SALAMAN TRIAL

Taranaki Daily News, 22 November 1930, Page 3

SALAMAN TRIAL

(MANSLAUGHTER ALLEGED ) • .J ' • • ' BOY’S DEATH FROM DIABETES I ' i MOTHER CROSS-EXAMINED DOCTOR EXPLAINS INSULIN » Charged, with the manslaughter of Lyall' Gordon Christie, aged six and ahalf years, by causing or hastening his death through failure to have or to use reasonable care or skill, Abraham Wally Mahomed. 'Salaman, Indian herbalist, stood hie second, day of trial before the Chief Justice, Sir Michael Myers; in the Supreme Court at New Plymouth yesterday. The boy, who suffered from diabetes, died on August 2 in a boarding-house at New Plymouth. / The hearing will be continued today. Yesterday morning was' occupied almost wholly by a lengthy cross-exam-ination of Mrs. Christie by Mr. H. J'F. O’Leary, who,' with Mr. A. A. Bennett, is conducting the defence. Afterwards the Crown Prosecutor, Mr) C. H. Weston, led further evidence/iAcluditrg that* of a consulting physician from Wellington who had made a special study of diabetes'. * ■' Resuming her evidence for the Crown yesterday Mrs. Christie, Fordell, mother of the dead boy, said that after the' first interview with Salaman at -New Plymouth on the Wednesday she and her daughter’returned with her son Lyall to her elder son’s farm at Kakaramea. She did not alter the diet that night, but stopped giving insulin next morning. On, the following day (Thursday) they stayed at Kakaramea, the boy seeming to be well. He went about the farm. He seemed well in the morniqg, and had a short sleep towards the evening. White of egg was not given, in the morning. He would not eat some sago-at iiight. ’ On Friday morning he refused his breakfast and did not want to get .out of bed. Her daughter and she brought him to New, Plymouth. The boy vomited twice' op the way. As they arrived at Salamah’s the boy complained bf a.pain in the chest, but later said it was in his stomach. When Salaman came into room the boy was lying on the couch. She told him the boy had had no insulin since Wednesday and that he had been sick twice on the way in. Salaman seemed to expect that. It was a good thing he no medicine, he said; otherwise they would have blamed his medicine for the trouble. He said he could not £reat the ease yet. If she wanted him to treat her boy she would have, to stay in New Plymouth, he added,' They decided to stay at a boarding-house, over the road. They car 7 ried Lyall to the car and then into the boardinghouse. He was put to bed, and his clothing was lods'ened as Salaman had told them, so that he would have free circulation. This was about 3 o’clock.

Later her daughter visited Salaman. She returned and said they could give him Bovril or beef-tea, and a little'scalded milk and water. She put hot bags in the bed. The boy was thirsty and asked for drink and' that might have been why- she sent her daughter to Salaman. He kept on asking for drinks, Sometimes' 1 she gave • him sips and at other times more. He ;appeared to .be very ' thirsty indeed. On the' Friday night she and her daughter took turns at sitting by the bedside. The boy was gasping for breath 'and ’ between the gasps she sometimes thought he had. died. He -would rouse himself and they kept lifting , him. She thought it was wdlile she was there that’ hfj stopped ask-, ing for .drink. He was breathinng heavily at Salaman’s and it continued all night a# far as. she could remember. His eyes were partly open. She' did not think he was wholly in a coma up to the time May resuniecl her watch early in the morning, ■ WOULD NOT- ANSWER HER. ;, In' ths morning the. boy would not answer her.. He hud difficulty in swallowing. . Shq went to Salaman and told a' young woman at the door that the little boy did not answer when spoken to and had difficulty in swallowing. As a result the girl returned with a message from. Salaman to give him “half the usual. dose of insulin, but not too much.” .1 Op, ■witness’ return to the boardinghouse about 8 a.m. her daughter May gave tlie boy insqjifl,. This had no effect as far as witness could tell. Later, about 'lO a.m., she went to Salaman and told him the injection had not taken effect. He told .her it would take about four hours. She returned and watched the boy.'-. Sometime afterwards his breathing was quiet; she thought it a good sign. She thought it was her daughter who lYent over next time, about 12 o’clock. She was not sure what Salaman said, ■ - ’ ' ' ' ' ■ Another, half dose was given about 2 o’clock on . Salanian’s instructions, and she kept the boy warm. Witness again went to Salaman. She asked hin) whether she would take the r boy to him, or would he come over. Salaman said he would see the boy between 3 and 4 p.m.. . Before their going to see Salaniair the boy was breathing very quietly. She did not think she told Salaman the boy was unconscious, or that lie was any better. She did-not know whether May or she went to Salaman next. A message came through May that quiet breathing was a good sign. She, her daughter Jlay and Mrs. Armistead wrapped Lyall in blankets and lie was carried from the car into Salaman’s house. She told Salaman she had noticed a change on returning from her previous visit ’to him and that she thought the little boy was gone. She let liiiu see Lyall. „ “Oh, no,” he replied, “he is not gone. He told her to take him back and pack him with hot packs, particularly around the heart, because the circulation was bud. While in. the consulting room the boy was gasping at intervals. Between the periods of gasping she thought he might have died. "I think he s gone, she’ said to Salaman when she first went in- ' “No, he isn’t,” he said. His Honour: Was that all he said? Witness thought ho said it was the effect of the insulin on the heart and told her to take him back and apply heat. “If he gets over this he will he all right.” Salaman said. "This is the turning point.” “DID HE USE INSULIN?”

