T. 0. SAVAGE. 1

91

HZ—3lb.

the same, I would have injected small doses of vaccine for the treatment. It is quite a serious matter and quite a difficult matter to get a uterine swab which is worth anything. I would have taken the swab at the moment there was reason to think the patient was septicaemic, and not before. As to the child, I agree with many of the authorities who state that if you get tubecular disease in very younginfants the infective cause is nearly always the mother. As to what I said before, I say that I would take cultures when I had reasonable grounds for suspecting sepsis. Personally, Ido not suspect sepsis all through that chart. Cross-examined by Mr. Skelton.] I would suspect from pain in the uterus, pain in the vagina, distended abdomen, pain on examination, a look of illness, a complaint of feeling ill, together with a high temperature and rapid pulse. Cases of sepsis where there is no pain and no sign of local infection die within five days of the puerperium. The symptoms in puerperal septicaemia always present are an increase in the pulse-rate, more or less rise of temperature, feeling of illness. Practically, that is all. Ido not think the patient's rapid pulse when she went in would be due to excitement, not with a subnormal temperature. Ido not think it is possible. My experience in midwifery has extended over eighteen years. I should think the doctor who had charge of the case and the doctor who came in on the 28th and remained with it for four or five days would be in a better position than lam to judge what was wrong with, the patient. I think that what the woman suffered from from the start continued right through to the end. lam not sure that I admit that Dr. Goldstein is in a better position than lam to judge what the patient was suffering from. In certain points lam in a better position to judge what the patient was suffering irom than was Dr. Goldstein, who attended her for some days. I say that there is more evidence against the septicaemia theory than for it. I am not necessarily in a better position to judge as to what the woman was suffering from than was Dr. Goldstein or Dr. Lindsay. For these reasons : first, that one of them states in evidence that he could not decide the cause of the illness, but thought it prudent to treat it as a case of septicaemia ; the other says that he did not consider the lung condition satisfactorily accounted for all the symptoms, and he also thought it would be well to suspect it as septicaemia. Yet the result of their blood-test for septicaemia is negative. The whole of the evidence as regards septicaemia from a bacteriological point of view is negative. Personally, I would absolutely disregard the result of the swab. Personally,.! would have taken the swab myself 1 , or seen it taken. I w 7 ould not trust a swab taken from a patient of mine unless taken in the manner mentioned by me. Another reason why lam not necessarily in a less favourable position to judge as to the woman's illness is that one of those who saw her—Dr. Lindsay—states that he has very little experience of septicaemia. I am, unfortunately, not in that position. I cannot answer the question on oath as to whether or not there are symptoms or signs of septicaemia, in the evidence before me, without misrepresenting myself. The chart and all the evidence before me does not suggest to me that the woman suffered from septicaemia at all. Mr. Skelton.] Can you find in the chart and other evidence submitted to you any evidence of symptoms which are usually found in cases of puerperal sepsis ?—I cannot say. To Mr. Skelton.] When I said " I cannot say," I did not understand the question. My answ 7 er to the question is " Yes." There are such symptoms, but those symptoms may be associated with many other diseases, I think the probable cause of death was acute miliary tuberculosis. With a negative blood-culture 1 think the swab did not show the true state of the uterus. Ido not think it possible that it did so, taking into consideration the negative blood-culture. T think, broadly speaking, it would be unwise to permit midwives to suture ruptured perinaeums, though there may be well trained women who are quite capable of doing it. Ido not believe children are born tubercular. The cases are very very rare. Children born of women who are tubercular are prone to develop tubercular trouble —that is, they are born susceptible to it. If a child taken from its mother on the fifth day died at six months from tubercular trouble I should regard that as strong presumptive evidence that its mother or father were strongly tubercular, and that it inherited from one of them, more probably the mother, a strong tendency to tuberculosis Provided streptococci are found in the blood-stream, then I should use vaccine. [Lancet of 28tb December, 1912, page 1799, " Vaccines and puerperal septicaemia," put in.] In my experience, I never use vaccines early, but they are of some use in later stages provided organisms are found in the blood-stream. To the Comt.] It does not seem to me possible that the woman was suffering from bronchial pneumonia and septicaemia together. I have been in St. Helens Home once. I should not think its site a suitable one for a hospital of this character. I think it would lead to a greal deal of confusion if the maternity hospital were, placed near to the General Hospital. It should be quite a long way from the surgical, typhoid, and infectious wards. I think it would be better to be quite by itself. lam not in a position to say anything about the suitability of the present building. I know the drug called hyoscine. While I use it a lot, I never actually administer it. Ido not think it should be administered without communicating with the doctor. In bronchial pneumonia there is no need to examine the sputum early. Examination of the sputum would give evidence as to the germs in the lung, but none as to the extent of the disease. If the attendant is a skilful man he can tell by an examination of the chest if the patient has bronchial pneumonia. Cross-examined by Mr. Nicol.] I see the charts relating to Mrs. Porch. I say that the patient was suffering from some pelvic infection with an abscess. That is what it looks like. Apparently the patient has sepsis. If I knew that a nurse was suffering from a vaginal discharge I would not permit her to attend to a maternity case. Re-examined.] As a general principle the insertion of sutures and the administration of hyoscine should not be left to a midwife, but if I knew 7 the midwife to be trained and capable I would have no objection to leave these matters to her —that is, I would not permit it, with a reservation ir favour of certain individuals whom I knew to be capable. [Mr. Mays says this is the end of his case, and that he has no further witnesses except Dr. McDowell.]