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Q. And when did he graduate ?
Q. And from that time on you have never come in contact with him in any way?
A. I have not.
Q. And all you know about him is that he has held this position as a practitioner at the island ?
A. Yes, sir; and also his other position.
I think shortly after graduation he was appointed at the island and has held these positions ever since that time, as far as I am aware.
Q. (By Mr. RILEY.) Well, his practice was down there? 4. Yes, sir.
Q. (By Ald. LEE.) Well, after graduation did he devote any time to the City Hospital or the Massachusetts General, that you know of?
1. I think he was probably one of the house physicians. Q. At the City Hospital ? d. Yes, that is my impression, but I am not positive on that point.
Q: (By Mr. REED.). Now, doctor, assuming that when Dr. Cogswell took charge of the hospital on Long Island he found such a man in charge of the pharmacy as Brother Brandeis has described to you, compounding medicines, as Brother Brandeis says and administering them to the patients, and he immediately removed that man from that position and placed in his stead to do that work a practising physician, should you then say that Dr. Cogswell had used good judgment in that matter?
A. If he were satisfied that this other person ras incompetent, he had done his duty. That is a question of judgment.
Q: You spoke in your direct-examination of seeing seventy to one hundred patients in the hospital, and you stated that there was sufficient nursing there or a sufficient number of nurses to take care of such patients as you saw.
Mr. Brandeis has assumed that the number of patients was greater, and has asked you a hypothetical question. Now, assuming that the number of patients was one hundred and forty-five on that day, that your estimate of the number in the hospital ; namely, from seventy to one hundred, is a correct estimate, and that those whom you didn't see were out-doors walking about the island, were suffering only with chronic complaints, and slept all night long, and required no attention in the day-time should you then say that the number of nurses was suflicient.
Q. When you were at Long Island I understand you to say that you discovered no such proportion of acute diseases as Dr. Harkins, who has testified here, sets forth in his report of four years ago or three years ago. Am I correct ?
ul. Of course that report does not give a statement of what existed on any particular day. It wasn't the season for measles, for instance, when I was there, wasn't the season for scarlet fever when I was there, a little early for typhoid fever on my first visit — shouldn't be any typhoid fever there unless it was brought down from the city.
Q. Well, you understand, doctor, that all these hypothetical questions based upon what Dr. Harkins says are in reference to the old hospital which was in the institution building, and that everything that Dr. Harkins says was in reference to that hospital and the statement made before this new hospital was ever constructed, was it not?
A. I wasn't aware that any such distinction was made by Mr. Brandeis in asking me the hypothetical question. I didn't understand him to make any distinction between then and now. He merely asked me a hypothetical question, which I answered to the best of my ability.
Q. I simply wanted you to understand that his hypothetical question was based on a statement made by Dr. Harkins in regard to another hospital entirely, and that Dr. Harkins has not testified here. Some questions have been asked yon in regard to nurses and the training which they should have received before being competent to serve in the hospital at Long Island. I would like to ask you if a nurse who had had several years' experience as a nurse in the City Hospital would, in your judgment, be competent to take charge of å ward or to be head nurse in the Long Island Hospital?
4. Ought to be competant from training and all.
Mr. REED. ~ It is not a fact that she cannot write. I have seen her write her name.
Mr. BRANDEIS. – I guess that is all she can do.
A. If she has been employed in the several hospitals several years, even if she couldn't write, I should think she was likely to be a competent nurse, or they wouldn't have kept her if she hadn't been for that time.
Mr. PROTOR. -- Penmanship is no part of the qualifications of a nurse, any way.
Q. (By Mr. REED.) Did you discover in the hospital on Long Island any bathing facilities in the open wards ?
A. I saw none.
Q. Do you know, doctor, that as long ago as 1852, the institution at Tewksbury was established and that they didn't introduce this system of consulting physicians until 1889 ?
A. I heard the statement that in 1889 the Board was established.
Q. Now, I would like to ask you in regard to the condition of the plumbing there -- whether if the water were emporarily cut off from the Massachusetts General Hospital by the breaking of the supply-pipe by accident, as in the case at Long Island, such a condition as has been assumed to have existed at Long Island might not well have occurred even in the Massachusetts General Hospital ?
A. Might have.
Q. (By Mr. BRANDEIS.) Would it have continued for months --been allowed to continue for months, at the Massachusetts General Hospital?
