DEATH UNDER CHLOROFORM.

Auckland Star, Volume XXXV, Issue 94, 20 April 1904, Page 5

DEATH UNDER CHLOROFORM.

A COMBINATION OF DISEASES. INTERESTING SURGICAL STUDY. In continuing last evening the inquest on Mrs Sarah Drinnan, who died under chloroform at the Hospital on Monday the Coroner, reading from the anaesthetieai report of the British Medical Association for 1900, stated that fatalities under anaesthetics were found to be twice as frequent with males as with females, and the most important factor in safe administration was the experience that had been acquired by the administrator. He asked Dr. Parkas what knowledge he had of Dr. Walshe's skill as an anaesthetist. Dr. Parkes said Dr. Walslie had administered anaesthetics for him in. a number of cases, some of which had been difficult and prolonged eases, but Dr. Walshe had always given entire satisfaction. The Coroner (still reading): "In many cases the anaesthetisation completely transcends the operation in importance, and to ensure success it is absolutely essential that an anaesthetist of laro-e experience should conduct the administration." Does Dr. Walsh come within that description? Dr. Parkes: Certainly. Police Sergeant Hendry: The husband's complaint seems to be that a dangerous operation was goinor to be performed on his wife and he was notinformed of it. * The Coroner pointed out that the wife desired the operation. The husband, being too upset to eross-exaniine. a brother-in-law (named Smith) did so for him, and asked Dr. Parkes whether tbe first operation was necessary. Dr. Parkes: There would be no relief to her condition without one. Smith: Wa3 it absolutely necessary that these stitches should be removed at that time? Dr. Parkes: It was absolutely necessary, otherwise ulceration might upset s good deal of the work done at the operation. Smith: Did she ask for chloroform? Dr. Parkes: I don't know that I asked her; I told her we could not proceed without it, and she took it quite willingly. Smith: Is it a rule in cases of operation that the husband should be notified? Dr. Parkes: Yes. For operations, certainly. Dr. Parkes stated the cause of death to be paralysis of the nervous centre controlling respiration—in other words poisoning of that centre by chloroform. The conclusion of the evidence disclosed a 'case which Dr. de Clive Lowe declared was an exceedingly interesting one to medical men. From the evidence given by Dr. Lowe (who made the postmortem examination) and by Dr. Collins (senior medical officer at the Hospital), who assisted at that function, it appears that about a year or eighteen months ago Mrs. Drinnan consulted Dr. Collins about her health, and he advised a simple operation as being sufficient for the time. If the husband did not know of the woman's condition,, it was probably because she did not care to discuss such a subject with Mm. Eventually, about a month ago, she came back to the Hospital, and Dr. I Parkes -greed with, him as to the ad-1 visabiiity of the operation. With the j Woman's consent the operation was perfarmed, and performed successfully, by i Dr. Parkes. Dr. Walshe administering: the chloroform. Dr. Walshe had administered chloroform in 500 of the 1000 cases in which that anaesthetic had been used during the past year at the Hospital, and he had never previously had a mishap. The period generally allowed to intervene before the withdrawal of the sti'ihes varies from six days to six weeks iii different cases. In the present case i 8 was considered desirable to remove them on the eleventh day, as they appeared likely to tear away.the flesh if allowed to remain longer. For this purpose the second comparatively trivial operation was performed. Dr. Walshe administering the chloroform by the open method as before. When the patient collapsed Dr. Collins assisted in the attempts to revive her, and opened veins in the legs to inject oxygen and other counter-irri-tants. But all methods known to the profession failed. Including Dr. Craig, there were four doctors present at this j ■cene.

