Star. — London, England, 1828-12-15 00:00:00

'Callaway, ermined by Mr. Pouocir, cle t be was Assistant-Surgeots at Guy's; has e practice fifteen years; has seen Sir Astley rform the operation of lifhotomy; was present ration in question as Assistant-Surgeon ; the lasted fifty minutes. From the position in toad. he could see the incision; but the knife e staff, therefore he had no doubt the incision into the bladder; saw the body after death ; can judge of the difficulty of the operation erator ; his situation as Assistant did not give ter opportunity of judging than a common there was evidently great difficulty ; no person itroduce the forceps unless he was convinced ger that the bladder was penetrateJ ; had he forceps were used; the stone appeared to igher part of the bladder, behind the pubes. unted for the forceps not finding it. Stones rally found at the bottom of the bladder. 'fiat stone. That accounted for the forceps v it. The scoop was used. S ,, unded the day he was cut, and found the stone. The s a stout man. Mr. Cooper, during the ope ed witness to try his finger, because Mr. old not reach the bladder. He could not ,ladder. It was necessary to make the inci ; a cutting gorges was then introduced ; does iber that a blunt gorget was used; a gorget re wound opening too much ; if the incision is enough, a cutting gorget makes it larger. m used the proper means, and no unnecessary He thought the operation was per formed as ly and with as much care as the nature of the 1 allow. The delay was occasioned by the of finding the stone. Mr. Cooper was cer• ilful surgeon. Plaintiff was in the Peninsula rica; plaintiff was at Norwich; Norfolk is I for diseases of the bladder. On the post aminanon, should have seen if there had been ty force used; the patient was an unhealthy case required great anatomical knowledge. d greater knowledge Co tie the subclavian n to cut for the stone. Would not form a judg case of this description without consulting or. unlined by Mr. Wakely—Did not pass his Gogh the wound at the post modem examina not aware whether the stone was attached to I or not ; in one part of the bladder witness n appearance which induced him to say that tad been embedded there. Did not think the new the si union of the stone; it appeared to lifficulty. He could not have a knowledge of situation of the stone, as it was in the interior bladder ; there is a loose cellular membrane he interior patt of the bladder and the pubes; ment which attaches the bladder to the ;idles v is contracted when there is not urine; the ay embrace the stone when it is contraited ; any wine in the bladder it will contract nd propel 'it so the urethra: The bladder is o any sub.tance but the pubes; it has other ts. but no fixed points ; the stone would fall into of the bladder by its own gravity. The sides dder are not generally in actual contact. Had that the f ',ceps entered the bladder. Wit not in a situation to see whether they entered me, but his opinion was that they did. A flat Ruch more difficult to obtain than a rotted I small one is more diffikult than a large one. less if the opening required time to do it with cutting might take ten seconds. The gorges used once; this was gekitness's opinion ; did e osmium for an esplimation until the opeta wen The patient had been removed ft bin the ten the operator explained ; he was riot kept instant while the explanation was ping for sidered Mr.B.Cooper to be a vet, skilttil prat- 1 All surgeons differed upon some points, but ' portant points should have no hesitation Of Mr. Cooper's opinions. Had never said it was put job to place Mt. Cooper over witness's ke all disappointed candidates, witness might that the election ought to have fallen on him ; 4 never said that Mr. Cooper was better fitted large fortune than to be a member of the ; witness might have wished thit he had a one, and wished so now ; for if Mr. Cooper furtisne, witness might perhaps now be the instead of the assistant. Cannot distinguish !potation between the cut made by the gorget by the knife; hive seen an appearance pro the cellular membrane by the forceps passing ie bladder and the rectum, but the appearance aes and the one in question were not similar; ow there was exteavasoted blood and in the 'e was none; the cellular membrane was dark which might be the case without its contain rasated blond. Nen Wit re-ezartibled by Sir JA 1113 SCA R Ltl7 Ilse of the bent folcepi i , and the Witnes'a de it horn the time at whith hlr.C. Used the bent ►e (Mr. Callaway) conceived that Mr. Cooper ' e had the same idea of the difficulty which passing in his *And; it was not the sfitnplf of tatting which ocessibAed the delay in per the opetation. uror—..The operation k alviays thought to be when the stone is in the *Mellor part of she but did not antiespate