A. No, sir.
Q. Do you think those in charge of the Massachusetts General Hospital, if they had all the means of having all the great ocean around them and of having a pump in the building, would, after the long continance of this break in a water main, have pumped water up and kept their hospital clean?
A. I think steps should have been taken at once to overcome the difficulties which arose in that way.
Mr. PROCTOR. Well, you knew it was only two days, Brother Brandeis ?
Mr. BRANDEIS. – I know this condition of things was repeated from time to time, and lasted in all, for months.
Mr. PROCTOR. — You didn't put in any evidence of that, you know except your own statement. You are not under oath.
Mr. REED. -- Why didn't you bring a witness to that effect?
Mr. BRANDEIS. We will put in the evidence now if you will give us an opportunity.
Mr. PROCTOR. - But you forgot it, didn't you didn't think it of sufficient importance to put it in last spring?
Mr. BRANDEIS. – I think you will find that that is in testified to. Mr. PROCTOR. Never any such thing.
Q. (By Mr. BRANDEIS.) Now, doctor, Mr. Reed asked you, called your attention to the fact, that this specific list of diseases that Dr. Harkins gave his opinion on related to the year 1891. I will ask you now to look at that list of diseases which appears in the report for the year 1893–94, and ask you whether you observe any difference between what Dr. Harkins made his report on and what you have now in
your hand ?
A. This report relates to the hospital at Long Island.
And you have called my attention to one page.
X. Simply Class A and Class B. I see there are other pages in sequence.
Q. This is the physician's report, it is Dr. Cogswell's own report.
d. So far as first page goes here, which I have compared, it seems to me there was not the same class of diseases in the two reports.
Q. Not the same class of diseases on which Dr. Harkins made his report; that they were not all chronic cases, as supposed, and you find there, also, in that list cases of a different nature from those which you observed in the course of your visits in the summer and fall of this year?
A. Certainly none of these, so far as I am aware; none of these acute cases which are here on this page did I see anything of at the time of either visit.
Q. Yes; but if you should find that from year to year these acute cases did exist at that hospital, do you think provision should be made for taking care of them?
Q. And that a hospital that was equipped on the theory of their being
A. I should say that it doesn't require very much of an equipment to treat that class of cases, acute cases, different from the same equipment that would be necessary for chronic.
Q. But it is to betaken into consideration ---I mean by “ equipment” the whole plan of the hospital, including the matter of nursing ?
A. No, I should say not, no sir, that it didn't require anything essentially different in the administration of the hospital if such acute cases as are to be seen there were to be found.
Q. What kind of cases that ordinarily happen in hospitals do not appear on that list?
A. I should have to look the list over.
A. I shouldn't do that, because I haven't looked the list over with sufficient detail to reply to that statement.
Q. What kind of cases do think now, do you have in mind, requiring special attention, that will not be found there?
1. I haven't any thought in the matter. You asked for a statement of the fact. I will give it to you if you wish me to look over the list.
Q. It is only valuable by tracing your opinion, and if you nave not anything special in mind I don't know as we can gain anything.
A. Put your question in such a way that I can.
Q. I thought you drew distinctions between two kinds of hospitals. Now, when I showed you this list of cases apparently there appeared to be in the list prepared by Dr. Cogswell instances of diseases which you had not observed any cases of, and you say that that does not affect your opinion as to the conduct of the institutions. Now, I ask you what kind of cases you have in mind that would affect your opinion?
1. I would state that in a hospital like the City Hospital or the Massachusetts General Hospital there are a great many acute cases that are brought in there and stay there from four to six weeks, and then others come in and take their places; whereas there are other institutions which are frequented by chronic cases that will remain, perhaps, for years in the institution. Take a chronic case during the stay of a chronic case in a hospital or institution-there may be some intercurrent acute disease, so that you may have in a report like that a case of what might be called intermittent ferer or Bright's disease. The Bright's disease may be a chronic disease, the intermittent fever an affair of a few days, but it is the same patient, and every provision has to be made for his care or diet if he has Bright's disease or intermittent fever.
Q. Well, what is the number of nurses? What number of nurses do you suppose there are in the City Hospital or the Massachusetts General Hospital to the patients to the acute cases, I mean on the average ?
