MATERNITY DEATHS.

Auckland Star, Volume 55, Issue 49, 27 February 1924, Page 8

MATERNITY DEATHS.

THE KELVIN CASES,

EXTRAORDINARY STATEMENTS EPTICAEMIA AS "FKEtTMOHTA" j OTHER CASES WOT NOTIFIED. j KIFTEEX ABNORMAL "CHARTS." Continuing his address before the Com- \ mission of Inquiry after the "Star" went I to press yesterday, llr. Richmond said I that whilst he was appearing lor the I Health Department he wished to make | it quite clear that he was not repreI senting the officers of the Department. I His instructions were to appear solely in | the interests of the public. Should there he any blame attached to any member of the Department that was not his concern. He was to take an entirely I non-partisan attitude, and to produce through the officers of the Department the whole of the Departmental material available to the Crown. It might be | that no blame attached to anyone, but | tbe inquiry might show that there were I various directions in which the hands | of the .Minister and the Health Department might be strengthened. Counsel I believed from the information before ' him that the Health Office of Auckland had to cover far too wide a field, both in the matters which it had to attend to and its geographical extent. The Medical Officer of Health to Auckland had to cover the whole of the province, and he had to attend to various muniei- , pal schemes—and to help keep the country free from rats! ! High Maternity Death Rate. ""] he Minister of Health, and indeed the whole of ihe public, are greatly perturbed at the maternity mortality statistics of Xew Zealand, which compare unfavourably with those of other parts of the world," said counsel, who ; went on to state that our maternity mortality rate was the eighth highest I of the countries of which we had any record. This compared exceedingly unj favourably with Norway, Sweden and Denmark, and also with England and j Australia. He hoped that weaknesses r ex]>osed by the evidence to be given before the Commission would strengthen the hands of the representatives of the people in getting an extra vote of money for the Health Department, which coun- ', sel hinted was being financially stinted. I Cases Hot Notified. ! Counsel went on to describe at length ! the work of the health officers, and to i set forth the regulations dealing with : maternity hospitals and infectious diseases, and he said that he desired to I put in as evidence the compulsory register book of Kelvin Hospital. The regulations with regard to notification were , weak, said Mr. Richmond, when there occurred a group of high temperature cases none of which were notified, and ' which were perhaps followed by deaths from septicaemia. Kelvin had been ! inspected from time to time since 1913, and had been found to be a place of very .high standard. A "matron might know of half a dozen high temperatures, but she would not officially know that they were sepsis unless she was so notified by the medical attendants. It had been j suggested that it should be the duty of , the nurse to report a temperature which ran to the 10U for three days—as a j fact, not as a disease. f "Unhappy Doctors. j No doctor, continued counsel, was I happy in having to report sepsis, and i there was a reluctance on the part of ! doctors to allow temperature to be reI garded as suspicious. But the position ; in this case was that in September, at • this hospital, out of 18 or 20 cases, i there were nine abnormal temperature I charts. In October there were five ; abnormal charts out of 25 patients. • Most of these cases had temperatures ' • of oyer 100 degrees; one went over 107 j degrees; the majority were over 103 : degrees. One authority laid it down j that a temperature of 100.4 should be ! taken, in maternity casea> as prima i facie evidence of infection, : There was no co-ordination among ! doctors in these big private hospitals. j They did not report their cases to each ! other; in fact, septic eases were kept I secret by one from the other. In the j big public hospitals co-ordination was effected by the superintendent, to whom J all reports came. '■ A Conflagration Wanted. | There had been a great deal of doubt : about Kelvin being re-opened, and : some people had written to the Departi nient saying it should be burned uown. I It had been shut from November 12 to ( the end of January, until the Depart - I ment was satisfied that it was quite I safe to be re-opened. Ii the very desperate remedy suggested by some of the i public was resorted to counsel was afraid tbat we should be burning down our hospitals very frequently. In regard to the question as to whether the Department acted with promptitude on receiving notification, there would be put beiore the commission the whole of put before the Commission the whole of what had been done, and letters from medical men attending various patients, explaining their attitude in the matter. It was the opinion of the Department that the early cases of death were isolated cases or septicaemia, and probably had no connection with those which came later. "Matter for Gravest Inquiry." "But," said counsel, "it does seem a matter for the gravest inquiry and consideration as to whether the large group of temperatures, ending in tne death of Mrs. Delaniore, were not bound to raise a suspicion of something in the way of an epidemic of septicaemia." There was a remarkable temperature chart which was never reported—that of Mrs. Carter. Her temperature was 103 on the fourth day, and it jumped up and down in a very remarkable manner for a number of days. It reached 105 on November 4, and the patient on that day had a rigour. She eventually recovered, but her case was never reported as suspicious in any way. The doctor who attended her also attended Sirs. Delaniore, who was confined on November 4—on the very day that Mrs. Carter's temperature was 105. Where Does Suspicion Begin. It appeared to counsel that if this was not a ease of reasonable suspicion, then it would be hard for a layman to tell where reasonable suspicion began. After the Delamore case had been diagnosed as septicaemia, there was still no notification received regarding Mrs. Carter. Her condition was not known to the Department until the health officer visited Kelvin after he , had received notice of Mrs. Delamore's condition. Tbft. officer also investigated the case of Mrs. Muir, and whilst that was being done a ring cani e to the hospital from his office stating that the medical man had notified the case of Mrs. Muir as septicaemia. It was not alleged, said counsel, thai this notifical tion was inspired by the health officer's visit to the hospital*

