Was the amateur doctor responsible for the death of his patient?

Consider the case of elderly James Wise stricken with incurable cancer. Facing death, what had he to lose when a well-meaning relative recommended an amateur doctor who had reputedly saved three others similarly afflicted?

It was November 5, 1858, when the 68-year-old looked into the bathroom mirror to shave and noticing a blemish on his lower lip, he consulted the village doctor who diagnosed early stages of the killer disease. Admitted to hospital, it was swiftly removed.

Much relieved, the wheelwright returned to his home near Basingstoke, but six months later it was back, the malignancy spread across his left cheek.

Wise was referred to surgeons but alas, in their opinion, it was inoperable.

"There is nothing we can do for you," they candidly explained. "It is too dangerous to use a knife. It is better not to attempt any means."

There seemed no hope when he broke the news to his family - save one who suggested a radical approach.

"I know just the man," he assured him. "Benjamin Crook a Southampton blacksmith. He can do it."

19th century Southampton.

Having examined him, Crook was adamant that he could cure him.

Wise however was not so sure and hesitated for several hours until his family finally cajoled him into reluctantly agreeing.

Wise settled back into his favourite armchair as Crook spent 20 minutes principally smothering oil on the offending cheek with a piece of whalebone and powder.

The revolting concoction soon made him not only feel sick but the cheek ominously began steaming and swelling. Such was the excruciating pain he could not sleep and paced up and down throughout the long night.

Eventually he was persuaded to lay down on his bed. He was never to leave it, dying within days in agony.

Crook appears to have little remorse or sympathy. Astonishingly he demanded 50s for his work but after remonstrating with Wise's brother-in-law accepted half the sum for his service and left.

London Road, Basingstoke.

The next occasion the 48-year-old amateur doctor encountered Wise's kin was at the coroner's court and duly committed to Hampshire Assizes charged with manslaughter, he appeared before Mr Justice Watson on March 5, 1859.

The case was naturally dominated by medical evidence.

Basingstoke doctor Mr Sweeting told jurors how Wise had accepted there was no cure.

"I saw him several times after that and on November 19 he appeared more cheerful and better. The next time was after he had been under the prisoner. There was a line of demarcation around the tumour and all the tissues had been destroyed, as if some powerful caustic had been applied. The general symptoms showed poisoning by some irritant substance.

"Corrosive sublimate was sometimes applied to wounds but it was dangerous to apply to a large surface. The quantity should be very small."

Outlining his post-mortem, he said Wise had suffered extensive inflammation to the bowels and numerous ulcerations - the effect of mercury being applied to the tumour - and had died from the effects of corrosive sublimate.

The surgeon concluded: "We knew the case as hopeless. The deceased might have died within 12 months but death was accelerated."

Reading Hospital.

His observations were endorsed by George May who had conducted the operation at Reading Hospital, confirming that on the second occasion he had informed Wise that he was beyond medical help.

"I saw him again after death. There was a large surface on his neck covered by a brownish paste. There was an extremely offensive smell coming from it for which I believed was from mercury in his system. Death was from the application of corrosive sublimate. That would not be a proper treatment for cancer. I would consider it an improper caustic because it is very painful and dangerous if used in large quantities."

W M Cooke, defending, urged jurors to believe the blacksmith had been humane in his efforts to save Wise.

Delivering his final address, he submitted: "If he has acted honestly and bona fide, he is not guilty of manslaughter, although he is not a regular practitioner. He hoped the time would never arrive when the poor man should be prevented from having the assistance of neighbours.

"The first question is whether the application caused or accelerated death and then had the prisoner acted with a criminal intention or with gross neglect."

The judge at once interjected: "If it was a criminal intention, it would be murder - it was criminal inattention."

Cooke apologised, claiming it was a mistake in the print, then urging them to consider what they would have done in the same predicament when told there was no remedy and he had been refused further assistance.

A blacksmith at work.

"Place yourself in the same situation as this unhappy man looking to a speedy death. He applied to the prisoner who had a reputation for skill. He was requested to come and see him and his opinion was that in the course of a short time, the deceased would be able to come to him. He applied this powder but can you be satisfied that if there had been no application, the deceased would not have died as soon as he did?

"Five weeks before he died, he began to fall and became an exhausted and dying man. Under all the circumstances, I trust you will think you will not be justified in convicting him."

The blacksmith did not testify, instead Cooke called three witnesses who were adamant he had cured them of cancer.

In his summing up, the judge directed jurors as to the law with regard to manslaughter - where unqualified, uneducated and unskilled people treated dangerous diseases with dangerous remedies.

"All of us are doomed to die but if death is accelerated, if man was doomed to die at ten 'clock and another came in and beat out his brains, that was manslaughter. The question here is whether death was accelerated by the use of these alleged remedies.

"Learned counsel for the defence has with much eloquence endeavoured to show the prisoner's motive was to benefit suffering humanity. Where proper medical skill cannot be obtained, the provision of simple remedies by intelligent persons is doubtless a benefit to society but where unqualified, ignorant people take it upon themselves the cure of dangerous diseases and imposed on the lower classes especially, it is not a benefit but a great injury to society."

Casting a dispersion on Crook's character, he pointedly commented: "It is clear his motive was not entirely for the benefit of suffering humanity for he charged 50s and got 25s for his trouble."

Following a deliberation, jury convicted Crook but backed with a plea for mercy.

The judge took heed: "I am quite satisfied in my own mind that you thought you could cure this man but unfortunately you took it upon yourself to do that which no man but a man of skill has a right to do. I quite agree with the jury that this is not a case for severe punishment. The sentence will be three months imprisonment without hard labour."