Thursday, June 17.
While the Court was waiting for witnesses, Mr Stephen said that Mr Templar, (the promotor in Morgan's case) was preparing a memorial to his
Honor, recommending the prisoner to mercy, and
asked if it would be accepted.
His Honor said it would make not the least differ- ence in his mind. The only quarter from which he should pay the least attention to such a recommenda- tion, was the Jury. But he would hear witnesses to general character.
Mr Stephen said Mr Templer had never intended to prefer any charge more serious than for a common assault.
His Honor-His intention makes no difference.
After a delay of a whole hour, from the absence of witness.
Henry William Coates was placed at the bar, his Honor not suffering him to sit by his counsel, under
indictment for manslaughter, in having, by his sur- gical neglect, caused the death of Nicholls Ball, during his treatment for a compound fracture of his left leg.
The indictment having been read, His Honor asked
the Advocate, General if the indictment were suffi- cient. He had laid stress on the duty to attend once a day - was there any binding law to that effect? Then he was called "surgeon, apothecary, and med- ical attendant." He knew of no such profession.
On this, however, he would lay little stress, but rather on the duty to attend once a day.
The Advocate General believed he could prove, on good authority, that such was a surgeon's duty in a
case of compound fracture. His Honor thought he would have been better to
have put the duty of a medical man in a more general way, and to have set forth the particulars and efforts of the neglect.
The Advocate General had been anxious to
avoid the appearance of vagueness.
His Honor thought he had exactly fallen into it. The prisoner being then arraigned, pleaded not
guilty. We have recently published the evidence before
the Coroner's Jury so fully, that we need now do
little more than recapitulate the facts. The deceased, Nicholas Ball, a miner, at the North Kapunda; broke his left leg by a fall into a well, on Monday the 12thApril last. The compound fracture was immediately reduced by Mr Coates, who promised to
see him again on the Wednesday. This he did not do, and the man lay unattended to the Friday even. ing, when Mr. Coates having been sent for, came and dressed the leg. It had then assumed a very
dangerous form and the patient, by the doctor's con- sent, was sent to Adelaide, a distance of fifty miles,
in a dray, where he arrived on Sunday morning, and was placed in the hospital. Mortification had then extended so far, that amputation, even had the patient been able to endure it, would have been useless, and he died on Tuesday. The Coroner's Jury returned a -verdict to the effect that the cause of death was the
surgical neglect of Mr. Coates.
The Advocate: General opened the case, by detail ing the foregoing facts. He emphasized the fact, that after his first visit, Mr Coates led the friends of the deceased to expect his early return, and had left with them neither medicine nor instructions. Re- ferring to the castor oil administered by Mr Hack,
he said he would prove that it was beneficial, and
therefore was not to be regarded as an interference with Mr Coates, and the main fault in the treatment of the case was, that such medicine had not been given earlier and more frequently. He would prove, that when Mr Coates resumed his attendance, insen- sibility had commenced-that that in fact which he called erysipelas, was in fact gangrene or incipient mortification. If so, their duty would be an easy one, as he could prove, that with ordinary care, no such consequences would have followed the fracture. He next remarked on his having sanctioned the removal of a person in such a state- a person who was pro bably, even then, from precious neglect, past reco
very. He had inserted a second count, in which the removal was laid as the cause of death ; but his real position was, that death bad been caused already, and had been accelerated by the removal.The duty of a
medical man, in a case like the present, was very simple, though he doubted not it would be made a
subject of mystification. The.learned counsel then explained the difference between simple and com pound fractures, and the greater necessity of close attention to the latter than to the former. On this subject, and on the general treatment of compound fractures he read extracts from Cooper's Surgical Dictionary, calling particular attention to the direc tion that they should be dressed every day. Different fractures of coarse required different degrees of care, and there was no doubt that the present was a bad case ; but they found that no care whatever had been used -that the patient had been wholly abandoned from the moment he was firs laid down. He did not charge the prisoner with want of know ledge, but with a very gross neglect of that ordinary care which the circumstances required. He would not seek to aggravate their feelings against an indivi dual, but it was a matter of public importance that practising surgeons should be compelled to use ordi nary care in those cases which they undertook. He did not say that a medical man was bound to take the charge of a case without pay, or even with it, though in either a chivalrous feeling usually led him to do; but having undertaken it, he had no right to throw it aside, or relieve himself from res ponsibility, by pleading other calls on his time or attention. He was bound to use all diligence, and in the event of his absence, to shew the positive impos sibility of his presence. This was not a case such as might happen in large communities, where a surgeon's duty was ended when a certain operation was per formed, and others would attend the patient after ward. Mr Coates, as he would prove, undertook the entire case, and understood that no other surgeon would interfere.