The next step, after the matter had been placed in the coroner's hands, was the post-mortem examination, and it was at this stage that the interesting features referred to by Dr. Lowe were disclosed. The heart —the first of the danger signals in the sphere of anaestherieism—was found to be perfectly sound: yet tbe doctors were forced to attribute death to heart failure on account of cnu unusual combination of other disorders. The strangest of all these was the unexpected discovery of an enlarged thymus gland. The thymus gland, as Dr. Lowe explained, is a gland of childhood situated behind the breastbone and almost filling the whole front of the chest in babies, but disappearing during youth and leaving nothing but a mere trace. It has never previously known to exist in any person after the age of 25 years. Mrs. Drinnan, however, was 35, and the enlarged thymus gland was still present. It was li inches long, and in thickness varied from 1 inch to i inch. When the gland existed in grown-up persons it found to bring in its trail a series of ailments, which could not be detected before death, but which nevertheless were a menace to life. The most recent theory was as to the action of the gland in relation to the two processes, the continuous building up and breaking down of the tissues of tbe body. The gland waa suspected of absorbing a certain amount of the buiid-ing-up material, and thus preventing the renewal of some of the worn-out structures. Life thence became more precarious. This, however, was only a theory, for no one could tell with certainty. Dr. Collins, following up the remarks of Dr. Lowe, said that an enlarged thymus gland was generally associated with sudden death. Persons who died in their sleep, perhaps through a fright in their dreams, were often found to have an enlarged thymus gland. They were liable at any time to death from fright.

The next feature of interest was the enlargement of the thyroid gland (goitre). This, Dr. Lowe explained, was m Mrs Drinnan's case not the usual Schistic enlargement, but was due to an enlargement of the gland substance itself. The goitre in the present case Was not extensive enough to interfere yath free respiration, as was the result m more serious cases. It could easily m detected externally, and many people were walking about with enlarged thyroid glands. The coroner said this "was a characteristic of Swiss peasants, and ir would have been interesting to know if there had been any Swiss blood ■m' deceased.

At Dr. Collins' suggestion a search was made for the pituitary, a degeneratory organ at the base of the brain, representing, in human beings, according to Dr. Lowe, the relic of a third eye, such as the lizard has. This body also was found to be unusually enlarged. The other conditions which called i or attention were the degeneration of the liver and the diseased and greatly enlarged stater of the kidneys. Taking all these conditions into account, the conclusions arrived at were that Mrs Drinnan was likely at any moment to die suddenly through the evil influence of the enlarged thymus and pituitary, or from kidney disease. The effect of the diseases of the kidneys was to- necessitate greater effort by the heart to force the blood through. The disease of the liver would result in the improper purification of the blood and consequent injurious effect on the heart. The enlarged glands were con. neeted with the central sympathetic nervous system, to which also were connected the ganglia, the glandular organs which caused the heart to beat, so that in this way again the heart was in peril from these abnormal glands, and from the disordered state of the patient's nervous system. A shock was therefore likely at any time to cause her death from cardiac syncope, and this shock the chloroform supplied. Both Dr. Collins and Dr. Lowe dissented from Dr. Parkes' opinion that death resulted from chloroform poisoning at the nerve centres controlling respiration. Dr. Parkes, they explained, had formed his opinion from the external evidence afforded him as the patient's medical attendant, but the postmortem examination had shown other things which could not possibly have been known before. There had been no external evidence that deceased would be a dangerous chloroform patient, but even if there had been, said Dr. Collins, it might still have been advisable to administer it. If a man came In with peritonitis they would not refuse to j operate because he had a weak heart. There had been many eases treated at the hospital in which the administration of chloroform was attended with grave danger, and if death occurred in the administration it would have been difficult to convince the public that it was right to take tbe risk. Yet if the risk had not been taken the patients would probably have died, and their relatives would have blamed the hospital authorities. In the hospital they often had to undertake very serious responsibility, and he could not help feeling annoyed when the relatives of patients came and charged him with poisoning them, as Mrs Drinnan's husband had done in this ease, without knowing the facts. He hoped Mr Drinnan would retract the charge he had made, and disabuse his mind of such an idea. Dr. Collins afterwards stated that the average percentage of deaths in the colony under chloroform, was one in 12,000 cases. At the Auckland Hospital the average was one in 16,000. Their hist death under chloroform occurred two years ago. Mr Smith, deceased's brother, who had conducted the husband's cross-ex-amination, said that Mr Drinnan had naturally been very much distressed, but he desired to say that all the relatives had the utmost confidence in Dr. Collins and the other medical men associated with the hospital, and felt that everything that was possible was done to save Mrs Drinnan's life. Dr. Lowe, replying to Dr. Walshe, said that in view of the diseased state of the patient's kidneys, the use of | ether would have been more dangerous than the use of chloroform. The jury after a brief consultation I found that although deceased's heart was healthy, she died under chloroform from heart failure accelerated by the diseased state of her liver and kidneys and the enlarged thymus gland.