used others.

where there were two ventilators, and I don't remember any

Q. But you do remember distinctly in regard to the ventilators in the nursery ward?

A.

Yes.

Q. And on that windy March morning it was necessary that one of those ventilators be closed while you were there.

A. Well, it had to be—not wholly closed, but more closed than it was when I came into the room, because the wind was so that some flakes of snow came down there, and I noticed, in order to avoid that, the ventilator was closed something further than it was when I first went into the ward.

Q. How much notice did you give the officials of that institution that you were coming that morning?

A. I didn't give them any notice. I was requested by Dr. Cogswell to come and look over the institution, and I was to come at the earliest convenience, and I thought if I was going to look into it at any time under any conditions that perhaps a stormy March Monday morning would be as good a time to get the inside facts as any other.

Q. And you went from your home across to Deer Island?

A. Yes I must correct myself. I started to go from my home to drive to Deer Island, but on account of the storm I went to Boston and took the boat from Boston down. I recollect now that I changed my plans.

Q. Did you make any examination of the instruments instruments?

A. Yes.

Q. Well, how was the hospital equipped in that respect?

surgical

A. Oh, all the surgery there is emergency surgery, and they have got all the instruments there to do everything except staphylorrhaphy. I should say, and I think the hospital could get along with about half the instruments they have got now. They have got a great many more instruments there than are required for any likely surgical procedure that is necessary.

Q. You have referred to an operation will you tell the committee

what is is?

A. Oh, that is an operation for cleft palate, where you want a certain peculiar kind of gangs to hold the mouth open, where they strip up the hard palate and sew it together. I didn't suppose they required that down at Long Island.

Q. Well, where the instruments kept at the first time you were there do you remember in drawers?

A. In drawers, in a glass closet.

Q. Well, you have been there since that time again?

A. Yes, sir.

Q. And are they kept in a glass case now?

A.

Yes, sir; a new glass case, beautiful, lovely, all laid out in rows. Q. You visited the pharmacy, I presume?

A.

Q.

I did.

And how was the stock of medicines ?

A. Well, of course I can't tell about the contents, but they had plenty of bottles and labels indicating that they had all the drugs ordinarily required. I should think there were perhaps 100 or 200 varieties, the average human being not needing at more five to ten.

Q. Then so far as you observed what is your judgment as to their equipment in that respect ?

A. Yes, I think they had drugs enough

Q. Well, do the diseases which they have to treat there requires constant nursing?

A. No, nothing more than any chronic case. Of course there might

PUBLIC INSTITUTIONS.

3131

be an acute case might be several. I am only speaking of the time I was there that there were none, but of course an acute case requires very careful watching and pretty constant nursing. But as a rule the class of cases there don't require any considerable amount of nursing in the sense in which we ordinarily use it - trained nursing. They require looking after and being properly bathed and properly fed and things of that sort, and such drugs as are administered at the proper time and in accordance with the orders of the physician. But it doesn't require that amount of nursing that you would expect in a hospital like the City Hospital or the Massachusetts Hospital, where there are a great many surgical and acute cases.

૨. Can you give the committee any idea about how many patients were confined to their beds when you were there, or don't you recollect?

A. I had memoranda of those things and I have got them at my office, but I haven't them with me, and it is only a random statement. I think in a ward which had some thirty beds there were only two confined to the bed. I think it varied. In some wards, I think there were as many as eleven in bed, but in most cases the patients were sitting up beside the bed or in the sun-room at the first visit, and on the second visit it was about the same, only I noticed that some of the people who were in bed on my first visit, one case especiaily, was up on my second visit. It was a very interesting case and that is the reason I remem

ber it.

Q. Which ward was that in, doctor?

A. That was in the female ward, and this was a special case of specific disease that was very marked what physicians would call a splendid case, and it had done splendidly between the time of my two visits. So I remembered the case particularly on that account.

Q. Then you would say that the treatment of that case, judging by the result, had been proper, would you not?

A. Oh, eminently so. It was a case of specific rupia, where the whole face was a mass of coarse and disagreeable disfiguration, and it had come out, with the exception of a little color change which would pass away, had come away as smooth and nice as could be an excellent result.

Q. Did you form any judgment as to whether the patients were properly nursed in that hospital?

A. Seemed to be no indication that they were not.

Q. Did you make any examination of the records that were kept in the hospital?

A. Yes.

A.

