Pain from an infection in an American woman's nervous system was so bad she could not even respond to her name, a Coroner's jury heard yesterday.

And it emerged that Mia Warren, of Memphis, Tennessee, was so uncontrollable she had to be restrained -- by a method banned in the UK.

Coroner Will Francis and a jury of four women and four men heard how the 21-year-old waitress died of staphylococcal meningitis on June 4, 1997 at King Edward VII Memorial Hospital.

Ms Warren went to the hospital complaining of back pain and was treated and released, but returned to KEMH two days later with debilitating pain.

Meningitis is inflammation of the outer portion of the brain usually due to viral or, in Ms Warren' case, bacterial infection. The jury has seen X-ray evidence of a cyst surrounding one of two specially designed Harrington Rods supporting her spine which were inserted after a 1995 accident in her hometown.

Ms Warren was disoriented and did not even know her name when questioned by a St. Brendan's psychiatrist, called out of his bed at 1.20 a.m. on June 3 to examine the woman. Hours before, she had fallen from the bed and had begun kicking and biting hospital staff and picking at her hair -- prompting suspicions she was on drugs.

"Mia Warren was clearly disoriented in time, place, and person,'' Gareth Smith -- who has returned home to Scotland -- told the jury.

He immediately did a fundoscopy or the common retina check that all doctors perform during examinations.

"In this case the retina at the back of the eye was swollen to an extent I had never seen before. I had only read about it in textbooks,'' he said in response to lawyer Michael Smith who represents the Warren family.

"I was annoyed. I ordered the blood tests which I saw no evidence of already being ordered in the days previously,'' Dr. Smith said.

"Yes, if Dr. (Naveed) Abbassi had done a fundoscopy, he would have seen such swelling.'' When Mr. Smith asked about the method used to restrain Ms Warren, who had been flopping uncontrollably about the bed, Dr. Smith said: "She was spread-eagled about (and strapped to) the bed. I had never seen that before. It was very distressing.

"It's a level of restraint we don't even use at St. Brendan's. If I have a distressed patient, I have a nurse or nurses hold them for a time. It's more humane. This sort of thing is completely illegal in the UK.'' Later, Dr. Smith explained his perception of Ms Warren's condition, three days into the ordeal.

"You could smell the sickness in that room,'' he said. "You could tell someone was very, very sick. That's why I wrote that they should take a blood sample before they call a psychiatrist.'' The inquest is expected to last all week as doctors are grilled on how Ms Warren died.

The jury has heard how Ms Warren suffered a severe back injury in June 1995 in a car accident and was in Bermuda for a wedding of a family member.

According to her mother, Ms Warren lived with some pain, but it was "nothing serious''.

Jody Lynn Hays, testified her daughter was mobile and able to work in the months before coming to Bermuda, but developed pain shortly after her arrival.

Inquest into US waitress' painful death in hospital Mrs. Hays said her daughter "acted crazy'' after US doctors gave her an overdose of pain killers in hospital in 1995 and during a visit to her daughter at KEMH, she exhibited similar behaviour.

Family friend Robert Garlock said a doctor at KEMH -- whom he could not identify -- told Ms Warren's family she was having muscle spasms at either end of the two rods and that muscle relaxants were being prescribed.

An autopsy report said a quarter of a litre of pus was drained from her spine and there was an equally large amount in her brain.

KEMH radiologist Daniel Stovell, reading from X-rays he inspected while Ms Warren was in hospital, said he thought an "abnormal'' oval shaped area on her left side could have been several possibilities.

"Knowing what we know now, that is the abscess that caused the meningitis,'' he said.

Also appearing before the inquest was KEMH Chief of Staff Dr. John Patton who read in the statements of four doctors who have now left the Island.

Lawyer Jai Pachai represents the Bermuda Hospitals Board and Sgt. Phil Taylor is the Police Coroner's Officer.

The inquest continues today in Magistrates' Court.