".His Honour: Did he at this stage use insulin! ,'<■■ ‘ . Witness: No. . His Honour: Did he advise you to do SO . Witnesp: No. Mr. Weston: Did he use a stethoscope that time? Witness: i Yes. Mr. IVeston: Where? Mhat part oi the body? Witness: I think over the heart, his pyjama coat.

On Salaman’s advice they took the boy to the boardinghouse and applied heat. About half an hour later he,died. She sent a message to Salaman asking him if he would, come over, but he would not. ■

She telephoned for a doctor, because she thought the boy was dead. A doctor was necessary to pronounce life extinct and she knew she would have! to have a certificate. ■■ *

They telephoned about seven doctors before finally getting Dr. Church to i come. The urine sample handed to the police was taken by her on the Friday morning, she thought. She gave the police the syringe and bottle of insulin produced. To Mr. O’Leary: Besides Drs. Ronnie and Nelson, Dr. Crawford would have known the boy was getting insulin treatment in the Wanganui hospital. O.n coming out of the hospital, at about his third birthday, Dr. Crawford had told her the boy woiild live only two years, or possibly until his sixth birthday. He said the fact she .had to face was that the disease would get him in the end: “Actually the boy lived eight months after his sixth birthday?” said Mr. O’Leary. “Nearly eight months,”, said Mrs. Christie. ‘ She was sure the doctors thought he would not live long. When he came out of the coma in the Wanganui hospital Dr. Nelson said: “Mrs. Christie, it is only temporary.” Dr. Rennie said: “We have already explained that to Mrs. Christie.” That was in November, 1926. In September, 1928, she consulted Dr. Robertson. WITHOUT INSULIN BEFORE.’ “Between'the time he left the hospital and you* consulted Dr. Robertson, did Lyall have any insulin treatment?” asked Mr. O’Leary. ' ■ “None whatever.” After she had taken the boy into her own hands and altered the diet he was sugar-free for months,, with occasional .returns of trades. Dr! Crawford congratulated her on his condition. When. the sugar showed in greater quantity, than she thought goikl she consulted' Dr. Robertson. Between<»the coma he had in hospital at his’ third birthday and his being taken to Dr. Robertson he had nothing approaching coma. . ’And during that time he had a diet that was really contrary to the doctor’s orders and’no insulin?”’ said counsel.' “Yes,” was the reply. “There was ho suggestion at that time that he did not, .have diabetes then?” No, said. Mrs. Christie; ‘ (The doctors had told her he had the, disease long before. Dr. Robertson re-started insulin treatment. ..Some days were missed without any obvious effects! After-eever or eight weeks ’her daughter gave the injections instead of the doctor and continued to give them till , they came to New Plymouth. / ! / The insulin- -was -given once a. day. "Dr. Robertson told me it would not hurt to give the little chap an occasional holiday, say for a few days,” said Mrs. Christie, “though lie. might slip back a little.”

