MRS BOYLES'S DEATH

Otago Witness, Issue 3280, 24 January 1917, Page 24

MRS BOYLES'S DEATH

] NQUEST CONTINUED. Mr H. A. Young, S.M. (coroner) continued the inquest on the- 18th into tho circumstances surrounding the death of Amelia Mary Boyles, a married woman, who died at tho Sfeacliff Mental Hospital last Friday, after being admitted from tho St. Helens Maternity Hospital. Constable Sivyer gave evidence concerning tho conveyance of Mrs Boyles. in a motor car to Seacliff. Witness sat on ono side of the patient in tho back scat with the polico matron on tho other side. Going along Georgo street the patient complained, that sho was cold, and Miss lngfis and witness thought it would bo better to get a rug. They went to tho North-East Valley police station, and borrowed a blanket from tho constable there. The blanket was wrapped round the patient, who appeared to bo quito comfortable. Any questions witness asked her sho. answered in a rational manner, and said that she Avas all right. Witness borrowed Boylcs's handkerchief to tie round the patient's hat. The patient's hair had not been dressed, and they could not keep tho hat on properly. There was not much conversation, but what there was was quite rational on tho patient's partTo the matron at St. Helens: Ho remembered that she (tho matron) had thought that tho patient was to lie along tho seat on the back. It was impossible to carry tho patient in that position. They tried to keep her in a lying position as much as possible. Charles Boyles, confectioner, residing at Cavcrsham, said ho sent his wife to tho St. Helena Hospital on the night of Thursday, December 21. The child was born on tho following day. Tho first visit witness paid to the hospital was on tho following Sundaj—tho 24th. Witness tnought his wife seemed fairly well. She complained that at times sho felt rather cold'—that there was rather much air in tho morning. Sho also complained of being disturbed because of babies being allowed to cry in the vicinity. Sho said that once a baby commenced to cry it was allowed to cry itself out, and that it was beginning to get on her nerves. Witness made no complaints to the authorities. His wife also stated that the patients were disturbed every two hours, whether they wero asleep or not. Witness noticed that a draught was blowing—that might, however, bo necessary in a place like that. Witness saw his wife on tho Monday. Sho had then been removed to the isolation building, and was looking rather ill and nervous. She stated that during the preyious night she felt cold, and that in tho morning she took a shivering fit, and that they had removed her to tho isolation ward. When witness arrived at the hospital tho sub-matron told him that Mrs Boylca was not feeling very well, and that they had removed her for the sake of quietness. Witness saw his wife again on the. Tuesday, December 26. She was in the same room, and was looking very poorly indeed. She appeared to witness as if she was going to have a nervous breakdown. Tho room was very draughty—there were some swing ventilators and doors open. There was a door leading into another room, which was open, and this door was continually banging and squeaking with tho draught. iSome distance away another door would shut with a terrific bang about every five minutes. Under another door there was a space of an inch or more, and with all these openings there was a very strong draught in tho room, as there was a high wind blowing that day. Witness asked his wife how sho could stand all the noise and draught, and sho replied that sho was not standing it at all —that she had rheumatics in the lingers, one of which was bound up. She also complained of having sciatica In the right leg. Her eyes were running, and sho was suil'ering either from oold or influenza. She also stated that that afternoon tho matron had told her for the second time that sho would have to find a name for the baby within a day or two. His wifo said that if she was asked again she would say any name for peace sake. Witness said that he would see the matron and tell her that the matter which immediately concerned her was his wife's health, and not tho baby's name. His wife begged him not to say anything to the matron. She said, "You don't know how horrid she can be. She will make me suffer if you speak to her." Witness was not satisfied at all, and lie suggested_ seeing another doctor, with a view to having his wifo removed in an ambulance elsewhere. Deceased persuaded him not to do anything in tho matter in the meantime. Witness rang up the hospital that evening, and told them that, with regard to tho baby's name, that was a matter he would attend to, and that he did not want his wife worried oyer unimportant matters. His wifo told him that she first saw a doctor on the Monday, and he understood that it was on the doctor's orders that she was removed tO' the isolation room. In reply to witness his- wife said Dr Siedebcrg waa the doctor. Deceased told him that some of the instructions issued by the doctor had been ignored, and that the doctor had called the nurses to account for it. He understood this to refer to fires, which had not been lighted, although the doctor had