Lt. -Col. DONEGAN (Ex R.A.M.C)
(C.B., LL.D., L.R.C.P., L.R.C.S.)
"Dare Doctor's Think?" Verbatim Report of the Great Meeting held at Queen's Hall, London, Fri, Feb 6, 1925. In connection with the Rex versus Hadwen manslaughter charge
Lt. -Col. DONEGAN commenced a witty speech by saying that he did not intend to deal with statistics.
I consider myself, he said, capable of proving any argument I liked by statistics. Suppose, for examples sake, that you wanted me to prove that no one had died in such important cities as Manchester in England and Ballyhooley in the Irish Free Statewell, I could do it. As we are so near the headquarters of the mystic art, I shall tell you how the trick is done.
All I would have to do is, to go to the places I have mentioned and steal the burial records. Then ask the municipal authorities for the exact number of burials for the period in question. If they, for reasons stated, could not say the exact number of burials, statistically there would be no deaths. (Laughter.)
I think you will agree with me that the nobility of the medical profession, to which I have the honour to belong, is beyond all question, as it is the only calling where one is likely to get anything for nothing. At the same time, we have to admit that this noble profession suffers at times from being somewhat too dogmatic, and most of its dogmas are, I regret to say, the result of conventionalism on the part of the general public. When I was a student I remember being told by a professor of tropical medicine that the surgeon who would bleed for sunstroke deserved to be hanged as a murderer. All I can say is, that if the dear old gentleman had lived longer he would have required a lot of silken rope, and many members of the profession would have been elevated. I was also taught that to give opium to a child in agony was murder. When I went to a foreign country and saw the newly born babies sucking chunks of opium about half the size of themselves (and still, like Johnny Walkers whiskey, going strong), somehow or other I altered my original opinion. (Laughter.)
You may not know it, but it takes years and years to alter the dose of a drug in the British Pharmacopceia. I think it was Moses who first ordained that the dose of bicarbonate of soda should be 10 to 20 grains, and so it still remains to the best of my belief, though I often consume about a quarter of a pound a day myself.
At present the profession is exceedingly dogmatic on antitoxin inoculation, but in a few years, should the idea of Besredka (who recommends giving antitoxins by the mouth in steel capsules) be adopted, the profession will be out to hang those who stuck to the old-fashioned method of inoculation. (Hear, hear, and laughter.)
A few years ago, as you know, people were mad on the name antitoxin. Everything was called antitoxin, down to Formamint lozenges. I once heard a lady say to a young Middy who was suffering from a mild attack of clergymans sore throat; "Now, George, say good-night to your Uncle Tom, and don't forget to take your anti-toxin up to bed with you." Time will not allow going into our Army method of treating disease antitoxins, so I shall confine myself to two varieties---anti-tetanic and anti-typhoid.
I went to Mespot with the original expedition in 1914. I am not going to say one word about the medical arrangements. They were perfect God forgive me! (Laughter) with the conditions, arrangements surroundings such that the betting was 20 to I on the bug against the man. Up to the middle of 1916, there was not a case that could be even mistaken for tetanus October, 1915, we captured Kut, and at that time we the only fighting force that had advanced one inch. That gallant officer, the late Sir Charles Townshend, not drove his opponent into his own 25, but converted into a goal by the capture of el-Amarah. From that date we came into the notice of the home authorities, and, in due course received our reward.
At that time we had very little of anything, antitoxins or thing else. Still, we had an abundant supply of anti-commonsense---orders from the base, with which we wrestled both day and night (Cheers.)
The day before the Battle of Ctestephon, some months later, my immediate medical superior made his way to where I was, being accompanied by four cartloads of most beautiful wooden packing cases.
"Here," he said, "is our reward a supply of antitetanic serum!" He also told me that serum was very highly thought of at home both by its original introducer and the manufacturer. (Laughter).
"What is to be done with it?" I asked.
"It is to be inoculated into the troops," he replied.
"Now?" I enquired.
"No," he retorted, "the original order of precedence is to hold good, the bullet hole first and the syringe hole afterwards." (Laughter.)
"But," I continued, "there appear to be no syringes to inject it with."
My chief admitted that the absence of syringes certainly was a complication. "However," he said, "make best use you can of it." which I certainly did.
The morning of the battle, when the Turks were driven out of their first line trenches, our force advanced and put the wounded into these trenches, having, of course, previously thrown out the dead Turks. Trenches may not appear to you an ideal place to put our wounded, but you must remember we were not fighting in silk dressing gowns and there were no convents or grand hotels in vicinity.
Now it happened that wood was particularly scarce the country, so the cases of the anti-tetanic serum were a God-send as kindling, as we were badly in want of tea. (Laughter.)
As regards the anti-tetanic serum we chucked the bottles full of it over the trenches also; it went over the top after the dead Turks. (Applause.)
