INQUEST.

Evening Star, Issue 3351, 15 November 1873, Page 2

INQUEST.

An inquest was held before Mr Hocken, coroner, at the Hospital to-day, ©n the body of Jane Duke, who died in that institution yesterday evening. The Coroner stated that deceased died while under the administration of chloroform. It appeared that some twelve or eighteen months ago an operation had been performed on deceased for a similar disease (cancer in the breast), on which occasion chloroform was given without any ill effect. This time, unfortunately, a false result ensued, and it would be for the jury to decile whether the chloroform was administered carefully and skilfully, or whether blame was attachable to any one. Ann Cooper, nurse in the Hospital, had deceased under her charge before the operation was performed. Deceased was in considerable pain, and was anxious to have it performed, hhe bad been admitted to the Hospital about a fortnight ago. Witness was present when the chloroform was administered yesterday by Dr Yates, in the presence of Drs Alexander and Hulme. Deceased was very much excited at the idea of taking chloroform and about the operation. About three minutes after inhaling the chloroform, she took a spasm. She had been accustomed to take such spasms when well. Shortly after she took a worse spasm, and the chloroform was stopped, Dr Hulme saying her pulse had ceased. The chloroform had been stopped two or three times before She seemed then to be dead, but efforts were made to revive her, trying to excite respiration by working the arms and body. Wit ness stayed about half an hour after de ceascd’s pulse ceased, during which time the medical men were trying to revive her. Had often seen chloroform given, and thought there was nothing in this case to render such dangerous. Every c.re was taken. Edward Hulme, surgeon to the Hospital, had operated on deceased about eighteen months ago for cancer in the right breast, when chloroform was administered. Did not remember what effect it had on that occasion, but she was under it for a considerable time. About ten days ago she was again admitted to the Hospital, complaining of a small tumor in the side, near the breast, which witness de ermined to remove. Accordingly, between one and two o’clock, Or Yates administered chloroform. Two or three minutes after Dr Yates commenced, but before deceased was under the influence of the chloroform, witness and Dr Alexander went into the room, i eceased held her breath and resisted, and a spasm in the glottis or windpipe took place, as is often the case. Witness told Dr Yates to take the chloroform away and let her have some fresh air, which was done. On repeating the application, the same kind of spasm occurred repeatedly, deceased being only partially under the influence. Witness held her pulse nearly all the time. At one time it nearly stopped, and the chloroform was again taken away. Deceased partly rose up teen and seemed conscious, smiling and nodding to witness. The chloroform was again applied, witness feeling her pulse, which stopped immediately. Dr Alexander then felt the pulse, and instantly artificial respiration was attempted, and kept up for about half an-hour, but without getting a sign of life. Did not try galvanism, electricity, or any other mode of restoring consciousness. Thought artificial respiration was the best means, having had cases in which patients were revived by it. Deceased was generally cancerous, and degeneration of the muscular fibres of the heart was, in witness’s opinion, the cause of her death. To a Juror: Unless there is suspicion of heart disease, it is not usual to examine patients before administering chloroform. Removing a cancer, as was done on the first occasion, would only relieve a patient for about two years, as it would be certain to return again. To the Coroner: A fatal case of this description has never occurred in the Hospital before, though chloroform is being continually used. If deceased had revived, the chloroform would have not been re-administered, after her pulse stopping. Edward William Alexander, duly registered medical practitioner, was present when the chloroform was given, going into the room as it was being administered. Deceased was not under its influence, and was taking it with considerable difficulty, and was very excitable. bhe had several spasms, as is often the case, on which occurring the chloroform was removed. Immediately after one spasm Dr H ulme asked witness to feel deceased’s pulse, which he did, and found it had ceased. There was nothing unusual before, but the breathing ceased at the same time as the pulse. Artificial respiration was attempted, witness drawing her tongue forward while Dr. Hulme worked her arms. (Witness expressed the same opinion as Dr. Hulme as to that being the best means for restoring a patient under the circumstances.) Would give chloroform to any person without examining the heart first. To a Juror : Artificial respiration is better than using a galvanic battery, as the time lost in fixing the latter would probably lose all chance of saving life. Some failure or paralysis of the heart must have been the cause of death in this cise. William Augustus Yates, house surgeon to the Hospital, said deceased was a widow, aged about forty three, and she used to get her living by washing, &c. Remembered giving her chloroform about seventeen months ago, when she took it well. Had heard that since that time she had been rather addicted to drink ; but could not say that wia true. Un this occasion deceased id not take the chloroform well. Spasms occurred and the chloroform was stopped. After one spasm the breathing ceased, when artificial respiration was attempted, but without avail. Deceased stood the chloroform well before, so witness did not examine her heart. Considered it important and necessary to examine a patient’s heart before giving chloroform, and always did so, unless such had taken it before.

To a Juror : Deceased’s condition was not so good as on her previous admission to the Hospital. Would not give chloroform to a person suffering from heart disease. This was the first fatal case during witness’s eleven years’ experience in administering chloro f onn in this Hospital. The Coroner said that having heard the evidence, the jury must decide if the chloroform was given carefully and by experienced men ; if in the affirmative, they would find a verdict of “ homicide by misadventure ” as the law termed it—the word “misadventure” meaning misfortune while doing a lawful act in a cautious manner. If, however, the jury thought otherwise, they would have to find a verdict of “ manslaughter :” one or the other was the case. The jury returned a verdict to the following effect: —“ That the deceased Jane Duke died acidentally, and casually, and by misfortune, from paralysis of the heart when under chloroform, which was being administered to her in a proper and cautious manner by Dr W. A. Yates ; ” and added a rider to the effect that no blame was attached to the other medical men in attendance.