MATERNAL MORTALITY.

New Zealand Herald, Volume LXI, Issue 18649, 4 March 1924, Page 9

MATERNAL MORTALITY.

KELVIN CONDITIONS. CONSULTANT'S EVIDENCE. SAFEGUARDING PATIENTS. RELIANCE ON HEALTH OFFICE WIDER NOTIFICATION URGED The Royal Commission's inquiry into the deaths of five mothers in Auckland hospitals was resumed yesterday morning, with Mr. F. Earl, K.C., as chairman. Other members of the commission are:— Sir Donald McGavin, C.M.G., D.5.0., Director-General of Medical Services; Dr. J. S. Elliott, of Wellington, and Lady Luke, also of Wellington. Counsel .for the different parties concerned axe —Mr. Richmond, for "the Health Department; Mr. A. H. Johnstone, for the petitioners.; Mr. Finlay, for Nurse Gibbons, matron of Kelvin Private Maternity Hospital; and Mr. Lean,-, with Mr. Duthie, for Dr. A. E. Williams, Dr. W. N. Abbott, and Dr. W. M. McCormick. In addition to further examination of Mrs. Rhodes, mother of Mrs. Delamore, evidence was given by Dr. S. A. Bull, who was examined at length on questions concerning the illness and death of that patient in Kelvin Hospitals. Mrs. Rhodes made certain complaints' regarding conditions at Kelvin. Her daughter, Mrs. Delamore,, said that the doctors had washed their hands in her room, the labour room. The noise and management were very dreadful, to her mind. Dr. Hughes said to her, "Are you not going to lay a charge against the doctors?" Witness thought that her daughter had been given chloroform before the doctors arrived. The Chairman: You, are not making a suggestion that any unqualified person administered chloroform?—l can't swear, but I believe it. Reason for Public: Protest. Mr. Friday: You claim to be the originator of the commission ? — have sent in protests. '.•■■ * Your purpose is to close up Kelvin?— I have not said that. . What is your purpose ?—To stop • the 'deaths of our womenAfter questioning, witness said that she would do the best she could to put Nurse Gibbons out of business. Counsel: That is your determination? —It is still my wish, and hope. Witness denied that she had devoted a great deal of effort to the matter. _, Counsel: Did you not suggest to the fisherman that he should not go to Kelvin?— have never seen a fisherman. I think that is very funny. Mr.' Richmond: Do you suggest, Mrs. Rhodes, that Dr. Hughes, when you saw him on November 26, took up a hostile attitude ?—He ! was nice to me, but he gave me the impression that he did not intend to do anything further or to make any fuss about complaints. _ What were your complaints?—l had complained that the house was a septic house, that the matron knew it, and that Dr. Hughes knew it,"or ought to have known it. I say that my daughter's death was legalised murder. That is what I feel in my heart. Under cross-examination by Mr. Finlay, witness refused to accept the suggestion that' the two special nurses took charge of her daughter, from the time they entered .the hospital. Mrs. Rhodes contended that:it was impossible for them to do it, as one nurse could not do all the work without aid.- She also declined to accept the chart of Mrs. : Delaroore's condition as a full record of her condition, and explained personal knowledge of conditions which were not recorded in the ■ ; chart at all. 'Notification ol Suspicious Oases. ' Dr. S A. Bull said be was called in consultation, with Dr. McCormick on the case of Mrs. Delamore. He found- the patient in bed. with a high temperature, and she.was intensely anaemic. He examined her, and came to the conclusion that she , was' suffering from some form of infection,r with some , form of blooddestroying organism. Quinine treatment, which was considered suitable in the patient's condition and : history, did not bring an improvement, and he concluded that she should .be notified as a septic case. '. , Witness thought . that in such a case, where the temperature rose.to 100 to 101 degrees, it should be notified tcrtne Health Department. Any case with a temperature of over 100 needed special careT Early bacteriological examination could do no harm. v., ~ In reply to Lady Luke, witness- said that if he had a patient about to enter a maternity home, he would not inquire into the recent history of the home, as he would expect the nurse to notify him of any septic cases. _ The Chairman: Why should she? It is not likely that she is going to volun- > teer the information.—lf she had an undoubted case of sepsis, I should expect her to notify. I think that one should rely on the medical officer of health.

Trust in Medical Men. The Chairman: Supposing you had been in charge of a maternity case, in, say, the first week of November, and you had known of the : deaths of Mrs. Jones and Mrs..Da«re from septicaemia, would you have e'dowed your patient to go into that hospital?— should have made particular inquiries. You would have been put upon your guard, and your patient would not have gone into the hospital until, you were satisfied?— That is so. Is it not a part of the trust imposed in a medical man bv his patient that he is satisfied as to the hospital?— doubt, but if that were to be carried out fully in practice each medical man would have to inspect every nursing institution. It is more practicable to have inspection concentrated in a centra] department. The question of infectious cases, he added, was a matter for the Health Department. Medical men could not individually go into each case. They had to rely upon the Health Department. Relying on Broken Reed.