given instructions that this should bo done. Deceased also said that she had not much chance of recovery, as they were always changing the nurses. Witness next visited the hospital on the Thursday, at the request of the matron. His wife was asleep when he arrived, and the matron told him she was under the influence of morphia. Witness stayed at (lie hospital all night, and injections of morphia, were continued at intervals during the night—the last injection was given at about 8 a.m. Dr Siedoberg, so far a 3 ho knew, saw the patient at 3 o'clock that morning, and, so far a.s witness was aware, did not seo her again. He was informed that he would have to see tiie magistrate that morning (Friday) with reference to committing his wife to the Mental Hospital, lie was told this course would be necessary. At about 9 o'clock the matron informed witness that ho was wanted at tho Magistrate's Court. He went to the court, and found Dr iSicdeberg. After filling in some particulars he returned to the hospital, and found his wife awake and quite rational. Sho was eating an orange. The magistrate arrived a few minutes later, and the questions asked her then she answered quite rationally. Witness suggested to the matron about a quarter of an hour later that, as the deceased had recovered her mind, it would be unnecessary to remove her to a distant place like Seacliff. The matron said she would have to be removed from there —that sho had no time to attend to such cases; that they had no facilities; and that her hands were unset enough already. The patient would have to bo removed as soon as possible. Witness then suggested calling

ill another doctor, but the matron said that ho could not bring a doctor there without tho consent of Dr Sii deborg, who was in chary..' of tho hospital. Just then he was called on tho telephone, and Consfcablo Sivyor told him that his wife had been formally committed to Soacliff. Witness asked that tho patient should be wrapped up a bit better when they wcro all standing round the car. The remark was not addressed to anyone particularly, and no reply was made. Witness suggested that he should tako his seat by the side of his wife, but no reply was made, to this request. One day when witness saw his wife at Soacliff she said one of tho nurses at St. Helens had said sho could die, if she liked. She also said that, just prior to leaving iSt. Helens. tho sub-matron told her that she was full of disease. To Dt Siedeberg: On the Thursday night—about two hours after his arrivalIns wife woke up from the morphia. Tho nurses took hold of her and administered another injection. Hia wife struggled violently during the operation. Three injections, or probably more, were given. At tho intervals between his wifo wakening up and the next injection taking place his wifo was violent. There were two nurses beside himself holding his wife, and a th.'rd nurse injected the morphia, lie also thought there was another nurse holding the arm in position. To the Senior Sergeant: His wife had complained some years ago that the sun had affected tho back of her head. She had had another slight sunstroke later on. Tho sunstroke had not affected her mentality. Witness had thought that he should have overruled his wife's request and called in another doctor. Ho now believed that he should have called in another doctor, in view of his wife'3 complaints. When the magistrate visited her sho answered the questions quite rationally. Constable Sivyer and the poiice matron wcro quite considerate to him and his wife. He had no complaint whatever as regards the officer and the police matron. There was no insanity in his wife's family. To the Magistrate: He had no complaint to make as to his wife's treatment at Soacliff. He desired, in fact, to express hia gratitude to Dr M'Killop and the matron and the nurses for the kindness shown hia wife. In answer to a question by the magistrate, witness said that he could not seo any justification for his wife being committed to Soacliff. Ho thought she could have been treated in the public hospital. His wife was never violent all the time she was at Soacliff. The Magistrate read over the order of committal to the witness, and asked witness why ho had signed it if he did not think it was necessary. Witness said he thought it was impossible for him to do anything else. He thought too much hurry was evinced in getting his wife out of St. Helens. Ho thought some particular place should be provided for tho treatment of such cases. The Magistrate: Do you remember that I saw your wifo and asked her one or two questions, and she only whispered to you? She was then under the influence of the drug. Witness: Naturally she was a bit dazed with the morphia. Tho Magistrate: You made no application to mo that she should not be admitted to Soacliff. In answer to tho matron at St. Helens, Witness said ho was not sure whether it was the patients or tho babies who were wakened every two hours. Tho Matron said she asked the question because it was a pure delusion. Dr Siedeberg, in charge of the St. Helens Hospital, stated that tno deceased was admitted to tho hospital on December 21 at about 11 o'clock at night. Witness saw her that night