St. Giles’, Sunday, Feb. 22nd, 1852.
To Dr. Bell.
“This shows that Mr. Webber went in my absence and talked to the man. I
had told him to leave Swann in my hands, but instead of that, he visited
him in my absence. Up to that night, the nurse had invariably told me
that it was the injection which had injured him, but after that, Mr.
Webber and the nurse seemed to have set him against my treatment. On
Tuesday, the 24th, when I visited him, he would have nothing to do either
with me or my medicine, and the nurse suggested that I should send for
another medical man.
“On Wednesday morning, the nurse came to me, and asked me to see him
early. I went immediately to him, and found him labouring under a
paroxysm of the stone. He declined to receive any medicine from me. The
nurse then suggested that Mr. Webber should attend him—I was much
surprised at this, as previously she had always abused Mr. Webber. I
asked the man if he wished Mr. Webber to see him, and he replied that he
did. About nine o’clock the same morning, I wrote to Mr. Webber, stating
that the man refused to use my medicine, and that he wished to see him.
Mr. Webber sent me a note, stating that the wife of Swann had just been,
and requested that he would take charge of her husband’s case, which he
had promised to do. The man after this remained five weeks in Norwich,
during which I had nothing to do with him.”
The coroner commenced ordering strangers and witnesses to withdraw,
previous to his summing up, when Mr. Webber asked the coroner why he had
been summoned, and insisted on his right to be heard, after the palpably
incorrect statements which Dr. Bell had been allowed to make—the coroner
replied that he did not consider it was necessary for Mr. Webber to give
evidence at all. {46} The foreman of the jury, (Mr. Coleman) said “He
thought it would be no more than right, that as Dr. Bell had made a
statement, Mr. Webber should be allowed to make a statement also;” this
opinion his brother jurors coincided in, and much against the inclination
openly expressed, and the significence of great and frequent impatience
of the coroner during the time occupied in the delivery of the evidence.
Mr. Webber, after being sworn, deposed as follows:
I am a M.R.C.S., Eng., residing in Norwich. I received a note from Dr.
Bell on the morning of the 11th of February, who asked at what time I
could see a patient of his who had been sent by a lady, to be placed
under his care, to which I returned an answer, and agreeably to
arrangement, Dr. Bell called on me, and proceeding on our way to Mrs.
Phillips’, in Union Place, he said he believed the patient, Wm. Swann had
a stone in his bladder. That Mr. John Coleby of North Walsham had
examined him, but had not found one, and he therefore wished to be
satisfied that he was correct in the opinion he had formed. That he
intended to treat him homæopathically, and that if the man should not be
relieved by his treatment, about which he was “sceptical,” (“as he had
had no experience in this disease”)—he would then hand him over to me to
be operated upon, as he believed I was fond of operating in such cases—I
told him I had no fondness for cutting up anybody, but, that when
operations came in my way, and they were necessary, I never hesitated to
perform them. He said he was not in the habit himself of operating in
such cases. I agreed to go and examine the case, stating at the same
time that I would have nothing to do with the treatment he proposed.
That if his system proved to be a sound one, I should not hesitate to
proclaim it as a great boon to suffering humanity, but that if it should
prove to be otherwise, he might rest assured I should expose it.
Arriving at Nurse Phillips’, I there saw Swann, who was a man about five
feet, nine or ten inches in height, in tolerably fair plight, no
emaciation, no evidence of extensive organic disease going on, nothing
beyond a slight wearing from the irritation which generally accompanies
stone in the bladder, and with nothing in his appearance to interdict an
operation after a week or two preparation, nor to exclude the benefits of
opportune and proper treatment.
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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