MAJOR OPERATIONS

Dominion, Volume 19, Issue 100, 22 January 1926, Page 10

MAJOR OPERATIONS

WHO SHALL PERFORM THEM?

SPECIALIST OR YOUNG

SURGEON FATHER’S SOLEMN PROTEST “Tlie question of the propriety of allowing a young surgeon of thirteen months’ experience and another of seven months' experience to perforin a major operation is one for the opinion of medical men. The question must depend upon the nature of the operation. At any rate it would appear desirable that a surgeon of longer experience should be in attendance.”

The above remarks were made by the Coroner, Air. 13. Page, S.AI., in the Magistrate's Court yesterday, when the circumstances surrounding the death of Haiward Sigfried Cederholm, aged five rears, who died under an operation in the Wellington Hospital on January 18, were investigated. Senior-Sergeant Scott appeared for the police. Marion Florence Cederholm, mother of deceased, said that on January 17 last she took her son to the Wellington Hospital, where she interviewed Dr. Austin, who subsequently examined the child. Witness asked that the child should be placed under an anasthetic and examined as to adenoids, but requested that the tonsils should not be removed for the present. She did not want them removed unless it were absolutely necessary. Dr. Austin had a consultation with Dr. Cohen, who stated that the tojsils would have to be removed. After discussing the matter with her husband, witness decided, to proceed witli this operation, considering it to be quite a simple one. She took the child to the hospital on Saturday and left him there. Before leaving she inquired as to who was going to perform the operation, and was told that Dr. Simpson would carry it out. “I left with the understanding that Dr. Simpson, who they said was a specialist, was going to perform the operation,” continued witness. “Aly child was well and fit when I left him. At one o’clock on the day of the operation I learned that the operation was proceeding, and about an hour later I received a further message from the hospital. When I arrived there the child was dead.’* A Father’s Protest. Walter Sigfried Cederholm, father ot tlie child, said he had suggested to Dr. Austin that the boy had met his death through an overdose of ether. Dr. Austin said he did not think that the amount of ether adminisfered would have killed a normal child. When witness suggested that perhaps the bov’s heart was not as strong as another child’s, the doctor admitted that it was quite possible that he may have become “etherised.” Inquiry produced the information that Dr. Simpson had operated on two'of his own patients that morning, while the tonsil case had been handed over to his assistants. Witness understood that Dr. Simpson, had left - the hospital and was not in attendance when the little boy was operated on. “Dr. Austin expressed his great sorrow as to what had taken place,” continued witness, “and for my own part I do not lay any blame on him. . . . At the same time I would like to utter my solemn protest against an administration that will allow such a state of affairs as .this. By this, I mean that assistants or students should not be allowed without direct supervision to carry out intricate and evidently dangerous operations of this kind. I think that if assistants are allowed to carry out vital operations, then a specialist should be in close attendance. I have not the slightest doubt whatsoever that if the operation on my little son had been carried out by a skilled man he would be alive and well to-day.” Dr. Robert Ewen Austin, said that on January 18 he performed an opueration on deceased for the removal of his tonsils. An examination tlie previous day had shown the child to be in a perfectly fit condition to undergo the operation. At tlie conclusion of the operation it was noticed that he had become somewhat blue and that the breathing was becoming embarrassed. The child’s head immediately lowered and artificial respiration and stimulants were given. These were tried for almost an hour, but the child failed to revive. Alethods Discussed. Cross-examined by the Coroner, witness stated that the ether was administered bv Dr. Forsyth, who was attending tlie child throughout the operation. The child had been under the anaesthetic for three-quarters of, an hour when his breathing was noticed. There were two methods of removing the tonsils, and the dissecting method, which was surer, was used for the operation. It was a slightly more dangerous method. The general difference between the two was that in the old system the tonsils were nipped off. Alucli depended on the nature of each case in deciding what method should be adopted. Dr. Cohen had advised the method used on tlie boy. It was a fact that a large amount of blood could be expected in the course of the operation.