The doctor, however, bad pointed out that a stoppage of the treatment/for more than one day might result in the boy not wanting to face’ the ' needle again. She therefore kept on the insulin almost daily, .. Dr. Robertson said at first that /he; did not -know whether he could do any good. He began Rhe insulin right away. He said that the only chance was that on his diet, plus insulin, the gland might begin to function again. The doctor changed the diet. , . BAD TURNS WHEN UNDER DOCTOR. "During the time Dr, Robertson advised you -,did the boy have any '.bad turns?” asked counsel. “Yes. T)vo. very severe turns and (two minor ones.” ‘ . • . .. , ■ “Was he attended by the doctor for them?” ■ : ' 1 ; \ -' '', - \ - -“Yes. For the two bigger ones.” ..‘‘What did he do ?” • ' “On both' occasions he stopped the insulin.” .- "• ’... , ■ .. She thought the first bad turn occurred' in December, 1928, Lyall became ill on a Sunday-and.-on the Tuesday -was getting about again. The next bad. turn was in October, 1’929, It was altogether different in appearance,, but it did not affect the boy longer than the first on?. She took the boy iqto Wanganui.and the insulin was again ' stopped for • a short time. . ’ ' '' ' ' “And the boy came round again and was as well as befdre?” continued Mr. O’Leary. /. / / . . . . "Yes,” said Mrs. Christie. For inonths she used her own judgnient. without consulting the doctor. She.’ was at liberty to vary the i asulin doses herself; the doctor had told her so. . Dr. Robertson left for England on July 23. and on .July 29 they decided to bring the .boy to New Plymouth. .. “Had the boy, just prior to your coming to Taranaki, been , in the same condition as before, you would not . have come to Salaman ?” as»ked Mr. O Leary. “That as- so/.’ she replied. “I saw the child slipping back and I was getting wcriicd.” ; HAD SLIPPED • BACK ■ FURTHER."You had the boy under constant observation?” "Yes.” ’ .... ‘ .. ) “Had you noticed this slipping back before your last, interview Dr. Robertson ?” .” “Yes.” ’, ' . ’ "How was lie slipping back? “He complained more freqlientiy o. his head, his sugar was getting mole pronounced, and his knee joints were becoming stiffer.” . . She thought she told the doctor about the head and the sugar. The doctor felt the knee joints. He just left her to carry on with the insulin and diet. Before go- 1 ing to the doctor she had increased the insulin when the sugar increased, but in her opinion the insulin seemed to be losing its effect. “So,” said counsel, “Dr. Robertson s hope that the gland would strengthen was obviously not realised?” "Oh, yes. Hb told me so.” The last time she saw the doctor before he left for England was on Jfly 23. Between that and July 2J the sjinp-toms-became worse. The boy was getting tee stout and .his eyes were not clear. “An? I suppose you were just getting distracted and desperate, so you came to New Plymouth as a last resort? said counsel. "Yes. 1 consulted my- family before corn ing/’ “Can I say that it was a last possible effort to save the boy?” said Mr. O'Lear v. “les,” said Mrs. Christie. . Mrs. Christie'said Dr. Elizabeth Gunn saw Lyall on July 4 during a school in-si-eetion. .She had examined him the yciu before. Last July . Dr. Gunn asked her a number of questions but did not interfere because he was under the care of another doctor. She told me I was living on the edge of a precipice with the boy and that she thought it wonderful \\bat. I was doing for him,” said Mrs. Christie. r She had never seen Salaman before her first interview with him. LEFT HER-JO DECIDE. “I put it to you,” said counsel, “that it was left to you whether you should

