DEATH OF A BOY

Taranaki Daily News, 21 November 1930, Page 3

DEATH OF A BOY

MANSLAUGHTER ALLEGED SALAMAN TRIAL BEGINS CROWN STATES ITS CASE EVIDENCE OF THE MOTHER i / i. Standing his trial on a charge of manslaughter, Abraham Wally Mahomed Salaman was brought before the Supreme Court at New Plymouth yesterday afternoon. The Chief Justice, Sir Michael Myers, presided. 'Four specific charges were laid by the Crown,'represented by the Crown Prosecutor, Mr. C. H. Weston. The charges related to the death of a boy, Lyall Gordon Christie,' whom Salaman is alleged to have attended to and prescribed for. Salaman was represented by Air. H. F. O’Leary and Mr. A. A. Bennett.

The greater part of the day was occupied with the opening address of the Crown Prosecutor. One witness. Alary Anne Christie, the mother of the child, gave part of her evidence yesterday before the court rose till 10 o’clock this morning. At the adjournment, His Honour said that he would not keep the jury, back from their homes, but he stressed to them the necessity for strictly avoiding any communication other than with their fellow jurymen upon the circumstances of the case. . The specific charges were: —

(1) That on August 2, 1930, at New Plymouth, he caused the death of Lyall Gordon Christie and thereby committed the crime of manslaughter by omitting without lawful excuse to perform a legal duty assumed, by him in respect of Christie in that, in attending to and prescribing for, him he failed to have and to use reasonable skill.

(2) That on August 2 he hastened the death of Christie and thereby committed the crime of manslaughter by omitting without lawful excuse to perform a°legal duty assumed by him in respect of Christie in that in attending to and prescribing for him he failed to have and to use reasonable skill. (3) Tliat oh August 2 at New Plymouth he caused the death of Christie and committed manslaughter by omitting, without lawful excuse, to perform a legal duty assumed, by him. in respect of. Christie in that in attending to and prescribing for him, he failed to use reasonable care.

(4) Tliat on August 2 he hastened the death of Christie and thereby committed manslaughter by omitting without lawful excuse to perform a. legal duty assumed by him in respebt of Christie in that in attending to and prescribing for him he failed to use reasonable care. ■

Salaman pleaded not guilty. The jury was empanelled as follows: Messrs. A. C. Walsh (foreman),'W. E. Keating, R. J. Treweek, S. H. Norris, I. Fagan, P. E. Trevalla, K. Al. Ward, A. A. Handley, E. O’Riley, F. G. Mack!, A. W. Alason, J. Williams.

Three jurymen were stood down by the Crown and one was challenged by the defence.

At th? request of defending counsel witnesses were ordered, out of court.

LAW TO PROTECT; THE PUBLIC;

In opening the case for the Crown Mr. Weston asked the jurymen to dispossess their minds of anything they might previously have heard about the case. It .was a case not in any way a portion, of a conflict between medical men and the man in the dock, It was a case which might have been brought against a licensed ; practitioner or an unlicensed practitioner. The-. law. was framed for the protection of the public. The main question was whether the boy’s death was caused or hastened by the accused’s treatment. The accused (1) might not have had the required skill to treat thi case, or (2) might still have displayed carelessness. ‘)I suggest you will agree,” said Air. Weston, '“that' the older one gets the more respect one has for the other man’s job. We have the greater respect for a-man who has been brought up to his job and spends his life In it. The law has provided in many cases that none but registered people shall do certain jobs. In the treatment of people, however, it is different. The only difference between the accused and a medical man is that the accused cannot call himself a doctor and he cannot sue for his fees.”

Apart from . these facts - there was nothing to prevent the accused from treating anyone for reward. But if a man held himself out as a person skilled to treat people then he was liable both for damages or in the criminal court. That applied to doctors as well as anyone else.. It was common .to both the doctor and the charlatan.

“I do emphasise that it is your duty to help the public,” said Mr, Weston, “because people,'in ill-health and their relations will clutch at any straw and look for short cuts. It is a fact that th-? accused held himself out as a healer for reward.