Q.

No, I don't remember anything else.

Did you make any inquiries or were you informed as to the medi

cal staff and the medical organization of the hospital?

A. I understood the superintendent and two house physicians. Q. Well, in your judgment was that a proper medical staff for that hospital?

A. As far as numbers were concerned. That number of physicians ought to be able to take care of that number of patients who were afflicted only with that class of diseases. It wouldn't answer for a lot of acute cases or where there was a great deal of multiple surgery. Q. Do you have any recollection as to when what they call the cal history," I believe, was begun the date at which it was begun, in your examination of the records? Was your attention called to that?

elini

A. I think it was, but I cannot answer. I have not refreshed my memory at all since that time and I cannot answer the question.

Q. Wasn't it the 15th of June, 1893?

A. I can't answer.

Q. From your observation at those two visits to which you have referred should you say that at the second visit any changes had been made in the management of the hospital?

A. Well, between the first visit and my second visit?

Q. Yes, sir.

A. Any changes in the management?

Q. In the management or as to to the care of patients or as to the equipment of the hospital? Did you notice any change

A. Well, I can only say I was informed that some additional instruments had been bought, but as far as any, observation of patients or conditions in the hospital I saw no difference between the two times.

Q. And what was the date of your second visit, if you remember? A. It was early in April, I cannot remember the day.

Q. And you haven't been there since ?

A. No.

Q. Do you regard the presence of an ether cone as absolutely necessary in a hospital of that kind?

A. Well, I have administered ether at the Massachusetts General Hospital for a year at a time constantly, and I have etherized a good many patients, and I must confess that I don't know what an ether cone is. If you mean a sponge in the form of a cone, of course I know that, but if there is some special instrument called an "ether cone" I don't know it. doctor, that they have been criticised for not Some doctor has said he ought to have one and

Q. Well, I believe, having an ether cone. can't get it?

A. Well, I can't say it may be a very valuable thing, but we have always managed at the Massachusetts Hospital without one. (Alderman LEE in the chair.)

Q. Well, are surgical sponges necessary down there?

A. If you are going to do any surgery you have got to have things to sponge with- needn't necessarily be a sponge in the ordinary acceptance of the term, like a bath sponge, but you have to have things made of cotton generally, improvised at the time, so that they can be thrown away. In an up-to-date practice of surgery, when things are full of bacteria, they would object very much to using the same sponge, like a sea sponge, over and over again; but it is necessary to have something to sponge with in the ordinary practice of sponging.

Q. Well, how would wads of absorbent cotton do?
A. I think that is what is generally used.

Q. Now, will you tell us what a bristle probang is?

A. Bristle probang- that is a thing that is called a money catcher." A probang is a long elastic affair with a bulbous end, and between the bulbous end and a little way up the shaft are arranged a series of bristles which, by pressing or turning at the top spread out into a ring shape or close up on a line parallel with the probang itself. It is generally used for children or for people that have fishbones in their throat or children who put pieces of money down. They slip this probang by and turn it and it becomes like a wad and is drawn up and draws the foreign substance with it — used to take stuff out of the esophagus. Q. Not out of the trachea?

A. No, it would kill anybody to put it in the trachea. I thought you were asking the question seriously, Mr. Reed.

Q. I was asking it in all seriousness, doctor.

Mr. RILEY. You asked it in a laughing manner.

Mr. REED. — I will tell you what I was laughing at. The chairman

of the committee suggested that if a bristle probang was used in that way it might make a duty for the medical examiner. That is what caused me to smile.

Q. Now, I will quote from the testimony in order that you may see upon what I base the question. One of the witnesses who has testified here, a physician, in referring to a case in the hospital at Long Island which culminated fatally said that if he had had a bristle probang the case might have resulted differently, or words to that effect. When questioned he was asked: Well, what would you have done with a probang if you had it there?" His answer was: Perhaps there was another piece down there, farther down, and I could have put the probang down beside the meat and pulled it up, and would have cleaned out the trachea.

"Q. What would you have done with this piece of meat that you did get out, with the probang, if you had had it— anything?

"A. No, if I could have got hold of it with my fingers, as I did, or the forceps, I wouldn't have used the probang; but I say it is a doubt in my mind but what there was another piece farther down, and even if we had the probang at the time I was called I may have saved his life; I may have or we may have." A man, according to that physician's testimony, had a piece of meat in his trachea and died of asphyxiation, and when asked how long that obstruction was there he said, "Perhaps four or five minutes." Now, would that be a sudden death by asphyxiation - four or five minutes ?

