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CHESTER SEPTUAGENARIAN'S DEATH.…

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CHESTER SEPTUAGENARIAN'S DEATH. .0 ALLEGATIONS AGAINST THE INFIRMARY STAFF. REMARKABLE EVIDENCE. DOCTORS DIFFER. On Monday night, at the Chester Workhouse, Mr. J. C. Bate, coroner, held an inquest touch- ing the death of John Williams, aged 78 years, who was the tenant of an almshouse in Pepper- street, and who died at the Workhouse on Friday. The Coroner mentioned that the inquest was adjourned from Saturday evening, when the evidence taken was to the effect that the deceased fell in Newgate-street, opposite to the residence of Elizabeth Davies, on the 1st October. With the assistance of a neighbour. Mrs. Davies removed him to his house in Pepper-street, where Dr. Hamilton, jun., saw him. About three o'clock in the afternoon Williams was removed to the Chester Infirmary. Dr. Herbert Markby, resident surgeon at the Infirmary, was now called. He said Williams was admitted to the Infirmary about four o'clock in the afternoon, when the assistant house surgeon saw him. He (witness) examined him in the evening. Williams was then in a very dangerous condition, and could not answer any questions coherently. His assistant told him that as far as he could ascertain it was a fractured thigh. The Coroner Did you ascertain this beyond any doubt?—Witness: As far as one could ascertain. It was a fracture you could not swear to; it was what is called an impacted fracture, the two ends of the bone jammed in one another. And it was close to the socket P- Yes. And that would make it difficult to ascertain? —Yes. What was done for the man, doctor P-I con- sidered the best plan was to leave him quietly alone, leave it entirely at it wae. And this was what was done ?—Yes. Any means of keeping his leg in position ?- No. Mr. Hamilton saw him next morning. Of course he was admitted under his care. I told him I had done nothing beyond leaving him quietly alone, and he said he thought it was much the best plan. Continuing, Dr. Markby said about the second day after Williams came into the Infirmary he became very collapsed indeed, and they thought he was going to die. But he began to pick up again, and later on he became very troublesome. The Coroner: When was it he became troublesome ?—Witness: About the seventh or eighth day. Tell us what this troublesomeness was P-He would not keep quiet in bed; he would sit up and sit on the edge of the bed. He would shout and disturb the other patients in the night- time. What was the cause of that ?—Well, I should say an old man's senile imbecility. You put it down to senile decay P-Yes, being a troublesome old man. Wasshe troublesome wilfully-we want to know exactly what it was-or was it something over which he had no control ?—I don't think he had any control over himself. Was it the result of the pain P—Oh, no, x because he had no pain except when one tried to move him. He did not complain of pain except when he was touched. On the 12th inst. he was moved here. Who was it suggested he should be moved here.- I told Mr. Hamilton, senr., he was becoming very troublesome and noisy, and disturbing other patients, and he said Well, better remove him to the Workhouse, I really thought of sending him there first. You had better make arrangements for his removal. Who made the arrangements ?—I did; I wrote to the relieving officer. When did Dr. Hamilton suggest that he should come here P-I think it was Thursday morning. And that was the day he was removed ?-No, he was removed on the Friday, I think. At any rate, it was the day before he was re- moved. Did Dr. Hamilton ask you whether he was fit ?-He would not have given his consent if he did not think so. Did you both consider that he was fit to be moved ?—Yes, quite fit. I think you certified to the Relieving Officer that he was fit to be removed P-Yes, I did. Was there anything else the matter with him except this fracture P—No. Did you hear that he was suffering from apoplexy ?—No, I never heard that. Did Dr. Hamilton say anything about that or epilepsy ?—No. And you did not think the noise he made was the result of something wrong with his brain ? No, sir. It was not suggested to you and you saw no sign of it ?—No. And the only thing wrong with the man was this fracture P- Yes. and old age. Suppose he had died at the Infirmary, would you have given him a certificate ?—Oh, dear no. Hear the Coroner handed a letter to the doctor and asked him to say whether he agreed with the contents or not. The doctor replied in the affirmative. The Coroner (quoting): "The injury to the hip had nothing to do with his death, which in my opinion was the result of a fall." Do you agree with that F-Witness: "From," if you will follow it up, "an apoplectic or epileptic—" The Coroner: It is said the injury to his hip had nothing to do with his death?— Witness: I don't think it had anything to do with his death; I think it might have hastened on death, but I don't think it caused his death. What do you think he died of ?—Old age, accelerated by the fracture. You said you had in hand his removal. Did you see him put into the cab ?