"I think it my duty to say. that it seems to a layman, representing the public interest, that the case of Mrs. Carter, coining at it did after a great many others, and followed by the death of Mrs. Delamore. who was attended by the same medical praetii-ioiier, is a matter calling for very strict investigation," declared counsel. Health Officials Claim Overwork. Dr. T. J. Hughes, then gave evidence. In answer to Mr. Richmond, he gave evidence of the nature and extent of the work of his office, which exercised supervision from the Xorth Cape to Taumarunui and from East Cape to Taranaki. He declared that it \a-as impossible to do the work of his office as it should be done. He often had to work long hours, the quarantining of a ship disorganised tbe whole of the office, and he was liable to be called away to the country at any time. There was quite sufficient work in Auckland and suburbs alone to occupy the whole of the time of a medical officer of health. Diagnosis, Pneumonia —Post Mortem, Septicaemia. Regarding the matter of the notifications, Dr. Hughes said that the case of Airs. Jones was reported by Dr. Abbott as one of pneumonia. After the patient's death at the Auckland Hospital, to which she was removed, an autopsy revealed a septic puerperal uterus. This patient died on September 22. On October 8. witness received a letter from Dr. Williams, reporting a case of puerperal septicaemia, "if it could be called such when arising fifteen days after delivery.'' It was stated that this case (Mrs. Dacre) was, excepting for a sudden rise of temperature on the fourth day. very ivell throughout, and the patient was eager to get up on the tenth day. When the car was waiting for her on the fifteenth day, she looked ill and her temperature was taken and found to be very high. Dr. (arrick Robertson was consulted, and he had her taken to the Mater Alisericordiae Hospital. The doctor thought in this case that infection occurred after the patient got up. Didn't Think it Dangerous. Witness said that he did not think there was any danger of others being infected in regard to these two cases, judging by the medical reports and the circumstances, and the fact thnt disinfection had been carried out. The next case notified, said Dr. Hughes, was that of Mrs. Delamore. The notification was on November 10, but witness did not go to Kelvin until the 12th. He had only returned from Rotorua on the Saturday and on Sunday he had to go to bod, ill and tired out. In a Desperate Condition. The chairman: Dr. McCormick says he rang you on the oth and was informed you had gone to Kotorua. Why on earth he could not have notilied your assistant. Dr. Boyd, or some one else in the office, I can't understand. Mrs. Delamore was apparently in n desperate condition on the 9th. and there should not have been any delay in notifying her case. Why did you not go to Kelvin on the Saturday—or even Sunday—doctor ? Dr. Hughes said he had to go and report on a mysterious disease at Parneli, which had been brought under his notice as urgent by the City Council, and which was found to be enteric among the Maoris. The.Chairman: I should think that might have waited, that this septicaemia was more urgent. What Was Found at Kelvin. Dr. Hughes said he thought the other was more important at the moment. He explained that on the Sunday he had to go to bed, tired, out and ill." On the following day he visited Kelvin, accompanied by Miss Bagby. of his department. In addition to the case of Mrs. Delamore, he investigated other cases. While he was there he was informed over the 'phone that Dr. McDiarmid had reported the case of Mrs. Muir as septic. Mrs. Carter was reported as a case of pneumonia, but the chart shown him by the matron revealed that she had been given an injection of serum. Serum would be used for a septic condition, and he certainly thought that the case was one of suspicion. Dr. W. M. McCormick, who attended the patient, also attended Mrs. Delamore. Mrs. Carter had at no time been reported as a suspected case of septicaemia. After Mrs. Delamore's death, a long explanatory letter was received from Dr. McCorniick. This did not remove all suspicion from his mind, for Mrs. Carter may have had septicaemia and recovered. The Patient's "Chance." Mr. Richmond: Is it usual for medical men attending such a case as Mrs Carter's to attend another case without notification of any kind—is there not an "etiquette"' of any kind in this regard, or does the other patient just have to take her chance.

Dr. Hughes: I do not know whether the patient is notified or not.

Dr. Hughes then defended his action in reopening Kelvin Hospital late in January, and explained in detail the measures taken to disinfect, burn bedding; etc. The hospital had been empty for six weeks. If they acted on the suggestion that the hospital should be burned'down, then they would need to burn all hospitals down at some time or other.

To-day's proceedings are reported on another page.