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Q. About two hours ?
A. Yes, sir.

Q. And did you make the examination of the hospital alone or were you accompanied by Dr. Cogswell?

A. Accompanied by Dr. Cogswell.
Q. The whole tine?
A. The whole time.

Q. And the second time you went down did you make the examination alone or in company with him?

In company with him. Q. Did you have any occasion when you were down there to converse alone with the assistant physician ?

A. The assistant physicain was not present.
Q. At all ?

At all.
Q. Did you have any opportunity to talk alone to the nurses?

A. I had opportunities to talk both to the assistant and the nurses; but I didn't avail myself of them.

Q. And you were all the time in the presence of Dr. Cogswell ?
A. Not absolutely — the greater part of the time.

Q. The greater part of the time. Well, now, when you went down there the second time, you were down there also about two houis,

A.

you think?

A. Yes.
Q. Each time about two hours?

A. I think the second visit was a little shorter than the first. On the second visit I went simply to the hospital, and on the first I went to the institution is well.

Q. You spoke of the kind of cases there were there. How many patients were there in there in the hospital altogether at the time?

A. I could make merely a guess. Of the persons whom I saw there were a number of patients in bed and a number up and about. I should have to make a guess. I cannot say whether the guess I would make would be within twenty-five per cent. of the total number present.

Q. Well, how many, according to your guess, Wils there in the hospital, taking it as a whole?

A. Well, there mily have been between seventy and one hundred.

Q. Between seventy and one hundred in the hospital. When you said that you thought one nurse in each ward would be sufficient, how many wards did you count?

A. I counted three wards.

Q. And your idea was then that there should be one nurse to about tweny-five or thirty palients ?

A.

Yes.

Q. When you say that you counted three wards, what wards do you refer to ?

4. Well, there was a male and the female wards. I have two female wards and one male ward in my mind.

Q. Now, if you should find it to be so, or if it were a fact, doctor, that the number of patients in the hospital, instead of being from seventy-five to one hundred was just twice that, was from 150 to 200, would your answer be the same in regard to the number of nurses and the number of physicians needed ?

A. It would not. Q. It would not? d. It would not.

Q. Now, what would you say in regard to that if it should be shown to be a fact? As it matter of fact there were from 150 to 200 patients in the hospital. 4.

I should think a larger nursing service would be necessary, providing a considerable portion of the patients were bed-ridden patients.

Q. You saw the patients in the summer?
A. I did.

Q. And from your experience as a physician, would you say there would be more likely or less likely to be a larger number of patients out of bed in the summer or in the winter ?

A. Well, it would depend on conditions that I would want to know and consider before basing an opinion in the matter.

Q. Now, you spoke of the class of patients there. Did you speak of the class of patients from investigation of the records of the hospital or from what you observed ?

A. From what I observed.
Q. In passing through?
Ă. From what I observed in passing through.
Q. Have you ever examined the record?
Ă. I examined the record books showing the history of the cases.

Q. No, I mean the regular schedules made out in accordance with the practice of physicians in hospitals, showing the number of cases treated, and the nature of the cases which had been treated at the Long Island Hospital from time to time?

A. I bave no recollection of seeing them.

Q Now, doctor, in the report of the Commissioners of Public Institutions for 1891, Dr. Harkins, -- by the way, do you know Dr. Harkins, who was formerly resident physician at Long Island ?

A. I don't remember him by name.
Q. He then stated :

There is an erroneous impression with those outside the institution that the majority of cases treated here are chronic and incurable ; but a glance at the accompany statistics will convince the most sceptical that such is not the

Case.

Mr. REED. Mr. Chairman, I would like to say that Dr. Harkins left Long Island before the present hospital was completed, and of course Dr. Fitz has only examined this hospital. He wasn't there before this hospital was completed.

Mr. BRANDEIS. No, but he is a witness, and a very competent one. Mr. REED. — Yes, that is right.

Mr. BRANDEIS. And I should like his opinion upon the general subject.

Mr. REED. Oh, I hope you will get it; but I only wanted to call the committee's attention to thai fact.

Q. (By Mr. BRANDEIS.) I should like to have you look over that schedule which Dr. Harkins refers to, and see whether in those two how's that you were down there you had occasion to ascertain the nature of the various cases that came up at Long Island ?

