at least, adds the claim of having paid considerable attention to a subject of no little importance to the Northern and Eastern districts of the County.”
_Norwich Mercury_.
“The subject of this Essay is indeed of prime importance—First in a national point of view, as embracing particularly the interest of the public, and concerning in the closest manner the preservation of all the property of individuals situated on the contour of the coast of Norfolk, from the North Westerly point at Wells, to the Haven of Great Yarmouth.
“The main object of the enquiry is to discover the best plan of restraining the ravages of the sea, during the periods of extraordinary high tides; and on this point we entirely agree with Mr. Hewitt’s general view, and are strongly inclined to believe that it will answer in most cases where it may be judiciously carried into effect”
_Norfolk News_.
“The publication of this volume may be considered well timed. It contains much information respecting the tides and currents of the ocean—the formation of the Norfolk Coast—the damage done by irruptions of the sea, &c. We are no engineers, therefore we do not pretend to pronounce upon the merits of Mr. Hewitt’s plan for the construction of jetties, breakwaters, &c.; but it appears feasible, and merits the consideration of those whose property has been, and is threatened to be injured by the incursions of the ocean. And we consider the work (which is dedicated to the Lords of the Admiralty,) to be creditable to the industry of the Author.”
_Norfolk Chronicle_.
“The author is a gentleman, whose profession (a surgeon,) could hardly be supposed to allow him much time to devote to a subject such earnest thought and investigation, as the one he has here attacked. Mr. Hewitt, however, has evidently applied himself to this question con amore, and the work now before us evinces that he has brought to its consideration, a mind capable of patient and careful research into the many and varied causes that bear upon it. Though undertaken more especially with a view to searching out and propounding a remedy for the locality of which it immediately treats, a considerable portion of the work refers to the Encroachments of the Ocean generally, upon all exposed points of the coast, and there is much in it that would apply to the Southern, as forcibly as to the Eastern coast
“Mr. Hewitt describes the plan which he recommends as the best mode of imposing a check to the Encroachments of the Ocean, and shows the supposed elevation of the beach from the deposit of sand likely to be caused by the inventor’s plan.
“The work is written in an earnest, but modest and unpretending style, and the aim of the author is so good and praiseworthy, that should it fail to make the impression on head quarters, desired by its writer, he will, under all circumstances, have the satisfaction of feeling that he has laboured in a good cause. While other minds may perhaps entertain different views as to the utility or practicability of his scheme, they cannot fail to admit Mr. Hewitt deserves the thanks of his country, for the benevolent motives which have actuated, and the patient and diligent care which has directed his efforts in the field in which he has thus become a labourer.”
_Sussex Advertiser_, _and Surrey Gazette_.
“A remarkable ‘Essay’ which has met with the usual attention bestowed upon Cassandric warnings.”
_Dickens’ Household Words_.
FOOTNOTES.
{7} Those havens that lie towards France, and have been thought by our kings to be such as ought most vigilantly to be observed against invasion. In which respect, the places where they have a special governor or keeper, called by his office, Lord Warden of the _Cinque Ports_; and various privileges granted to them, as a particular jurisdiction; their Warden have an authority among them, and sending out writs in his own name. The Ports are Dover, Sandwich, Rye, Hastings, Winchelsea, Romney and Hithe. Some of which as the number exceeds five, must either be added to the first institution by some later grant or accounted as appendant to some of the rest.
{17} _Vide_ Sewell, on the Law of Coroners.
{28} What were the tests applied, to prove that Laudanum had been administered to the infant? If the child did not die from the effects of Laudanum, what caused its death?
{32} Lord Lyndhurst, in a recent case, laid down the following rule:—