DENTISTRY AND DAMAGES

Dominion, Volume 2, Issue 523, 2 June 1909, Page 8

DENTISTRY AND DAMAGES

PRACTITIONER SUED FOR £501. 'A CASE OF RAPE) ( EXTRAOTION. WHAT IS THE EIGHT ANAESTHETIO? Before Mr. Justice Cooper and ft Bpecial jury of twelve, the hearing of the case Rose Galvin (who was represented by Mr. Gray, with him Mr. O'Regan) against T. E. K. Burgess, dentist (for whom Mr. Skerrett, K.C.j with him Mr. Stout appeared), was continued yesterday. According to plaintiff she had twenty-eight teeth drawn by defondant . in February, 1907. For tho purposes of the operation she was placed under gas. She alloged. that, when she recovered, two of the teeth which had not been removed were extracted. When the operation was concluded, she had a pain in her left lung. As she became worse she consulted Dr. Cahill from time to time. -Her cough gradually became worse, and she was compelled to'give up her : employment. Eight months after the operation she coughed up ft tooth in the pres«nco of her sister. Plaintiff claimed £601 damages in respect of defendant's aUeged negligent and unskilful treatment. . For the plaintiff. Dr. Fyffo (under cross-exanrinataon) deposed, that gas, was an ideal. anoes&etio far a short operation. Chloroform had , an effect upon the heart and lungs, and so bad ether, but to less extent. It was possible for an ordinary 'operator to take out twenty-six or twenty-eight teeth in ten minutes,' but he would not like to say that it was safe.. , Re-examined, witness stated that, seeing that plaintiff had recovered so quickly, it was more probable that the impaired state of the lung had been due to the presence of a foreign body than to disease. gas was the safest anaesthetio, the use.pt ft by the nasal method required the presence of two assistants, in addition to tne dentist.: He did not consider it a prudent thing'for a dentist, assisted only by his fe-r male attendant, to attempt to take out twenty-eight teeth at one sitting, under gas. An Eye-Wltness of the Operation., Margaret Mlean deposed that she went in company with plaintiff to defendants surgery,: and was present when the operation was performed.. Plaintiff came out of tho gas before two of the teeth could be drawn, and they were extracted without the use of gas. Whon plaintiff came to see her a. fortnight later she appeared to'be suffering from Dr. M'Gavin stated that the condition of plaintiff's lung was consistent with her story, ff a dentist bad to take out twenty-eight teeth with the aid of gas he should have an assistant to administer the gas. _ Ihe assistant, however, did not, in his opinion, jmoed to bo-a skilled assistant-i.e., a doctor '(or another dentist. ■'■'.;. I To Mr. Skerrett: As far os be knew, plains tiff had not suffered from the method m whiph the gas had been administered., It. was possible for a tooth to remain in the region of the larynx for a considerable time before .passing into. the trachea. Also, it was possible ror a foreign bodyvto remain In a hing for some years, provided* that it was not septic. If it were septio, there would be indications within forty-eight hours. Re-examined, witness stated that a loose tooth lying in the mouth might be inhaled during deep breathing. Tho 'likelihood of: such a happening had to be guarded against On an occasion when he used gas admixed with oxygen for fifteen minutes,' the anaesthetic was administered by a dentist. Jane Sutton, assistant matron . at the Y.M.C.A., deposed that when she was housekeeper at Mr.' H: D. Bell's, plaintiff obtained a position thcro. Plaintiff became so unwell that at the end of six weeks she, had to leave her.employment. ~;-. "Accidents Will Happen." Arthur Hoby, dentist, Baid that it was possible to extract twenty; or more teeth whilst a patient was under tbe ; influence of t as admixed with oxygen.' Before the introuction of oxygon, twelve years ago, he had conduoted dental '''operations;- for minutes with gas atone.. If twonty-oight teeth had to be extracted, ho. would,'prefor that ether or chloroform- should be used, but would use gas if the patient insisted. For a short operation to extract only a few teeth gas was the best anaesthetic. ..-..■ Mr. Skerrett: Is it not possible that with the utmost care an accident might happen? -"Yes." . ■ •■■■■'■ During the.extraction of ragged, uneven, teeth ono might be Whaled by the patient without lie knowledge of the operator?— "Yes." ..V . ■'.•"' -' Ro-examined, witness stated that ho did not count a patient's teeth-.as ho extracted themi His practice was to see that every individual tooth was removed from the mouth. • : Douglas A. Fife, dental surgeon, gave evidence, that in extracting a largo number of teeth ho preferred ether administered by ft medical man. ; .' Mr. Skerrett: Do you' know that the general tendency among advanced dentists nowadays, is to prefer gas administered by, a nasal inhaler 1 to ether 1 or the- case'of a satisfactory., subjeot twenty-, eight tooth 1 could be drawn m fiat way. How long would it take to extract twentyeight teetlh? —They could bo drawn at the rate of one to every 2i seconds. Of "course some teeth might take much longer. Mary. Chapman, sister of plaintiff, gave evidence as to plaintiff's illness and as to coughing up a tooth. • /Ellen Chapman,, daughter of the previous witness, also stated .that she saw the tooth soon offer it had been coughed up. This closed tie case for the pkmtiffi ' "A Bolt From the Blue." Fox the defendant, Mr.' Skerrett stated that two facts showed the very unfair position in which defendant was placed. The first was that seventeen months elapsed after the operation, without complaint, before the charge was first brought against defendant. Secondly, eight months wont past after tho discovery, of the tooth before any complaint, written or verbal, was given by plaintiff to defendant. It was tie positive'duty of plaintiff directly she-had coughed up tho tooth, and directly.':she formed,the opinion it came there in consequence of the negligence of defondant, to have brought the matter under defendant's notice by letter or otherwise.. As a result of the charge not having been brought for eighteen months, it oamo as a bolt from the blue, and defendant was not in a position'to adequately defend himself. If a dentist were a pusillanimous man he would probably have. settled the claim: if ho valued his reputation he would defend himself, which would' mean that,, even if he succeeded, it would cost him a considerable sum in costs. The only suggestion of neghgehco came from Dr. Fyffo. On the previous day Dr. Fyffe had led_ thorn to understand that the maximum period of anaesthesia under gas was about forty r five seconds, and that that was too short a period.in which to extract twenty-eight teeth. From his croasoxamination, however, it appeared that a patient could be safely kept in a state of anaesthesia under gas up to ten or even fifteen minutes.- It had-been suggested that there should have been in attendance a competent assistant to attend to tho administration of the gas. If plaintiff had suffered any ill • effects from tho administration of the. anaesthetic the point would be of extreme importance. ■ As a matter of fact, however, patient had token the gns very well and made a splendid'recovery. How tho tooth got into the , lung, and whother it did actually pass into the luhr 'woro matters which were open to doubt. There was reason for believing that the tooth did not reach the lung at all, but lodged somewhere in the region of the larynx. From appearances, it was not the' whole of a tooth, but merely a fang. It was possible that plaintiff.inbaled it during sleep prior, to the operation'.- Or, again, it was possiblo that, during tho operation, it. was concealed in the gum. In all respects defendant had, he submitted, exercised proper caro and attention. Testimony . of the Defendant.; Defendant (upon oatlj) stated that his were New Zealand qualifications, and that he had been three years in practice. His nurse had had five or six years' experience of dentistry work. When plaintiff became unconscious the .noise took charge of the inhalox. 6oao-of