-No sir. What were your orders F-That he was to be carried down and put into a cab. Would it not be a painful thing for a man with his hip broken to be put in a sitting position ?—I did not think it would with him, because he had been sitting up by the side of the bed quite comfortably, and not complaining at all. For any length of time P-No. When he was found sitting on the edge of the bed he was promptly put back again; but if it had hurt him he would not have sat there. Would it not be quite certain that any heal- ing of the bone would be entirely undone by the removal.—Oh, no. Not at all ?—No, not if carefully removed. A fracture-board was put right across the seat, so that he could be put comfortably on that. You did not think it necessary that he should be sent on a stretcher ?-No. A man who is approaching 80 years of age does not recover very readily ifrom fracture of any kind, therefore you did not expect him to get better ?—I did not expect him to get better. I thought when he became troublesome he might have been so many weeks. Was there anything you could have done to have relieved his pain in the way of tying his legs together, or anything like that ?--He was carried down on a stretcher, and then his two legs were held together while he was lifted into the cab and put on the board. Our head porter and a nurse went with him, and I enquired how he travelled, and they said he travelled very comfortably in fact, that he was dozing the whole of the way. Mr. J. Hewitt (a juror): How was he troublesome, doctor ?—Shouting and trying to get out of bed in the night time, calling out and disturbing other patients, and using bad language. Mr. Hewitt. With regard to his pain, could you not have relieved him P—Witness He had no pain. Do you think it possible that a man of 78 years of age with a broken hip had no pain P— You find patients brought in with broken legs comfortable enough; they don't, as a rule, suffer pain. Mr. Hewitt: I think it enough to make any man noisy.—Witness s If he had been in pain and could not have slept, we should have given him a sleeping draught. The only time he complained of pain was when we were trying to thoroughly examine his leg. Did you give him a sleeping draught then ?— No, because the pain was soon over. Another Juror: Would he keep awake at nights to annoy other patients for pleasure ?— No, sometimes during the night he would wake up and become troublesome for a little time and perhaps settle down to sleep again. Would he not'have been better in a lying position P The bringing of him in a cab in an upright position, would not that cause him greater pain than on an ambulance stretcher I did not think it would, if I had thought it would have been, I should have tried to arrange for a stretcher. because, of course, the body way (practically upright and the jogging would act upon it ?— His leg was straight out. Yes, but the working of the body ?—Well, if you call the porter or the nurse you can get evidence from them that the old man dozed the whole of the way down practically. Was he unconscious with the pain ?-If he was given any pain he would have called out at once. Mr. Hewitt: That is from a doctor's point of view, of course, but from a human point of view ? You did not see the patient sent to the Workhouse. You gave orders for him to be w removed, but you did not trouble yourself how he went. You did not bind his limb up in such a way as to relieve him from any pain he might have been subject to. Witness: I considered he would travel quite comfortably, as I bad arranged for a fracture board to be placed and, with the porter to look after him, I thought he would be more com- fortable in that way than any other. Mr. Hewitt remarked that he was once a member of an ambulance class, and Dr. Markby's idea and what he was taught at that time were two different things. Asked by another juror whether it would not have been better to have had the injured leg in splints, witness replied that it was an impacted fracture, and a great many medical men con- sidered it best to treat such an injury without splints. The Coroner: Can you tell me the rules about the admission and removal of patients ? Aren't they kept there until the injury is cured? —Witness: As a general rule. Any distinction between poor men and rich men ?-No, all treated alike. Supposing this man had been in a position to have paid for his maintenance, would you have sent him to the Workhouse P—No, I should have told his friends to come and take him. As you could not do with his noise ?— Suffering, as we considered this old man was, from senile decay, and causing noise, I should have told his friends. The fact that he was an old man assisted you in getting rid of him ?-No., his mental con- dition. Supposing he had not been an old man ?— One would have known that it was the result of delirium tremens, and that he would have either died or got over it in a few days. Mr. Hewitt: If he had been able to pay for a private room, would you have put him into a private room ?