DEATH WHILE UNDER CHLOROFORM,

Gisborne Times, Volume V, Issue 100, 7 May 1901, Page 3

DEATH WHILE UNDER CHLOROFORM,

THE DOCTOR EXONERATED.

| Special to Times. | Auckland, last night,

The inquiry into the circumstances relating to the death of the young man, John McGuire, who died while under chloroform at the Auckland’ District Hospital, held before Mr T. Gresham, coroner, and a jury of six, with Mr J. M. Jefferson as foreman, is concluded. Mr W. J. Napier appeared for the relatives of the deceased, and Mr T. Cotter (instructed by Messrs Hesketh and Richmond) watched the proceedings on behalf of Dr Adams. Sergt. Gordon represented the police. The enquiry lasted seven days. In summing up, the Coroner pointed out to the Jury that they could return one of two verdicts, “Manslaughter” or “Death from misadventure.” The question was whether deceased’s death was due to misadventure or culpable negligence. With regard to the interview in the Hospital Grounds between Dr Adams and deceased’s relatives, Dr Adams’ assurance );thatHhe words, “ instrument ” or “ improper instrument ” did not refer to the instrument used by Dr Scott, but to the Junker apparatus, had cleared up the matter, and had put a very different aspect upon the interview.

After reviewing the evidence Mr Gresham put several questions to the jury to answer, and said that it was quite within their province, although he never advocated the giving of a rider, to express an opinion on the practice of a public body which entrusted young medical practitioners of small experience with operations involving the lives of Hospital patients. After some twenty minutes’ deliberation, the jury returned a verdict of 11 Death from misadventuro.”

The questions formulated by. the Coroner were answered as follows : -*?»

1. Was tho death occasioned by chloroform ? If not, how was the death_ occasioned ?

Answer : Yes, by chloroform. 2. Was the chloroform administered at the request of deceased ? Answer : No evidence to show that deceased requested the operation.

3. Was the use of the anaesthetic in a professional point of view a necessary part of the treatment '? Answer : We do not know.

4. Was it skilfully and properly administered ? Was common skill used in administering it ? Answer: We consider ordinary skill was used.

5. Could the deceased’s condition of the heart, which rendered the chloroform more fatal than usual, have been detected by a thoroughly competent and careful operator, so as to show the impropriety of administering it in this case ? Answer : The balance of evidence goes to show the condition of deceased’s heart could not have been found out during life.

The following rider was brought in by the jury : “ We consider that the hospital should not be left in charge of a comparatively young and inexperienced medical man without the supervision of an older and more experienced resident medical officor.” CROSS-EXAMINATION OF DR, SCOTT. ' Dr. W. G. Scott, cross-examined by Mr Napier, in answer to questions, said that he had not plugged the nostrils prior to the operation, and did not believe that it could have been done in the case of the deceased. He did not think the course was necessary. The patient was placed horizontally. Witness was the senior medical officer present at the operation, and Dr. Adams was subject to him in all matters. Ho could not say whether or not a defined quantity of chloroform had been given, as he was not paying particular attention to the administration of the chloroform, but was preparing for the operation. The responsibility for the proper administration of the chloroform rested entirely with the anesthetist, or person administering the chloroform. The operation, if completed, would have occupied three minutes in its entirety. Witness did not insert the scissors in deceased’s nose until the inhaling tube had been placed in the mouth. He could not say whether the windows of the operating room were open or not on the day of the operation. It was the common practice in Auckland to use the' Esmarch mask in administering chloroform. The use of the mask did not impede the breathing in the slightest, and witness did not know that the Esmaroh mask had been condemned,

