WHY DR. BERRY PRESCRIBED HOT BATHS FOR CHILD

Hawke's Bay Herald-Tribune, Issue 131, 19 June 1937, Page 6

WHY DR. BERRY PRESCRIBED HOT BATHS FOR CHILD

Claim in Medical Phamphlet

DEATH CERTIFICATE "One of You is Not Telling Truth," Says Chairman HYPERPYREXIA FACTOR The claim in a medical pamphlet that the treatment would cure the diseaee in eight days was advanced by Dr. J. Allan Berry yesterday to tbe Koyal Commission investigating tbe management and administration of tbe Napier Public Hospital as tbe reason wby be prtescribed tbe bot-batb treatment for a child patient infected with vulvo-vagi-nitis in tbe Sbrimpton Ward. Tbe doctor admitted that his failure to acquaint tbe medical superintendent, Dr. J.- J. Foley, with tbe afterdeatb temperature of tha patient bad not enabled Dr. Foley to certify hyperpyrexia (bigb fever) in tbe death certificate. "One of ^you is not telling tbe truth," commented tbe chairman, Mr E. D. Moeley, S.M., when it was pointed out to Dr. Berry that there was a discrepancy in tbe testimonies given by himself and by Dr. Foley and the coroner, Mr A. E. Bedford. Dr. Berry admitted that tbe bot bath was probably a contribntory cause of death.' In his opinion tbe cause of death was b&art failure, witb byperpyrexia as a contributory cause. •In tbe eourse of lengthy questioning regarding tbe bot-batb treatment, Dr. Berry expressed tbe opinion that all treatments were experiments. Tbe ebairman expressed astonisbment. Continuing Ms evidence yesterday, Dr. J. A. Berry said Ms written instructions were tbat the temperature of tbe batb should be from. 102 to 106.8 for a period of one bour. The Mayo ciinic pamphlet stated tbat with this treatment tbe disease would be cured In eigbt .days. Tbis did not turn out to be coxrect. The bot-batb treatment did not finterfere witb the plasture treatment, as the plasture was specially split, to allow for it. He would topudiate any suggestion tbat tbe hipdisease treatment was in any way Jeopardised by tbe eubsequent treatment. Tbe eontinuance of tbe local treatment for tbe vulvo-vaginitis would bave been much easier and would bave saved a lot of trouble. Mr Foden: "Wby did you abandon tbe local treatment, then? Witness: A treatment that was elaimed to cure a disease in eigbt days was worth trying. Considered Treatment Justifled. Although tbe cbild bad tMs hip disease you considered tbat you were justdfied in adopting tMs treatment? — "It was little more tban a bygienic hot-water batb. It was not as Jiot as many people bave their baths." Wbat were tbe temperaturesf — "102 to 106.8 degrees." # Did you give special instructions to the sister to see tbat tbere was no disfrurbance in tbe position of tbe child's hip? — "I think I did." Tbat would involve a considerable fisk? — "In myjudgment it didn't, and it didn't, eitlxer; tbe child's Mps were getting on well." TMs is tbe iirst time you traed.this treatment? — ■" Yes. " It was an experiment? — "All treatments are experiments." I take it tbat every time one puts oneself in tbe bands of a medical man one is in for an experiment? — "Tbat is not quite tbe point." Tbe ebairman: Tbat ds tbe deduction from your own answer. Witness: Everyone has Ms own idiosyncrasies. Mr Foden: Tbe principle of your treatment is based on ordinary bot baths for vulvo-vaginitis? Witness: I did not pin my faitb on it, but I tbougbt it was wortb trying. You considered that there was no risk? — "Not in tbe Mp batb." You knew tbat some of Dr. Whyto's patients were reeeiving bot batbs?: — "I learnt of it later." Who informed you of it? — "Tbe sister." You saw tbe children in tbe batb? — "J missed them out of their room. I said: 'Aie they baviug the batb. treatment too'r ' : ' At *5h:s s+age Mr Foden produced a small book in which reeords were kept privately by the ward sister. Witness said that he had not seen the book ontil the commission had started. Mr Foden: When the other children were having the hot baths, did you tiiscuss it witb the honorary at all? * Witness: No Why not? — "It was not my concern to know wTtat otlicr doctors' patients were doing." Do you regard that as being in ae cordance with proitssional etiquette?— "Yes " "No Air of Secrecy " As far as the other doctors were concerned, they were quite likely to be in the d-ark in regard to the treatment their patients were getting? — "I don't think they were in the dark about it " Doesu't it strike you that there is an air of secrecy about this treatment?— "No." Was dt at your direction that this treatment was given to the other patients? — "No, certainly not!" Yop. will agree that the sister who knew the other children were havinp ihe batbs and did not inform the othedoctors would fbe committing a grave breacb of duty? — "Later on " , . The ebairman: Answer tbe questioa, doctor. You ' are sufficiently intelligent to answer tbe questaon witbout hedging. * , Witness: Yes. Mr Foden: You regard your conduct j£ tbt jnattsf as .cpnsiitejUi sdih tbe