A

A. Well, of course it all depends on the degree and the cause. person may be three or four minutes or five minutes in being asphyxiated by drowning. He may be all night getting asphyxiated with foul air; but in the case of the insertion of a foreign body, like a piece of meat, which as a rule does not go into the wind-pipe but goes down and sticks in the back part of the throat, which prevents the entrance of air just the same, although the death is said to be by asphyxiation, and is from asphyxiation in some sense, because the air does not get in really the man dies of apoplexy, and the death takes place right off, within thirty seconds. I have had two or three cases come under my official observation, one on Market street a few years ago, where a man ravenously hungry sat down at the table and bolted his food, and after taking one large mouthful of meat suddenly rose and fell on the floor dead. The post-morten showed all the signs of asphyxia, and I removed from the back part of the throat- not from the trachea, but from the upper part of his esophagus — a piece of meat as large as that. Now, the only good of a probang such as this bristle probang is, as I say, say, for little things in the esophagus, to pull them up, or the probang may be used to push things down into the stomach, where they can take care of themselves. In regard to the wind pipe, it is only small things that can get in there on account of the narrow neck in the glottis—a very uarrow affair. In that case you cannot do anything with a probang at all. The largest thing I ever saw get down there was a small stick of asparagus. I have found in a man's lungs peas, beans, and asparagus, but I never found anything any larger.

Q. Well, after your two examinations of the hospital, what was the impression left in your mind as to the suitability of the building for the purposes, as to the medical treatment which the patients received, and as to the care, and attendance, and the food?

A. As I say, I can only speak of the food as I saw it in the institution building, but it struck me, as far as the hospital itself was concerned, that the building was admirably appointed for the care of the sick that were admitted to it under those conditions, and of course I had to take the statement as to the number of nurses. There was one nurse to each female ward, and one male nurse to each male ward. That seemed to be sufficient for the purposes of the cases that were

then there; and there was an ample supply of instruments and apparently of drugs. Patients exhibited no lack of care.

Q. You have some acquaintance with the present superintendent, have you not?

A.

Yes.

Q. You know him as a physician ?

A. Yes, I have known him a good while, since he was port physician. Q. And you know something of his ability and standing as a physician?

Q. Well, of course, I never have seen any of his practical work except his work as superintendent and as quarantine officer, but his reputation is quite as good as any man's.

CROSS-EXAMINATION.

Q. (By Mr. BRANDEIS.) Doctor, when you went into the institution kitchen that day in March, did they show you that sink that was sometimes used as a spittoon and sometimes for mixing the bread-pudding? A. They showed me a sink in regard to which that allegation was said to be made.

Q. They hadn't at that time put in the new mixing trough for the bread-pudding?

A. At neither of my visits had there been any change in the condition of things.

Q. Then your visits were very near to one another?

A. Yes, I think one in the early part of March and the other in the middle or latter part of April. It can be fixed by the date of Dr. McCollom's visits, because I was there with him, and I don't know what the date was.

Q. Well, they were both after this investigation began?

A. Yes.

Q. You hadn't been at the hospital at all the time that the visitors described?

A. I had been there at the time Mr. Galvin was superintendent there, too.

Q. Mr. who?

A.

When Mr. Galvin was superintendent I have been there.

Q. But that was before that new hospital was opened?

A.

Yes, sir.

Q. I say you have never been in this new hospital which the visitors described in the report of February 16, 1894 P

A.

Well, that I don't know, because I haven't seen that report.

Q. Haven't seen the report ?

A. No, sir.

Q. You are acquainted with Dr. Charles T. Putnam, chairman of the Board of Visitors ?

A. I know him by sight.

Q. You know his reputation as a physician?

A. I have simply heard him always well spoken of as a children's physician?

Q. You don't know him persoally?

A. I only just know him by sight. I haven't any other acquaintance with him. His brother was a classmate of mine at college, but Dr. Charles Putnam I don't know personally.

Q. And you came down to this hospital at the request of Dr. Cogswell?

A. I did.

Q. Made to you some days before you came down?

A. Yes, some days or some weeks.

Q. And you don't know what changes were made or how much the hospital was prepared for your visit?