any extraordinary diffi• this case, though the patient was of that weak It he was not unlikely to sink under a great ; the sound could nor have placed* the stone don more difficult to be got at. .A. Kai examined-1 am the senior surgeon Hospital; I am a surgeon since 1812; 1 have 4 50 or 60 operations in litbotomy myself ; I 'Ti Mr. Cooper operate several times; in the is Mr. Cooper has performed he has not lost n the average number of patients • from the 3 n of the op erat i on , as g iv en by Mr:Callaway, likely that 1 should r ave adopted the same sa as adopted by Mr. B. Cuomo. The length cellpied in thelperation was no criterion of a the operator ; have known CAMS where, the stone could be touched, there Was yet great in extracting ir, in consequence of the bladder use stone. I think from' the evidenee ad 'at the operation was scientifically performed: Piolence had bien used, I. thick its effects' discovered after death. The passage in the nembral2e would hit& hetn' found liketatiod. state of slough, with extravasated blond. I was t the post ntortens ekiiMnat on. and the cellular 11411 4 linfictly emit and' htle lbzeiateit: If ps had been introduced with great forte into .te"gland, it would liavealsown the elfsettrat bat no - ugh effeeti• wirelAsitstraftee &nth. nd•psesrnted the appltitattaf* of a fate AI lbh welt of the'blAtifeEttiraugh 'films Welland. ins the Mt, eti to do so if potsible t I had taint conversation with Mr Lambert in the square of the Hospital ; Mr.Lansbert said. " Your straight staff will never reach a deep'perinen m." I replied, ia Sir, you know nothing about it, having never performed the operation yourself." The staff will answer as well with a deep as with a shallow one. I told him if he thought this perineum deep, I had operated upon one twice.as deep. Not having seen the perineum during life, I could give no opinion as to its depth, and did not therefore say that it was a l deep one. Mr. B. Cooper, in his operations, has seldom 1 , exceeded the average time. I have tied the subclavian ' artery twice; it is, when tied in cases of aneurism, one of the most difficult operations in surgery, but when there is no illsease the operation is easy enough. It re- quires great skill, great presence of mind, and great knowledge of anatomy, to perform such an operation. I assisted Mr. B. Cooper in perforMing this operation, and I never saw one better performed in my life; it was for aneurism. I never saw Mr. B. Cooper lose his pre. sence of mind upon any occasion. I consider him tu be a good and skilful surgeon. Cross-examined—l saw in the Lancet a report of the tying of the subclavian artery. Sir J. SCARLETT—My Lurd, there was such a repot t, in which Mr. Cooper was spoken of very handsomely ; that was prior to the quarrel between Mr. Lambert and Mr. Cooper at the dinner. Mr.Wakely —Was that report prior or subsequent to the dinner ? Witness—it was subsequent to it, most certainly. I object to the use of the gorge' before an opening is made into the bladder, because then a con siderable degree of force most be used ; but after an opening has been made Into the bladder my objection will certainly not apply. I have operated between fifty or sixty times ; forty of these were at Guy's Hospital, and lust only three patients With justice to Mr. Cooper I ought to say that the major part of these forty were young patients; Mr. Cooper performed about twelve times at the hospital, but As I do not keep an account of his patients, I cannot tell bowman, of them died. I use as many instruments in the lithotomy operi• tions as I may find necessary for extracting the stone. , sometimes three, sometimes more. It the bladder con tracts, it may hold the stone in contact with it. 1 think that I had performed about three 'Tendons before I published my work on lithotomy. In the case in which ; Mr. Bransby Cooper tied the sunclavian artery, the patient ultimately died, but 1 think that he died more from disease than from the operation itself—his death Was occasioned by suppuration below the ligature...l- 1 Neither on the operations that I have seea,nor t!.at I have myself performed, have I seen the subclavian artery tied in a better manner than it was done by Mr. Bransby. Cooper. I consider Mr. Cooper a scientific surgeon. What do you mean by science as applied to surgery? —I consider that a man is scientific who knows good reasons for what he does. I am certain that I had no conversation with M. Bransby Cooper respecting this operation before the report appeared; I have since that conversed with him, but it was upon immaterial points; I had never the difficulties of this operation explained to Have you ever sent aeontribution to the Laneel?— Yen; upon the occasion of the separation of St. Thomas and Guy's Hospitals, I sent an answer to an article which previously appeared in the Lancet. 