Until 1921, continued Mr. Weston, diabetes in the case of children - was a fatal disease. The percentage of deaths was 100 per cent. In the case of elderly people the matter was different and a very rigid diet postponed fatal effects. The- symptoms were the excessive passing of urine and extreme thirst. The patient wasted and there was the symptom of sugar in the urine and the blood. The first test was that of the urine. DISEASE IN FATAL STAGE. K ,If the disease passed on to a fata) stage the patient went into a state of coma. Before that came a restlessness and an inability to speak and swallowThe cause of the disease lay . in the pancreas or sweet-bread which provided insulin. The food one took consisted of three elements—protein, carbo-hy-drates and fats. Protein made bone and muscle. Carbo-hydrates were necessary for the purpose of turning food into sugar' which was a fuel to give the body heat and energy. When these foods were taken they were turned into sugar in the stomach and then absorbed into the blood and used by the tissues. The sugar in the blood had to be burned, up, and the fuel that supplied the heat to burn it up with was insulin.

The fats were also burned up in two stages. In the first stage they turned into very poisonous acids and then the acids were finally dissolved into the requirements of the body. When the blood had not sufficient insulin to use up the sugar the system, in desperation, turned to the fats. The sugar lay not used in the blood. In the presence of that sugar the fats were used only as far as the first stage of poisonous acid. This caused acidosis or the coma.

When the patient’s system w-as choked with sugar the system choked all, the fluid into the blood in an effort to dissolve the sugar so that it could pass

through the kidneys as a liquid into the bladder. That resulted in the flooding of the bladder with water and causing thirst. This was called dehydration. The whole body became waterless.

Before'' 1921 diabetes in children was a fatal disease. Two years was given the child in which to live after Mie diagnosis. In 1921 a Toronto doctor discovered the cure. The euro took, time to spread. New Zealand was not the centre of the world and people were conservative. Insulin was an animal extract and the insulin used in New Zealand was prepared at Melbourne' and at the present time it had to he injected into the blood by hypodermic syringes. The injections were made variously in the arms, stomach and the legs. Insulin had to be given once a dayand.it was unpleasant. There was a barometer as to the progress of the disease—the sugar ji> the urine. That varied from time to time. The real test was the sugar In the blood. According to the amount of sugar seen so the amount of insulin to be given was varied. In serious cases insulin was given in large doses at very short intervals. At the same time water was given to the patient. If he could not swallow then the water was put in through the rectum, Into the veins or under the skin. INSULIN NOT A CURE. Insulin was not a cure. Diabetes in children was a kind of deformity because the child had been''born without sufficient secretion from the pancreatic gland. It was just the same as being born without a thumb. Insulin was a food. With insulin now, said Air. Weston, the deaths were less than one per cent, per annum. The children were sometimes taught to make the injections of insulin themselves. The giving of insulin had the collateral advantage of making a strict diet unnecessary. Ifi the old days the children had to be put on a strict diet and had to be half starved. With insulin the. children developed physically into healthy children, as they could be given food as well. When the insulin was stopped the disease came back very quickly, within hours, and then came the. coma. Unless the child was given large doses' of insulin, sugar ■ and water the child was as good as dead. . . The only really accurate test was the sugar in the .blood. It was not only with diabetes that one found sugar .in the urine. In every healthy man’s blood there was a fair amount of sugar. That sugar could not get through the kidneys, which were like filters. If, however, there was anything wrong with the kidneys they did allow some sugar tp pass through. So a person showing sugar in the urine might not necessarily have diabetes. At present there was no cure known for diabetes in children, said Air. Weston. The medical profession was seeking ?ome substitute for. insulin which could be taken through the mouth and so avoid the syringe.

Ip the present case Airs. Mary Anne Christie; of Fordell, had a little boy 6J years of age. It was the ordinary case of diabetes' and, in a child, that meant it was a bad attack. It was discovered when he was' three. When it was first diagnosed the child went into a coma. He was unconscious in the hospital but was treated with insulin and canie round. The mother saw him in that condition;

After the- child was discharged from the. Wanganui hospital he was put by Dr. Crawford on dietetic treatment. The parents saw he was not making progress so they took the wsk and increased his diet. Two years later, in 1928, the diabetes returned and Dr. Robertson put him on the insulin treat? ment. , , .As it was far to the hospital Mary Christie/ was taught how to give the insulin and the mother taught how to make the tests of the urine. The boy grew well and developed. Airs. Christie would say that the doctors had left her the impression that the boy ’would die. Before 1921 that would have been correct, but Air. Weston suggested there was no.reason at all,- now they knew bf insulin, Why the boy should not be alive to-day. •• / ’ • ■ FEAR FOR. BOY’S HEALTH. Airs. Christie thought the boy was going back. If that were correct hf should have been given more insulin. Still the boy was at school and even the morning they ' left .for New .Plymouth the boy was still at school. Thb mother had heard of Salaman. For some reaspn, either clutching at a straw or seeking a short cut to thf boy’s health,-- she decided to consult Salaman,. “-I suggest that was a’fatal decision,” said Air. Weston. They left Wanganui on Tuesday, July 29, stayed the night with a son, Mr. J. G. Christie, at Kakaramea, and on Wednesday, July 30, were in New Plymoiith. The boy was given his.usual dose of insulin. ' .