about 11.30, also on tho morning of the 22nd, when she was sitting in the nursery. The child was born at 6.15 p.m. on the 22nd, but she was not in attendance, as the birth was a perfectly normal one. Tho sub-matron and Nurse Campbell wcro in attendance. Nurse Campbell had not been in attendance on any septic cases previously. No examinations whatever werO made on the patient previous to delivery. This was important in view of the fact that it was sometimes considered that a subsequent septic condition arose from the examinations. Witness saw Mrs Boyles again on the morning of the 23rd, and she w;ls then in a normal condition. Witness saw her again on the morning of the 24th, and just atter Christmas dinner on the 25th. At 5 o'clock that afternoon witness goc a telephono message to say that the patient's temperature had gone up to 103, and that she complained of pain in the lower abdomen ; that sho had suddenly called out with it, and that she was complaining of a cold spot on tho top of her head—that it was similar to attacks she had previously when she saw those creepy things over tho walls and floor. Witness at once went to St. Helens and saw the patient. Witness found no definite symptoms surrounding the parts except tenderness over the lower abdomen Tho patient complained of pains at tiie back of her neck and through her body. Witness saw her again on December 26. ' Deceased complained of pain in one of the joints of her lingers. "Witness examined it, and saw a slight redness, and ordered hot compresses to be put on. That evening witness rang Dr Jolly at tho general hospital, and asked her to come along next morning and tako a blood test tor examination at the laboratory for the strepto coccus organism. Vv'itness had recognised that evidently some virulent organism was at' work and wished to get a culture. Dr Jollv came on December 27 at 2.30 p.m. and took a blood specimen to the hospital. The report came back from Dr Jolly on the morning of December 29. The blood culture proved negative. saw the deceased on the morning of the 2Sih, and cave treatment, and at 5 o'clock the same afternoon witness, got a telephone message to come to tho hospital immediately as Mr 3 Boylos had developed acute mania. Nurso Shepherd, who had been trained at Seacliff, was put on her case. Witness arrived almost immediately, and found tho deceased suffering from acute mania, and gave her an injection of hyoscyamine and morphia. It took several nurses to hold tho patient down while the injection was being administered. Tho lower bar of the bedstead was padded to prevent her injuring herself. Witness waited until tho deceased got under the influence of tho morphia, and then rang up tho police department to know if it would be possible to feet the assistance of a constable during tho night. Witness know that her nurses were exhausted —they had had a big rush of work. Both the matron and sub-matron were played out. The policej department notified that they could not ar. range for tho assistance to bo given, and asked her what she intended to do. They said the only alternative was to find othei

accommodation for tho night. Witness said that was out of the question, and discussed tho matter with the matron, and decided, as tho nurses were so i xhausted, that .'-ho would go down herself. Witness took her sister, Who had also been _ trained as a nuf.se, and they sent a special message to Mr Boyles to come and give them assistance. Witness stayed from 10 o'clock till 4 next morning. Mr Boylcs rested in un adjoining room. At 10 o'clock the patient was commencing to come oul of the previous dose of morphia, and witness went to administer another dose. Tho patient became violent, ami other nurses were called to assist. Witness and her sister stayed in tho room, and tho matron and sub-matron were sent away to rest for a few hours. At 3 o'clock the patient commenced to be violent again, and witness gavo her another dose of morphia. It was on this occasion that Mr Boylcs helped them to hold the patient. Witness waited till the patient was fully under the influence. Then the sub-matron and Nurse Shepherd came on duty. Witness went home till 4 o'clock. She left instructions that, if the patient became very violent an-other-close of rnornhia was to be given. She asked Mr Boylcs that morning for details of his wife's previous life. Boylcs said that she had had several hysterical attacks—that she had had three what he called sunstrokes, with pain at tho back of her neck and a cold spot on the top of her head. Witness asked him about her mother, and he said that she was at present Buffering from delusions of persecution, but that that could only be expected in old people. Also that the mother's condition had been a source of great anxiety and worry to tho deceased. Boyles had also told her that he understood that his wife's father had died in a lit of insanity. Later Boyles was unwilling to corroborate that statement, as ho said his wife's sister would know more about it than he did. The delusion that tho patient was awakened every two hours, and > that she first saw witness on the Monday, the delusion that the doctor.'s instructions wero ignored by the nurses, that the