best traditions of tbe profeesionf' Witness: Yes. You made no mention of it to Dr. Wbyte?— "No." That measures "up to ihe tradifion of the profession. — "I tbink so." If you knew that Dr. Whyte's patients were baving your treatment and knew that he did not know of it, would you bave told him? — "Yes, or have told the sister to tell him." There are permanent written reeords of this treatment. — "I made none, and as far as I know none have been made." That little book is a private and secret record? — "I don't know." Whose property is that? — "I should say the property of the sister." You consider that in your capacity as a memh'er of the board your embarking on this treatment was in the interest of tbe institution? — "Certainly." And ihe treatment was not recorded? —"Not many of the treatments are." Had Temperaturea Raised, What about the other treatment — not the hip treatment which you keep slipping hack on to?— "As the tests were showing positive I had the temperatures raised. to commence at 100 and at the end of a qUarter of an hour to be raised to 110. Temperatures were to be taken every 15 minutes. The child while in the bath was to be given a drink of saline as often as it wanted it. Its bead was sponged with cold water. After the bath it was wrapped up and taken into bed. Temperatures were to be taken .and also the pulse." Where did you get those instructions from? Out of another pamphlet? — "They were my own safeguar'ds." What paris of your instructions did you compile? — "The taking of tbe temperature in tbe bath every quarterbour. I think that that is all not prescribed for." By whomP— "By the authorities." Asked to quote his authority Dr. Berry gave a name and proceeded to read an article dealing with the bath treatment, Mr. Foden: For what is tbat treatment prescribed? Witness; For rheumatoid arthritis. I used it for vulvo-vaginitis. Tbat was another course of special treatment you embarked on" without consulting) your colleagues ? — "Yes." That too was an experiment? — "Yes." Having failed in the first experiment you resorted to adopting the second? — "Yes." With regard to the second treatment, you will say that it was not attended with rfsk?— '"'There jvas some risk." Will you poiut out what risk? — "There was a remote cbance of hyperpynexia." In that artiele from wMch you took the treatment there was a warning on risk? — ' 'There is some refetence to it." You consider that the risk in your treatment was negligible? — "Yes." Only One Risk, You disagree • with Loader and others? — "Yes. There was only one risk, that being getting the. temperature tOo high." Tbe water? — "The patient/'' If the temperature of tbe water became too bigb there would be a risk? — "We are talking too vaguely/' "You are doing a fair amount of tt," commented Mr. Foden. "Where was tMs risk? Was that a aegligible risk?" he aske.d. Witness: It should be. So that that risk depends largely on che care of the nurse ?— "Yes." And there was no other risk? — "1 did not think so at the time." Do you still think tli9 risk as a whole is negligible? — "Yes." You did not think fit to get the consent of the parenta?— "No." Why? — "I didn't think of it, and in any case I did not think it necessary to inform them, as I considered tlie risks as negligible." When children are committed to your care you feel that you are entitled to embark on any course you tMnk fit if you tMnk the risk is negligible? — "Yes." In your view the safety of the lives of the children committed to your care depends upon whether you thinis the treatment has risk or not? — "Yes." There are risks in operations j in f act we are always taking risks." Don't you think that it was your duty to tell the parents what you were doing? — "I did not look upon that as mv responsibility." Wben did' yo ustop- tbe hot-water oaths for the children. — "1 had nothmg to do with the other children." When did you stop the hot-water then, for the one ' child? — "When it died." Were the hot baths for the other children diseontinued then? — "They would be." When the child died you were called to its bedside? — "Yes." You took its temperature? — "Yes." What was it?