A. I think the number in both those hospitals is unusually large, because each hospital has a training school connected with it, and one of the functions of the City Hospital is to provide or educate trained nurses, so that they have a larger number of nurses in attendance than is actually necessary for the immediate needs of the patients.
Q. Well, is there any reason why this institution should not also do its share in the general education of the public.
A. The answer to that would be that the kind, the variety of cases, isn't of a sort which would be likely to serve as useful material for the training of nurses.
Q. Well, I would ask you what class of hospital and class of cases would be comparable to this ?
4. I should compare this institution with Tewksbury, for instance.
Q. Yes, and would there be any reason why the distinction should be drawn between here and Tewksbury ?
1. I think not.
Q. Well, I ask you, taking the statement of Dr. Putnam, on page 715 of the report, whether you would agree with him :
Though the amount of nursing service in the Almshouse may not be fairly compared with that of the wards for acute cases at the City Hospital, where there are less than four patients to a nurse, because the diseases there are of a different character, yet certainly it may fairly be placed in contrast to the City Convalescent Home in Dorchester, where there are only fifteen patients to a nurse, as well as to the hospital at the Tewkshury Almshouse, where there are eighteen patients to a nurse.
Do you think that comparison made by Dr. Putnam is a fair comparison?
A. I won't say anything about Dr. Putnam's comparison, but I would say that if I were in charge of an institution of that sort I should be satisfied with one still head nurse in a ward of thirty or forty patients, and that I should expect to draft from the inmates of that institution more than enough service to carry out, provide all the assistance that was necessary in the care of the patients.
Q. Then you think that eighteen patients to a nurse, or a nurse to eighteen patients, at Tewksbury, is an unwise provision ?
A. I don't know about Tewksbury, I have no knowledge of Tewksbury, but if Tewksbury has a number of apparently strong and intelligent paupers, such as I saw at Long Island, I should say that at Tewksbury they should make more of them work and assist in nursing.
Q. Well, in speaking of twenty-five or thirty patients to 1 nurse you mean a nurse for the day and a nurse for the night? 11.
I mean a competent head nurse for day and another for night, who should direct everything in the details of the management of the patients when in the ward, and enough assistance should be provided for her. I don't expect her to wash and scrub and give medicine to each patient, but she should be held responsible that each patient received the proper care, and the assistance should be provided that nurse which in an institution of that kind I can conceive could be readily obtained without any additional cost to the institution.
Q. But if you found, as Dr. Putman found, that, counting both day and night nurses, there was only one nurse to twenty-six patients, I mean day and night, which practically would be one to fifty-two, - you would think that Dr. Putnam was right, in complaining that the number was not great enough?
A. I wouldn't accept the practical interpretation that you put upon it. I should say one nurse for the day-time, and another nurse for the night-time, both of them trained and skilful purses, were essential in an institution of the sort that I saw at Long Island.
Q. Yes; would you think that a hospital, even if it were a hospital for the poor, was properly managed, and everything ended at eight o'clock, that there was no care and no diet provided beyond that, under any circumstances, and everything practically shut down, so far as nursing was concerned, at eight o'clock ?
4. I should like to have that question stated, if you please, again. Mr. PROCTOR. What page are you reading now?
Mr. BRANDEIS. It is not on a page, but it is a question for the witness to testify to.
Mr. PROCTOR. What is the name of the witness, I would like to look it up ?
Mr. BRANDEIS. - Well, it is not on a page.
Mr. PROCTOR. Well, that is another witness you forgot about, last spring, is it?
Mr. BRANDEIS. Well, some things have happened since last spring.
Mr. PROCTOR. Yes, I noticed that happening all the time. This isn't in the testimony at all. You are making another attempt of the same kind you made before.
Mr. BRANDEIS. - Simply stating a fact.
Q. (By Mr. BRANDEIS.) If you found, doctor, in these institutions, that the nursing practically ended at eight o'clock, so that patients couldn't under any circumstances get any food between eight and six in the morning, although it might be deemed necessary by the physicians, would you think that that was proper for a puper hospital ?
4. I should not.
JOHN H. MCCOLLOM, M.D. Su0712. Q. (By Mr. REED.) You are a physician, Dr. McCollom ? A. I am, 0. And how long have you been a physician? A. About twenty years. Q. Where were you educated ? 4. At the Harvard Medical School.
Q. And what year did you graduate from the Harvard Medical School?