-No, I should have told his friends. Witness, replying to further questions, said they could not keep patients who were noisy and riotous, as they could not isolate cases of that kind. Mr. Hewitt: The dead man's only fault was that he was troublesome. Witness: You seem to forget that the Infirmary is not for one patient, but for others. This patient became very troublesome and noisy, and was doing harm to other patients. When P—About the end of the first week. We had to consider other patients, and Mr. Hamilton agreed with me that it was the best plan for him to be removed here. The Coroner: When he gets here you know there are patients. Witness: This is the place where they are supposed te be sent to. Mr. Hewitt: That is for the ratepayers to say. The Coroner: Why send them here to disturb other patients here. What object had you ? Witness: I was quite under the impression you had accommodation for patients like that. The Coroner (to Dr. Archer) Have you ? Dr. Archer: No. The Coroner (to witness) You did not make enquiries whether they had ? Witness: No. Another juror mentioned that the old man was a Forester and in receipt of sick pay, and asked if the Infirmary had had any of that money ? Witness: Not a penny so far as I know. Nurse Ada Beeson, one of the nurses who attended the deceased at the Infirmary, said Williams was restless when he first came in, and then for two days he became quiet, and afterwards again became restless and tried to get out of bed. She did not ask why he was removed. The Coroner; Was there any reason ?—Yes, he was restless. Had you any other patients in the ward P— Yes, one boy. And how many more slept in the ward ?— Two besides the boy. Why was he removed P—He was not a fit patient to be kept with other patients. Will you tell us why ?—His conversation and his talk were not fit. Was he noisy ?—Yes. Did he shout at night ?—Yes. Did he disturb the other patients ?—I was not in charge. Was he quite conscious of what he was doing ? —Yes, he seemed to be, but not always. Continuing, witness said Williams was very quiet in the cab and did not complain. The Coroner: Did he know where he was going ?—Well, we did not tell him until we got him here. Did he ask where he was going ?-No. Witness further stated that Williams did not seem to be in any pain, and, in answer to Mr. Chas. Harrison, she said he was not uncon- scious. Dr. Archer, medical officer of the Union, said he was told during Friday that a man was coming to the Workhouse from the Infirmary. He (witness) saw him a few minutes past eight o'clock the same night. He made an examina- tion and found that his body was filthy. The Coroner Do you mean dirty P—Yes. His body was ?—Yes. Continuing, Dr. Archer said there was a large bruise up the right side of the hip joint. His left leg was shortened from two to three inches, and the foot in- verted. That was a sign of impacted fracture. He had two or three sores on the right knee. He was in a delirious state and uncon- scious of what was going on around him. His pulse was very weak. The Coroner a From that did you consider him in a condition to be removed t—I did not. Can you say certainly not f—I should say certainly not. Do you agree with what Dr. Markby said that the only thing was to keep him quiet P-Yes. Then it was the worst thing they could do to put him in a cab and drive him ?—I consider it extremely dangerous. He had told Dr. Markby that it was a most inhuman thing to do. The raising of the man and the putting of him in a sitting position would be a very painful thing P—I should say so. And to ride with his weight on the thigh-bone which was fractured would be a still more painful thing P—It is a matter of common sense and not for an expert to give that opinion. Did you have any complaints at the Work- house ?-Not after the first day. Suppose it was absolutely necessary to remove him from the Infirmary, how would you have removed him?—I should certainly have removed him in a recumbent position. In reply to further questions by the Coroner, Dr. Archer said there was no more convenience at the Workhouse for such a patient than there was at the Infirmary. The only place they could put him was where there were other patients, and if he had been objectionable and noisy he would have annoyed eight or nine other patients. He was not asked whether there was accommodation for the man before he was sent. He had ha<f similar cases. If there was any chance of their recovering one expected them to be sent to the Workhouse, but not if they were in a critical condition. The Coroner: You think that moving him here accelerated his death P-l do. He died on the 19th. As to the cause of death P—Senile decay first cause, and fracture and shock secondly. You saw no apoplectic or epileptic seizures?— No. Do you agree with Dr. Markby, that the injury to the thigh had nothing to do with the death ?—I do not. You say death was accelerated by it P—I say death was caused by fracture of the thigh acting upon an old man. The man had a prospect of living except for this fracture ?—Yes. By Mr. Hewitt. He did not think it would have been better had he been called to attend the man as soon as he got to the Workhouse, because the patient was sleeping, and he could have done nothing for him. Mr. Hewitt: But you could have done some- thing for him ?