nurses had been called to .account by witness, and what, the nurses had said as to her being full of disease—these delusions, although not brought before tho hospital at the time. wero evidently part of the patient's mental condition. Tho hospital people recognised oven before mania developed that the patient's vitality was low; she was hysterical, and looked suspiciously at her attendants. Witness oame back to tho hospital at 9 o'clock in tho morning to sco tho latest condition of the patient before fixing up for tho committal by the court. After filling in the papers at the court, witness went back to St. Helens, and while there she conducted the magistrate to the patient. To tho Senior Sergeant: Witness was not present when tho patient left the hospital. Tho husband never brought forward any complaint as to the deceased's treatment while at tho hospital. After the committal Boyles told tho matron that he was not satisfied with witness's and Dr Boss's committal, and that he would like another doctor called. He did not make this complaint to witness personally. Witness got the blood culture taken because she saw signs of soptio poisoning. They knew that throughout oho wholo of New Zealand_ p. virulent organism was about that was giving trouble everywhere. When tho blood culture proved negative it was witnosses's intention to get a swab culture, but by that time tho patient was too violent for the swab culture to bo taken. Tho organism may have been within the patient before she entered St. Helens Hospital, and immediately after delivery a puerperal woman was more prone than at other times to infection. If a patient's physical condition was lowered either by disease or mental anxiety and worry, tho infection was more liable to take "a big hold of her. and unless she had good natural resisting power she succumbed to a virulent organism. This patient was not in a good physical condition on entering the hospital, 'and her nervous vitality was low. Had it not been for the mental condition, tho patient might have been sent to the General Hospital, where full facilities existed for tho treatment of these cases. One did not expect to find these facilities at a mental hospital. .The St. Helens Hospital authorities could not accept a patient with acute mania. To the Senior Sergeant: It was no uso asking her if it was advisable to send a patient to Seacliff when there was another tiling to do. Under tho circumstances it was not a thing a doctor would do to send a patient so far away so soon after a confinement if she could bo sent anywhere else. They had never had any previous occasion to send a patient to the Seacliff Mental Hospital. They had, however, sent two or three to the public hospital during the past 12 years. They could not be expected to close down the hospital in tho case of one infection. The cold which Mr Boyles referred to was the chili preparatory to the fever. Tho patient was put into the isolation room in case tho other patients might become infected, and because thoy recognised that in her nervous condition rest from the noises of tho hospital was preferable. The isolation building- was purposely provided with many doors by the health authorities for treating infectious cases with, plenty of fresh air. To Mr Boyles: Witness considered that some of the complaints made by the patient to him wore delusions. In no hospital would patients be awakened every two hours. Tho babies were, however, fed every three hours during the clay. Witness quoted from her visiting book to show that tho patient had been seen by her every day. The patient's temperature was normal on her admission, and remained so till 4 o'clock on the morning of the 25th, when it rose to 101. At 8 a.m. it was 100.8. Ad noon it was 103.4. This was when the abdominal pains were experienced. Special precautions were taken to prevent infection when every patient was admitted to the hospital. It was not possible to contract a chill at St. Helens under ordinary circumstances—not within a fortnight at any rate. Witness would deny that tho patient caught a chill. The room was not unduly draughty. No huskiness was reported to witness, and witness herself noticed no huskiness. Witness saw no nasal discharge. Tho reddening of the finger joints was likely to be a manifestation of septio infection. Witness did not think she ordered a fire —it. was very hot weather. A (ire was lighted during the night. Witness did not remember giving a direction that n fire should be put on, and that it was not carried out. The statement that she had hauled her nurses over the coals was quite a delusion on Mrs Boyles's part. Her nurses always carried out, their work well. Mr Boyles: Was tho anxiety to get rid of tho patient duo to her .physical condition or to her mental condition? Dr Siedeberg: Oh, certainly the mental

