DEATH UNDER CHLOROFORM

Otago Daily Times, Issue 9343, 6 February 1892, Page 6 (Supplement)

DEATH UNDER CHLOROFORM

THE INQUEST. An inque3t was held yesterday afternoon in Mr Myera' dental surgery, before the district orono (MrE. H. Carew) and a jury of six (Mr Jas. Todd foreman), on .the body of Hannah Emily Callick, whosu death while under chloroform on tlio previous day has already bueri recorded by us. j Sergcant'Morice conducted the inquiry, and Mr Galknvay appeared on behalf of the relatives of . the deceased to watch the proceedings. Walter Callick, railway platelayer, residing at Abbotsford, deposed that his wife, tho deceased, ■mis born in London, and had been about eight years in tho colony, She was 31 years of ago on ' -thy 15th January lust. Witness had been married I j deceased for close on six years. The deceased had never been under medical treatment, except at the times of childbirth. Witness never knew her to have any trouble that required medical ■ treatment; she was strong and . healthy. .At , times she was troubled with toothache.' About live minutes to 7 on Thursday morning, when witness left for work, was the last time he saw her alive. She had told him she was coining into Dunedin to have her teeth extracted, preparatory to having a new set put in, as she had been troubled with her teeth for some time. There were three children—two boys and a girl. On the occasion of the birth of the first child Dr Christie attended her. She told him that the doctor used chloroform, but she made no complaint of it having any ill effect, and he had no reason to think that there was anything wrong with her with regard to her heart or anything else. She Had not seen Mr Myers' to, witness' knowledge, abput extracting her teeth before she came into town on Thursday; Septimus Myers, dentist, deposed : I have been practising for 16 or V? years. I had not seen the deceased, to my knowledge, before Thursday. She came here about 20 minutes past 11. I did not see her till some short time afterwards. Shecame into the surgery about 20 minutes to 12. She told me she came to see me about a set. of teeth, and asked me to examine her mouth. I did so, and as her teetli were i;i a very bad state I told her they would have to bo removed. Slio told me that it Vasto have that done that she had come into town. I told her that she would need to have some aniusthetic to have them out as she could not otherwise stand the pain, and I asked horif she had been attended by a medical man. She said, "' No, that she had not needed medical men." I asked her if she had ever had chloroform, and she said, "Yes, two in1 three times." I asked her who had administered it as I would like to get the same doctor. She told me it was Dr Brown who had given her chloroform. ~. As Dr Brown was away Home, I told her I might get Dr Macphcrson as he was handy, and I said I would ring up him if she liked. She was quite agreeable to that, but she made the remark that she did not know Dr Macpherson. I said that I know Dr Macpherson had administered chloroform on a good many occasions. Before ringing up I a3ked nerif she had had any breakfast, and I understood her to say she had had a piece of bread and : butter. I rang up Dr Macpherson and he came over in a few minutes. He had a conversation with Mrs Callick. I heard him telling her to loosen her clothes preparatory to his sounding her, and I left, the room then for a few minutes. When I came back again the doctor was administering: an .anaesthetic to her. I could smellchloroform. She was lying down at the time oh a chair specially made for the administration of anasthoties. ;Her clothes were entirely loose. I have looked up my book roughly and find that I have been present at the administration of chloroform about 1600 times in Dunedin, and a good many hundred times before I came to Dunedin. : When I came into the room, as the administration of the ' anresthetic was going on, the doctor remarked to me that there was an appearance of sickness. I saw that sne had vomited liquid matter very slightly. T!ie doctor asked her if^she was sure she had had no breakfast, and she said "Only half a slice; I have hardly eaten anything fora week; Ido wish my teeth were out." The doctor then suggested a small drop of brandy, and she took it, making the remark that she was not accustomed to taKe spirits. The doctor commenced giving her the chloryf orm again. He had some oh a piece of lint which waj previously pinned to a napkin, and lie held it within a few inches of her mouth. The napkin-was held arched-over with the lint on the lower side. There was plenty of room for air. The chloroform was applied slowly, the doctor bringing it'gradually'towards her to about: an inch from her mouth. She appeared, after hiving the spirits, to take the chloroform splendidly. She had about an ounce of spirits, perhaps alittleless thunan ounce, andanequalamount of,water was added. She was going on well when I was called out of the room and left. Up'to this time I notice! nothing particular about her face— . nothing more than was usual in a person under an amosthetic. I dare say I was out of the room for a little over aminuto, and the lad, who had renamed inside," camo out and told me she was ready. I returned to the room, and I remarked to the doctor how well she,had gone. off. I thought, under the circumstances, that she looked very well then, 1 put a gag in her mouth and there was no rellex action of the muscles whatever. After oijuning her mouth. I commenced to extract her teetli,' I "took out one upper molar ami was taking out another, when the doctor said, "Stop, I cannot get her pulse." The doctor had hold of her arm up to this. I said, "But she is breathing well, doctor." I could see by the muscular motion in her .mouth' that she was breathing. As I finished speaking I observed the change myself ami noticed that the breathing was shallow. The doctor commenced "artificial respiration at once and ■ applied nitrate of amjT; then inverted her. entirely; laid her flat on The floor, and applied a galvanic battery, and artificial respiration was again tried. -It appeared to iv« that she commenced to breathe. I made the rejiiark "Thank God; that's a