Under cover of the dark the live Turks, reinforced with two divisions of fresh troops from Gallipoli, started their counter-attack. On they came with their tails up like Felix the Cat; but when they reached our anti-tetanic sector they halted and retired. As a matter of fact, they were so cut about by broken glass that they could come no further. I feel sure you will admit that I made good use of this wonderful serum, which on this occasion, with the assistance of its broken bottles, proved itself anti-Turkish as well as anti-tetanic. (Laughter and applause.)
CHANGING THE NAME.
At one time in the Army, we called enteric, "enteric," and a rose, a rose; but I served long enough to hear a rose called anything from a head of cabbage to a scarlet pimpernel. (Laughter.) A man in the Army contracting enteric, provided he had not been previously inoculated, was diagnosed enteric and treated for this affection from the start. If he had been inoculated and still got ill with symptoms that were, so to speak, a mirage of enteric, the procedure was different. He was first of all classified as N.Y.D. N.Y.D. was popularly supposed to mean "Not Yet Dead," but professionally it meant "Not Yet Diagnosed." (Laughter.)
After the patient had struggled along in this classification for a week or 10 days, if his temperature remained insubordinate and refused to come down when ordered to do so, his disease was changed by a stroke of the pen; because the pen is mightier than the sword. (Laughter.)
The case was then called P.U.O. Vulgar people called P.U.O. "Protesting Under Officialism," but it really meant "Pyrexia of Uncertain Origin." (Laughter.) If the patient recovered he remained a P.U.O., but if on the other hand he notified his intention of going for a drive covered with a Union Jack and accompanied by his comrades at a slow march, his disease was changed again.
The next change was called P.T.
You must not get confused between the letters P.T. and T.P.
T.P. means T.P. OConnor, the Father of the House, whereas P.T. means paratyphoid, derived from the Greek words Parameaning "Just the Same as" Typhoidenteric fever. When a P.T. case recovered, he had a distinct advantage. He was a free man, as he could go where he liked and become a cat burglar if he so desired. On the other hand, the recovered enteric was not so well situated, as he had to go to the wireless experts to see if he had a carrier wave in his constitution. (Laughter.)
If he happened to possess a carrier wave he was for years after notified as a perpetual oscillater, and his valves were removed whenever a symphony concert was broadcasted by the B.B.C. (Laughter.)
VALUE OF SANITATION.
I shall now pass on to other means for prevention which I have seen adopted in the Army. As you know, in the Great War we had inoculation against enteric, chlorinated water, and last, but not least, wonderfully improved sanitary conditions in the field. We had, so to speak, three horses pulling the coach, but no one ever advocated finding out which horse was really pulling the waggon. If all the good results were due to inoculation why not let us live with our pigs, and drink any water we could swallow? If, on the other hand, the improved health was due to chlorinated water, we could have dispensed with inoculation, and if the troops had been supplied with leather linings to their stomachs as well as gas masks they would have been happy. (Laughter,)
I have given up betting for many years, but I was always prepared to lay 20 to I on improved sanitation against all other competitors. (Cheers.) For years I wallowed in enteric fever, and though never inoculated against it I, as you see, survive. I hope you will not think me egotistical if I say that for years I saw as many cases in a day as one in general practice would see in a year; fully 40 or 50. I hope you wont consider I am competing for the Baron Munchausen prize when I say that I have seen as many as 700 cases in a day, but when I mention the placeLadysmith under siege conditionsI can picture-those who had intended making me a presentation putting their money back in their pockets.
In addition to prevention, the Utopian Army had a means of eradicating disease completely. It was excellent, and it was called the Spot-Plan system. It was as follows. In this movement in C flat the treble was played by the statistical branch, the bass by the sanitary experts, while the melody was supported by the Director General of the Army Medical Service. (Laughter.) There are, as you know, in Utopia such things as Parliamentary Reports, wherein are stated the numbers of soldiers admitted to hospital during the preceding year and the diseases for which they were admitted.
THE SPOT-PLAN SYSTEM.
One fine day a Director General was signing one of these documents, and by accident lie cast his eye over the body of the report. He saw that there were a large number of admissions for sore throatlet us say 5,000, He sent for his Sanitary Expert and said: "There are too many admissions for this disease this year, you must take steps to see that the numbers are reduced in future."
The Grand Vizier took the matter in hand, but instead of taking steps, he took a twelve foot ladder to the job. He issued an Army Circular on the point expressing the extreme displeasure of the D.G. at the number of cases of sore throat. He then gave some very valuable flannel-next-your-skin suggestions; saying, amongst other things, that if Medical Officers would only sit on the barrack-room steps to see that men coming in with wet feet changed their socks immediately, so doing would considerably reduce the number of admissions. He went on to say that in the event of a case being diagnosed "sore throat," a Spot Plan should be submitted.
A Spot Plan consisted of a freehand drawing of the barracks and its vicinity, a detailed drawing of the room in which the case occurred, giving the exact size, cubic capacity, number of doors, windows, beds and pillows; a photo of the ventilators which had been closed by unauthorised persons, with finger mark, was also required; also an hourly report of how the case progressed under treatment.
