Monday Series: An Inquest into a Surgical Procedure I

Ah, yes, Dear Reader…I have a treat for you for this Monday’s Series! This is something I’ve been researching for the past three years and part of the paper I presented at the Meeting of the Three Societies last summer.

I wrote earlier about the inquest into Alexander Turnbull’s practice following the death of his patient, 68-year-old William Whitbread after a procedure involving Eustachian tube catheterization. While the Whitbread inquest ceased to attract significant public attention to draw attention to Turnbull’s status as a practitioner, or on safety of Eustachian tube catheterization, the death of eighteen-year hold Joseph Hall was another story. The case raised considerable more attention amongst the public and medical practitioners, than that of Whitbread’s; daily newspapers reported the case with immense details from the proceedings and depositions and the case’s medical attributes were even discussed in The Lancet. Hall’s death on Saturday June 22 was strikingly similar that that of Whitbread’s only a few days earlier: he had been plagued with a constant irritation in his ear and headed to Turnbull for continuous treatments, and died following the application of catheterization. What made this case different than the first to merit such public and professional interest?

First, Hall’s young age and witness reports of him being in “perfect health” prior to arriving at Turnbull’s raised suspicion about negligence, particularly since Hall was operated on by one of Turnbull’s assistants, a Mr. Lyon, instead of by Turnbull himself. A full postmortem examination was thus requested to discover the cause of death and attribute whether any charges should be place, thus rallying in prominent medical and surgical experts into the case. During the inquiry proceedings, many leading members of the medical profession even attended the inquest. Secondly, the involvement of Thomas Wakley (1795-1862), M.P., and elected coroner of West Middlesex, heightened the publicity of the case.

Thomas Wakley, M.D., about 1840. Engraving by W. H. Engleton

Thomas Wakley, M.D., about 1840. Engraving by W. H. Engleton

Triumphantly elected in 1839, Wakley became the first medically qualified coroner in London and used his platform and period in office to raise awareness to the flaws surrounding medical coronership and to emphasize the need for reform. He often publicized his cases in The Lancet, particularly those with interesting medical details that he felt would stir controversy among medical and public circles and support his campaign for reform; the Hall case was among one of Wakley’s promotions. Thirdly, Hall’s death became a forum for discussing the merits of Eustachian tube catheterization as a surgical procedure. On the public front, commentators remarked on the effectiveness of the procedure and the qualifications necessary for employing it; accusations of quackery persisted and undermined the value of aural surgery. For aurists, the public interplay severely damaged their attempts for surgical consensus and undermined their attempts for maintaining their authority as surgical specialists; they feared public attacks would severely damage the credibility of aural surgery as a profession.

The inquiry into Hall’s death commenced at Montague Arms in Russell Square in front of Wakley and a jury of tradesmen. As soon as the jury was sworn in, solicitor Mr. Sleap stated he was in attendance on the part of the relatives of the deceased seeking to make sure there was a full investigation into Hall’s death. Wakley asked “whether he attended…to inculpate any one, because, if he did, it was only fair that the party should know it.” Sleap replied that he was only there to observe the proceedings and ensure it was followed through thoroughly. While Wakley remarked he had no objections to Sleap’s attendance, he made it clear that in his court no one was in trial. The investigation was simply to ascertain the cause of Hall’s death, thus making Wakley’s goals clear: the coroner’s court was not a court of law run and managed by lawyers, but rather a forum for medical investigation and expertise.[1]

The investigation took place on Wednesday June 26 and Friday June 28, owing to the fact that a member of Wakley’s medical team (Robert Liston) could not attend the jury viewing of the body on the Wednesday evening and Wakley did not think it right to proceed with the investigation with an absence. According to the depositions, the statements of George Kimber, ornament composition-maker of Rathbone-place who worked with Hall, and Charles Spradbrow of Gravesend, who was at Turnbull’s residence at the time of Hall’s death, were imperative for revealing the state of Hall’s health prior to his treatment. Kimber, who was Hall’s roommate, had seen Hall the morning before he left for his treatment, and “appeared to be in perfectly good health.” Kimber testified he knew Hall had been under treatment for deafness, but did not know of his ever taking any medicine or being ill, but he was aware of Hall’s visits to Turnbull, stating

Two months ago [he] first heard that [Hall] went to Dr. Turnbull. [Hall] had been very deaf for about six months, but had become more deaf during the last week of his life. He did not say anything as to the cause of his increased deafness, though sometimes directly after he returned from Dr. Turnbull’s he could hear very plainly. He was not so deaf when he first came to town, as he was two months ago. He said that the operation for his deafness gave him great pain the first time it was performed, but not afterwards.[2]

From Kimber’s deposition, it was made clear to the jury that Hall was likely suffering from temporary deafness, but in all other respects he was quite well and healthy until his last treatment at Turnbull’s practice.

[1] Prior to 1840, coroners were not required to have either legal or medical qualification, nor were they any legal requirements for medical testimony to be used as evidence. As Carol Loar explains, the typical coroner’s inquest was very formulaic, “revealing little more than the names of the coroner, jurors, deceased, suspects and the jury’s verdict.” Wakley’s campaign to reform medical coronership demanded that medical qualifications become an essential aspect of coronership, and he used his cases to highlight the importance and benefits of medical testimony, particularly autopsy reports, as evidence for juries. Carol Loar, “Medical Knowledge and the Early Modern English Coroner’s Inquest,” Social History of Medicine 23 (2010): 475-491; 478.

[2] “Inquests in Middlesex: Evidence of Witnesses at the Inquest on the Body of Joseph Hall. From the Depositions taken before the Court of June 26th and 28th, 1839, in the Parish of St. George, Bloomsbury, Mr. Wakley, M.P., Coroner,” The Lancet 32 (3 August 1839), 690.

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