narrow shave, ■ doctor." The doctor replied that she was not' *igbt yet, and said a second time, "No, by Heavens, she's dead, Myers.". I felt excited, and do- not remember, the exact words that were spoken. We continued artificial respiration arid - the battery for some short time, even after the \ ~ ~ctocttri-strid she wns-cleadrtrat 'Wlthaatreffectr-The' doctor said it was no use continuing any longer, and we then removed her into the chloroform *. room, which is kept specially forpatients after chloroform. After the doctor said that he could not get the pulse, I noticed the deceased's face get a blue colour. I did not notice'the. doctor examine the eyes. The doctor brought the chloroform that was used. I dropped the1 chloroform on to the lint for the doctor part of the time, and so far as I could ;see the average quantity was used. I have often seen three or four times as much, and I have often seen less used. I should think three to five, or three to foiir drachms were used—about half an'mince.. • ' To Sergeant Morice: I always have a' medical practitioner present when chloroform is adminis- : tered for the extraction of teeth. My practice is to get the doctor who is attending the patient. Dr Macpherson has administered chloroforni hundreds of times in my surgery. Sometimes three times a day. Before she had the brandy and water she appeared to waver between consciousness and unconsciousness. Very little force was required for the extraction of the teeth. I have never had a mishap, orivany previous occasion : when chloroform was administered for the extraction of teeth. ■ .To Mr Gallaway: I do not Ahink that the doctor was depending more on the pulse ■ ; than on the respiration^. As' he held the pulse he kept his eyes on the patient. By shallow breathing I meant no ordinary strong breathing. The doctor was sitting, ; and in the best position to see the respiration. Mrs Gallick made no mention to me about taking gas for the operation. She could have taken gas but it would have required several applications, [ ' ' and I do not care about administering gas more than once in a day. She said it ..was to have a tooth out that Dr Brown administered chloroform. Dr^Macpherson had, I believe, entirely ceased to administer chloroform. in this case. when I commenced to operate. There was no woman in the room during the administration of .the chloroform. A female friend of Mrs Callick's was present when the doctor came, but she left the room.' I saw the tongue was well forward when respiration stopped; Dr Macpherson deposed :' I have been in practice for nine years, and have administered chloroform from 400 to 600 times, in addition to seeing it administered many times. I have never had any mishap in my own practice. This is the third death I have seen under chloroform. The other two deaths were occasions in which I took no part. I came over here between 10 and 20 minutes to .12 on Thursday, and saw Mrs Callick , with Mr Myers, who told me she would want to have some amesthetic as she had a lot of very bad teeth to come out. I looked at her teeth myself, and then asked her to sit down in the chair. I examined her chest and her heart by the stethoscope, and made inquiries as to whether she had - any breakfast. She said she had had very little, and that she had not been able to eat much for about a week on account of her mouth. She was then brought into a horizontal position, and I commenced to administer chloroform. I had - •■ found her heart perfectly sound. I think I asked her whether she had had rheumatic fever. As far as I could malce out, I could see nothing to contra-indicate the administration of chloroform. I.did not ask her' if she had had chloroform administered before, but she stated so voluntarily. As soon as I put it near her face she said, " Oh, I know what that is; that is chloroform; I have had it before." She made no objection to it. I went, on with the .administration in the usual' way, and the patient seemed to be coming under its influence very well. After giving it for fioin six to eight minutes she appeared to be sufficiently well under the influence for operative purposes, and then quite suddenly she commenced retching, and during the time she was retching the administration of chloroform was stopped . She brought up nothing but a little bile or mucus! I think the administration was stopped for about five minutes,- and during this time she became perfectly conscious and spoke to us. In my experience, I should like to say, about one patient in three is sick during the administration of chloroform I asked her at this time again whether she was sure she had nothing to eat at or since breakfast. She replied that she had half a slice or a slice of toast at breakfast, and nothing since then I asked Mr Myers to get a little brandy, and she had about half an ounce of it with water. I commenced to administer chloroform again, and this time she took it very well. There was no . trouble whatever, there was no further sickness, and her breathing and pulse were good. I was sitting in a chair by the side of her head, so that I could see both her face and the movements of her chest, and I had my finger most of the time on the temporal artery. I think in about five to six minutes she seemed sufficiently under the influence, and I told the lad who was there to tell Mr Myer3 she was ready. I stopped the administration of chloroform as Mr Myers came into the room, and then took her wrist in my ' hand and watched her face. Mr Myets commenced operationsat hermouth, and he had taken out one or two teeth when her pulse, which had previously been good, flickered twice and stopped I called out to Mr Myers toistop, as her pulse had gone, and asked him to get nitrite of amylto apply Mr Myers said she was right-she was breathing well, I noticed also that her breathing, was good at this time. I said she was not right and asta-d him. again to get the nitrite of amyl wh.chhedul at once; and I then noticed something which alarmed me very much-thafc her pupils were very widely dilated. That usually indicates chloroform poisoning. I then commenced artificial respiration at once, and •continued it, I suppose /or a minute, in the chair. Dunns _ this time she was breathing. Then we laid her on the floor. She breathed several times after being placed on1 the floor, but it wasadecidedlyshallow.gasping breathing I went on with the artificial respiration and I asked Mr Myers to flick her chest with a "wetted towel, as that sometimes starts the heart's action. Her face then commenced to get livid in colour, and 1 asked Mr Myers if he had a battery me boy came with one in a minute or two, and -that we went On with artificial respiration for

