Monday Series: An Inquest into a Surgical Procedure II

Charles Spradbrow also witnessed Joseph Hall in perfectly good health on Saturday June 22, having had seen him at Turnbull’s ten or twelve times on occasion to be treated for deafness, and was “always very anxious to use the instrument.” Several other individuals—as many as thirty, according to some reports—were also at Turnbull’s that Saturday, awaiting their turn to be treated for deafness. As Spradbrow testified, sometime around 10 o’clock, Hall filled up the air pump as full as possible, having become familiar with the set-up process from his previous visits. He also assisted Hall and Mr. Lyon, Turnbull’s surgical assistant, in setting up the instruments for catheterization, including connecting catheter to the pump. Spradbrow emphasized that both he and Hall were following the Lyon’s directions. Once the instruments were setup accordingly, Hall seated himself and Lyon inserted the catheter into Hall’s nostril and began to proceed with the process:

Mr. Lyon put the long tube up the deceased’s right nostril…turned the cock, and let the air out. It escapes in less than a minute. [Spradbrow] then filled the pump with air, and the tube being put by Mr. Lyon up the left nostril, he turned the air on, by Mr. Lyon’s desire, strong, a second time. Witness did not turn on the air so strong as he could have done. Mr. Lyon then removed the tube, and asked deceased if he would have it once more. Deceased said “Oh, yes,” or words to that effect. Mr. Lyon then put the tune up the left nostril again. Witness filled the pump, and turned the air off exactly as on the first occasion. The tube being emptied the fourth time, Mr. Lyon withdrew it, when, immediately, there was a low gurgling noise in deceased’s throat, and then fell back, very gradually, with his head against the top of the chair…and did not speak, or move, or open his eyes again.[1]

Example of an air press & catheter set-up. From: William Wilde, Practical Observations on Aural Surgery (London, 1853).

Example of an air press & catheter set-up. From: William Wilde, Practical Observations on Aural Surgery (London, 1853).

Upon realizing something had gone horribly wrong, Lyon ordered Hall removed and relocated to the adjoining room, away from other waiting clients. All attempts to resuscitate Hall failed.

At the inquiry, Wakley questioned Spradbrow on whether he had the operation performed on himself and to describe his experiences.  Spradbrow testified it had been three weeks since he last had the operation, but he had taken three or four charges at a single sitting, and was used to the effects of the procedure; the operation at times “produced a swimming in the head, and a portion of the air appeared to escape by the mouth, and the rest down the throat.” Spradbrow also described how he witnessed one other patient—an elderly gentleman—go into a fit and faint from the procedure, but he recovered with the aid of smelling salts; Spradbrow did not see the patient use the catheter again, though he still saw the elderly man visit Turnbull for other treatments for deafness. Another witness—name is unclear—testified that Hall had fainted during the same operation a month before and had declared he “would never try the experiment again.” All witness depositions revealed that something had gone wrong with Hall’s catheterization, but the question raised in the inquest was whether the procedure itself was the direct cause of death, or merely a byproduct of an underlying disease.

A postmortem examination was thus necessary to ascertain whether Lyon and even Turnbull were culpable for Hall’s death: “the Coroner observed it was the most desirable in an inquiry of this importance, that it should be terminated in one day, so that no ex parte statement might go forth to the public. It would, therefore, be advisable, that the medical witnesses should be examined in each other’s presence, and to proceed till the case was ended”[2]  Since coroners often had a hand in every step of the inquest procedure (including summoning juries, writing up the documents, publication of recommendations), Wakley chose his team of medical experts to conduct the postmortem.[3] The team included: leading surgeon James Reid (1803-1854), examiner in midwifery and member of the Royal College of Surgeons; Robert Liston (1794-1847), surgeon and Professor of Clinical Surgery at University College Hospital who attended the postmortem on Turnbull’s behalf; Henry Savage, Professor of Anatomy at Westminster Hospital, attending on behalf of the friends of the deceased; Richard Quain (1800-1887), Professor of Anatomy at University of London, and a Mr. Lynn.

Robert Liston. Mezzotint by W. O. Geller, 1841, after W. Bagg.

Robert Liston. Mezzotint by W. O. Geller, 1841, after W. Bagg.

Sir Richard Quain. Lithograph by W. Sharpe.

Sir Richard Quain. Lithograph by W. Sharpe.

The body was examined the day prior the inquiry, and according to Reid, it was “a most tedious examination, and necessarily so, and occupied three hours,” particularly since the body was already in a state of decomposition thus the “examination was not so satisfactory as it might have been.”

[1] “Inquests in Middlesex,” 691.

[2] The Chartist Sunday June 30, 1839, issue 22.

[3] Elizabeth Cawthon, “Thomas Wakley and the Medical Coronership: Occupational Death and the Judicial Process,” Medical History 30 (1986): 191-202; 194.

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