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in the right hypochondrium. The miracle had hap-pened, and now my own effort must begin.The textbook description of the postoperative period

following cholecystectomy needs great amplification.The period is divided into three stages:

1. The bed-oj-nails stage.-This lasts two days, and painseems to emanate from every sensory perceptor in the body.All power is removed from muscles both above and below the

incision, leaving very little that can be actively contracted atwill. In this stage the attendants can extract any sum of moneyor promise for the future in return for an omnopon injectionwhich is the only resort of the destitute.

2. The stage of the rack follows in the next two days. Allfour limbs become fixed in extension; the body gradually slipsdown the bed; and the spreadeagling becomes fixed by thepain and spasm in the wound. This can be overcome only bythe nurses bending the body forwards beyond the point ofcritical flexion, despite all hysterical protests. Both these stagesare dominated by the patient’s struggles to cough without tear-ing open the incision which at each attempt seems inevitable.These struggles last throughout the day and night and resultin the patient assuming most unnatural positions. This is a

practical illustration of the effect of an upper abdominal incisionwhich seems to strike at the root of normal respiration.

3. The knife-in-the-side stage.-Suddenly the patient awakenson the fifth day and feels confident that he is going to survive,there having been some slight doubt until then. He can breatheand cough and is delighted to find his other physiologicalfunctions returning to normal. He is still affected by a con-

tinuous ache in the incision, but this is nuisance value only.He now goes for walks with his physiotherapist, who, however,will not accept his explanation that he can only either straightenhis knees or hold his head back on walking, but demands both.The removal of drain and sutures at this stage is like whistlingin the wind by comparison with his previous troubles-pleasantdistractions in the daily routine. He now feels up to taking afinal-year group through the postoperative management ofcholecystectomy. His confidence is returning; during thefirst two stages he made a final vow never to submit anyhuman being to a major abdominal operation, but he isnow coming round to the view that everyone should have acholecystectomy.With no interesting complications, I went home on

the twelfth day, rather to the apprehension of my family.This is the time for philosophical reflection. What hasbeen gained from the experience? First, a tardy andreluctant agreement with my wife’s axiom that everyabdominal surgeon should have had an abdominaloperation; then, the equally reluctant recognition thatno single person is indispensable in surgery, and thatoperations can be done equally successfully by others.This leads on to the reminder that surgery today is ateam effort, and I am profoundly thankful to have beenable to place my confidence in a team of like-mindedcolleagues. Finally, a shared experience with my patientswill inevitably produce greater understanding.

P. GILROY BEVAN.

Medicine and the Law

Legal Assessor’s Duties

CHARLES CLAYTONBarrister-at-Law.

THE Disciplinary Committee of the General MedicalCouncil held on May 29, 1963,1 that Dr. MahadevaSivarajah had been guilty of infamous conduct ina professional respect and ordered his name to beerased from the Medical Register. He appealed to theJudicial Committee of the Privy Council who,for reasons to be delivered later, dismissed the appeal onNov. 19, 1963.Lord GUEST, giving their Lordships’ reasons on Jan. 14,

said that the appellant was not represented before thecommittee, and the only witness who gave evidence at thehearing was the complainant, Mrs. Armstrong. It wassaid in Fox v. General Medical Council 2 that " the appealmust fail unless there was some defect in the conduct ofthe inquiry, by way of admission or rejection of evidenceor otherwise, that may fairly be thought to have been ofsufficient significance to the result to invalidate the Com-mittee’s decision ". In the present case a cogent criticismof the proceedings related to an observation made by theLegal Assessor in the course of his advice to the commit-tee regarding the corroborative effect of a letter sent by theappellant to the committee in which he said " I denyhaving had sexual relations with Mrs. Armstrong-priorto 1960 ". It would have been preferable if the advicetendered had been that the letter was capable of beingconsidered as corroboration, but that it was for the com-mittee to judge whether it in fact corroborated the com-plainant’s evidence, and that was what the Legal Assessorclearly meant to say. The Legal Assessor was, however,in no sense in the position of a judge summing up to ajury, nor was the committee’s function analogous to that

1. See Lancet, 1963, i, 1258.2. [1960] 1 W.L.R. 1017

of a jury. The Legal Assessor’s duties were confined to" advising on questions of law referred to him and tointervention for the purpose of informing the Committeeof any irregularity in the conduct of their proceedingswhich comes to his knowledge 11.3 The committee weremasters both of the law and of the facts. The impugnedadvice by the Legal Assessor did not amount to such adefect in the conduct of the inquiry as to invalidate thecommittee’s decision. If Mrs. Armstrong’s evidence wasaccepted by the committee, there was ample evidence tojustify their finding; they were warned by the LegalAssessor in the clearest possible terms of the danger of afinding of adultery on the uncorroborated evidence of Mrs.Armstrong, and their Lordships did not think that thecommittee’s finding could be interfered with. Further, ingeneral their Lordships considered it undesirable that anyuse should be made of a statutory declaration, except in sofar as it was made evidence by being made use of by thepractitioner or his counsel. It could not be said in the

present case that the production of the statutory declara-tion was in the whole circumstances sufficient ground forinvalidating the committee’s finding.Mahadeva Sivarajah v. General Medical Council. Judicial Committee of

the Privy Council: Viscount Radcliffe, Lord Morris of Borth-y-Gest, andLord Guest: Nov. 19, 1963; Jan. 14, 1964. Counsel and Solicitors: PeterRipman (S. Rutter & Co.); Peter Boydell (Waterhouse & Co.).

Dangerous Cot StandA child, aged 2 months, died after her portable cot tipped

her out of its collapsible metal stand.4 At the inquest inRomford, the coroner for West Essex, Dr. H. H. Kenshole,said that the metal stand was the worst possible device for thesafety of a child in the cot. He added that he would makeevery effort to see that the sale of that style of stand wasstopped unless it could be made safer.

3. ibid. p. 1021.4. Times, Jan. 18, 1964.