— "108.4." Did you tell Dr. Foley what it was? -"1 said that she was hot." Why did you not tell him? — "I lnfcended to discuss it outside." COndition of Child's Skin. Was that because the sister was there? — "1 don't kuow uow what my reasons were." Did you notice anything Rtrange about the child's skin? — "No." Was it normal? — "Yes." Just as if it had not had a bath? — "No." Did you notice no spots? — "No, there was nothing of that sort." What was tlie colour of the i'ace? — "lfc was rosy-cheeked." No sign of any uiiusual condition ? — "No." There wero no sigiis of hyperpynexia ? — "No." is there nothing more to tell regardmg the condition of the child? — "No." You have made a full and frank diselosure of your observations ? — •Certainly." I think shortly afterwa-^ds you were with the sister in her office. What was the disfcussion that took place? — "I can remember Cxactly what took place and what was said. Dr. Foley was blaming} the sister, and I said that was n.ot farr - if thers w.ae any blame

it should be on two men, Dr. Foley and myself. I can place the conversation properly. I don't know exactly what Dr. Foley was blaming her for." Did you not tell the sister to write a detaOed account of the child's death i in her diary? — "Yes." ■ Why did you do that? — "If she was to be blamed she would have & full ■ record of all that had occurred." Was there any discussion of the cause of death? — "Y'es; hyperpynexia was discussed." Dr. Berry detailed a message from Dr. Foley, who had told him that the child was dead. He said that the cause was hpyerpynexia. Mr Foden : You do not think that she died from hyperpynexia? Witness: No; I did not know. In reply to Sir James Elliott, witness said that he did not tell Dr. Foley until some time after the burial that its temperature was 108.4. Sir James Elliott pointed out that Dr. Foley would not be able to tell the cause of death when this information was deniea him. "Dr. Foley Appeered to Know," Mr Foden: Did you at that etage tell Dr. Foley that the child had been having a hot bath treatment? Witness: No; he appeared to know all _about it. On what do you base that assumption? — "In the conv'ersation in the sister's office he seemed to know all about it." You didn't expect the child to have a sudden death? — "No.'» It was an obvious sudden death? — "Yes ; from the history I received it appeared that the pulse was normal and then there was a sudden collapse." Was it in your view an obvious sudden death? — "Yes." You did not insist upon an inquest? — "No." As an experienced medical practitioner and one versed in the procedure, don't you think you acted improperly in not asking for an inquest? — "I think, on looking back, that it would have been wiser. There was no suspicious circumstances as to the causS of death." In other words your treatment was above suspicion ? — "Yes." You were the particular person to whom it was necessary to sea that an inquest was held? — '"No." You weren't apprehensive of an inquest because you had not told the superintendent of the treatment? — "No." You went to the coroner late at night? — Yes." Why? — "To tell him about the death." "Why? — "Because ho was the coroner/' The chairman : And a member of the board ? Witness: Yes. And you are a member of the board? —"Yes." Mr Foden: You did tell Mr Bedford about the hot-bath treatment? Witness: Yes, the whole story. If Mr Bedford said that you didn't, there is a, disctepancy somewhere? — "Yes." "Someone Not Telling Truth." You thought it incumbent upon you to tell Mr Bedford about the hot-bath treatment and not tell Dr. Foley about it, yet he had to sign the death certificate? — "He knew all about dt." * Dr. Foley says sometMng quite different; in fact, he says just the opposite. There is a discrepancy between the testimonies; in fact, we reach an interesting triangular conflict of testimonies? — "I