The boy was taken to Salaman. He asked what was the trouble. She said sugar diabetes. Salaman had asked what was the treatment. She told him insulin. He .gave her to understand that if the treatment were stopped he could cure the child. He also used the stethoscope on the neck of the boy. That, so far as he was instructed, said " Mr. Weston, was- merely an artifice to impress people with. It was a pure piece of mummery. -, • The boy was taken back to Kakaramea. On Thursday, the next day, he had no insulin. On Friday morning he did not want to get up, he- could not, walk steadily, vomited on; the way and complained of pains in the stomach. Mrs. Christie laid him on the couch and the . boy asked, for water. Mrs. Christie explained that the boy had had no insulin since Wednesday. Salaman advised rest and thp boy was taken by Mrs. Christie to rooms. The child was carried from Salaman’s rooms and put in the car with a hot water bag. He was crying for water. The insulin had gone, the sugar- was pi,ling up in the boy’s blood, and he required water to get rid of it. Later in the day Salaman said not to give the boy more than, a pirit of milk in 24 hours, but he -would not restrict Bovril and beef tea. Mrs. Christie carried out the order, giving the boy little sips at a time. They would notice what implicit faith she had in Salaman.

During the night the boy stopped asking for drink, was restless, later could not speak and towards the morning he could not swallow. Mrs. Christie had complete faith in Salaman and before 8 o’clock on Saturday morning gave a message to Salaman to say the boy was worse. ALLEGED WANT OF CARE. All that Mrs. Christie got was a message to give the boy half the usual dose of insulin, not too much. That was a complete change of front by Salaman. The jury would draw its own conclusions. He didn’t bother to talk to the mother and he didn’t bother to go and see the child. The Crown’s case, said Mr. Weston, was as ..much the want of care as want of skill. The boy died that afternoon, so in the morning he must have been dying. But medical evidence, including a specialist from Wellington, would say that the boy might have been saved with large doses of insulin, water and sugar. After the half dose of insulin on the Saturday morning the boy ate nothing.

Airs. Christie Went over at 10 'o’clock to say the insulin had no effect; Salaman said: “Give it four hours before you report again.” The daughter went over at ■ 12, said the insulin had not taken any effect, and tliat the breathing had quietened down.' Then Salaman said that heavy 'bi-eathirig was bad and that the boy’s breathing was becoming more natural. What was tIX situation?; A few yards away the boy was dying. For the third time that morning they had come to him with the fear of death on their lips. He did not trouble to step across the road. Salaman said if there was no change by 2 o’clock give the boy a quarter dose of insulin. He told the girl that he wanted to get the insulin out of the boy’s system so that lie could begin his treatment. She gave the boy a quarter dose' of insulin but the boy did not improve. Salaman said he would see the boy between 3 and 4.

At 3.30 Airs. Christie ran over and asked would Salaman come over or should she bring the boy to him? He told her to bring the boy over. Airs. Christie said she was afraid the boy was dying. Salaman said no, take him over. If Salaman had had any care, said Mr. Weston, he would have said: doctor.”

Airs. Christie sent over a message to say she thought the. boy was deadThe reply was sent, “I can’t go over. I am not taking the case.” The boy was just dying when Airs. Christie callel in the doctor. Dr. Church arrived and found .the boy was .dead. A postmortem showed that there whs not a drop bf. water in the bladder and not an ounce of sugar in the body. In law, said Air. Weston, accelerating death was just as much manslaughter as was causing death. Aliss Coralie Helen Batten, dispenser at the Wanganui hospital, gave details of the supply of insulin to Airs. Christie; EVIDENCE OF THE MOTHER. Airs. Alary Ann Christie, wife of Robert Gray Christie, Fordell, mother of Lyall Gordon Christie, said the boy weighed 911 b when born. Whert he was two years and nine months old he became ill and Dr. Crawford, ; Wanganui, treated him for glandular trouble in the neck. After about three weeks he seemed to get better, but later developed an abnormal thirst. Dr. Crawford called in Dr. Rennie, Dunedin. Sugar was found and the trouble' was finally diagnosed as diabetes, this being confirmed .by the consultation. The boy was taken to the Wanganui hospital within an hour of Dr. Rennie’s arrival. Before that he had showns signs of conid. He appeared to become unconscious. Tho doctors said they did not know whether they could bring him out of that state.