continue the insulin treatment or not?* “Yes. I took it that way.” “At that stage you had not made up’ your mind to discontinue it?” “No, I had not.” .. • "So that when you left Salaman on that occasion he dkl not know whether ycu were going to discontinue the -in- - • sulin treatment?” “No.” “Did you make the decision your- ' self.” ■;■/?''' “I conferred with my husband and . other members of the family bld enough / to understand. I telephoned to Wanganui after returning to Kakaramea.” ■, “You decided that night to stop th# insulin treatment?” 1 ~ \;• .'7.‘ <; Yes.” • - “In the ordinary course he would be due for an injection the next <lay? ! ’r “Yes.”, ’ ’/ “You just stopped it next day without communicating with Salaman,?” “Yes.” “lou saw Salaman next day, Fri- ’ r dav?” ' ’ ’ . '■ ’- ’’■< “Yes.” . < . ’ .'///! “Would-it be correct to" say that it . vas on the Friday ,that Salaman first / learned that you had stopped the insulin?” -- ‘ ■ “Yes.” ; After she had explained that the boy .. had sugar diabetes and about the strict diet and insulin, continued Mrs.. Christie, Salaman said, .‘‘Oh, insulin. I won’t touch the boy.” t'r : ' '• if she Stopped ths insulin. , ’j It was' after* that that she asked , whether, if |he stopped the insulin, would he do a'nything for the boy.- ■ “And what did he reply to that?” asked His: Honour. "He said ‘Yes,’” said Mrs. Christie. "But you didn’t tell him you would?” suggested Mr. ,O’Leary. ? . “No.” ■ She reinembercd'Salaman saying that 1 if the insulin were stopped he would want to see the boy. It was that night that the family decided to. stop-the insulin, i ' , ’ / "Why?” asked Honour. ; “Because he thought', even if he could not actually be cured he . might get <•. ea.se.” z What she understood 1 was that Seaman would not the boy while he had insulin in hi§/§ystem. The first consultation with Salaman was not very loi'g. because until site;decided to stop the insulin Salaman would not treat thechild; not until the insulin was out of. his system. \ ’ *• ‘ . J Before the boy’s death she asked Sala-; ;> ■ / nail if he could give a death certificate, in. the event of death. That was on the Friday. No, he could not, said -.Sala’-;:.} , man,-because lie was not a, doctor. Salaman. made a-suggestion about a .../: slight alteration in the -diet., The .boy was practically on the "same, diet up-to the time, of. his death., - COULD NOT TREAT HIM THEN. . When on the Friday morning she told • Salaman* she had stopped .the insulin, he . said lie could not treat;.him then-- ; 7 he could not give any of liis mixtures.' / ■ ; “Actually he gave (you up mixtures for the boy?” said Mr, O’Leary. ; “That is so.” -- ; ..“You paid him no fee, did you?” . ! "Oh, no, none whatever.”- 1 ■' o "Was it discussed?” asked His -our.“J. offered him soma money, but-herre- . T; fused.” . . - ■ “Would I be right in raying he’ndw • ■ solicited, work; or. asked “for money?” asked Mr. O’Leary. ' ■ ' “les.” : ■:’< . :•■' ■ She believed, she. asked Dr. ChurehTf he could give a certificate after he toM. > her Lyall was dead. He asked her'if there ivere any doctor who could give a certificate. She replied that Dr. Robertsen had just left for England. -.-’L 1 -'- . "Did you tell him ‘ anything '■ alioiul; voui-having seen'Salaman?” said ,coiin,sel - ■■' ’ '■■.' // ' ■ ' • “Yes.” ■' , ~~ ~ ~ ■ ' She admitted she was very on the Saturday morning. She'.did not remember asking the girl at.the-door if'. Sa laman could go and see the boj»,-If.* -was \