The patient was lying in the usual attitude, the head being low. The entry of blood into the air passages was to be reasonably anticipated in operations of that sort, but it was not a general occurrence. Steps were taken to guard against it, such steps being those usually adopted. Question of Experience.

Mr. I’age: You suggest that no other precautions or steps could have been taxen to have avoided this?

Witness: Everything possible was done.

You heard the father of the child protest against assistants in these operations ?—“Yes.”

How long have you qualified?—“Tliirtecu months.”

Do you specialise in this work or are you a general surgeon?—“l am a general surgeon.” Have yon seen the operation for dissecting tonsils done before? —“Yes. About a hundred or a hundred and fifty times.”

Witness added that he had assisted in administering the anaesthetic in all those cases, and had performed the operation himself about fifteen or twenty times. In all these cases such a tiling as the matter under review had not occurred. The same steps taken in the previous operations had been taken in the present one. Tlie reason for the occurrence was probably due to the child gasping. The process of choking would be a gradual one and would take two or four minutes. It would be the duty of the anaesthetist to watch tlie condition of the patient. They had had the assistance of two qualified sisters and a probationer. Dr. John Cenick Forsyth, house surgeon, at the Hospital, said he had administered the anaesthetic for the operation, which commenced, at a quarter past twelve and was being concluded at five minutes to one when he noticed that the child’s colour was turning blue. As the pulse began to fall off, he asked that the operation cease. The head of the table was immediately lowered and the back of the throat cleared out. The tongue forceps were applied and artificial respiration resorted to. Injections were given. Air. Page: How long have you been a qualified surgeon ? Witness; Seven months.

Have you seen many operations of this sort?—“l have seen six or seven for tonsils.” / Dr. Phillip Patrick Llynch said that on January 19 he made a medical examination of the deceased. He was lying in the morgue. Both tonsils had been removed and death was due to asphyxia. Adequate Steps Taken.

Dr. IL B. Ewen, acting medical superintendent of the Hospital, said, that he had had eleven years’ experience as a doctor and had seen that class of operation performed. As far as he was able to say the usual steps were taken to prevent the blood getting into the lungs. The Coroner: Would you consider the steps to be adequate ? Witness: Yes; they are recommended by tlie specialists. Can you suggest why they were inadequate in this case?—“No. I can add nothing to what has already been stated. The child may have gasped.” How would you describe the operation as far as its gravity was concerned? —“It was a major operation.” Who is it that decides whether the operation should be performed by a specialist or one of the staff?—“The honorary surgeon in charge. He is in control of that ward during his period there.”

What have you to say of propriety? A man with thirteen months’ standing and seven months?—“l think it is quite all right. The operating surgeon was evidently satisfied and I think his decision was a proper one.” ■ “I would like to express my sorrow for this unavoidable occurrence,” said Dr. Ewen at the conclusion of the crossexamination. “I am satisfied that in the institution there was no incompetency or carelessness on any part to prevent such contingencies. In reference, to Mr. Cederholm’s remarks concerning assistants and students in the Wellington Hospital, I would like to say that there are no students there unqualified who are allowed to perforin any operation.” Coroner’s Finding. “My finding in this case is that deceased died during the course of an operation for dissection of his tonsils,” said the Coroner in returning a verdict. “The cause of death was due to asphyxia due to some of the blood escaping in the lower passages. The father of the child has protested against the operation, and I think it is necessary that I should make some remarks in connection with tnat protest. In the first place Dr. Aus, tin is a surgeon of some thirteen months’ standing. He has viewed a large number of operations of this sort and has himself performed fifteen or twenty of them. The child was healthy and well, and in the course of the operation Dr. Austin appears to have taken the usual and best steps that are necessary to en, sure the successful carrying out of the operation. The operation, however, resulted in failure. Some of the blood was not taken away and got into the air passages and caused the death of the deceased.”