THE CROSS-EXAMINATION.

Taranaki Daily News, 16 October 1930, Page 6

THE CROSS-EXAMINATION.

“Is the court to understand that the true interpretation . of your, evidence, from your knowledge of this case, and in youF opinion, the person responsible for the stopping of insulin treatment did, by so acting cause or accelerate the child’s death?” asked Mr. Bennett. “Yes.” “That is definite so fap as your opinion is concerned?” • ' ’ .' ’ i ' “Yes. That is my personal opinion.” “Do you wish to carry that any further?” 1 “No.” ' ' “Is that a fair statement?” “Yes.” “Will you admit that according to the latest records about 1 per cent, of diabetic children die;” “No.” The records, said the doctor, showed that 1 per cent, of diabetic children died, but not necessarily from diabetic coma. He was not'sure what ages the statistics referred to, but they probably referred to persons under '2O. He had said the estimate of sugar in the urine was not sufficient under “ideal circumstances.” By “ideal circumstances'’ he meant that if a hospital were available it should be used and a bloodsugar estimation obtained. A hospital must bo handy for the estimation. He personally had taken blood from diabetics to a hospital for estimation. “In this particular case, would you regard the child’s condition as the result of stopping the' insulin treatment for, say, one day, and small doses ror the two following days, one of emergency and one making its life hopeless?” asked counsel,

“I agree with the first p?rt of ■ the question, but the second part would depend on the clinical condition of the child.”

With his knowledge of the circumstances and of the body latter death he would not say life had been hopeless. It would depend on the blood-sugar test and how long the child had been in coma. If the insulin had been stopped for two days and a small quantity given on the third day he would regard it as a condition of emergency. Having regard to this case, had the child been seen on the .Saturday morning it might have been saved. He. did not think small doses of insulin would have had a great deal of effect. They would not have hurt the child and, in the circumstances, would have had very, little effect in helping the child. An effective' dose would have been one of 100 units .instead of 10. ' “Is there a maximum safe doge ..of insulin?” ■' ?'.

“There is no maximum dose.. I have read of cases in which 1000 units have been given in a day. That-would kill most people. Qpe has to be guided ,by the blood-sugar test.” r “Is there any difference. in; the effect of insulin injected in the ' arm and leg?” - " ■ ;

“None whatever. It is suggested the site of the injection should,. tk> varied.”

