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CROSS-EXAMINATION.

- you would

Q. (By Mr. BRANDEIS.) That is, the other physicians on the board who live nearer the institution than you do, you think are called frequently?

A. I am so informed.

Q. And you believe in boards of that sort as aiding the physician, and raising the general tone of the management of the institution, don't you?

A.. Well, I think it is a good thing to have some older man to call on or some specialist in special cases.

Q; And some contact with the outside world which would infuse into the institution the most advanced views in the profession ?

4. Well, one cannot get the special experience except in the outside world.

Q. Yes, and I say that is the value of a consulting board, isn't it?
A. Yes, sir.

Q. You would think that such a board would tend to improve and to keep at a high level the hospital at Long Island, would you not?

A. If it was an active board, yes, sir.

Q. And the best physicians in Boston, like yourself, would be willing to serve on such a board, would they not?

A. Well, I think they would, unless it took too much time. I think they would under the same conditions that they have at Tewksbury. The services are all paid for there.

2. There would be no difficulty, I mean, in getting the best physicians in Boston to take such positions as that under the conditions the State prescribe for its institutions ?

4. Under favorable condition I think they would.

Q. And if you were consulted in regard to the hospital at Long Island – I mean consulted as to the management of it have proved that suggestion of the Board of Visitors that a consulting board be organized ?

A. I think it would be a good thing. I don't see any objection to it.

Q. And you knew that Dr. Morton Prince and Dr. Putnam had both recommended the consulting board ?

A. I did not; no sir.

Q. Well, what is the standing of Dr. Morton Prince and Dr. Putnam?

Dr. Prince stands high in diseases of the nervous system, and Dr. Charles P. Putnam is a general practitiouer of high standing. They are both friends of mine.

Q. Would you think that the opinions of those two gentlemen in regard to the nianagement of the hospital at Long Island, maile after careful investigation, could be trusted ?

#. I shoul give them due weight; yes, sir.

Q. And you think that the investigation which they made, and the observations which Dr. Putnam, for instance, inade, in regard to the condition of the hospital, could be relied upon; I mean his observation of those matters ? A. I should think they would be good ; yes, sir.

Q. And if Dr. Putnam described the hospital as dirty or shiftless in any respect you would trust his observation in that respect from personal inspection ?

d. I should say it was dirty at the time he saw it, if he said so.

Q. And if at the time he silw it and investigated it he declared that the food was insufficient or improper for patients you would say that Dr. Putman's judgments on that matter at the time he investigated it was to be trusted ;

A. I should say he thought so if he said so wouldn't say so unless he thought so.

4.

Q. Have you any reason to doubt the correctness of his judgment ?

A. will say his judgment was that the food was not sufficient and that the plate was dirty.

Q. Now, you were giving some testimony here in regard to the condition of the hospital on March 27, 1894. Had you ever seen the hospital before that time?

À. The 23d. I never had seen it except from a distance.
Q. You had never been on the island before ?
A. Yes, sir; before the hospital was built.
Q. But not since the hospital was built ?
A. Not to my recollection, I believe.

Q. So you know nothing whatever about the condition of the huspital at the time the Board of Visitors appointed by the Mayor in 1892, or fron this board in 1893, made their investigations and their report ?

A. No, sir; nothing at all.

Q. You are testifying from facts as you found them after this investigation was commenced ?

A. Well, I don't know when this investigation began, but it was a long time ago.

Q. Well, it began before you were requested to go down there, didn't it?

A. Well, I don't know of my own knowledge when this began, but I was there the 23d of March, and if this investigation began before that it began before that.

Q. You do not, of course, express any opinion in regard to anything prior to the time you went down?

Q. No, sir.

Ă. Well, now, you say you went there at the request of Dr. Cogswell?

A. Yes, sir.
Q. And did he tell you he wished you to testify here?

A. No, he didn't say anything about it. I don't think he said anything about it. He asked me to come down and look over the place.

Q. How soon after he suggested this did you go down ? A. Well, my impression was that it was some little time — perhaps two or three weeks. I was very busy then and I took my own time, as I did on the second visit - I telephoned in the morning.

Q. So that he had ample time to clean up the hospital or introduce any minor changes in regard to things that might have been found fault with in the report of the visitors which was given him some three or four weeks before ?

