DEATH UNDER CHLOROFORM
THE INQUEST.
An inquest was held yesterday afternoon in Mr Myers' dental surgery, before the district coroner (Mr E. H. Carew) and a jury of six (Mr Jas. Todd foreman), on the body of Hannah Emily Callick, whose death while under chloroform on the previous day has already been recorded by us. Sergeant Morice conducted the inquiry, and Mr Gallaway appeared on behalf of the relatives of the deceased to watch the proceedings.
Walter Callick, railway platelayer, residing at Abbotsford, deposed that his wife, the deceased, was born in London, and had been about eight years in the colony. She was 31 years of ago on the 15th January last. Witness had been married to 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 five 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 coming 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, about extracting her teeth before she came into town on Thursday.
Septimus Myers, dentist, deposed: I have been practising for 16 or 17 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. She came 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 teeth were in a very bad state I told her they would have to be removed. She told me that it was to have that done that she had come into town. I told her that she would need to have some anaesthetic to have them out as she could not otherwise stand the pain, and I asked her if 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 or 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 Macpherson 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 asked her if 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 smell chloroform. She was lying down at the time on a chair specially made for the administration of anaesthetics. 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 she had vomited liquid matter very slightly. The doctor asked her if she was sure she had had no breakfast, and she said "Only half a slice; I have hardly eaten anything for a week; I do 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 chloroform again. He had some on a piece of lint which was previously pinned to a napkin, and he 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 having the spirits, to take the chloroform splendidly. She had about an ounce of spirits, perhaps a little less than an ounce, and an equal amount of water was added. She was going on well when I was called out of the room and left. Up to this time I noticed nothing particular about her face — nothing more than was usual in a person under an anaesthetic. I dare say I was out of the room for a little over a minute, and the lad, who had remained inside, came 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. I put a gag in her mouth and there was no reflex action of the muscles whatever. After opening her mouth, I commenced to extract her teeth. I took out one upper molar and 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 and noticed that the breathing was shallow. The doctor commenced artificial respiration at once and applied nitrate of amyl; then inverted her entirely, laid her flat on the floor, and applied a galvanic battery, and artificial respiration was again tried. It appeared to me that she commenced to breathe. I made the remark "Thank God; that's a narrow shave, doctor." The doctor replied that she was not right 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 and the battery for some short time, even after the doctor said she was dead, but without effect. The doctor said it was no use continuing any longer, and we then removed her into the chloroform room, which is kept specially for patients 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 the 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 four drachms were used — about half an ounce.
To Sergeant Morice: I always have a medical practitioner present when chloroform is administered for the extraction of teeth. My practice is to get the doctor who is attending the patient. Dr Macpherson has administered chloroform 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, on any previous occasion when chloroform was administered for the extraction of teeth.
To Mr Gallaway: I do not think 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 make 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 from 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 Myers 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 Myers commenced operationsat her mouth, 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 to stop, as her pulse had gone, and asked him to get nitrite of amyl to 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 asked him again to get the nitrite of amyl which he did at once; and I then noticed something which alarmed me very much - that her pupils were very widely dilated. That usually indicates chloroform poisoning. I then commenced artificial respiration at once, and continued it, I suppose for a minute in the chair. During this time she was breathing. Then we laid her on the floor. She breathed several times after being placed on the floor, but it was a decidedly shallow, 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 asked Mr Myers if he had a battery. The boy came with one in a minute or two, and we applied galvanism to the region of the heart, but without effect. I think it was at that time - after we had applied galvanism - that I said to Mr Myers that I thought she was dead. After 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 influence 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 the only warning. I procured the chloroform two days before, and I used some of it on the day before from the same bottle, when a patient was anaesthetised with it in Mr Myers' surgery. The chloroform was Duncan and Flockhart's — recognised as the best chloroform. There were originally 2oz in the bottle. I used it for the patient before, and to-day I measured it and there was slightly over 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 anaesthetic.
To Mr Gallaway: The usual process of testing the 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 the heart. It is usually given in cases of angina pectoris. The circulation in this case stopped instantaneously. In administering chloroform I invariably take the 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 the operation.
Dr Coughtrey, examined 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 the usual way, and, judging from the evidence, I think the case was watched with great care before the 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 my 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 2600 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 and good thing to have given brandy in this case, and as it turned out it was an almost providential thing that Dr Macpherson did give it.
Dr Alexander, called at the request of and examined by Mr Gallaway, deposed: Having heard the evidence of Mr 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, is 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 deceased 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 battery 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?
Witness: 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 deceased for the administration of the anaesthetic, and that no restorative measures were left untried." -Otago Daily Times, 6/2/1892.
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