1 law in the Lancet since the operation in question, an article highly praising Mr. Bransby Cooper, and undoubtedly it is my belief that I expressed my approval of that.attielb. Mi. Joseph Laundy examined by Sir J. SCA RLIITT-... I held the instruments for Mr. Cooper while he was performing the operation; I have witnessed almost all the operatiohs at Sr. Thomas and Guy's Hospitals for the last thirty yearn, and have seen Sir A%tley Cooper an.l Mr. Cline periorfu several times; some operations of the description now under consideration have lasted AS long; the most tedious one I ever sew was by Mr. Cline, surgeon; it lasted an hour and to , ty minutes' the stone was ultimately ex' ratted. 1 hive seen ibe operation last an hour, but not often; one by gh A.stley lasted on hour; it was At the Hospital, Cross examined by the defendant—l am not a sttrgeon ; I am an istArunient maker, and do not know the causes of the delay in the cases that lasted an hour. Dr. Hodgskin, a quaker, examined by S rJ. SCAR LETT-4 Oa Professor cf Morbid Anatomy at Guy's Hos pital; I should think that the perineum of the deceased, from his size, must have been deep. Froth the appear. ance of the parts, I was aware of no other wound, except One front the external surface into vie bladder—there was noAe between the bladder and the rectum ; the kidneys, as is gener,lly the case ir. subjects of that nature, «etc mottled with white spots. I should certainly nave seen it, if there had been any wound between the bladder' , and rectum. I cannot say that the wound passed any where but into the bladder. Alter I removed the parts they were put away, and J. Lambert asked to see them. I orone of my assistant, took them down for him. I went away ; afterwards James Lambert showed me a passage between the bladder and the rectum, and as I halt not seen the passage before, I taxed him with making it. He had the finger in - the passage when he showed it to me. If that had been made recently befit, death, there would have been an extravasition o f blood. It is My firm conviction that it was made after death. From my knowledge of Mr. Cooper, I look on him as, a very fair surgeon and a good anatomist. Cross-examined—l read or heard the report of the peal modern examination in the Lancet read, and it was correct as it appeared at the examination, except so fir as regarded the passage between the rectum and the bladder. ' Mr. Brodie, examined by Mr. Pounci—l have re peltedlp conversed with the plaintiff on surgical sub jects. and conceive him a very intelligent surgeon ; I heard Mr. Calliway's account of the operation, and I think that it most have been difficult; I think that Mr. Cooper performed it skilfully, but I have never seen that gentleman pertorm any operation ; I have repeat edly performed the operation of lithotomy. and it varies in ice circumstances more than any other; the use of a great number of instruments indicates the difficulty of the case. Cross-examined—l attended a Meeting at the Free. masons' Tavern, coniposed of the Lecturers at several Hospitals, and it was'ctMsictered that We had all a com mon caobe - against the' Land; I paid part of the ex panes of the' second* application to the Com' of Chirac's* for an injunction to restrain the pUblication of Mt. Abernetby's' Lectures; I have subscribed to enable a man to set iris alifippaiition Journal to the' BACA; besilltelhit' Matte kabwif nothing of it. Re‘exatarstfilite.-1f appeared to me to be a great li ki "atiCiate have die Lectures published, because they -webs published incorrectly, and brought great discredit those. whose Lettuces were published. Met haters-.I have been in practice 20 yedri, and I Wit been in the profession since 18b0; I hive heard the Mance of Mr. Callaway at to the operation, and I have Me of no cireirmstane* which could inipeach the skill oftbromfratte. I think the'operator is' the best judge eirtirthftltreatitit vihich eughtli tiiised. The Igoe; setlireif* . cSitatioa. of the skill of the operator. I 41lithwainted with Pdf..Ctiwpgr,. attittlilalrtlntt he it . .l" an %pink!' intellrgdnt Wein, Et fo r twe situation he holds as Surgeon of Guy's Hospital. There ate often cases of lithotomy which for a long time kallie the skill of the best operator, and I conceive case in question to be one of thit description. I have had con versations at St. Thomas's Hospital on the subject of the Lancet; the surgeons met upon the subject. I was . not present at any difference of opinion betaren Mr. Lambert and MY Cooper. I have read the report in the Lancet, and I do not considet it to be a fair or a professional account. of the operation. Cross examined—l did nor witness either the opera. tion or the post monism examination; I have performed the operation twice