A. Well, if he had gone and put everybody on the island at work he could have got the hospital in the condition I found it. I telephoned down in the morning that I could go, and they perhaps had an hour and a half or two hours' notice.

Q. But I mean to say that you went down there sometime after he had suggested it ?

A. Certainly.

Q. And if, as was testified to by some of the witnesses here, it was cleaned up prior to visits and gotten into shape, they could have done it for you as they were alleged to have done it for others ?

A. I think he could have had two or three weeks from the time he first spoke to me until the time I went down.

Q. Yes.

A. But from the time he knew I was coming until I got there was just time to send the boat up and back.

Q. Now, in regard to the second visit, did you go down and make that second visit unawares, or did you make that also by appointment?

A. I made an appointment with Dr. Fitz and Dr. Cogswell to go down that morning.

A.

Q. And he had talked with you some days before that?

A. I talked with him about it. I told him I would like to see the place again and he said he would be glad to have me. I took my own time and went down with my friend, Dr. Fitz. We notified bim that morning and he sent up the "Vigilant” and we went right down there and came right back after two hours.

Q. How long were you down there?
4. About two hours.
Q. And what hours were you down there?

A. Well, we left the Massachusetts Hospital at ten o'clock and we got home about one.

Q. That is, you got back to Boston about one ?
A. Yes, sir; and that gave us about two hours there.
Q. And did you take lunch down there or in Boston ?
A. No, we had a cup of coffee and I had some of the salt fish.
Q. That was the second visit?
A. The second visit.
Q. You were gone from Boston three hours?
A. Yes, ten to one, perhaps a little longer than that.
Q. And the first visit was how long?
A. I was on the island thirty minutes.
Q. And how long were you in the hospital ?
A. Well, about thirty minutes.

Q. That is, you were on the island thirty minutes — it took you some time to get up to the hospital and get back ?

A. Yes, have to take that out. I don't know how long it was.

Q. Whatever time it took going from the wharf up to the hospital and going back to the wharf ?

Yes, sir; the visit was brief, and that is the reason I wanted to make another one afterwards.

Q. And the next one you did make was this one in November?
A. Yes, sir.

Q. And in November you were on the island about two hourstwo hours ?

4. Yes, sir; about two hours.

Q. And when you were lunching there where did you lunch — in Dr. Cogswell's house or the hospital?

A. In the hospital ward partly - I didn't really lunch there. I took a cup of coffee and perhaps a sardine. We didn't have time, didn't go down there to lunch, and I shouldn't have taken anything except that they had it ready, and perhaps we spent five minutes at the table.

Q. That is Dr. Cogswell's house?
u. No, that was in the hospital.
Q. What is called the Administration Building ?
A. This is in the hospital building.
Q. Was it in one of the wards or one of the rooms adjoining it ?

A. It is where Dr. Cogswell's lives. I understand that that is in the hospital building.

Q. It is a part of the same building - separated by the corridor from the rest of it, from the wards ?

A. Yes, sir; that is right.

Q. In the report of the Board of Visitors, which was made in February - February 16 of this year!

A. Yes, sir.
Q. I don't know whether you have seen that report. Have you?

4. I may have read it at the time - I don't remember I don't know what is in it.

Q. Among the recommendations made by Dr. Putnam and his associates were that: In the hospital the medical staff should consist of a physician in-chief, who shall visit every patient at least once a day; who shall do all surgical operations himself, or be responsible for their being done skilfully by some one else; who shall see that suitable records of each patient are kept; and shall, in general, be personally reresponsible for the management of the whole hospital and of the infirmary. Or a visiting physician, resident in Boston, might be in charge, as suggested above. In another case, the physician-in-chief should have two or three assistants, one of them a physician, the other, or the other two, either medical students or recent graduates in medicine.” Would you, doctor, approve that recommendation which Dr. Putnam and his associates made?

A. I should approve that in most respects. I don't think it is a good plan to have a visiting physician from Boston.

Q. Well, that is a suggestion as an alternative?

A. Well, there were three wards, and those three wards can easily be run by one head and two assistants.

Q. Yes.

A. I don't mean to say there is any objection to more assistance that I know of, if you want to pay for them, but the cases are chronic ones and require very little care.