—I don't think I should have touched him. Mr. Hewitt was proceeding to make some observations, when the Coroner remarked that jurors should not express individual opinions. They could express a unanimous opinion after they had considered their verdict. Mr. Hewitt: I am new to this job, but I hare heard enough to sicken me of another. The Coroner, in summing up, said they had got abundant evidence as to what was the cause of death. They would come to the conclusion that the fall was accidental. The only thing he could sug- gest to them as likely to cause the fall was that being an old man he was liable to giddiness, which was a common thing among men of great age. They had heard the medical evidence, which shewed them pretty clearly that a man of anything approaching the age the deceased was, was not very likely to recover from a fractured thigh. If he were extremely quiet and easy to manage, and his vitality survived a good length of time, he might have recovered sufficiently to be convalescent; but under the circumstances- his removal from the Infirmary to the Work- house-there did not seem to have been any chance of his recovering. Dr. Markby. had stated that the reason for his removal was that he was noisy and objectionable. Well, he (the Coroner) could not help feeling that if he were objectionable at the Infirmary, he would be just as objectionable at the Workhouse. There was no reason why pauper patients should be annoyed by men any more than patients at the Infirmary. The deceased was a man known in Chester-he (the Coroner) had known him many years—and he had no doubt that he gave his voluntary contribution to the institu- tion. He thought the deceased man was quite entitled to the benefits of the voluntary surgical aid provided at the Infirmary. However, he seemed to have been brought to the workhouse because he was noisy and objectionable, and he was at that time in a condition about which the doctors differed. It was not the only case in which doctors had differed. Dr. Markby was satisfied that the deceased was in a fit condition to be removed. He might be of that opinion, but he (the Coroner) was not of that opinion. A man who had had a fractured leg for twelve days, and had been in a restless condition during those twelve days, was cer- tainly not in a fit condition to be sent in a cab in an upright position in the way in which he was sent to the Workhouse. Dr. Archer had told them that when he saw him at the Work- house his pulse was very feeble, and he could see in a moment that the man was dying. It did appear to him (the Coroner) that if he had been a man in a good position he would never have been sent to the Workhouse, and it was simply due to the fact that he was a poor man, and unable to pay for his board and lodging at the Infirmary, that he was sent to the Workhouse. The case was one in which they could not help expressing their feelings a little strongly. Nevertheless, there was nothing like an enquiry of that kind to put such matters as that with which they had to deal then before the public and get them righted. If they had anything to say with regard to the conduct of any person since the 1st October, it was quite right and proper for them to express their opinion. As to the cause of death, they would accept the evidence of Dr. Archer, the last medical nun who saw him. The jury retired to consider their verdict, and, on returning, the foreman (Mr. D. Dickson) said the jury were of the unanimous opinion that death was caused by shock from a fractured thigh, and they were also of opinion that the deceased was not in a fit condition to be removed from the Infirmary on the day he was brought to the Workhouse, and they con- sidered that if it were absolutely necessary to remove such patients proper appliances should be provided. DISCUSSION AT THE WORKHOUSE. At the fortnightly meeting of Chester Board of Guardians yesterday (Tuesday) morning, when Mr. J. Pover presided, Mr. A. W. Jones directed attention to a report in the newspapers of an inquest held at the Workhouse the previous evening, on a man named John Williams, 79 years of age, who was a patient at the Chester Infirmary, and in consequence of his noisy and troublesome behaviour was sent to the Workhouse, where he died. The Coroner said some very strong remarks about the pro- priety or rather about the want of humanity on the part of the Infirmary authorities in sending the man to the Workhouse as they did in a cab. Dr. Archer said it was most inhuman to send the man there. He understood there wete two reasons for the course of action adopted by the Infirmary authorities, one being that there was no pay for the man being kept there, and the other that he was troublesome and noisy. If he was troublesome and noisy he would be equally so in the Workhouse ho&pital, and why should the poor have to put up with what the other part of the community would not tolerate. But the reason he brought the matter forward at all was for the purpose of asking the Clerk by what authority the Infirm- ary doctors should send patients who were troublesome to the Workhouse. Mr. Rowe Morris: I asked the question five years ago, and it has never been answered yet. 1he Clerk (Mr. W. Turnock) said the only thing he could say was that the Infirmary Board had no power to send any cases there, and they were not compelled to admit them, but it seemed to have been a kind of usage there for many years, long before he became clerk, that if there had been a_case at the Infirmary that they could not properly