where there was no stone, although the patient had previously all the symptoms, which ceased after the operation. He had the opinion of four other surgeons as to the existence of the complaint be fore he performed the operation. Re-examined—lf I had never heard of the report, should, on reading it, blush for the person who had made such a report. Mr. Green was nest examined—l am nephew of the late Mr. Cline, and have been for eight years Surgeon to St. Thomas's Hospital; I have often performed the operation of lithotomy, and am reputed to be very suc cessful; I witnessed one capital operation by Mr. Bransby Cooper, a hick he per formed admirably well ; the ope ration was that of tying the external iliac artery, which, for skill, is somewhat like putting a ligature on the subclavian artery. From Mr. Callaway's desci iption of the operation, I think it was skilfully conducted, and I should conceive it to have been a case of great diffi culty; and length of time is of itself no criterion of the skill of the operator; the most skilful surgeon might have occupied the same time, and yet the result have been equally fatal. Cross-examined—lt requires great anatomiesl know ledge to to the iliac artery . . I was at the meeting at the Freema.ons'Tavern; Some Lectures of mite at that time had been published; I conttibuted to the expenses of the Injunction. Re-examined—The lectures were incorrectly pub lished ; only one of them was free Loos misrepretentatia n. Dr. Babington was next called and examined by Mr. POLLOCK—I knew the plaintiff well, and have had con versations with him upon anatomical subjects, with which he seemed to be perfectly acquainted. The best proof of my conviction of his skill is, that I have placed my youngest son under him as an apprentice. Cross-examined—The apprentices to the surgeons of the hospital have all their advantages in common ; it makes no difference what surgeon they are placed under las to the knowledge they may have an opportunity of acquiring. Dr. Roget examined—l !lave had many opportunities of witnessing Mr. Cooper's ptactice, and I think that he is a skilful and judicious surgeon; I have read this re• port, and think that no medical man ought to have written such a report. Mr. Morgan was next examined, and gave similar testimony as to Mr. Cooper's abilities. This witness was not cross-examined. Mr. Hilton examined—l was a pupil at St.Thomaes, and I am now an assistant demonstrator ; I was at the post mortem examination, and could not reach the black der with my finger ; I did nor witness the operation. Sir A. Cooper—l was subrcenaed by the defendant, and I heard the account given by Mr. Harrison of the education of Mr. Bransby Cooper; that account was perfectly correct ; Mr. Bratisby Cociper had been in my house, and had continued opportunities of witnessing my practice ,• he had opportunities of experience at Salamanca, Toblouie, and Vittoria, and ,afterwards in Canada. I subsequently took him as an appren lice, not conceiving that the spec:es of practice he had witnessed was the most proper for an Hospital : the plan of placing him as Surgeon of the Hospital was not mine, but it I thought that he was not fit for the situation, 1 should most certainly haveoppo-e his appointment. In my practice I have often sent him as my substitute, which I should not have done if I did not think him competent. Mr. Bransby Cooper, when he first went to the Wapiti!, was a. good ;Mato mist, and a very good surgeio, but Ile s anted expo, ience in hospital practice. Sill a young man must not be crushed in the outset, or the country will be deprived of perhaps the first-late abilities; the dill.ulty in the pre sent case was, that the stone was enveloped in the f Ids of the bladder which did not let go its hold of it until the man became eery considerably exhausted, and then it dropped, so that the, straight forceps could catch it. With respect to time, it was not to be at all considered as a criterion of skill; the stone was small, and it should be known, that it was the small stones which caused the difficulty, because they were often enfolded in the bladder ; no man could be a judge cf the operation unless he had pet lot med it, and no man could ju ige of the individual case unless he was the performer; I have been twenty five years in practice, and I have in one year pram med the operation r f lithotomy eighteen times ; I should think it unkind to form an opinion of the skill displayed in a case with, ut communicating with the operator, for I should be loth to destroy the character of another man—and unwise, because that opinion could scarcely be correct. Cross examined by Mr. Wakely—Sir Astley, have you never said that a good 'urgent' ought to be like a good General, that be should wade up to the neck in blood? Have you not said so in yr ur lectures to y ter pupils ?