interview

Q&A with Gavin Hamilton M.D., author of The Nurses are Innocent

Tell us about your book

The story deals with two chains of events. The first was the discovery of a contaminant, leaching from the pharmaceutical rubber parts of medical devices (syringes, drug ampoules and intravenous apparatus) that could cause death from severe allergic reactions, or from the contaminant’s cumulative toxicity.  In December 1987, this contamination became linked to an earlier sequence of events – an unexplained increase in deaths (1980-81) on the cardiac wards of the Toronto Hospital for Sick Children.

In the latter instance, based on the interpretation of specimens taken by a pathologist in the hospital’s autopsy rooms, a theory arose of intentional lethal overdosing with the heart drug, digoxin by someone on the nursing staff.  A young nurse, Susan Nelles, the daughter of a prominent Belleville paediatrician, became the focus of a criminal investigation, ultimately being charged with four counts of murder – charges that had to be dropped because of insufficient evidence. Evidence indicating that there were no murders was ignored. The question of multiple murders lingers to this day.

This complex subject is now a major case study in Canadian jurisprudence. At the time it resulted in the creation of the Grange Royal Commission of Inquiry lasting well over a year, with many expert witnesses – paediatricians, cardiologists, nurses, forensic scientists, and pathologists being called to testify.  Dr. Peter Macklem, the Professor of Medicine at McGill was called as an expert witness at the Inquiry. He denounced the interpretations of autopsy digoxin levels as indicating the digoxin status in a living baby, pointing out that no such digoxin testing had been done before – anywhere – and there were no standards with which to compare the results. It is reasonable to conclude that Dr. Macklem’s testimony, may have saved Susan Nelles from conviction and false imprisonment, although many Ontarians have been falsely convicted and imprisoned since that time, based on incorrect interpretations of child autopsy findings by a pathologist.

“The Nurses are Innocent – The Digoxin Poisoning Fallacy,” presents evidence, accumulated over a thirty year period, from four continents. In the words Dr. Macklem, who later consented to write the Foreword, “…… you now have conclusive evidence that there were no murders, so [Justice] Grange ….. should apologize to both Phyllis [Trayner] …… and to Susan.”

Did you have a specific readership in mind when you wrote your book?

My intent from the start was to prove to the police, the judiciary, the Ontario Chief Coroner, the Attorney General, the medical staff at the Toronto Hospital for Sick Children, the media – and to the Canadian public at large – that no digoxin poisoning occurred and that Susan Nelles was innocent. I believe that the nursing profession will concur with my explanations and will welcome this evidence which exculpates Susan Nelles – and the nursing profession she continues to represent so well.  The false idea of  multiple murders and the incorrect diagnosis of digoxin poisoning has been allowed to linger for 30 years – and is dismissed with multiple solid references.

What was your first publication?

Throughout my career as a diagnostic radiologist, I wrote in peer reviewed journals – seventeen publications in all.

The first of these publications was a December 1971 article in the Canadian Medical Association Journal, entitled, “Unilateral decrease in renal vascularity on the “excretory” urogram,.  This article described a new technique to show a dense image of the vascular pattern of kidney tissue after a rapid intravenous injection of a radio-opaque contrast agent (“an X-ray dye”).  The wealth of new diagnostic information offered by this simple new technique resulted in 1000 referrals to my office for this procedure each year.

Research into the cause of two clusters of  allergic reactions I encountered during these injections of X-ray “dyes” implicated a toxic / allergenic contaminant that was common to injections of any pharmaceuticals, intravenous fluids and blood transfusions , partly because the contaminant was read as digoxin by testing methods. This contaminant became linked to the 1980-81 Toronto Hospital for Sick Children baby deaths. The contaminant was being read as digoxin by the testing methods used at the Toronto Hospital for Sick Children – and by the test method used by the Centre for Forensic Sciences during the time of the Grange Inquiry into the deaths.

What inspired you to write your first book?

In 1957, while I was a senior intern on a neurosurgery rotation, I saw a patient’s carotid arteriogram displaying arteriographic standing waves – an unexplained phenomenon. These beautiful symmetric simple harmonic waves, outlined by an X-ray “dye,” occurred during a rapid injection of dye into an artery.  In arteriographic standing waves, I imagined standing sound waves similar to the periodic waves seen in a high school physics experiment when powder was sprinkled along the base of a glass tube in which a standing wave sound field was created (the Kundt’s tube experiment).

This phenomenon of arteriographic standing waves became the key to unraveling a longstanding enigma in fundamental fluid dynamics – why does laminar flow (streamline flow) suddenly turn into turbulent flow, with a dramatic increase in resistance to flow. This phenomenon affects airflow around automobiles, aircraft and rockets, and water resistance in the motion of ships and submarines – as well as fluid flows through pipes; it has been described by Mohamed Gad-el-Hak as “The Last Conundrum” of classical physics.

I was driven to write about this theory that suggests that simple harmonic sound energy generated by the flow, is the cause of the abrupt transition from streamline flow to turbulent flow. Sound has been considered to be an effect of turbulent flow, rather than the cause.

Research into “The Last Conundrum” led to my writing an article to the Journal of Fluid Mechanics in 1975. Although it was rejected, the editor, George Batchelor, of Cambridge said that he and the reviewers were quite interested in the phenomenon of arteriographic standing waves, which they were unaware of and couldn’t explain. The understanding of the cause of transition allows researchers and engineers to devise methods of  delaying or preventing transition with great savings in energy consumption.

I auto-published my first book on this subject in 1980, “Patterns in Fluid Flow Paradoxes– Variations on a Theme.” The auto-publishing route was deemed necessary because science editors would be unlikely to accept such a theory that – 1) was revolutionary and 2) was written by a diagnostic radiologist, not a physicist or an engineer trained in fluid dynamics.  This was the first of five monographs challenging the conventional theory that there is chaos in turbulent flow.  My fifth monograph on this subject, “Order in Chaos – The Physics of Transition to Turbulence,” was auto-published in August 2011. In its present form, I trust that the theory will gain acceptance.

Describe the most memorable response you’ve received from a reader.

In 1990, ten years after my first book on transition from laminar to turbulent flow in fluid dynamics was auto-published, I sent a copy to Dr. George Batchelor of Cambridge, the editor of the Journal of Fluid Mechanics. While not endorsing the theory, he replied as follows: “Thank you for your letter of April 2 with the kind gift of a copy of your book on “Patterns in Fluid Flow Paradoxes.” I was delighted also to see that our rejection of the paper that you submitted to JFM in 1975 acted more as a spur to action than as a disappointment.”

© 2011 Defining Canada.