deal with, they made an application to the re- lieving officer, and the officer transferred the case to the Workhouse, as in the instance under discussion. He quite agreed with what Mr. Jones said, that if a patient was troublesome at the Infirmary, there was no reason why he should be brought to the Workhouse to be equally troublesome and noisy, and disturbing to the patients in that institution. It was competent for the Board to give instructions to the officers not to take in such cases, because as long as the man was a patient in the Infirmary he was not destitute. Mr. A. W. Jones said he begged to move that such cases be not accepted, and he quite thought, with Dr. Archer, that it was most inhuman to put a man who had broken his thigh to such torture as to sit bolt upright in a cab. The least that could have been done was to send him on an ambulance. Mr. M. Kennedy said he had known the deceased for many years, and for a long time he was a porter at Bolland's, and latterly he was employed by Messrs. Churton, Elphick and Co. If all that had been stated was true and Hnexaggerated it was a very serious charge to bring against the Infirmary, and he hoped that when the circumstances were investigated they would not turn out so bad as had been repre- sented. It had been stated that the man was sent there with a broken leg without either splint or bandage. If such a thing had happened in any foreign country they would know what a very dreadful thing it was. He should like to ask the Master whether it was a fact that he came there without splint or bandage. The Master (Mr. R. C. Turner) said it was perfectly true. The man was put to sit upright in the cab, but a fracture board was put under him fer the purpose of holding the leg in posi- tion; but the fractured part was the thigh, and the whole weight of the body was upon it. (" Shame. ) He received the man himself at the entrance, and immediately had the case sent round to the hospital, and the old man was lifted out of the cab and carried upstairs on a stretcher. When they got him upstairs he went to sleep. There was no splint used what- ever, but he should like to say this, that when the relieving officer came to him and informed him that the patient was going to be sent from the Infirmary he gave him to understand that Dr. Markby had said that he was going to put a splint on the man's leg. The man, however, came without any splint, and the reason why was not explained. Mr. Kennedy said he had great pleasure in seconding the resolution, but he should also like to call the attention of the Infirmary Board to this matter. It was such a serious charge to bring against an institution of that kind, that unless the charge was replied to it might have a very serious effect upon the income of the Infirmary, which was largely supported by the contributions of the working classes on Hospital Saturday. They would say "If this is the treatment our poor fellow-creatures get,we will not contribute any more. It was desirable, in the interests of the institution, that there should be some explanation. The Clerk explained tthat Mr. H. Ander- son was acting for Mr. Harrop at the time of this removal, and Mr. Anderson called upon him (the Clerk) with Dr. Markby's letter, which stated that the Infirmary had a patient named John Williams, 79 years of age, who was admitted a week age with a fracture of the thigh, and who had been so troublesome and noisy that he appeared to be a suitable case for the Workhouse Infirmary. He (the Clerk) advised Mr. Anderson to get a certificate from the medical officer, which would state that the man was in a fit state to be removed, and the certificate obtained was as follows The Infirmary, Chester, Oct. 12th.-I hereby certify that John Williams is a Atf;cme toltbe Iremoved to the: Workhouse Infirmary," so the Board could see by that that its officer, Mr. Anderson, protected himself in the action he took. (Hear, hear.) Mr. Kennedy I am very glad he did. Mr. Anderson explained that Dr. Markby promised at first to send a temporary splint, but when the cab went down he expressed the opinion that the patient being in the cab a splint would be the worse thing that could be put on him, so instead of a splint being used the man was placed on a fracture board and a nurse and the Infirmary head porter went with him. Every- thing was done for him that could be done, and he could not have had a more comfortable journey. Mr. Butler: The man died the next morning after he came here. Mr. A. W. Jones: It does not matter what Mr. Anderson says. Our own medical officer said it was most inhuman to bring the man here in a cab, and he ought to know. Mr. Butler: I think we ought to write for an explanation. The Master: I hope and understand that the Workhouse authorities were exonerated at the inquest. (Hear, hear). The Rev. F. Edwards suggested that the motion submitted by Mr. A. W. Jones should be allowed to remain in abeyance, and that before further steps were taken the clerk should communicate with the Board of Manage- ment of the Infirmary, asking for an explana- tion. Mr. Jones agreed to withdraw his motion in favour of this amendment, which was put to the meeting and unanimously carried.

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