DEATH UNDER ANAESTHETIC
The adjourned inquest on the body of Albert Glass, who died at the Adelaide Hos- pital while under ether, was continued at that institution by the City Coroner, Dr. Whittell,
and a Jury on Friday morning. Dr. Arthur Goode, who had charge of the deceased as House Surgeon under Dr. A. A. Hamilton, said the patient was suffering from acute tonsilitis on the left side with swelling on tho right. When the abscess on the left side broke ho rallied somewhat, and began to improve. He continued to get better till about December 12, when his tem- perature again rose to 100°, and the throat became sore. On December 14 the ternperatnro fell to 99, rising in tho evening; to 103; the right tonsil was much more swollen, and he had far greater difficulty in swallowing medicine. The glands under the angle of the jaw were swollen. It was possible then to open tho patient's mouth sufficiently to examine the throat. Next day he became much worse. He had a bad night on December 16. Had some difficulty in opening his mouth, but the doctor was able to get his finger in as far as the tonsil, which was soft and semi-fluctuant. It was then de- cided to lance the tonsil, which was done after a gag had been inserted. There was bleeding, but no matter came. The patient appeared to get easier after a while. There was no pus. On December 17 the tem- perature rose to 105°, while the swelling of the tonsil and of tho glands of the neck was greater. Patient was then only able to open his mouth about one eighth of an inch. Then went to the Resident Medical Superintendent, and laid tho case before him, and they agreed that an operation was necessary, and that an anaesthetic would have to be given. TJj,'ly symptoms set in ; his respiration became impeded, and attempts to rally him were of no avail, and he died some quarter of an hour of 20 minutes after witness started to give tho ether. Had had good practical expcrieuco in giving ether. Had he known that there was inflam- mation of tho trachea or oedema of the glottis would' not have administered the ether, because he thought there would be great danger, the reason being that it would set up more inflammation. Had he known all the facts as revealed at the postmortem examination before tho operation ho would not have given other and cut the tonsil for abscess. If he had known the exact symptoms ho would have referred tho case to Dr. A. A. Hamilton, and had the patient transferred to tho surgical ward. As after events proved, if any operation was necessary, it was tracheotomy rather than the cutting of the tonsil. The day Dr. Hamilton saw the case the patient was a littlo worse than he was on the previous day, but there were no alarming symptoms. Did not regard the case as dangerous. Did not think it neces- sary to send word to Dr. Hamilton because he thought the disease was localized in the tonsil and that witness could manago the case. Saw Dr. Hamilton on Monday, and told him that ho had lanced deceased's tonsil, that he had not struck pus and that the man had ex- pressed himself relieved. His reason for not sending for Dr. Hamilton before ho under took to operate was because he thought it was a minor operation, and under such circumstances it was not usual to send for the honorary. Such operations were often done under the care of the Medical Superintendent, who was present on this occasion. If Dr. Hamilton was at home he conld have come down in a few minutes, but they did not think it worth while sending for him, as they regarded the opera- tion as trivial. 'The Coroner— Is any operation trivial which requires the use of anesthetics? Witness— Perhaps I should not have used the word trivial. If you will allow me I'll scratcb it out and call it a minor. Coroner— Is any operation with the tempera- ture of the patient at 103°, with tho symptoms this man presented and requiring anaesthetics, a minor operation? Witness: Yes, I think so. I wanted to do moro thoroughly what I had done tho day before and so aspirated ether. The Coroner— There is a little confusion about the rules. I understand your duty is to look after the patient and carry out the instructions of the hon. medical officer, and there is a Residcnt Superintendent who stands between you and the honorary when the honorary cannot bo got at. Witness— Yes. Coroner— Is it the practice of the Hospital to administer anaesthetics to one of the hono- rary's patients in his absence? Dr. Goodc— Yes, if it is thought necessary by one of the house surgeons, in the presenoo of the Medical Superintendent. Coroner— Placing myself in the honorary position, I must confess I should havo felt a little indignant if the operation bad been per- formed in my abscnoe without my having the