Therefore there should be one man at the head to whom the assistants are directly responsible. And that man at the head, if he is to do surgical operations, should be a surgeon with experience in trivial, minor surgery. Great surgery should not be done except by those especially fitted, and I don't think you could get anybody to take such a place. As I understand the cases, these cases used to be at Deer Island when I used to go down as consulting surgeon, and the cases requiring a special surgeon are rery few, I think, indeed, but there are cases of minor surgery in which it would be perfectly proper, I think, to have a very young man to take charge, even a medical student, but I don't think in any hospital that a medical student ought to be allowed to do surgical operations unless the senior is directly responsible and can see that it is done properly.

Q. Now, doctor, you have described precisely what Dr. Putnam and his associates recommended ?

A. I dare say.

Q. “In the hospital the medical staff should consist of a physician-inchief, who shall visit every patient at least once a day; who shall do all surgical operations himself, or be responsible for their being done skilfully by some one else; who shall see that suitable records of each patient are kept; and shall, in general, be personally responsible for the management of the whole hospital and of the infirmary."

d. Yes.

Q. "Or," he says, as an alternative, that a visiting physician, resident in Boston, might be in charge, as suggested above. In either case the physician-in-chief should have two or three assistants, one of them a physician, the other, or the other two, either medical students or recent graduates in medicine.”

I think the only difference was possible in the number. Q. Well, he says a physician-in-chief and two or three assistants.

I should say the suggestions were good ones, and that it would not be a bad thing to consider such suggestions. I wouldn't like to say oft-hand. I don't see much difference.

2. They don't differ in any respect from what you have recomnended ?

A. Excuse me, I was going to say I didn't see much difference from the arrangement as I understand it now, the head physician and two assistants, or the first assistant and two others. That is plenty:

Q. Well, isn't it a fact, doctor, that that was not the condition when Dr. Putnam reported on it, although it may have been the time you went there?

A.

A.

were.

A. My information was taken from my notes at the time I was there.

Q. Yes.
A. I don't know anything about what was there before.

Q. Yes. Then the next suggestion is, that A staff of consulting physicians and surgeons should be appointed." That you have already given your opinion upon favorably. Now, where did you get you information, doctor?

A. About what? About the physicians ?
Q. Yes, sir.
A. Well, I was introduced to them all, I think.
Q. Whom were you introduced to.

A. Dr. Parker – I think his name was Parker — and two others, I think.

Q. Who were the others ?

A. I don't know. I have't got the names. There were two others sitting there in the consulting-room, and I was introduced to both of them.

Q. Two other physicians ?
A. Well, I was introduced to them as “ Doctor," so I supposed they

I don't know who they were. That makes four doctors. Q. Well, that is all they recommend, isn't it They would be satisfied with three as a consulting board ?

A. That is just what I said, that did not differ from the number that I found there.

Q Only you found one more even than they deem necessary.
Mr. REED. - That was the second visit.
Mr. BRANDEIS. Well, he stated it as if it were the first.
The WITNESS. That was the second visit.
Q. It was the second visit you are talking about?
A. Yes.
Q. And there is a change in that respect, isn't there?

Mr. REED. -- There was. I don't know that there is now. At that time there might have been three doctors there, but I don't understand that there are now.

Mr. BRANDEIS. Well, there are so many changes that it is difficult to keep track of them.

Mr. REED. — I understand that your associate, Dr. Parker, has resigned.

Mr. BRANDEIS. — Well, that is the only change, is it?
Mr. RFED. — The only one I know anything about.
Q. (By Mr. BRANDEIS.) The next recommendation that they made

- The number of nurses should be increased; one of the nurses in the male ward should be a woman, and a woman should be appointed head nurse of all the wards, both male and female" ?

A. Head nurse to each of the wards, you mean?
Q. No, all wards, for the whole hospital?
A. A matron?

Q. Yes, whatever you would call her. Do you think that is a good recommendation ?

A. Let me see; how many nurses does that make to each ward for the day-time Q. Well, it doesn't state the number here.

I don't know the nnmber of nurses, but my impression was that there were two on in the day-time, and one at night, aided by the well patients — by the convalescents.

Q. You mean in the whole hospital ?
A. Each ward, I mean.

Q. Well, this particular matter was the head nurse, the matter I asked you about. The head nurse for the whole hospital you would agree to, wouldn't you?

was:

A.

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