not correct that at an interview before the death the girl returned with'.®' njetf-. sage that Salaman was>not treating the case and wpuld not go over. Thafwis said alter the boy died,..is;heq..Hm girl .=>. from the boarding-house visited Sala- Z man’s house.. . . ..'.T.;'. ■ Salaman saw the boy once on the ■ Friday 'and once on the Saturday at 4 o'clock when, they took him over. /. To Mr. Weston: The boyi.'had had 10 or 12 holidays from insulin, but never ■ one lasting more than a.day.- at a time. CONSIDERED THREE TREATMENTS. They.had considered three treatments ‘ before deciding to come tb‘ ,! Salahian. Otio • < E - . was an electrical treatment, which. Dr.' ■ . . / Robertson described as waste- of 'mopey, .; and the. other;-a tabloid‘'tbcatmentf'."., : ;' , . She had believed Salaman would-take no risks with Lyall if he thought-. he .y lir.ght die. She had discussed the queslion of a death certificate with Salaman . ' . because she thought : she might “face death any hour with that boy.”' .It was her-suggestion and not Mrs. Armrstead’s that she should, call a. doctor.; i . ' ‘When Dr. Church .-arrived didn’t-, you ask him if he could, draw a, sample of urine from the bmlyVand give a death certificate?” asked Mr. Weston, j . •’Oh, no. I gave him the sample taken before death.” , -Z ‘•All through yqu. have had: complete . - confidence in Salaman?” , •.< ' “ Yes ” i ' ■ ■ - “And you still have complete confid- . cr.ee in him?” “ ; /. / .p-V.’?--. 1 .' ,“I would .'not like to. blame him 'for. Lya'l'e death.” •‘•‘But that is” riot for you,” observed ■ his. Honour. “Do I understand that, for a considerable .-time before July .^0 /the bov *fvas under daily treatment wRh .insulin, except for an occasional day off?” • “Yes, for a considerable time.” • “After July; 30 you-discontinued th® insulin?” continued the Chief Justice. ■.< “Yes.” ..■_ ' “Was discontinuance consequent;' ' • on your conference with Salaman on the . Wednesday ’ 7 5 Mt was he said he could cure Lviiil if there were no insulin in his t'f; system, anR I also remembered that Dr. -■. Robertson allowed, me to diseontinuc.” . - “Would you have stopped the Insulin. jyj had it not been for Salaman telling j gu he equid cure your boy if the insulin were out of his system?” _ • “I would mot have stopped it if 1 had not 'been to Sklaman’s.” • , were to bring the boy-in again?” \ .- : < ;?•/.> “Yes.” ; Between the time you .the-plaw* -- ,j,E bn ‘Wednesday and brought him to see , - i; - Sa la man again you gave hipi no insulin.’’ “No, I did not.” .; “YOU • say that on the first occaisipii . - ../’ <■ he said he could treat the ’boy if * the \ insulin were out of his system. Dis be AytfA on any subsequent occasion tell you he could not or would not treat the boy! “No. On the Friday he said he could not (teat him yet.” ; , . ; ■ “Did lie still leave you on the Friday under the impression that when the in- . stdin was out of his rystem he would treat .he boy?” . “Yes, I thought ho would.” ' » , .V J.

j'SPECIALIST IX DIABETES. Dr. James R. Boyd, Wellington, consulting physician and honorary physician to the Wellington Hospital, said he had made a special stuc|y of diabetes and a considerable part of his z time was spent in treating diabetics. He explained simply the effects of diabetes in adults and children and the use of insulin. Unless, he said, the child patient was’ very carefully watched it would have ups and downs. - He thought every diabetic child had these , ups and downs. A diabetic developing the dis-,, ease in early childhood developed it in its pure state, without complications. ,; Diabetes in a child was more fatal than in an elderly man. The doctor 1 corroborated the statistics quoted in the Crown Prosecutor’s address regarding 'the deaths of children from diabetes before -1921. They were not warranted to-day in taking the same/serious view of the disease as they did before insulin whs discovered. Very few cures were effected-, but the majority of these cures had been in children. The treatment of diabetes had been explained to the jury by the Crown Prosecutor, said the doctor. The method of treatment, was not based on clinical fancy but 1 was based on experiment and experience. Towards the end of the last century it was thought that the pan- - creas was the seat of the trouble. In ISS6 a doctor in Europe operated on a dog, removing the pancreas. The dbg recovered from the operation but developed diabetes and died of diabetic coma. ' At about the same time another doctor in examining a slice of human pancreas with a magnifying lens noticed > that the surface had little round collec- . tibns of a tissue unlike the rest of the j gland. The different look of these was / due to the fact that they were ma.de *i of different material. It was an Edinburgh professor in 1906 who came to ,■ the conclusion that these little islands manufactured juice or secretions which prevented the development of diabetes. To this' substance he gave the name of insulin. After this several attempts were made to isolate the juice ,of the gland but it was not till 1921, at Toronto, that a chemist showed how the substance could be isolated without being destroyed in the process. The medical' authorities at Toronto at the time were, anxious, to prevent the release.of the insulin until all tests had been made, so arrangements were made to distribute it among a select' body of medical men in America and Canada. All the experiments were made on dogs and it was only after its use- ’ fulness had been, fully tested on dogs that insulin was used on humap beings. • ADVANTAGES’IM AMERICA. ;