choice or a word to say as to whether it should be done or not. Witness— I consider I was justified in what I did. Coroner— But now that you have had time to; think about it? Witness: Even now I don't think I was wrong. I did not think it was worth while troubling the honorary. Coroner— You were afraid of troubling him; did you ever know any medical man complain of that? Witness— I did not think the case was worth while bringing Dr. Hamilton down for. It was a small thing which required to be done. Dr. A. A. Hamilton, one of tho honorary physicians at the Hospital, said, it was the usual custom to visit tho Hospital on Wednes- day and Saturday of every woek. Last saw the patient on December 14, when there were absolutely no signs of laryngeal complication.' When he last saw the case he thought it wonld take the usual run of an ordinary quinsy. No dangerous symptoms had set in. On the Monday, after visiting the female ward, asked Dr. Goode the condition of the patients on tho malo side. He said that the temperature and swelling of tho patient had increased, and that he had lanced the tonsil. Did not think it necessary, to go and see the patient from what ho was told. On the following day heard that the man was dead. At tho post- mortem examination it was found that there was a much more extensive disease. From tho appearance at tho autopsy, tho oedema of the glottis was sufficient to account for death. Did not think there was any abso- lute evidence to show that tho administration of ether would increase tho oedema. Coroner— Do yon think that such an error of judgment with regard to tho existence of pus might havo been made by the most skilled and well-informed man? Witness— Certainly. I do not think the incising was an error of judgment. I think that was correct whether there was pus or whether there was not, to relievo tho tension and swelling. Coroner— Do you consider that the resident officers did right or wroner in deciding to operate and administer ether without com- municating with you? Witness— I think under the circumstances they were perfectly justified in doing so. Coroner— Supposing you had been so con- sulted, do you think from your knowledge of tho case that you would have followed the same course as they did? Witness— I think from the history I havo heard that I should have probably followed tho same course. From tho condition of the glottis I should say tho man would have died, ether or no ether. Dr. Hamilton further stated that he thought that death was entirely due to the oedema of tho glottis. Did not think tracheotomy in this case would have given the man any chance, considering tho extensivo inflammation re- vealed by the post-mortem. The Coroner in summing up said the primary reason for holding the enquiry was that a patient was said to havo died under the in- fluenco of an ansesthetic, and that it was the practice in all hospitals in England and else- where whenever that occurred. that an enquiry should be made by the Coroner with a view of ascertaining if every precaution had been taken in tho administration of the drug. They all knew that chloroform and ether had proved of incalculable benefit in preventing suffering in the case- of severe operations, but now and then instances occurred in which death fol- lowed on and was caused by the administra- tion of anaesthetics. These cases were rare, but when they did. happen it was always necessary to be satisfied that in the ad- ministration of these powerful drugs due care had been taken to avoid danger. The Jury wmtld agree with him that on the present occasion the anaesthetic was ad- ministered carefully and by a gentleman who had had plenty of experience. The case might have ended there had it not been that at the post-mortem examination it was found that the medical gentlemen who had charge of the case had somewhat mistaken the purport of the symptoms; In this instance thero was more than mere quinsoy, and amongst other things oedema of the glottis. That was only re- vealed at tho post-mortem examination. He was at first inclined to think that that condi- tion might have probably been anticipated by symptoms, and that other treatment would have been more effective. But Dr. Hamilton put them right when be said that the House Surgeon was not to blame in not discovering this condition of tho glottis. Dr. Hamil- ton further stated that he believed the man would have died whether ether had been administered or not, and that was a fair and legitimate conclusion from tho facts revealed by tho post-mortem examination. As to the responsibility of thoso who had charge of tho case he had the impression in tho earlier por- tion of the enquiry that Dr. Hamilton should have been sent for when the case was found so urgent as to require an operation. But Dr. Hamilton did not complain; in fact he quite approved of what had been done. He ap-
proved of the attempt to give chloroform and of tho incising of the tonsil. That was a great relief to his mind, and since he had heard it he had felt relieved of a responsibility; while it also relieved the resident men of responsibility. After a short retirement the jury returned a verdict to the effect that the 'doceasod died owing to oedema of the glottis.