and would be surprised to find that it had been. He was. however, aware that masks and inhalers of some description had been condemned, but not the Esmarch mask. He should say that the administration of chloroform by the use of the mask was more open than the methods described as open methods. The mask was usually held about inch from the patient’s face when administering chloroform. - Deceased - struggled very much as the anaesthetic was being administered. "Witness did not note any indications that there was any difficulty in .breathing on the part of the patient. "When witness examined deceased’s nose, after he' was under chloroform, the patient was breathing comfortably, and he was still breathing when witness commenced to use the scissors. There was no necessity to remove - the tube when insensibility occurred sufficiently to allow the witness commencing the opei-ation ; it was more comfijrtablo to a patient to continue the use of the anaesthetic during the operation. Witness asked Dr Adams for a mild and continuous anaesthesia. He did not want a deep anaesthesia, because he wanted the assistance of the patient himself to clear the pharynx in case of bleeding. The anaesthesia was so mild when the operation was commenced that the patient could have been revived for the purpose of clearing the pharynx, had it been necessary. There was veuy little bleeding. There were no steps taken to define the actual amount of chloroform used, and witness ,w r as not aware that there was any means of so doing. The use of tho tube reduced to a minimum the quantity of chloroform administrable at each inspiration. From the time witness last saw the patient comfortably breathing to the time Dr Adams said “ is he breathing,” not more than two minutes had elapsed ; quite possibly less. To Mr Cotter: Witness was acquainted with Dr Symes’ principle of administering chloroform ; it had been in existence for some 30 years, and was thoroughly established. He looked upon the use of the Esmarch mask as a great improvement on Dr Symes’ method, and as a system that retained all the advantages of that method with additional improvements. He knew of no safer method of administering chloroform than by the use of the Esmarch mask. For operations other than to tho nose, the use of the Esmarch mask would have been quito sufficient, but in the case of an operation on the nose the use of the Junker’s tube was desirable. He agreed with Dr Hewitt, the most eminent of authorities, that the use of Junker’s tube for surgical operations on the mouth and nose was of special advantage. Witness considered that in administering chloroform by the Esmarch mask, with the Junker’s inhaler, Dr Adams was acting with the highest skill. So far as he could see, with due attention to his operation, there was no indication of want of skill in the use of the apparatus, or,-in other words, in the administration of the anaesthetic. There was nothing whatever, as far as witness could see, to indicate that there had been neglect of any kind on the part of Dr Adams. The patient looked strong and healthy, and from his external appearance there was nothing to indicate that he wou'd be an unsuitable subject for chloroform. Tho use of chloroform or ether was a matter of opinion ; some medical men administered the one, and some the other anaesthetic. One practitioner might choose chloroform and another ether, and there could be nothing to imply that ether should have been used instead of chloroform in tho case of deceased. It was the usual practice at the hospital to use chloroform, and the anaesthetic had been administered by the proper person, as the home physician was also the anaesthetist. Dr. Adams occupied that position, and there had been no deviation from the usual custom lately at tho hospital with regard to the administration of chloroform. After having been present at the post-mortem examination his opinion as to the suitability of deceased for having chloroform administered to him was changed. This was on- account of some evidences of disorganisation of the kidneys, and the fatty degeneration of the heart. These conditions would not necessarily have been ascertainable in life, and witness would not say that any medical man who- failed in his antimortem to discover these defects could be called negligent. This opinion was supported by eminent authorities. The use of chloroform was never free from danger, and witness did not know of any specific quantity of chloroform that could be, or ever had been, prescribed, which could invariably be administered with perfect safety, and yet produce the required result, complete anaesthesia. The' quantity of chloroform required varied in almost every case ; a certain result was required, and one had to continue the administration of the anaesthetic until that had been obtained. He would agree with Lord Lister and Dr. Waller, the authorities quoted in the case, that death under chloroform was usually due to improper or faulty administration, in so far as they would mean by faulty administration the exhibition of too much or too little chloroform at any one moment of-its administrution, and that fallible humanity would be absolutely unable to carry out the conditions required. In the post-mortem of deceased, witness discovered conditions which would account for death under chloroform when administered with ordinary care. Statistical

returns in the British Medical Journal of February last showed that in cases of patients under chloroform, who suffered from disorganisations, tho ratio of deaths was 4.11 per cent. The use, of the towel' in administering chloroform (according to the journal) showed the highest complications and danger rates, whilst in the use of the Junker’s apparatus there was a diminution in both complication and danger rates. Witness agreed with the doctrine that, no method of administering chloroform was known that was absolutely free from danger. Ke-examined by Mr Napier: The tube used was not the latest pattern of the Jlinker’s tube. He admitted that deaths had occurred from the use of the particular apparatus in question, and that an attempt had been made to improvo it, but could not say the improved Junker diminished the risk, as he had not seen it. “With the apparatus used in the case of deceased it was possible for mistakes to occur in the screwing of the tubes into the bottle, while in the improved apparatus the liability to error ivas held to be eliminated. Ho believed that the tilting of the bottle of .the

apparatus that had been used might result in fatal effects ; he referred to a considerable tilting. When Dr Hewitt, in his work on anaesthetics, referred to the element of danger to.life that might be introduced through the bottle tilting and causing the liquid chloroform to flow into the efferent tube, witness considered that he was spcqkiug of the old Junker’s apparatus and not the one in use at the hospital. With the old apparatus there certainly was an element- of danger, but there was practically no danger with the apparatus in use. Had he known the condition of

the deceased's organs, as revealed by the post-mortem, before the operation was per" formed, be might have advised that the anaesthetic should not have been adminisj tered, as the case was not one of urgenej’, but one of choice. He would not be prepared to say that a physician using reasonable skill would have been able to ascertain the condition of deceased’s or-. gans before death, especially in the case of the heart. He would not say that he could have done so himself.

To Mr Cotter: Since the adjournment he had ascertained that the tubes,of the ' Junker’s bottle in use when deceased was put under chloroform could not be interchanged. The interchange was, however, possible in the case* of the old apparatus. Had a medical man examined deceased during life, and failed to ascertain that the organs were diseased, he would not say that such person was either negligent or that he did not possess,the average skill of a medical man, Dr. Scott's evidence concluded, a demonstration was given with the Junker’s apparatus used to show that it was practically impossible for the liquid chloroform to find its way into the efferent tube, even when the bottle was tilted in all possible directions. THE HOUSE SURGEON'S STATEMENT. Dr Peter Moir, acting house surgeon at the hospital, called, said it might or might not have been possible to diagnose the condition of the heart of deceased prior to death. He had nothing to do with the case until Dr Scott began to operate.