—Sir A. Cooper—l don't know, I may have said so; I am sometimes fond of using strong expres'sions; I like, in short, to be understood. I think it one of the greatest evils that a man should he attacked in early life ; and that he should be crushed because he hap pened to have a misfortune, however capable he might be to practise in his profession; it is a power which I think the public press ought not to have. Mr. Wakely—Sir Astley, do you not think that the interests of the public would be best consulted by hav ing men of experience appointed as surgeons to the Hospitals, and not to appoint them for the purpose of acquiring experience? Sir A. Cooper—l think that every Hospital ought to have an Assistant-surgeon,who would thereby be prepared for the situation which he would subsequently bold. Was Mr. IL ansby Cooper an assistant before he be came surgeon? Sir A. Cooper—No, be was not; but I think it would be a good regulation to adopt in all of them. What was the particular difficulty in this case?— Sir Astley Cooper—There was so little water in the bladder that this man must have made water imme diately before the operation; if the bladder had been lull of water the stone would have been easily struck. What is the danger to be guarded against in the opetedon of lithotomy ? Sir A. Cooper—The chief danger to be guarded against is violence. Supposing the stone to be felt, but enveloped in the folds of the bladder, would not the more prudent course be, atter having vainly tried for ten minutes to extract it, to place the patient in his bed again?—Su A. Cooper—l should certainly think not, if the stone could I be felt. In that cue the surgeon should persevere until be got it away. youtot toad Was. Sir Mdeyl—Elir Astley I —TraVe &pied tdio Cass, bet I de not copula . Celsus as a good surgical authority, although be is it classical one. Is it not the practice in Edinburgh and Paris to pot the patient to bed in such cases as f have supposed ? Sir A, Cooper-1 have studied in E lit•burgh, and I have witnessed operations of lithotomy in Paris, but I never saw such a practice resorted to. How lona may the contraction of the bladder con tinue? Sir Astley—it might last an h ur ; 1 Nal giae sou an example— I went into the theatre of St Thom is's Hospital, where an operation of lithotemy W4s being performed by a Gentleman who is now in Court ; it was one of great difficulty ;,the &toile was enveloped in the folds of the bladder, so that the point of it only could be felt; after nearly the lapse of an hour, be passed the instrument between the stone and the blad der, but the contraction still continued. What evil could result by placing the patient in bed until the contraction was oves ? Sir Astley—Just this, what you would not like—you would have two opera. tions to perform instead of One; if the stone was f.li, the surgeon ought to persevere. Why is it mole difficult to introduce the finger after death than before ? Sir Astley—lf you had ever put your finger into the bladder of a living subject, you would know the difference; by putting your finger into the bladder of, the dead . subject, you would have known as much of the difficulty of this case as you now do of what is passing in the moon. , • Re examined by Sir J. Scatteatri r My nephew wig, a surgeon in the arme..and lie was epy demonstritoref anatomy; he gaie great satisfaction to me; and the students were so gratified with the clearness of his lee tures, that they teltpleased that a mari who bad so easy a method of communicating knowledge should be placed in a situation Where he would have the means of conveying it. Mr. Dalrymple, the surgeon Of the Ncirwieli Hospi tal, deposed to the celebrity Of. that Hospital for its operations in lithotomy, and he bad himself performed the operation not less than 76 times; had heard Mr. Callaway's description of the operation, and saw horn that description Ito indication of waist of skill on, the part of the operator; has often had similar difficulties, and has always a greeter number of instruments than those that were mentioned as employed by Mr.Cootset. Believes Mr. Cooper well qualified to fill the, sitoation of hospital surgeon ; hid himself the misfortune to have a case where the stone was so large that it could not be removed, and in three hours the patient died. , Cross examined—ln that case the stone weighed over fourteen nun es. Mr. Watson examined—l am S•cretary to the Court of Examiners of the Apothecaries Company; the young man, Clapham, did come to be examined, in order to obtain his certificate; 1 have an affidavit ofJohnClapham s to the effect that he was 21 years cf age on the 21st of April, 18`28; this affidavit was necessary, in order that he should get his license to be examined; this