It happened, therefore, that the doctors in America, and Canada, who had opportunities of using insulin in 1921, 1922. and; 1923, had an advantage over the doctors in New Zealand. In 1923 witness was at Edinburgh and he asked one of the doctors there about insulin. He said he had not used it and had not seen it. Joslin, one of the foremost men in the knowledge of diabetes and the use of ■ insulin, said that now no child need die of diabetic coma. Joslin also said that when death did take place front diabetic coma there were only three causes to account for the coma: (1) Indiscretions.in the diet, (2)' omission of insulin—in connection with that he stated that a child on insulin was like a child on stilts; kick away his stilts and there could only ; be ;one result; the child' must fall; (3) the development of some fresh disease or illness in the child, such as pneumonia or scarlet fever. What he meant to imply was that if a child died of diabetic cpma he died of .some other disease because the other two causes could be rectified if the child were treated in time. The soouer the treatment of the child in diabetic coma was commenced the sooner the child would recover. . Insulin was now generally known to doctors in New Zealand but a great many doctors would ■ not take the responsibility in the case of children and . handed them over to the diabetic clinics or specialists. To his Honour: Insulin was the recognised treatment in the diaibetic clinics, in the hospitals and in the practice of those who specialised in the l disease. , . All cases, said the doctor, did. not require insulin. It. was very rarely that the pancreas was completely out of action.. If the pancreas were only very slightly affected, some modification in the diet would be sufficient for the patient without insulin. That sometimes occurred with children, but not often—it was far more common in adults. . “What is the result of the withdraw-«

al of insulin from a child who has been under insulin treatment?” asked Air. O’Leary. ‘‘The withdrawal of insulin, said the doctor, except under special supervision of the diet, must result in the child going into a diabetic coma. I cannot conceive of any occasion arising in a child under insulin treatment for omitting the- insulin, except in the case where a child is being given too big a dose.” ; From the evidence of Mrs. Christie, said the doctor, he thought Dr. Robertson advised her to omit a dose of insulin because the child was showing signs of having an excess. To His Honour: There was no other palliative known to-day to medical science for the treatment of diabetes in children than insulin. There was a flood of suggested palliatives every year because of. .the irksomeness ef the hsae-

dermic treatment. Attempts were being made to find a form which might 'be taken by the mouth.

TREATMENT IN COMA.

When the insulin "was withdrawn the coma began to develop in children within two to four days. On the onset of coma one would have to begin large doses of insulin at once. In the case before the court the dose should have been a very substantial one. Copious fluids and stimulants were required. Insulin alone 'in the treatment of the coma would probably be unsuccessful in 50 per cent; of cases. Fluids must also be given or the insulin would not get sufficient opportunity for action. If the patient were not treated with insulin and. water the body lost all its fluid. • To His Honour: That was a fact generally known to medical science. . “Are these , two facts—a knowledge that insulin was a necessity arid that water was a requirement —facts that should be known to every medical prac : titioner?” asked His Honour. “Yes,” replied the doctor. “The placing of the stethoscope to the neck and the diagnosis of kidney '.rouble was the bait to catch the trout, a pure deceit. There is absolutely no possibility of diagnosing kidney trouble by placing the stethoscope to the neck.’V “How long has insulin been in use in New Zealand?” asked Mr. O’Leary. “I cannot say, but in England it was not generally in’use in 1923,” said the doctor. • "’How long after that was it that I you knew it was in, use in New Zea- • land?” “I brought some back with me.” . . “You were one of the first to use it in New Zealand?” “Probably.” “You are dependent a great deal on Joslin and other authorities for such statements as "No child should die in diabetic coma.’ Does a child who has not had insulin, who develops a coma, is given >■ insulin and recovers, require insulin treatment afterwards?” “Not necessarily.” “All diabetic children do not need insulin?” “I’ve said that.” “‘No diabetic child should die of diabetic coma.’ Do you subscribe to that?” “Yes.”

•‘I take it that when diabetes is diagnosed, sooner or later that child will be put on insulin?” ? ■ “In the majority of cases.” “Do you actually know of cases of children dying from diabetic coma?’’ ‘‘Oh, yes.” ,■/ .. ; /' ’ / ' “And I add to that, treated with insulin ?” _• “No. I have seen no child suffering from. diabetic coma ,to whom insulin treatment Was given who did not recover from the coma.” ' •'Do you know that children suffering from diabetes and treated with insulin do go into a diabetic coma and die?” ' “Yes. There may have been some other cause.” ? .i

' “When a child goes into a coma, if it can be given insulin treatment then, the child should always recover?” "Yes, unless the coma has been precipitated by some other illness.” . ‘“ln New Zealand in'the last (eighteen months there have been five deaths of children under ten from diabetes,” said Mr. O’Leary. : v. . : “In 1921,” said the doctor, “when,the eases were a great deal less numerous than to-day, the deaths numbered pix. In 1922 there were four and from 1917 to 1922 there were 18.”

