H.—3lb.

34

0. LTJDWIG.

of the Hospital on my shoulders. I saw Mrs. Marsh when she came to book for her confinement. That would be about two months before it. I spoke to her about general matters and about the state of her health. All I remember she said was that she had not been feeling well. I understood her to say that she had been troubled with a weak heart for several months. I keep a register of patients. I saw Mrs. Marsh on. the evening she was admitted—at about 9 p.m. on the Ist July. Her confinement was quite normal. A slight rigor and a slight sore throat on the second day were the first things I noticed. There was a rash, too. I cannot remember the hour when they appeared. I noted the rise of temperature on the evening of the 3rd July. I informed the doctor by telephone of the rigor and the rash the day I noticed them. My instructions are definite that I must report all cases of temperature and abnormal symptoms as soon as possible. As soon as the doctor informed me that the case was one of scarlet-fever the patient was isolated. I thought myself it might possibly be a case of scarlet-fever. The patient died on the 9th July. The nurse told me two nights before the death that the pulse was getting a little quick. I did not myself go in the isolation ward. A special report in writing was kept in the isolation ward, but this was destroyed. We have had about six cases in the isolation ward. In each of these cases a report was kept on separate sheets of paper. The nurse would burn these, being cases of infection. For the first few days in the isolation ward the patient was attended by one of the pupil nurses. From the time serious symptoms showed themselves she was taken in charge by a trained nurse, who remained with her till her death. The pupil nurse was Nurse Holmes. The trained nurse was, I think, Nurse Seymour. The two nurses who attended the confinement have left the institution. I have some recollection of Mrs. Williams visit. It is incorrect that I said the patient contracted fever at Dr. Keller's. I questioned Mrs. Marsh as to the rash. She told me she had been out to Ponsonby to see a doctor. Ido not think she mentioned the name. I saw the doctor on the day of Mrs. Marsh's death with regard to sending for the relatives. I sent for them immediately I got the doctor's sanction. I sent a telegram to the husband and messages to the sisters. In mild cases of scarlet-fever one has to look well into the skin to see if there is peeling. I know of nothing that could have been done and of nothing that was done that could have saved Mrs. Marsh. We did our best. The doctor came without delay, and I reported to him as soon as possible. % To the Commissioner.] As far as I remember, the doctor visited Mrs. Marsh in the isolation ward every day. The nurses in attendance there never came out of the isolation ward into the main building. I suppose the patient was on a milk diet there. No diet-sheet is kept. The milk would be put on the step and the nurse would take it in. The nurse's food would be taken in in the same way. The dishes were kept in the ward, and boiled there. The nurse kept a temperature-card in there, and everything that was done or occurred would be put down. Ido not remember seeing the temperaturecard or the notes after isolation. The temperature-card before isolation was taken into the isolation ward with the patient. The temperature-card and notes kept by the nurse were destroyed. I expect this would be done when the other things were burnt by the gardener in the garden, having been first fumigated in the ward. We have no appliance for destroying these things. The case-book was entered up after the death —I do not remember how long after. If lam very busy I let them run on a month or two before entering them up. I got some of the information out of the delivery-book we keep. I suppose I would get the information as to the scarlet-fever out of the nurse's report-book. There is a report-book in which the nurses report hourly the condition of the patients. The report-books prior to the 22nd October, 1912, to the 10th December, 1912, have all been destroyed. I was told the present one had better be kept. I destroyed the others by tearing them up and putting them in the waste-paper basket. There were no old report-books there when I arrived, and I went on in the same way. The nurses write out the notes for me. In making up the present case in the case-book I had no access to the temperature-chart or the nurse's notes. The notes are made in the case-book at any time. I might have made the entries in the book relating to Mrs. Marsh any time—it might have been weeks after the event. I copied the entries from the notes of Nurse Holmes. Either myself or the assistant matron is present at every delivery. A special nurse was appointed to the isolation ward.' The entries in the book were written in by me from a draft prepared, by Nurse Holmes. I got the statement " that the fever was of a mild form " from Dr. Inglis. I suppose the doctor told me that the patient showed symptoms of heart-failure on the 7th, gradually got worse, and died on the 9th. The relatives were notified of the critical condition of the patient on the morning of the 9th. I did not consider it was necessary to notify the relatives earlier. I got the information that the patient had been treated for a weak heart from herself. The nurse was changed on account of the appearance of the symptoms of heart-failure. Nurse Seymour then went in in place of Nurse Holmes. Nurse Seymour is out of New Zealand now. She was called in from the Nurses Institute. Nurse Holmes was a pupil midwife. She had been six months in the home. The patient was in the isolation ward from the Monday to the Saturday. I did not look on the case as a serious one till the very end. We had no fear of her at all. There is no book in which the Medical Officer enters his report for my information. All his reports to me are verbal. If he comes'when lam busy the assistant matron attends to him, and she puts on paper anything special that the doctor says. The deliverybooks are torn up. A visitor's'book is kept Jor people who wish* to look round, but there is none kept for friends of patients. [By consent, cross-examination deferred.] Tracy Russell Inglis, recalled. To the Commissioner.] I see from my card that I attended Mrs. Marsh on the 2nd, 3rd, 4th, sth, 6th, early in morning of 7th, Bth, and"9th"July. The patient first showed symptoms of heart trouble on the Bth, as far as I remember. She rather got suddenly worse on the 9th. I talked the case over with the Matron each day. I made no record in the case-book or anywhere else.