affidavit was swo n at a police ii(4ee in Middlesex;, I don't kpnw that Mt. lambert did more than give a certificate oldie moral character of Clapham. Sir JAMES ScARLErr —That is my case. A shalt pause then took place, previous to the de. fendant rising to address the Court. Mr. Wakely then replied. He observed, that thit apprehension of Sir James Scarlett, on the previous day, that he (Mr. Wakely) would break down in bit case, and so leave the Learned Gentleman no Opp , rte. pity of supporting Mr. B. Cooper's character for skill by evidence, had come to nothing. Sir James, in, his addreis to the Jar f, had thought proper to bestow, oo thin almost every vituperative,epithet valid think of. He had called him a plunderer. a literary pirate, and had accused bian r f keepina a set of young mea l almost the outcasts of t..eir prufession, with a tit w to aggrandise himself by their Wows. He did not know Whether Sir lanes SCarlett had founded his statements on fel nit or from the instructions of his client. It the forme., the Learned Gentiemln had shown his indiscre tion; it tie latter, his client hakshosen still wester want of discretion. In carrying. on fte--publicatinn of the Lanai, his, principle always had been that he had a rig: t to publish those Lectures which were delivered in public, as he considered that, in fact, they belonged to , the public, and that the public, through the medium of periodicals, luid a right to be acquainted with what was going on in public theatres of surgery. With private lee • tures he had never meddled, because they did is t present the same leatiwei. For this publication of their lectures some surgeons had thought pioper to bring him into Chance, y, but there the question had been decided in his favour; and the surgeons, by pursuing such a course, liar only rendered themselves bye words to the pr, fession. Among others, Mr. Green's six lectures on diseases of the eye had been reported, and he was cer tainly veining to admit that five of those lectures, owing to very particular circumstancts, were - not accurately reported; the first cue, however, a* Mr. Green bad admitted, was accurate; and the reports . of Mr. Abeinethy's lectures were so correct, that that Gentleman had set forth their accuracy in an affidavit. The simple question respecting afte lectures was, whether they were public rropeity, or were to be made hole and corner work of? Such a decision he was determined to resist, and he had re■ sisted it with success. In coming to the case itself, he must say that it presented itself to the Jury under very peculiar circumstances; and it was most remaikable, tbat out of two hundred persons who were present. the plaintiff had thought proper only to call one—a solitary, one—to give evidence as to his skill; while a whole host of persons, who knew nothing at all of the operation, were called to support the plaintiff's cha. racter ; among them were Sir Astley Cooper. Mr. Green, and Dr. Babington ; he wondered, for his pan; that there were not added to the list the Emperor of China and the Great Mogul. By such a course it was attempted to practise the greatest imposition on el le Jury and the public ; but would the Jury be so blinded' and so duped as to allow themselves to be persuaded that the opinions of these men were to prove the report in the Lancet inaccurate? Why weie not the surgeons of Lewes produced, if they were able to state that there were considerable difficulties attached to the case? But no; the plaintiff had not ventured to do that; he chose rather to rely on that evidence of which he could be sure. Sir James Scarlett, in his address of that morning. had thought proper to dwell at great length on the person whom he chant to call 4. the hireling Lambert ;" but Sir James should remember, that in this case he himself was a hireling, had received his fee, and was working for the sake of lucre. Objections, too, had been taken to the term Bats." bat if they were to have their Whigs in politics, he did not see why they night not have, their Bats in hospitals ; and very sure he was that these hos. pital surgeons were much more like bats than Sir Jas. Scarlet like sour milk,uhich was the meaning of Whig , (Laughter). Yesterday he had taken the libesty of asset-. ing the Jury that he had every reason to believe that the whole of the statement in the Lance) was true; and he might now say that not one tact had been contradicted and indeed if thite should be some discrepancies in be ga, • i• ; grrget . N at,, I Wok; as iDecrumenrappli- : circumbtancee of the cese L litit thick knife 'll4lllltrai the porpnseapa!iy watt IM MO" CAW,. setottlittiteiVirlipaiibierdibr the betomeltedlildst aWirriag i I 1 I 1 1 1 'i t , i I [ i 1 i i 1 1 ' ii , , ' 1I i 1 1 , t 1 I I , i ; I i 1 I i I'' I I 1 1 1 ' '' ' lr , ) 1 t i