4. (Examining schedule.) Among the general diseases, I saw none.

Q. You mean those that are classed as general” in there?
d. Yes, sir; those under Schedule A."
Q. Well, there are quite a number in that schedule?
it. There are.

Q. And, therefore, when you gare your answer, you gare it without knowledge of such diseases as were there set forth?

4. There were no such diseases at the time I was there. I know nothing, of course, in regard to this list you have here. As to the other diseases which are on it. I should say that I saw illustrations of them.

Q. Well, that list does contain, as Dr. Harkins said, a good many instances of acute diseases?

d. It does.

Q And if the list as you see it there is correct, then Dr. Harkins' statement is also correct, isn't it?

A. What was his statement !
Q. It was the one that I read to you a few minutes ago.
Mr. REED. What is the date of that, Mr. Brandeis?
Mr. BRANDEIS. · 1891.
Ald. LEE. -- What year does it cover?

Mr. BRANDEIS. This is the report submitted February 1, 1892, covering the year 1891.

The WITNESS. -- I should want a little further information upon that subject before being able to answer that question with any degree of accuracy.

Q. Now, doctor, you are acquainted with Dr. Charles P. Putnam, are you not?

A. Yes, sir, I am.
Q. What is his standing as a physician?
A. Very high.

Q. And what would you think of his judgment in regard to hospitals and the proper care of pauper institutions ?

A. I should think it might be very good.
Q. You would think it would be very good ?
A. I should.
Q. Are you acquainted with Dr. Morton Prince ?
A. I am.
Q What is his standing in the profession?
A.

Also high. Q. And what would you think of his judgment as to the hospital connected with this institution ?

A. I should think it might be very good.

Q. And I would like to ask you not only in regard to their judgment, but as to what you would think of the accuracy of their observations, and of their ability to state correctly the result of their observations ?

A. I should have confidence in their observations, and also their judgment.

Q. Now, taking the Long Island Hospital as it was at the time this investigation began, or previously

Mr. REED. What is the date of that?

Mr. BRANDEIS. Before the investigation began, or after. I am going to put a lıypothetical question to him, as an expert.

Mr. REED, — Oh, I thought you had Mr. Morton Prince's report there in your hand, and I wanted to get the date of it.

Mr. BRANDEIS. That was dated June 30, 1892.
Mr. REED. Yes, sir; before the hospital was built.

Mr. BRANDEIS. This is dated 1894. This statement which I shall read is made in the report signed by Dr. Putnam as chairman. (Reading):

In the hospital department the Board find many changes desirable, botlı as to details of management and as to general organization. The medical staff consists of the superintendent, who is physician-in-chief, a first and second assistant, and at times an interne. The superintendent for the most part leaves the actual practice to his assistants, and when, as at present, there is no interne, the medical force seems to the Board to be inadequate.

Now, assuming it to be a fact, as stated by Dr. Putnam, that the medical superintent did leave it wholly to the assistant; that there were in the hospital between 150 and 200 patients; and that the diseases were of the general class appe:rring in the schedule made by Dr. Harkins, would you or would you not say that that was sufficient?

A. I should say from what I saw of the cases there that one physician on duty all the time was all that is necessary, the class of cases being such as not to require a further physician.

Q. Now, doctor, the report goes on as follows:

Moreover, the organization of the medical force is awkward; the head physician should actively practice and direct his subordinates, or the first assistant should be recognized as plıysician-in-chief, visiting all the patients daily and being held responsible for their treatment and for the administration of the hospital.

Would you agree to that statement ?

d. That would depend on how much the superintendent had to do outside. It is quite conceivable that he might be able to administer the affairs of the institution and to treat patients at the same time.

Q. Well, supposing it is a fact, as was testified here, that Dr. Cogswell did not, prior to the time this investigation brought certain changes, treat patients himself, but that he undertook to rule the hospital; would you say that was an awkward management of the hospital ?

A. I think there should be one head to the institution, and that the subordinates should be under the control of that head. If Dr. Cogswell had nothing to do with the treatment of the cases, and he differed in his views from the views of the gentleman who did have the treatment of the cases, I should say that under the circumstances Dr. Cogswell should get somebody else in as an assistant physician.

Mr. BRANDEIS Well, now, that is just what Dr. Putnam contended - that there should be another man.