The learned counsel then called
John Rowe, who described the circumstances of
the accident, which we have already given in . full. The only important addition to his evidence was, that on Thursday, about midnight, he ob served some small bladders, about the wound, which were larger next morning, and reached six inches above it. The limb was also inflamed and swollen.
John Yarwood -Had been present at the set- ting of the leg; asked Mr Coates, as he was going, if medicines would he necessary; he replied, "I shall be here the day after tomorrow;"
witness, on Thursday morning, gave deceased two ounces of castor oil and a little saltpetre for his relief ; each had the effect desired. J. B. Hack repeated his former evidence.
C. J. Carleton, assayer of ores at the Kapunda mine, had been at first sent for to attend de- ceased, but had recommended the calling in of prisoner; on his arrival, witness said to him, "An accident has occurred, you have been sent for to attend it, the man cannot pay for two attendants -recollect it's your case;" prisoner made no particular answer ; witness went away before deceased was brought up ; did not positively know the nature of prisoner's practice ; he had attended one case at the Kapunda Mine as sur- geon, and witness, by arrangement, acted as his assistant, seeing the patient every day,-and pri- soner doing so twice a week ; no such arrange-
ment had been made in Ball's case.
Wm. Freeman, the man who had charge of deceased on the road to town, proved that he had taken him there by prisoner's direction, and had bathed his leg with a lotion given him for the purpose; prisoner gave him other instructions, which he precisely followed; deceased was much shaken on the road; there was rain and a high wind; he could not sleep for pain.
J. G. Nash, Colonial Surgeon, repeated the evidence he had given before the Coroner and which we printed, at the time - When he first saw the deceased on Sunday, 18th April, mortifi cation extended entirely up the thigh, and must have existed two or three days ; called Mr Wyatt in to see him ; they agreed that nothing could be done for him-in fact, that he was sinking ; he died on the Tuesday ; with ordinary care, the fracture would not, in his opinion have produced mortification; he judged from the nature of the fracture (tibia and fibula broken), and the ap pearance of the man ; the first thing which ought to be done was to set the leg,- then to endeavour to close the external opening; aperient medicines should then be administered; should they not act, and inflammation run high, witness would bleed -that is, in a healthy man in the country; all the secretions being free, and the patient suffering pain, he would give him anodynes; he would also apply evaporating lotions to the leg to prevent swelling; should sse the patient at least every day, and, if there were any pain com plained of, would remove the splints and undo the bandage, to give the part relief; if much swelling occurred, and there were a disposition to suppurate, he would assist that disposition by fermentation and poultices; if suppuration be came too profuse for the patient's health, and he thought nature would not bear up, he would amputate as soon as possible ; considered such to be the duty of a medical man who undertakes the sole charge of a compound fracture ; had heard the evidence as to the facts ; considered the blisters seen on Thursday night to be a se paration of the cuticle, and that mortification had commenced; saw nothing in them like erysi- pelas; considered the case one of surgical ne- glect, from, the patient's having left for four days so shortly after the injury ; it was one which
required to have been seen at least once every day; had the splints and bandage been removed on the second day, and medicine administered, it is most probable mortification would have been prevented ; amputation should take place as soon
as possible after the appearance of mortification;
the various branches of the medical profession are not so clearly kept distinct here as in Eng- land.
By Mr. Stephen - A medical man in the country,
attending a case at a distance, might feel frequent at- tendance inconvenient, but in one of importance he
should make a point of giving due care. Were he twenty miles off he would have difficulty, and some part of his practice must be given up. One horse would be knocked up after a few days, and perhaps the
man too. If he had to walk he could not do it.
Where a case involved danger to life, witness would give up cases not dangerous to attend it. Should
not consider a compound fracture dangerous if he had
left proper medicine and instructions with an intel-
ligent person. Should have thought it likely Mr
Carlton would have been sent for in Dr. Coates's ab- sence. He had been with witness at the hospital as
dispenser, for some time; was an intelligent man,
and had seen much of surgical cases, but should not have relied on his attendance unless by arrangement; it is good practice to administer aperient medicine within the first four days ; would do so within three or four hours; it is the first thing he would .do. [Mr Stephen here read a passage from Sir Astley Cooper's lectures condemning aperients, and recommending bleeding.] Witness said that there were now mechanical contrivances to obviate the inconveniences referred to by Sir Astley. Though that mortification had commenced prior to removal, pain does not cease at the commencement. Of course
it does when the part becomes thoroughly dead. A surgeon would be justified in following so high an authority as Sir Astley Cooper.