Counsel for the defence produced live death certificates of children who had died in the last 18 months .from diabetes and three from diabetic coma. “There might be careless doctors as well as careless other people, might there not?” asked Mr.- Weston. SANCTITY OF HUMAN LIFE. “But, Mr. Weston,”'said His Honour, “such is our law in New Zealand and its regard to the sanctity of life that a doctor is in the same position in regard to criminal responsibility for the loss of life as anyone else.” If the insulin were stopped on the Wednesday and nothing were done till the Saturday, said the doctor, he would not like to say that on Saturday the child could be saved. There would be a very fair chance, if the usual dose had been given on Wednesday morning. If the insulin treatment had been given at midday on the Friday the child would have recovered. Of that he had no doubt whatever. • His Honour: You have heard what the child’s condition was on Friday at midday. Are the symptoms that then existed of diabetic coma or are they not?” “Yes, typical symptoms.’’ His Honour; If on the Friday a-medi-cal nlan had seen this child would he have had any difficulty in diagnosing the oncoming of diabetic coma ?”; “I feel sure he would not.” “If then the medical man had been there on the Friday at midday, was there then certain immediate treatment he should have applied?” asked His Honour. “Yes,” replied witness. “What was that treatment?” “Insulin injections and copious fluid.” “If that treatment had been applied on the Friday would the child's life have •been substantially prolonged?” asked His Honour.

‘‘Knowing, from the post mortem examination that there was no other disease I should say certainly, yes,” replied the doctor. Miss Marion May Christie said she had taken charge of the injections of insulin at Fordell ordered by the doctor. Her mother did the urine tests, the amount of insulin given depending on the results of these tests. The diet prescribed by Dr. Robertson was carefully adhered to and for a while afterwards the boy appeared to do well. After their arrival in New Plymouth

and following the dose on the morning of Wednesday, July 30, at her mother’s, instructions, she stopped giving Lyall' insulin.

On Thursday he was very well, but the. next morning he was not so well. She corroborated her mother’s evidence regarding the boys condition and regarding the visits to Salaman. Her mother had given her the instructions to stop the insulin after her visit to Salaman. IN THE CONSULTING ROOM. Lyall was lying on the sofa in Salaman’s consulting room on the Friday \vhen Salaman said it was just as well he had looked into the case and had not given any medicine, or they would have blamed his medicine for the boy’s condition. They carried the boy back to the house and gave him a hot water bottle. Recounting the instructions given her by Salaman when she had visited him to ask him about drinks for the boy, witness said Salaman told her not to give more than a pint of scalded milk and water in 24 hours, but that he would not restrict Bovril or beef-tea. He said they could sweeten the milk and water with a little honey. t During Friday night she helped her mother -to watch by the bedside. Lyall’s bbeathing was laboured. Next morning he would not answer when spoken to. Following her mother’s return from, a visit to Salaman she gave her brother half the usual dose of insulin. He appeared to be just the same afterwards. Her mother again visited Salaman about 10 a.m. At noon witness went to Salaman and told him the insulin had not taken any effect, but the boy’s breathing had quietened. Salaman said the heavy breathing was bad and that the boy's breathing was 'becoming more natural. Replying to Salaman she said she had given the injection in the boy’s leg. H t e said it should have been given in the arm; it would take longer to take effect in the leg.

Salaman said that if there were no improvement by 2 p.m. to give a quarter dose. Upon being asked Salaman said ifc would ta.ke thrsg day® for Lyall to

come out of that condition and that ho might have to have some more insulin at the end of that period. He wanted to get the insulin out of the boy’s system before commencing his treatment, but found the boy could not do wholly without .insulin, and so 'would , have to work his treatment in with it. He said he would gradually decrease the insulin. He said to give more insulin next day. Salaman told, her he would want to see the boy between 3 and 4 p.m. As the boy’s condition did not change they gave him the quarter dose of insulin in the arm. She did not come to the conclusion that her brother was dying until he was lifted to be taken t- Salaman’s the last time. Between 3 and 4 p.m. her mother went to see Salaman. On her return she told witness to wrap the boy up ..nd carry him over. On arriving at Salaman’s he examined the boy’s 1 neck with a stethoscope and said the circulation was bad. He told them to take him home and apply heat round the body, especially the heart, and to let him know how' the boy progressed. Later a message was sent by her mother to Salaman. They thought the boy was dead. Salaman did not come and her mother decided to telephone a doctor. Later Dr. Church arrived. GIVING INSULIN INJECTIONS. “From the time you learnt to give the injections till the time the boy died you gave the boy insulin?” asked Mr. O’Leary. ' “Yes,” said witness. “Did you keep to a regular dose?” “It varied with the amount of the tests.” “Your mother saw Dr. Robertson on July 23 and said she thought the boy was slipping back. Had you been giving him the ordinary dose?” “Yes.” “Do you remember the condition of the tests about the time your mother saw Dr. Robertson?”