am not passing judgment." The chairman: You draw the obvious conclusion? Witness: That I am not telling the truth? The chairman: That one of you is not telling the truth. Mr Foden: Did you tell Mr Bedford that the child's temperature was 108? Witness: I did not think it an important point. The chairman: Did you tell him ahout the temperature of the bath? , Witness; No; I did not think it important. Mr Bedford said that you did not tell him about the hot-bath treatment? — "He has probably forgotten." The chairman: Mr Bedford has sworn that you didn't tell him about it. One of you as saying something that is not true. Questioned about the death certificate, witness said that he did not learn from Mr Bedford what was going to be in the death certificate, but from Dr. Foley. Mr Foden: You did not know what was in the certificate when Dr. Foley signed itj Witness: No. Do you agree that the cause shown was sufficient? — "Yes." You would say dt was irregular?— "No; dncomplete." Don't you think that you uught to have suggested to the coroner' the possibility of hyperpyrexia caueing death? — "Yes." "Who conducted a post-mortem? — "T did." On whose authority? — "I don't know. I took it that authority was obtained. It could have been obtained from the parents.'' . Who Obtained Authority? The chairman: Was it? Witness: I don't know. You mean to say thut you don't remember wliether you obtained consent from the parents? — "At this distance of time 1 could not say whether l obtained it or Dr. Foley obtained it." j Mr Foden: You made some notes of' the post-mortcni. Where are they? Witness: I don't know. Did you destroy the paper? — "J nught have left them in the poetmortem room." What did it reveal? — "Nothing to iudieate the cause of death. The organs nppearod to be healtliy." Do you consider you were the proper person to hold the post-mortem in view of the public. interest? — "I considei that it would have been better if someone olsc had done it." ILow far had you progressed when Dr. Foley arrived? — "1 think I waited for him, as I wanted him to be present." No question of eonsent was discussed? — "No." That sxaminatioft did not onable you (

to discover the cause of death? — "No; the appearances did not indicate by any means that the cause of death was hyperpyrexia'." You say that the appearances of the body were not consistent with those described as hyperpyrexia? — "Yes." You know that samples were sent down to Dr. Lynch for analysie? — "Yes; I took care to get them." The chairman: Do you tMnk that the cause of death was influenced by the hot baths? Witness: Yes. Ho w ? — ' 'I don 't know. ' ' You heard about the collapse that the child had?— "I thought that it had been exaggerated owing to the normal appearance of the child." Yoni raised the temperature of the bath from 112. to 120 degrees? — "Yes — part of it." Child Not Immersed. What part? — "The top part. Th» cnild was not immersed but was sitting in the bath. When the temperature was 120 the chdld started to whimper, and I immediately took it out. Before that it was not upset at all." If I ask what was the canse of death what do you say it would be? — "Heart failure." And the CQntributory cause? — "Hyperpyrexia." To "Mr Harker, witness said he told the sister to be extremely carefol and watch the pulse continuously. He agreed that in connection with thds treatment it would have been wise to have advised the parenta so that they could deciile whether the risk shou'id be taken or not. Mr Harker: Did the sister keep a record at your request or for her own information? Witness: At my request. And yet you never saw those r,ecords? — "No." Have you read any authority where the internal temperature was produced in the way that at was produced by your treatment? — "No." Do you think now that you would have continued the bath treatment at all?— "No." * If the parents say that you did not ask for a post-mortem, would they be right? — "They probably would be. There never has been any secret about the post-mortem nor was the protest made." Dr. Foley told us yesterday that ho asked you for the temperature you took after death but that you made no reply? — "It was a time of tension." Was that not of importance to Dr. Foley? — "No. The temperature would go up after death." Would it not have been extremely helpful to Dr. Foley in filling in the death certificate? — "It probably would have been helpful." If he had had that knowledge would that not have caused him to vary the certificate? — "I don't think so." Provisional Ceftiflcate. The chairman: He could not fill in the certificate without it? Witness: A provisional certificate could be -given. A provisional death certificate?