By the Advocate General -His advice was not followed here, as be recommends bleeding in place of
aperient. Here neither alternative was adopted.
By the Judge -If the splints and bandages were left on for four days, mortification would be very likely to ensue. A case of compound, fracture left without attendance should be regarded as one of danger.
William Wyatt, J. P., coroner, detailed the cir cumstances of the inquest, and underwent a long pro fessional examination, which it would be tedious to record. It was, for the most part, a confirmation of what Mr Nash had said. On being pressed by Mr Stephen in cross-examination, as to the possibility of mortification being taken for for erysiplas, and having said that there was a very marked difference between the two, he admitted that he could imagine the possibility of that, or of any other stupid mistake being made.
J. B. Hack., recalled-Had only known prisoner as a medical practitioner ; he had acted as a surgeon in the case of a man who dislocated his ancle ; did not, of his own knowledge, know that he had applied medicines ; at the time of the accident he could not practice without it, as there was no resident apothe cary ; prisoner had said nothing about remuneration.
The Advocate General-This is my case. I sup pose, your Honor, no further proof is necessary of the profession.
His Honor thought he must prove the averment in the indictment. However, it was not for him to ad vise. The Advocate General must exercise his own judgment. The fact was, he had made a mis take in the indictment altogether. But the jury wished to retire, and he could point out the difficulties meanwhile.
Mr Stephen submitted that the course suggested
would not be fair to the prisoner.
His Honor would not adjourn, then, till the case
for the crown was closed. The Advocate General must proceed and take his own course. The learned Advocate then recalled
W. Freeman (who was examined by his Honor)
-He deposed that prisoner had administered to him a blister on the chest, and some powders, a short
time ago, when he was ill from drinking brackish water. Prisoner was there attending a sick woman
at the time.
His Honor.-This is very irregular.
The Advocate General wished to call another witness, but his Honor refused. He considered the case closed. He would ask no more questions ; but on the Advocate General insisting that the case was not closed, and that he: had a right to call whom he chose, suffered him to examine fresh witnesses him self.
Samuel Bray- Prisoner had, to his knowledge, managed a case of dislocated ancle.
By Mr Stephen- Was sent for Dr Coates on the the Friday, with a note; met him five or six miles from his own house on foot ; he said he was on his
way to visit deceased.
The Advocate General -Had you any conversation with him on the case?
His Honor- That question does not arise out of the cross examination.
The Advocate General- No, and I should have stopped the cross examination had it been worth
while. That did not arise out of my examination.
It was not cross to it.
His Honor (laughing) - No, it is not necessary. In cross examination any question may be asked.
The Advocate General called
Sergeant Lorrymer, who deposed that prisoner had attended-his family for illness of whatever kind, had supplied medicines, and was paid for them.
The learned Advocate remarked that he was awkwardly situated, from the fact of the prisoner not being a legally qualified medical practitioner accord ing to the law of the province. He had been told
that the witnesses from the mine would prove the nature of his practice.
This was the case for the Crown.
Mr Milner Stephen raised a number of legal ob jections to the indictment. That which appeared most important was that it was alleged to be the prisoner's duty to attend once a day during the treat
The Advocate General thought the evidence suf ficiently proved-this.
His Honor said that it was not even alleged that the leg had been set, still less that it was requisite it should be seen once a day. And it had not been shown that it was possible for the prisoner to attend every day a distance of twenty miles. The indictment should have set forth that the leg had been broken, was set, and that the splints and bandages required to be removed, and had not been so, then they could have come at the merits of the case. It should have been treated as want of skill, as in Rex v. Webb, where a man was indicted, criminally, for killing a
person with Morrison's pills.
His Honor thought the cause of death should have been more particularly alleged. The express in. stance of neglect should have been shown, and the mode in which it caused death; that the case re quired aperients and the removal of the ligature. A medical man would not be safe in answering alle- gations of so general a kind. The more be looked at the indictment the more he was convinced that it could not stand. He thought, also, that where it had been proved that the prisoner lived twenty miles off, and was found on his way on foot to attend the case, that the prosecution might be abandoned on the merits as fairly as on legal grounds.
The Advocate General, after that expression of opinion, would not press it further.
The jury then, under his Honor's direction, ac quitted the prisoner.
Adjourned till to-morrow, this day. The first case to be taken is that of Wiltshire.