the teeth were placed on the chest, some on a toweL and some might have gone on the floor. It was not a Tact that plaintiff re-, covered before the last two teeth had been extracted. She was unconscious for six or seven minutes. None of the teeth slipped from tho forceps in the course of the operation. After the extraction plaintiff said that it_ was rather foolish of her to have been frightened, as tho operation was not so bad after all, and that she would not mind going through it again if necessary! On none of the subsequent occasions on which plaintiff called upon him; did she complain of her physical condition or mention that she had consulted Dr. Cahill since the operation. He was not unduly hurried in the extraction of tho teeth, and thore was no need to have an assistant specially to administer the gas. The general practice all over New, Zealand was to carry out such an operation with tho aid of a nurse alone, and ho had not known of any casualty having happened where that practice had been followed. He had'removed twenty-eight teeth at ono sitting under gas hundreds of times. In this case, be had accounted for all the teeth in tho presence of plaintiff. To Mr. Gray: The only precaution which he took to prevent any of the teeth being inhaled _ was to place finger and thumb on either side of each tooth, and see that it was removed from the month. Ho could not account for the tooth in question having got into plaintiffs lung. Re-examined, defendant stated that the practico of placing a cloth in the mouth was oondemned by high authorities, and ho had never known a dentist to place his fingers, or allow his assistant to put her fingers in ttie back of a patient's mouth. Maud Bush, who was nurse at defendant's surgery on the date in question, gave evidence in corroboration of that given by plaintiff. To Mr. Gray: She remembered tho caso because if was the biugest one that sho had seen with the use of the nasal inhaler. Safety of "Laughing Gas." Dr. Napier M*Lean stated in evidence he did not think defendant had been guilty of negligence in using gas in connection with the extraction of so many teeth. With gas and air alone thirty-three teeth and stumps had been drawn in his presence. If oxygen were admixed with the gas, the. patient could safely be kept unconscious for twenty minutes. Out of many millions of administrations only three or four : deaths had been reported. Gas did not act on tho heart; the solo danger was asphixiation. When gas was used an expert oould control the anaesthesia by watching the breathing and the face of the patient. He would not approve of a,cloth being placed in the mouth to prevent a tooth being inhaled. It was his opinion that the gas had been properly administered in tho present case, and ho also thought that tho tooth in question was very septic. It waa highly improbable that tho tooth,,could have passed through the larynx' without being observed, and •he could not understand how such /a foreign body could havo remained in any portion of the lung without giving rise to symptoms of septicpneumonia. The symptoms which had been described' were' consistent with those of ordinary tuberculous pleurisy, which ■• would heal under, propor treatment. It was possible that the tooth had remained in a pouoh on either side of the larynx. There was on reoord a case where a foreign body had lodged there for close on throe years. He knew of a case where a foreign body had so remained.for eleven months without discomfort to tho patient. To Mr. Gray: He would allow a dentist who had been in practico say only one year, and who waa assisted only by a nurse, to draw his teeth under gas provided that there was nothing irregular about the teeth. It waa not necessary to have an assistant specially to'administer the gas. '■■■"•'. Dr. Morpeth, dental surgeon, stated that defendant had'followcd the _usual practice in connection with .the operation. Formerly, when a largo number of teeth had to be removed, ether or chloroform was used, but nowadays gas, administered by the nasal inhaler, was growing in favour. In Amorica, tho practico was to extract any number of teeth with the aid of gas so administered. It was not the practico for the dentist to put a cloth in the patient's month to-pre-vent teeth being swallowed or inhaled.. ,' ; To Mr. Gray: Ho had never seen■ a patient inhale a tooth. ' '; W.' H. Didsbury, surgeon dentist, gave evidence of a similar nature. He said that whilst a patient was under the influence of gas for seven minutes he had drawn twentyeight teeth. . Dr. Hislop and W. K Hnrsthotise, surgeon dentist, also gave evidence, and the case for. defendant was then closed. At this stage, the Court adjourned until fcwlay. . •: ','..'"■'-■'