— "Yes." Where is your authority for that? — "You can modify the certificate wards."Mr Harker: I think you say now that you consider that death was due to byperpyrexia? Witness: No; it was a factor. Do you consider your bath to have been a contributory factor? — "Yes,' I cuppose so," You will agree that if Dr. Foley, as medical superintendent, was not informed of the hot-bath trea'tment a serdous omission was made? — "Yes." Whose duty was it to tell Dr. Foley 1 — "The sister's/' Not telling him, then, was a dereliction of duty? — "Yes." " After the child's death another parent spoke to you about the risk? You said "They want kill — ".? — "I may have said it." What rrfade you change the treatment? — "The statement that an ordinary bath would cure the disease in eight days." That failing you went on with something more .intensive?— "I thought it was a good treatment." Have you had discussions with the sister and a nurse a few days before the commission of the evidence that was to be given?— "Yes." Was it because of that that she tells us of the treatment of the bath temperature at 106.8? "That is simply the truth of the matter." For the first time she puts the blame on to Dr. Whyte; you had nothing to do with that? — "No." "Responsibility of Shame." Tho chairman: If the medical officers of the hospital do not obey tbfe rules, how can you expect the subordinate officers and the nurses to obey? It is rnost reprehensible. A responsibility of shame rests upon some honoraries. Mr M. R. Grant (for the board) : You had nothing to do with the fact that the sister had lost the piece of paper on which you wrote the instructions ?> Witness: No. The sister suggests that the treatment was being kept deliberately secret J'rom superior officers and the honorary. Did you want it td be kept secret? — >"No, 1 did uot want it to be kept secret." You said tbere was a derelictlou of duly by Ihe sister? — "Yes." As a board member you opposed the dismissal of the sister? — "Yes." ' Can you give us the grounds? — i"Vies. r considered that in all cases she ' bad done all that was possible." In regard to th^ post-mortem, where did you gefc Ihe body from? — "J dou 't know. 1 could not say whether it was ou the table or not." Who told jou that there was to be a post-mortem? — "1 don't know." Who told Dr. Foley? — "I don't know." Some time in the aftemoon you and your brotber had been discussing what elfect the heat treatment had on the death of' the girl? — "Yes." And yon decided that it would hr advisahle to have a post-mortem ?•— "Yes." Is there a key to the post-mortem room? — "Yes." Wliere did you get it? — fI don't know that I did get it." Where is it kept? — "Ju the norter'e k office,"

In that train of arrangements, where did the parents come in?— "They did not come in at all." Key to the Mortuary. Or the coroner? — "No." Where is the key of tlie mortuary kept? — "ln the porter's room." So that 5ny honorary can get the key if he wants, it? — "Yes." That is where you got it from?— "if got I it." Dr. Foley says- that up to the time of the child's death he had no knowledge of tho heat treatment for any of the children? — "It seenis to me to be unlikely." In reply to a iurther question, witness said that Dr. Foley, uot knowing that hot baths had been given, could have given any other reason for tho cause of death. Mr Grant : Had you any reason for not telling Mi Bedford -that you had beid a post-morlein ? Witness: .No. Theu wby didn't you tell him? — I'tn uot sure that l did uot tell him." Is it a praetice to hold post-mortems without anyoue's knowledge? — "Not geuerally." Tbe chairman : Out vou bave lield some ? Witness: Yes. Here is tbe child sufFeriug from a cold, and a good dea] of pliyegm gets into the chest, doesn't it?— "Yes." Then what would be the etfect of givmg a young child with her chest full o'f phlegm? — "I don't think it was full of phlegm. Tho effect would be bad/' The commission then acljourned untg tnoruin£,