The boy was given insulin treatment and a starvation diet. He took a turn for the better after some days. He was in hospital seven weeks. On returning home he was placed on a special diet, which comprised certain vegetables, hall ah egg tw’ice a day and milk and oranges. He was supposed then to be free of sugar. At first he did not get on well on , the diet. After several weeks he made no headway. Dr. Crawford was consulted and advised keeping strictly to the diet. After some weeks she told her husband that if the child must die he might as well die being fed as being starved. They decided themselves to put him on fruit and vegetables, no milk, as much water as he liked, and lemon drinks. The. boy improved greatly during several months. The sugar appeared at times. Dr. Crawford said she must expect , the sugar to reappear. The boy was not given insulin. Dr. Crawford was very pleased when she took, the boy to him again and told her to keep on as she had been doing. The doctor was about to leave for England. Some time afterwards the boy went back generally. She then consulted Dr. George Robertson, Wanganui, this being about two years ago. The doctor prescribed a much more liberal diet than that the boy had. received at the hospital. ■ For weeks the boy .was taken to town from. Fordell daily for Dr. Robertson to give him the (insulin injections. Eventually, at Dr. Robertson’s suggestion, her daughter agreed to give the child the insulin to save the trips to town. The insulin was obtained from the hospital dispensary. The doctor showed her how to give -the insulin and balance it . according to the. amount of sugar showing in the urine.- The boy was - kept strictly to. diet' and allowed plenty to drink. TREATMENT BY.DOCTOR. Under Dr. Robertson’s treatment he improved, but ■ the' sugar was always there. The diet Was 1.0 per cent, and 5 per'cent, vegetables, l this referring to carbo-hydrates. There, were ho parsnips, beetroot or green peas. Apples, plums; oranges, strawberries, raspberries, gooseberries, lemons and rhubarb. were allowed. _ Lean meat, fish, a little, bacon, eggs, poultry, cheese and . butter were in the diet. He was never given any white flour. Witness gave other! details of the diet, which included, nuts, - except peanuts and chestnuts. f After several months the boy was allowed.to go to school for half a day at the doctor’s suggestion. This not proving injurious, he Yvas sent for the whole day. He went to school until last July, when he was brought to New Plymouth.' He was rather -a clever child. Dr. Robertson left for England about J.uly 26; the,-last time she saw him was about, throe days before that. She brought the boy from Fordell to New Plymouth on July 29 iii order to consult Salaman. The boy was slipping back—he showed sugar’ once and - sometimes twice a day—and she had been worried. They had heard of Salaman and decided to try him. Her daughter drove her and her son to Kakaramea to an elder son’s place on July 29. Next morning her son, drove them to Salaman’s house in Gill Street.

Her elder son, J. G. Christie, Lyall and she went into the house and waited in the waiting-room. She told Salanian these were,her two sons and she wondered if he could do anything for the little boy. Salaman asked what the treatment had been and she replied, “Insulin and a strict diet.” Salaman said, “Oh, insulin, then I can’t touch him.” He gave her to understand he would not treat Lyall with insulin. She asked him if he could give her means to cure the child if the insulin were stopped for a few days. He said, “Yes.” He put a stethoscope to the boy’s neck and said Lyall had a . bad kidney, which was aggravating the diabetes. If the insulin were . discontinued Salaman said he would have to see the boy again nefore he started the treatment. Salaman said that the further -he. saw the boy off the insulin treatment the better. Salaman told her one or two things that gave her confidence in him. He described what she had found in the tests, though he had not been told. He told her that if the insulin were discontinued thelittle boy might get sick. Ho toid her to come again on Thursday, or, better still, Friday. . She asked him should there be any change in the diet. ■ He said he would cut out one or two things and include one or two other things. Very little difference was made in the diet. He deleted cabbage, pumpkin, fish and white of egg, and put in a little rice or sago, and a little white bread. Salaman weighed the boy, it being found he had lost half a pound since Dr. (Robertson weighed him. After the interview she returned with the child to her son's place at Kakaramea.