EFFECT OF INriULIN. f■■ ■ . z

. i Insulin, - had its greatest ■ ■ effect one hour after , injection, said .the doctor, and iU. effect lasted\over about eight, hours. That was why insulin was injected half an hour .before a meal. He did npt know personally Dr. G. H. Robertson, Wanganui, -but one might.lnfer from ..the good,condition 'of the ; child that' his treatment ..had been successful.,-. He? could ;',see nothing from the condition <?f .the body or from his . knowledge, of the, case to indicate any incompetence so far as. Dr. Jlobertson ,was, concerned. Dr. Claude;-A. Taylor, physician at the New Plymouth public hospital, gave details of tlie,post-mortem examination of -the body of the boy Christie. He said he had been particularly interested in diabetes as a student and attended the diabetic clinic at the Otago Medical ‘School? He had later attended cases jn the Auckland hospital- for two years, then followed, two years' attendance on diabetic cases. in London. Afterwards he returned to Dunedin to teach regarding the,disease. In his present, position he had considerable perience of diabetes., i ■ ■ . i. At the post-mortem the body was found to’;: be that of a well nourished boy. All- the organs presented the pink appearance characteristic of diabetes. The. tissues were remarkably: dry and deficient? in- fluid. The pancreas was of normal'size and slightly, congested. The kidney, slightly enlarged, presented the typical pink colour of, sugar diabetes and there were slight catarrhal changes in the tubular portions. The doctor, gave an intimate account of . various , other parts of the body. Thg blood-sugar examination showed the amount to. be four times the normal percentage. A specimen of urine said to have ..bgen taken from the child a few hours before death was found to contain the following abnormal constituents: Sugar to t£e extent of 3 per cent. ;■ acetone and di'acetic acid in considerable- quantities. The post-mortem findings ent with the condition ■ of, did-befes mellitis.-' No cause.of death other than did: betic toxemia was found. This, opipipn was based: (1) On the appearance'■ and odour of the body; (?) the pink 'appearance of .the organs generally, -particularly the kidney; (3) an abnormal blood sugar reaction; (4) the .' presence of rducose acetone and diacetic 'acid: in the urine, which , was said to have been passed before death. The doctor said he- could not h?lp feeling that • insulin given ..in' proper. dpses°would have prevented' the child’s death. There was nothing-to show the child should, not have lived for some considerable time with Theorgans showed no abnormal features, except lack of human insulin-' The witness went op. to give technical descriptions of. conditions relating to the disDuring his.time at the.Otago MedicgT School the cases'of child diabetics ;were regarded, as hopeless. The teaching then was that few child diabetics could live more than two years., • Now-''the' records showed that child sufferers. hgd lived since 1922, were still taking, insulin and supplying the deficiency,; and were leading useful, happy lives., The percentage of deaths in America,- had apparently fallen to.'l per-cent. .. The question of whether, these -.children .should be allowed to marry ;w, as now being considered.. “■WOULD SUGGEST COMA.” .. ; -' Counsel: The last.injection- was given on the Wednesday morning. On -the Saturday, his 'sister noticed he was. lyino- in bed,, restless, the. eyes half open, extremely thirsty. and. not completely able to swalloxV. ,- ■ . ; The doctor: That would .suggest impending coma. ' ■ ’ ' The cause of that condition would possibly be. infection, such as from fever or a cold. In view of the post-mortem findings, however, the condition consistent with diabetes. . If he had been called in on-/the • Sst* urday at 8 aan. he would have first established a diagnosis of diabetic coma. A blood sugar and urine examination would have probably confirmed diabetes in view of the history. Treatment would have been the copious administration of fluids. If they could not have been taken by the mouth they would have been given through tlie bowel or the veins. This treatment would have gone hand in hand with the administration of insulin and carbo-" hydrates in sufficient quantities to bring the blood sugar, down to its normal°limit as quickly as possible and to clear the urine of the sugar, acetone.

apd diacetic ■ acid. Specimens of blood sugar would have to be taken, at least every tHree-hpurs'and of the urine every hour.. It -would probably have been found the symptoms would have, passed and ultimately disappeared in 24 to 36 hours. ~.. ' ■ ’ “WHat. is the ' result of- the-' withdrawalof-, insulip suddenly -in such a case.?’-’.'asked; Mr. Weston, “In my experience the result would be. an alarming onset of coma,” replied the doctor,.,.' . Dr. Taylor said Dr. Lynch, pathologist, 'Wellington, had examined certain organs from the boy. He had report-,

ed there was nothing inconsistent, with . the diagnosis-of-diabetes-in the examination of : the organs' submitted. . ‘ x Mr., Bennett said he.had no .questions to. ask. ' ' " 1 , , Detective P. Kearney said-hehnd other police ‘ officers' 'viritej; Salaman’s. house on 11. The, front door was , .open and they went in ridel He knocked; on an inner door. ' At the'same, time Sa'aman came put of a consulting room on th© left-hand side. He was wearing the' stethoscope produced.' ( He told Salaman he had a' warrant for'his arrest on a charge of manslaugli- ' tier. Salaman took them'into'his bed-

. .room* and'.asked'to- see, the warrant. - On beimr told that' the charge related to the Sea th :of the boy • Christie and 1 the, warrant being read he was given the' usual warning. that what. he said ■ mirrht be used in ’ evidence against him. > ...He.'said; “They brought the child > here a week before it died, but I had ■ nothing' to do "with it.” I '■ .--- ; ■’ ; L . l/ 1 — ’ . ■—* — ; —