Medical qualifications: optional

zeifertHere’s a report of a criminal trial at the Old Bailey from a little over a century ago which truly made me grateful for modern medicine – and in particular for the modern regulation of the profession.  In this case a doctor without any qualifications escaped with a slap on the wrist, despite having killed a patient.

On March 3rd 1908, a Polish émigré called Isidor Zeifert stood trial for manslaughter.  He ran a pharmacy in central London, Soho Drug Stores.  On the door was a sign stating ‘Teeth Extracted’.  A tailor who lived nearby, Nathan Farvish, entered the shop on January 18th.  In his evidence he explained why:

Deceased was my wife and lived with me. We are Russians. She was 41 years old. Up to January 18 last my wife was in pretty good health, but she suffered sometimes from rheumatism. At that date she was suffering all night from toothache, and I went with her to the defendant’s shop at 54 A, Broad Street, Soho, about 20 minutes past three. When we got there we first saw an assistant in the shop; then the prisoner came, to whom my daughter spoke. She said to him, “My mother is very weak; she is suffering from rheumatics; she was all night suffering from the toothache.” I then asked him if he had any gas in the place. He said he had not got any, that after gas she would suffer for weeks from the head. Then I said to him, “Have you got any stuff to give her to have her tooth out without any pain?”  He said he had got some stuff but it was very dear, and that was cocaine; that it would cost about half a crown each tooth. I said I did not mind about the money if he would try to take it out carefully without pain.

Cocaine was by this time well known to be an effective local anaesthetic.  One of the first to investigate its properties was the great surgeon William Halsted, who conducted experiments on himself – and as a result remained a cocaine addict for the rest of his career. Farvish and his wife agreed that Zeifer should go ahead.  The amateur dentist then

went into the shop with my daughter for about two or three minutes, and on coming back he took out from a drawer a little box, and took out a syringe. He also took a small bottle and put some stuff like water in the syringe. Then he says to me, “Hold up her head,” after which he put this staff into my wife’s mouth with, a syringe. She was sitting on the chair. After he had done that my wife says to me, “Look what he makes my face; it is all crooked.” Then Mr. Zeifert answered, “When the tooth will come out that will be all right again.” He took one tooth out and was showing it to me. Then he gave her some water to rinse her mouth out, and while that was being done Zeifert said it had taken too long; he could not afford to wait so long. I said then, “Do you mean to say you have no time to waste? I pay you for your time.” He then started to work on the other tooth, and when he had taken it out my missus shut her mouth, and some white stuff came out from the lips. Mr. Zeifert says, “We’ll take her out and lay her on the couch,” which we did. She was then in what you call a convulsion.

Clearly panicking, Zeifert sent for a doctor, and told Farvish not to worry as his wife would soon recover.  She didn’t.

Then I began screaming, and my wife got cold in the hands. When the doctor came it was about three-quarters of an hour, or half an hour, later. My wife was by this time very quiet, and he began working with her arms. Zeifert went to the door and asked the doctor quietly if he thought it was manslaughter.

Classy.

I then started to make a row: “My wife is dead; why did you not tell me before?” Before prisoner took the tooth out he never examined my wife, nor asked her any questions about her state of health.

The doctor called by Zeifert arrived; alas, too late.  He also gave evidence:

On January 18 last a boy came to me at 2, Charlotte Street, in consequence of which I went to prisoner’s place. When I got there he told me he had given, some cocaine to a woman to take out some teeth, that she had had convulsions, then fainted, and had remained in that condition. I then went into the room at the back of the shop and saw Mr. Farvish, and the woman lying on a couch. I examined the woman, and thought at first that she was alive, as I thought I saw a movement of the lower jaw; but on further examination I found no evidence of life. She might have just died as I came into the room. I tried artificial respiration, and gave her two injections of strychnine on the off-chance, but it was quite hopeless.

Strychnine, a deadly poison, was still being used as a cardiac stimulant at this date – it was even employed by some of the surgeons who conducted the first repairs of cardiac wounds.

The police then arrived, and I made a statement to them. Cocaine has been known in England for surgical use since about 1884; of course, the drug had been known for centuries. It is an uncertain drug, and is scheduled now as one of the poisons in the Poisons Act; that was done in 1905. All drugs are dangerous, of course; death has been known to result from Epsom salts; but those drugs which are scheduled as poisons are particularly dangerous. It is certainly desirable to examine the patient before administering these drugs; it is not done very often. It is highly probable that the condition of the deceased woman’s heart would be discovered by examination. Assuming that condition of the heart, cocaine was not a proper drug to use, in my opinion.

A police surgeon who also examined the body confirmed the view of the doctor that cocaine was dangerous, adding that the dose employed by the defendant was dangerously large.

The court then heard from the medic who conducted the post-mortem.  He reported that the woman was suffering from heart disease:

In my opinion, cause of death was failure of the heart and respiration while deceased was under the influence of cocaine. In the woman’s condition cocaine was a dangerous drug to use. Assuming a healthy patient, a quarter of a grain would be a sufficient dose of cocaine for extracting a tooth. Half a grain would be dangerous. (To the Judge.) It is not possible to say, even where the patient is supposed to be healthy, what the effect of cocaine will be; it is a very uncertain drug. I could not prognose what the effect would be even on myself. Cocaine should not be used on a person with a weak heart. I should advise that cocaine never be used.

The defendant was then called to give evidence:

I am a Russian born in Moscow. I studied at Vilna for seven years; afterwards entering Warsaw University, where I took a special course of medicine and surgery, and took the primary degree of bachelor of medicine. Before I got to the final examination I got into political troubles and had to fly the country. I came to London and took a position under a doctor, with whom I remained for 13 months, practising every day under him.

Medical qualifications at this date apparently being desirable rather than essential.

I then became assistant to a Dr. Harvey, with whom I was three years. I then went with another doctor for nearly three years; then started a drug store in Euston Square on my own account, after which I went to Broad Street, where I am now. For about 13 years I had been in constant practice as a dentist. I have never had any accident before, and I have administered cocaine a good many times. I had no intimation that deceased was suffering from a weak heart. The solution I gave was one-third of a grain, 3 per cent. solution, two grains to 60 minims of water.

Under cross-examination, he was asked whether he was aware of the dangers of using cocaine:

I believe I told the Farvishes that it was a dangerous drug to use. I cannot remember. They wished me to use cocaine and I did. In this case there were stumps, and you could not do otherwise than use. something to deaden the pain. You do not necessarily examine the patient first. I have seen many men who have not examined; they are supposed to, but they do not. It is nonsense.

An attitude which thankfully is rarely encountered today.  And the outcome?

Verdict, Not guilty.

His Lordship recommended prisoner to be more careful in future in ascertaining the condition of the patient’s heart before using cocaine.

That’s him told.

[The full trial transcript can be read here]

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