Then, if you depend ;upon the Health Department, which is admittedly understaffed, you are depending on a broken reed. Would vou say that the medical officer pi health should not be overworked, and that the department should not be understaffed ?—I quite admit that. Witness added that personally he had every confidence in the Health Department, after an experience of 30 years. The Chairman: As a reasonable man, I suggest that, it is desirable, seeing that the Health Department is overworked and understaffed, that there should be some pystera by which medical men could make inquiries before sending patients into a hospital. a system would he a good idea if it -were practicable, but it was not the custom. * If there were some such custom, would it not tend to save life ?—lt certainly would, if it were practicable. As a matter of fact, he added, the relatives of expectant mothers generally made the arrangements about the hospital and the medical man frequently did not know anything about it until he was summoned. In reply to Dr. Elliott, witness said it ■would be impossible for a medical man to make exhaustive personal inquiries from nurses and others every time he took a maternity case. Burden on Doctors. Dr. Elliott asked if a doctor with the almost intolerable burden he now had to carry were to assume responsibility for the making of preliminary inquiries into every case, would it not make it extremely difficult for women to find a doctor who

■would take up their cases ?—That is my opinion. In theory the making of inquiries is all right, but in practice it •would be impossible. Witness, in reply to Mr. Johnstone, said: that puerperal septicaemia -was most certainly a serious disease, and had a very serious effect upon expectant mothers. They often had these matters discussed quite openly before them, and the result was sometimes disastrous, especially in the case of a nervous patient. In reply to further questions Dr. Bull agreed that notification should be made as wide as possible. If. every case over a certain temperature were notified they ■would get everything, and would make certain of including puerperal' septicaemia. He most strongly disapproved of the sanitary arrangements at Kelvin. Menace of Plies. Witness also made reference to the manner in which micro-organisms were carried, and said that in a certain case of sepsis, he would look for direct infection. It was possible that infection from flies was too often overlooked. Later he stated that an extensive campaign against flies would result in nothing but good. Mr. Johnstone: Is it not most unusual for four septicaemia cases to appear at a j hospital within as many months?—l should say it is unusual. " ' Was not the treatment in Mrs. Carter's case rather unusual for bronchial pneumonia? The treatment was somewhat unusual. Is not all tha't* treatment" consistent with the diagnosis-of septic trouble-or a suspicion of it?—, You wish me. to judge the mind of the medical attendant. I cannot surmise what was in ' Dr. * McCormick's mind. • • To the ."chairman,, the. witness, said .the treatment was an antidote to septicaemiaEffects of Influenza. Cross-examined by Mr. Leary, witness ; agreed that influenza ravages were much wider and more severe than they were in 1908.' Sines it has extended its operation, it has affected in a septic manner a good many vital organs?— Yes. After further questioning, the chairman protested against the examination, which he was not able to follow. Counsel was getting into deep waters. Mr. Leary replied that he was laying the foundation for his address to the commission. He wanted to show that the effects of influenza had extended to an enormous degree, and attacked organs which before were free from the ill effects of influenza. There was no inherent reason why they should not attack the genital organs when they were susceptible to attack. He was trying to afford support, for that thesis, and that was the line of discussion. All I these matters concerned complaints of a septic nature brought on by influenza itself. And this' trouble was 'at the ; height of an influenza attack. Referring to the dieting of ..Mrs. Dela--1 more after confinement, witness said that in ;dieting of all patients there was room for education on the part of medical men and nurses. Tinned Salmon Bather Unusual. Lady Luke* Well, as a mother, if my daughter were given tinned salmon within 24 hours, I should want.to know what was the matter. —I quite agree with you. I think that the diet as it is stated to have been given to Mrs. Delamore is somewhat unusual. Tinned salmon is not a very wholesome delicacy. '. The Chairman: Can you defend it? It is decidedly unusual. But can you defend it? No. The chairman again questioned witness if he would have sent a patient into the hospital on November 4, if he knew that there had been two deaths from puerperal septicaemia on September 26 and October .10 respectively.— would certainly inform the patient's relatives. Would you take the responsibility of sending a patient to . the hospital?-—I would not accept the responsibility without making inquiries and taking precautions. ■;"'- Kelvin Sanitary Arrangements. Alfred Edward Edwards, plumbing and drainage inspector, Auckland City Council, said he had made an inspection of the sanitary fittings in Kelvin hospital. On the ground floor he saw ■, a lavatory compartment i about 12ft. by fl£ft. 6in., containing water-closet, bath, rosin, and sink the floor being covered with linoleum, having several joins. A nurse had informed him that the sink was used for washing out bed pans. This sink, in his opinion, was not suited for this purpose, .being an ordinary washing-up sink. The lavatory compartment appeared very cramped; and it would be possible when emptying the' bed pain after washing out to spill the contents into .the bath. If the sink, were meed for ordinary purposes it complied with the City Council's requirements. The dishing of a gully trap outside the sanitary fittings on the upstairs floor was defective, and it was possible for the waste -water to get outside "the drain and cause the ground to become foul. The, Commission adjourned till 9.30 this morning.