Mr. CURTIS. -- He says you had better get another man under Dr. Cogswell.

Mr. BRANDEJS, Well, he says you had better get another man.
Mr. CURTIS.— Well, I think you had better get another man, myself.
Mr. RILEY. We probably will when you are Mayor.

Mr. CURTIS. Well, that may happen. I am not so very uncertain in regard to that, too.

Mr. PROCTOR. That will be after you are Corporation Counsel, Jr. Riley

Q. (By Mr. BRANDEIS.) Now, you spoke of nurses at the hospital. Do you think it desirable in a hospital of this size, a hospital with 150 or 200 patients, to have a nurse as a head nurse?

A. I do.
Q. What should be the qualifications of that head nurse?
Å. She should have training,
Q. What do you mean by " training”?

I mean in some training school, or in some hospital where a variety of cases are to be seen and taken care of — trained as a nurse.

& Now, if you should be shown that the nurse who had been senior nurse in this hospital was one who had not any training in any school and who could not write, would you think that she should be at the head of the institution ?

A. Not at the present time. Ten years ago such id person would be found.

Q. But at the present time, in the city of Boston, you would say not? A. At the present time I would say not.

Q. Supposing you should find that the person who acted as nurse for the 85 or 90 persons in the male ward, the persun who acted for months as the sole night nurse, was a confirmed drunkard and could not be trusted with the liquor which he himself was obliged to administer from tiine to time to the patients, would you say that he was a proper person to be at the head of the male ward ?

I should say not. Q. Suppose, doctor, that the fact that this man was addicted to liquor was brought to the attention of the superintendent of the hospital, not once, but repeatedly, and that he nevertheless left that man in charge week after week, would you think that that person had properly administered the hospital ?

A.

d. Not unless there wils some very strong reasons for keeping him in charge.

Q. Well, supposing that the assistant physician and the deputy superintendent, and the other nurses, from time to time called that to the attention of the superintendent; and suppose, further, that this man was not il trained nurse in any sense, would you think then that special reasons could exist for l'etaining that man at the head of a liospital as head nurse when there were 75 to 100 patients there?

t. The special re:lson that I had in mind was that the superintendent should be satisfied of the truth of the acusations. If he was satisfied that this min was not to be trusted in the administering of liquor, he ought to be taken out at once.

Q I will ask you if you had the responsible charge of any hospital and your assistant physician, the deputy superintendent, and the nurses notitied you of that fact, would you keep such a person as nurse to administer medicine, whether you actually beliered it or not?

1. I would not like to condemn a person without knowing whether it was so or not.

Q. Well, but would you have a right to condemn the other ninetyfire?

1. It depends on the other ninety-five. Q. Well, do you think you would ?

. Well, I should want to know whether the ninety-five were telling the truth or not.

Q. Well, I ask you, would you consider it consistent with your duty as the head of a hospital, if you had no personal koowledge in regard to it, if they came to you and brought you reports that this man iras drunk, that there was ordered to be idministered by the physician two ounces of liquor and that there had been twenty ounces consumed, and that nobody had the key but this head nurse, and if the repeated statements of your deputy superintendent and nurses were made to you, would you persist in keeping him there?

d. If I believed their eriilence, I should not keep him there; if I didn't believe it, I probably should.

Q. I ask you if your deputy superintendent and your assistant physician should tell you that this was a fact, would you not naturally believe them?

If I had reason to suppose they would not tell me what was so, I would discharge them. Q. That is, you would not keep them if you did not beliere them?

If it was il false statement, certainly. I should investigate it, and I should discharge whicherer wis the lying party.

Q. You would discharge the nurse or all the witnesses ? d. Discharge some one: yes, sir.

Q. And you would think i superintenlent who did not do one or the other did not manage the hospital properly?

I should think he wis negligent in that matter.
Q. You know Dr. Rowe, of the City Hospital !
ut. Yes, sir.
Q. What is his position in the profession ?
4. Very high
Q. What is his reputation as al man?
d. Very good.
Q. For truth and veracity?
A. Very good.
Q. And for the correctness of luis observation?

Excellent
Q. And whitt is his capacity as the manager of a hospital?
it. Excellent.
Q. What would be his judgment on il nurse?

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