I Continuing, tho witness said there was another case of septicemia in St. Helens :,:";:.- tho illOlllh ol I J- c.em I K.r, but tllO \ patient was now well. The sense of I responsibility of the nurses at St. Helens was a very high one. Witness had no occasion to find fault with their conscientious work. It was the only alternative to take tho patient, from the hospital. They had nine nurses only at the hospital, and it would be impossible to look alter the other patients if six of tho nurses, say, had to look after one patient. All the patients could not be sacrificd for one. They had placed tho patient under the very best conditions possible. Witness did not think | herself justified in allowing tho patient to stay in the hospital another day to see if there would bo any recurrence of the I mania. As a matter of fact, if it could j have been arranged tho patient would have been shifted tho previous evening. Tho patient had the opportunity of making complaints to her (witness), but had never done : so. Witness hero stated that Mr Boy]< ! himself could have put forward any complaints. Mr Boylcs replied that he had not done so at his wife's request. To the Senior Sergeant: They had no provision at St. Helens for dealing with mental cases. Witness did not see the preparations made for tho witness to go away. When a woman got into tho menial condition of the patient, she was inclined to pull at her hair, and at Mrs Boyles's own request the hair was not touched. The chills experienced by Mrs Boyles on her journey in the motor car would bo caused by tho fever. In witness's opinion the patient had on sufficient clothing. Mr Boyles said he would like to explain that the actual cause of tho death of the father of his wife was through a rupture of the brain. Dr M'Kiliop, senior assistant medical officer at the Seacliff Mental Hospital, said the patient had had serum treatment, but that it did not appear to have any beneficial effect. Ho had repeated consultations with Dr Trilby King, who entirely agreed with witness as to the diagnosis and the treatment. To the Senior Sergeant: On admission to tho asylum the deceased was in a condition which usually followed on the symptoms already described. She was quite rational while in tho mental asylum. Deceased was a good patient, and very grateful for the atention given her. Tho deceased could not have been treated anywhere else except at a mental hospital. Alice Hannah Holford, matron at St. Helens Hospital, registered general nurse ancl midwife, said she was present 'when Mrs Boylcs was admitted, and had soon her many times prior to her being taken away. Mrs Boylcs never at any time made the slightest complaint as to her treatment. She was in a ward with seven or eight other patients. Had Mrs Boyles complained of any draught, steps would have been taken to at once remove the bed to another place. There was no unfavourable change in tho patient's condition till Christmas morning, when it was reported to witness that the patient was suffering from chills and that her temperature was up. At 6 o'clock, or a little afterwards, the patient had a screaming attack, and was weeping and complaining to witness that " the little creepy things wero on the walls and the floor," and that she had had these attacks before, and had pain on the top of her head again. Mrs Boyles then stated she had had sunstroke three times. Treatment was at once commenced, and matter reported to the doctor. The patient had another bad attack just, after Christmas dinner, and had to be removed to tho balcony. ancl later to tho isolation room. Mrs Boylcs had a special paid nurse while she was in the isolation ward. At about 5 o'clock on the Thursday the mania commenced. Six nurses wero required to hold the patient during tho first attack, and even then both witness ancl the sub-matron received kicks Witness then took off the special nurse and put tho mental nurse in charge. Tho patient had other clothes on besides those mentioned at the first inquest. It was an extremely hot day. Witness considered that tho patient was sufficiently clad. Certainly the sub-matron suggested that a blanket might bo put in tho'car, but witness considered that, it was hardly necessary, and she pointed out that Mr Boyles had a thick overcoat and that coulel be used if necessary. She did not think tho patient was affected by the motor ride. Witness only asked Mrs Boyles once if she had selected a name for the child. In that she was only doing her duty. To Mr Boyles: Witness knew when the patient was removed that she was suffering from some form of poisoning. At the tinio the deceased was in tho hospital there wero 12 or 14- patients and 19 babies. Several of these cases wero specials. They had some very bad cases at that particular time—not septic. There were about 12 nurses. Tho nurses were sufficient to run the. hospital under normal conditions. The patient was in a very nervous state. Under instructions from the Health !)