“I think they were showing a good deal of sugar.” - - “Did he get daily injections up to July 30?”

“Yes. Mother said that Dr. Robertson told her we could miss injections for a day or two. I do not remember more than one day being missed at a time.” James Gray Christie, 'farmer, Kaka- ' ramea, gave corroborative evidence. Salaman had said he could not touch the case, but if they liked to stop insulin he could treat the boy and he . thought he could cure him. He said if they discontinued the insulin the child would get very sick and languid and would lie about. After an examination with a stethoscope he said Lyall had kidney trouble. Something was mentioned about diet. Salaman advised the exclusion of one or two vegetables and the inclusion of rice arid sago. The kidney trouble was probably inherited and making the diabetes worse, Salaman had said. “When Salaman learned there had been insulin treatment he said he could not take the case?” asked Mr. O’Leary. “Yes.”

“Your* mother told us, she said, ‘lf we discontinue the insulin, would be take the case!”’ “Those were her very ■words.” “He said that then he would make a thorough examination of the case?” “Yes.” ; “You did not then definitely tell Salaman, ‘Very well, we will discontinue the treatment?’ ” “No.” Mrs. Kate Elisabeth Armistead, proprietress of the boarding-house in Gill Street at which the Christies stayed, gave evidence. ■ MESSAGE TO SALAMAN. ’ Pearl Alexandria Armistead, Koru, said that on conveying Mrs. Christie’s message to Salaman he said he could not go as he was not taking the case. She said she thought the little boy was dying. “Oh, dying, eh?” said Salaman. “Yes,” said witness.

Senior-Sergeant McCrorie related that about 7.30 p.m. on August 2 he joined Constables Palmer and Wilson at Armistead’s boarding-house. Mrs,- Christie gave him the hypodermic syringe, the bottle of insulin, a bottle of steril-

ising liquid and a bottle of urine. The last-named was passed on to Dr. C. A. Taylor. Constable Palmer gave corroborative evidence.

Frederick Duncan Mackay said his daughter, aged 14 years, had suffered from diabetes since the age of nine. Before Christmas, 1928, she had been receiving insulin through the New , Plymouth hospital and at home. Witness said he took the girl to Salaman in February, 1929. She had then been on insulin about 4J years. Salaman told him to bring the girl. His wife and he took her the following afternoon. Salaman examined her chest, throat and back with a stethoscope. Although witness had said the girl was in a serious condition Salaman said this was not'a serious case. He said’she had 'a tendency to dropsy and that he would have her at school again in three weeks. So far she had only had three -weeks’ schooling in 4J years, ; Naturally the parents -.were very pleased, Salaman told them to stop the insulin and to change the diet. At Salaman’a request the mother took the girl to him before breakfast the followinj morning. -On that occasion some medicine was supplied. The new diet was the opposite to that prescribed by the doctor. The girl took the medicine o’i the Thursday but was too ill on the Friday to take it. She was very bad at lunch time, but the parents decided to continue the treatment till 5 p.m. Witness then went to Salaman and asked him to come and see the . child, | who was very ill. Salaman said he could not possibly go till 9.30 p.m. Witness asked him if he should give the girl some insulin. 'Salaman seemed to hesitate and said he would look up a book about it.

On his return home witness saw the girl could not wait so he returned to Salaman and told him he would take her to the hospital. The girl was taken’ back to hospital in a state of coma. There the staff worked on her all night; he understood she received hourly injections of insulin.

The girl recovered. She was now given two injections of insulin a day agd she was on a diet. Sho was better

now than she had been for several years. - The mother of the girl gave corroborative evidence.?- ’