H.—3lb.

32

Ft. r. inglis.

case. I have heard the evidence of Mrs. Marsh's sister as to the pain in her left side, and the evidence ' of Mrs. Bowry as to Mrs. Marsh's palpitation. I think those two facts would render the patient more liable to attacks of the heart. Nothing more could have been done to save the life of Mrs. Marsh than was done. Hers is the class of case that one may meet with at any time in any maternity hospital. We cannot always foresee a sudden attack of heart-failure. So far as I can judge, the relatives of this patient could not safely have been admitted to see the patient earlier. To the Commissioner.] I first saw the rash on the second day after the confinement. Examined by Mrs. Nicol.] It is not my duty to see every patient who goes into the Hospital. It lies with my own judgment whether, when I go to see an abnormal case, I go and see all the other cases in the Hospital. I can do so or not, as I like. I always ask the Matron if there are other cases in the Hospital requiring my attention. Ido not think I was there at Mrs. Marsh's confinement. lam in charge of the Hospital. With regard to the medical administration, I can overrule the Matron, though I can hardly be held responsible for the mistakes of my subordinates. Igo round the Hospital and see all the patients on my visits. lam in charge of the medical part. The Matron is in charge of the domestic part and of the nurses. I consider lam responsible for the health of all the patients, whether lam called in or not. That is the position I have always taken up. If a patient were sutured by the Matron I would not say it was necessarily her duty to call me in. It depends on the suture. It is the custom in every maternity hospital I know of in New Zealand for the Matrons to insert the sutures in tears of the perinseum of the first degree. I know of some Matrons of outside institutions who carry out this duty. I have seen the duty carried out in Melbourne. There is nothing relating to the matter in the rules of St. Helens. It is certainly not a fact that pregnant women are almost invulnerable to scarlet-fever. It is the thing we fear most. I do not know Dr. Barrett's work on " Domestic Medicine." There were no other cases of scarlet-fever in the home when Mrs. Marsh was there. The contagion in scarlet-fever begins when the rash breaks out, or before that. I believe a patient is infectious almost right from the period of incubation. The patient is generally worse just before the rash appears. The period of incubation is from four to twenty days, averaging ten days. It is quite possible in a mild case of scarlet-fever that the patient might be cheerful and bright, and without any running of the nose on the day before the appearance of the rash. I think there was danger to the relatives being admitted to see the patient before they were. Infection is not limited to the peeling. I think it was dangerous to admit the husband, but there must have been some special reason for it. The rash is a certain symptom of scarlet-fever. There are other prior symptoms — sore throat, pain in the hack, a catarrhal condition of the nose. When Mrs. Marsh was seen by me when she had the rash she told me she had a sore throat. Ido not think I had seen her before she was confined. Ido not see patients before they are confined unless there is a special reason. It is not my opinion that the contagion is mostly due to peeling. The time from the rash to peeling depends on the severity of the attack. Had the patient the rash on the Sunday she could peel on the next Thursday or the Friday. Heart-failure might account for what I think was meant by the witnesses when they spoke of black patches. Heart-failure is also one of the results of septicaemia. The jaws being set is a sign of approaching death. There used to be an idea that scarlet-fever produced septicaemia. That is not now held. What was taken to be septicaemia is now taken to be a virulent form of scarlet-fever. Mrs. Marsh was isolated as soon as I was satisfied that there was scarlet-fever. I cannot now say when I suspected scarlet-fever. I cannot now say how long the patient remained in the room with the rash on her. I cannot say how long the patient had the rash on her before she was isolated. It is absolutely untrue that I informed Mr. Hooker that if the Matron said, to his sister-in-law that it was only a mild case of scarlet-fever the Matron ought not to have said it, as her case was hopeless. I say that the case of scarlet-fever was a mild one. I never told any one that the Matron was wrong in saying that it was a mild case of scarlet-fever, and the patient would be up in a fortnight. I never told any one that the Matron was wrong in anything she said. Ido not remember saying to any one that I had put on a special nurse. There was a special nurse on all the time. That was because it was a case of scarlet-fever, and the patient was isolated. To the Commissioner. —l swear positively as a medical man that in my opinion Mrs. Marsh died of scarlet-fever and heart-failure, and nothing else. I also swear that I gave the case all the attention and medical skill it demanded. I swear that the patient was properly treated throughout her illness. I know of nothing that was done or left undone that in any way contributed to the patient's death. The isolation ward in which the patient was placed was a suitable isolation ward as regards herself. It was all right that the ward should be used for other patients after thorough disinfection. It was made for disinfection. After thorough disinfection it would be quite safe to put another patient in that ward. Examination by Mrs. Nicol continued.] I could not say when I saw the symptoms of heart-failure. There were symptoms of heart trouble a day or so before the death—perhaps two days. I cannot fix it more definitely than that. The heart-failure killed the patient. Ido not at this time remember what the death certificate said. I gave the certificate. I have a record of it. Had the patient's condition at 9 a.m. on the date of death warranted it, the relatives might have been admitted then as well as twenty minutes before her death. When we considered death to be imminent we sent for the relatives. That was on the day she died. In my opinion, there was no necessity for alarm till the day the patient died. When the symptoms of heart-failure occurred it became a complicated case. When the symptoms of heart-failure appeared I still thought Mrs. Marsh would get over it. I did not call in a consultant, because when the case showed itself to be hopeless there was no chance and no necessity for a consultation. Re-examined.] Mrs. Marsh died just when the relatives were discussing the matter of calling in another doctor. So far as I know, the Matron sent for the relatives at once. I have an idea, but I am.not sure, that it was in the evening when I first heard of the rash. I know of no cases where the Matron has failed to report symptoms which. I ought to know.- All symptoms are reported promptly