•. partment they had to at once remove solely septic patients from St. Helens to the General Hospital. Thoy had never removed a patient with the object of reducing the death rate. Mary Jane Gow, sub-matron at St. Helens, said that Mr Boylcs spoke over the telephone about the patient's irritation at being- asked tho baby's name. She asked a nurse about it, nnd was told that Mrs Boylcs was irritated because she wanted to call the baby one name and Mr Boyles I wanted to call it another name. In regard I to fixing up the patient before she left, j witness did everything she coulel as far as i tin- patient woulel allow her. With the help j of the matron and another nurse, flannoiS i were put, across the patient, a full woman's I underclothing every detail so far as Mrs | Boyles possessed them. The patient's skirt was n heavy one. They put on a dressing gown as a blouse, a three-quarter-length woollen coat, and then a thin upper coat. When tne police matron arrived witness asked if she was quite satisfied that tho patient had everything sho desired. To tho Senior Sergeant: Sho considered that tho patient had sufficient clothing. It would not have done to over-clothe tho patient, as it would exhaust her. Witness wont elown to tho motor car and asked if anything more was required—a blanket or anything. Her own matron suggested that tho patient's head was not quite comfortable, and witness went back and secured a pillow. Witness was present when Mrs Boyles's baby was born, Mrs Boyles said t!int she hud a much easier time than she expected, because sho thought sho was goinj? , to die this time. Mrs Boylcs never uttered one- complaint in witness's presence. After ■ tho second screaming attack witness asked her if sho had ever hnel similar attacks before. Tho patient replied that she had occasionally during past years, and that nine years previously, after tho birth of a

baby, alio had been very poorly, and was frightened that her heart was ufficted. Wit-th'.-s had brought iii many patii nts to the hospital, sonic of them in a collapsed condition, and she preferred their carriage by a motor car to that of an ambulance. Nurse Holford said she had communicated with the matron at Seacliff, and had been informed that the woollen coat -cf which mention had been omitted in the first inquiry -had since been found at the Mental Asylum. Annie Isabella Hinchey, pupil nurse, said sho considered the patient was sufficiently clad when sho left St. Helens. The Coroner said the inquest had been adjourned from Seacliff at the request of Mr Boyles. The deceased bad been admitted to the Seacliff Hospital on the applicai : on of her husband and on the certificates of Drs Siedoberg and Ross. There was no suggestion made by the husband that there was anything but the best of treatment at the Seacliff Hospital. On the arrival of the deceased at, Seacliff, on the 29th. the doctor there came to the conclusion that she was suffering from septlcsemia, and she was put into a special hospital. She died on January 12. It had been stated in evidence that, when deceased was admitted to the iSt. Helens Hospital, her condition was normal, and that she then developed a temperature. Because of that temperature, and because of her screams, which affected the other patients, deceased was removed to another building, quite properly, he thought. She was treated there specially, and had a registered midwife, and also a nurse who had considerable experience in mental cases, to look after her. It seemed clear that, even before deceased was sent to this ward, she was mentally unbalanced. It was also clear from the report of Dr Jolly that the rise in temperature was due to something septic, but when the germs came into the system it was impossible to say. They may have arisen in connection with the confinement, or from trouble with the appendix or some pustube. It was quite clear that such cases could not be kept at St. Helens, and there was nothing else to be done but to make application for admission to the Seacliff Hospital, and the application was properly made by the husband. There were all the facilities at Seacliff for dealing with cases of septicaemia, and there was nothing to show that tbo deceased would have recovered had she been sent to the local General Hospital. She appeared to have received every treatment at Seacliff that could have been given her at the Duncdin General Hospital. He did not think deceased's septicemia was aggravated in any way by her journey to Seacliff—the doctor at, Seacliff said it would not bavo aggravated the disease. It appeared to him on the evidence that the deceased had been treated with all the skill at St. Helens that one could expect. Reference had been made to tho condition of deceased's hair. Under the circumstances, it seemed to him better not to have caused the deceased extra irritation by intcrf< ring with it—it might have brought on another attack of acute mania. As regarded tho clothing provided for the motor journey, it appeared from the evidence that the deceased had also a heavy woollen coat, apart from that mentioned at the opening inquest, and, bad Dr M'Killop known of thi3 coat, he would probably have said that she had sufficient clothing on. As regards tho complaint by the deceased of feeling cold when in the motor car, it was quite likely that the chill was part of the complaint, assisted by the high temperature. On the evidence, he could not find that the deceased was insufficiently covered when she was put into the car at St. Helens. The position was that deceased was properly and well looked after at Seacliff. and also at St. Helens, and it seemed to him that everything that could be done under the circumstances bad been done. His verdict was that deceased died at Seacliff on January 12, tho cause of death being septicaemia.