As can be realised, it took a brave man to diagnose sore throat after that. Some weak-minded officials diagnosed the disease tonsillitis, but anyone who desired advancement went the whole hog and called such affections "Sprain Right Ankle." (Laughter.)
This diagnosis did not harm the patient; in fact, it was often of assistance to him in the event of his being insured against accident.
The following year, strange to say, there was such a reduction in cases of sore throat, that the Director General called attention on to it , with the result that his despatch was received with cheers in the house.
Now as regards the case of Dr. Hadwen.
As you know, the Crown ran that good old horse "Statistics" in the Hadwen Stakes at Gloucester with his legs in swabs. He was in the same stable as "Diphtheria," with which they hoped to win, but I am glad to say good old Justice romped home by a street. (Applause.)
Mr. Vachell, counsel for the prosecution, gave an absolutely correct definition of the existing law on the subject. He might have said, that for an offence for which you or I would not ask a Cabinet Minister to dine a second time, or might fine a railway porter a half-crown, the grateful country was prepared to hang the doctor, or award him a term of imprisonment.
I am sure if the law on the subject was explained at our Universities that we should have fewer followers of Esculapius. (Applause.)
In putting the case to the Jury, Mr. Vachell said:
"If poor little Nellie Burnham had been inoculated with antitoxin she would in all human probability be alive to-day." I would not have put it in that way myself. I would have said: "Anyone who suffers from diphtheria who is not inoculated with antitoxin is absolutely certain to die." I would then have added in a low voice which could be heard by the judge and not by the jury the words "some time or other." (Laughter.)
Now I come to Dr. Ellis and his mode of procedure.
In this case I fear there is little doubt of marked animosity on his part. Perhaps he was moved by conscientious motives, but conscientiousness in practice not infrequently means doing actions that one would not like done to ones self. This gentleman said that he could not sign the death certificate from natural causes as he had not attended the poor child in her last illness. Now suppose, for examples sake, that the doctor had been playing golf with a friend, who had got into such trouble in a bunker that he burst an aortic aneurism trying to get out of it and died on the spot. Would the doctor refuse to certify that his friend had died of natural causes? The poor fellow had no last illness to he treated for!
Would he have called for an inquest with the object of getting a conviction against the maker of the niblick with which his friend had played his last stroke? These exact people may do anything. In acting as he did to Dr. Hadwen, he was like a huntsman digging out a fox and chucking him to the hounds, as he should know right well that in a case of this description an ordinary coroners juryman usually arrives at a verdict when he is eating his breakfast on the morning of the trial. If he had wished to act in a professional manner, he should have signed the certificate of death from natural causes. Afterwards he could have said what he liked about the medical treatment of the case, and he and Dr. Hadwen could have fought it out either with legal actions in the Courts or with fists like men in the Market Square. (Applause.)
I hope for his own sake that Dr. Ellis will never he in a positioh in which he helped to place Dr. Hadwen. Being tripped up badly by Sir Edward Marshall Hall when he asked him questions backwards was a nasty experience as a witness, but he would have found it far more trying had he been speaking from the dock. From the evidence, I can see no carelessness on the part of Dr. Hadwen, though he failed to see membrane, of which there appeared to be enough knocking about to re-sole the childrens boots! But he was guilty of two, mistakes. He used his finger as a tongue depressor instead of calling for the soup ladle or the kitchen poker, and he called vinegar, "vinegar," instead of "acetic acid." He should have known that a Coroners Jury in such a case will not stand a cruet being converted into a dispensary. Had he ordered a counter-irritant of mustard and salad oil, God knows what might have happened. (Laughter.)
From the evidence of Dr. Washbourn I see that the post mortem on poor little Nellie Burnham was conducted on the lines of a private fancy hail. Some people were invited and some were not. One gentleman got in without an invitation, a Dr. Bell, but evidence does not state whether he came into the room by the door or the chimney. As regards Mr. Justice Lush and his summing up of the case, it is quite easy to see that he saw through it from the start; he certainly made no particularly flattering remarks on the medical evidence produced by the Crown. It is a great pity that such a case was ever tried in the year 1924, for, with the addition of a little thumbscrew work, Dr. Hadwen could hardly have received worse treatment in the year 1524. (hear, hear.)
Mr. Vachell has told us the law as it stands; in such cases, both qualified and unqualified medical practitioners are graciously herded together. Dont you think it is about time that the British Medical Council got a move on and did something towards getting the law brought up-to-date in the interests of the medical profession? Knocking lawyers off their perch is more noble and better fun than knocking professional brothers off the register.
In conclusion, may I quote from Gilbert, who, in that grand old opera "The Mikado," says:
"The object all sublime, we may achieve in time
And let the punishment fit the crime, the punishment fit the crime.