about a quarter of an hour, but without any success, and eventually I concluded she was dead. The cause of death was, in my_ opinion, failure of the heart's action while under the iufluenco of chloroform. The authorities show that 1 in 2600 is about the present average of deaths under chloroform. There were no symptoms of asphyxia. The pulse gave tho only warning. I procured the chloroform two days before, and 1 used some of it on the day before from the same bottle, when a patient was anicsthetised with it in Mr Myers' surgery. Tho chloroform was Duncan and Flockhart's—recognised as tho best chloroform. Thero were originally 2oz in the bottle. I used it for the patient before, and to-day I measured it and there was slightly ovev loz. Probably the deceased had between three and four drachms, certainly not over half an ounce. That was about a usual quantity for the time that I used it. I administered it in the recognised manner. The deceased's teeth were in a very bad state, and I do not think she could have borne, the pain of having them extracted except under an ansesthetic. To Mr Gallaway: The usual process of testing tho heart is by examination by the stethoscope I think I could have detected fatty degeneration. There was no reason to suspect fatty degeneration of the heart in a woman of the deceased's age. Nitrite of amyl is applied to stimulate the action of tho heart. It is usually given in cases of angina pectoris. The circulation in .this case stopped instantaneously. In administering chloroform I invariably take tho evidence both of the pulse and of the breathing. Strong, robust men have succumbed under chloroform. Mr Myers' operations were not commenced too soon. There was no possibility of the patient having in any way been conscious at the commencement of tho operation. Dr Coughtrey, oxamined at the request of Dr Macpherson, deposed: I have had considerable experience in the administration of chloroform. I have heard the evidence of Mr Myers and Dr Macpherson, as to the manner in which chloroform was administered in this case, and I see no fault in it. It was administered in tho usual way, and, judging from the evidence, I think the case was watched with great care before tho flickering of the pulse took place, and the usual restorative measures were afterwards promptly followed. The consequence was not in my opinion the result of any 'neglect or want of skill. The brand of chloroform that was used is that which I favour in mv own practice. The quantity was moderate, and it seems to have been given gradually. I approve of the cessation of the chloroform during the time of the retching. I think the examination by the stethoscope prior to the administration of the chloroform'was sufficient. I differ from Dr Macpherson in one point, I do not think 1 in 2COO is a fair ratio of fatalities under chloroform. Statistics in connection with chloroform are so accurate in this respect, that they give all the accidents; but they do not give all the trivial cases in which chloroform is administered in private'practices. I think the proportion of deaths to the number of times on which chloroform is given is much less than 1 in 2600. To the Jury: I think it was a very proper am good thing to have given brandy in this case, ant as it turned out it was an almost providential thing that Dr Macpherson did give it. Dr Alexander, called at the request of and oxamined by Mr Gallaway, deposed: Having heard the evidence of Sir Myers and Dr Macpherson, I think the usual precautions were taken in the administration of chloroform. I think, having regard to the witnesses' description of the patient, there was nothing to put them on their guard as to there being any unusual danger in administering chloroform. I would not have hesitated.^, to give it myself. Chloroform or ether, not gas, 4s always given in cases such as Mr Myers described. I attach no importance to the sickness. That is not an unusual thing even when there is no food in the stomach. I think it was certainly a judicious thing to have given brandy under the circumstances. I can suggest nothing further than was done in the attempt to restore the patient. The Coroner having briefly referred to the evidence, the jury were left to consider their verdict. After an interval of about 10 minutes it was stated that the jury wished to put a question to Dr Macpherson. ,A Juror asked that witness whether, in his opinion, a galvanic battery ought not to be close at hand in all cases of this kind. :' Witness stated that so many things were used that they could not possibly have them all at hand. As a matter of fact he did not think the de; ceased was a minute and a-half off the chair before the battery was used, and even if it had been at hand he would not have used it sooner. The profession were told under all circumstances to go on first with artificial respiration. The batteiy was merely, mentioned as one of the things which might be used. Another thing which might be tried—and which he was very glad he did not try in this case—was the insertion of a long needle right on to the substance of the heart. That was recommended, and was frequently done. The Coroner: Do you think it a proper thing that chloroform should not be administered unless there is a galvanic battery at the place ? AVitoess : No, it is not a necessity. The Jury then returned the following verdict:— "■We find that death resulted from the failure of the heart's action while under the influence of chloroform. We desire to add that the evidence fully shows that all necessary medical precautions were taken to ascertain the fitness of the leceased for the administration of the anaesthetic, and that no restorative measures were left untried."