under such circumstances. However, the Commissioners must take that as they get it.

A reservoir was planned and begun by the old board of directors, but they put it in a sink hole where you would need pumps to force the water into the building. The Board of Commissioners has been criticised for its abandonment. But it seems to me they did exactly the thing which should have been done in abandoning it, because City Engineer Jackson said that that was not the place for a reservoir anywaythat it should be on the top of the island, where it is now, and that present reservoir was begun in the fall of 1892, before this investigation began. It will soon be completed.

Now, a great many questions have been asked in your presence. gentlemen, in regard to $,4000 which was spent for water to be delivered from Deer Island, because, it was said, of the lack of foresight of the Board of Commissioners. But as I am informed the break which rendered that necessary was a purely accidental break that might occur at any time. It might happen now, and if the Water Board could not within ninety or one hundred and twenty days repair the break, they would still be short of water at Long Island, although the City Engineer says that the reservoir they have is large enough.

Then there is much evidence in regard to cleanliness, and that is the third claim That the standard of cleanliness in the hospital at Long Island in regard to bed linen, clothing, and floors is far below what it ought to be." With respect to bed linen, the facts seem to be these, that they buy unbleached cotton to be used on the beds. That is a common practice throughout the country. It seems to have been adopted here, and, like the thickness of the soles on the ladies' shoes, it is an objection which will gradually wear away. The color will gradually become white by washing and bleaching, and it seems to me that that ought not to be laid up against the Commissioners of Public Institutions or the superintendent of that institution as a reason why the bed linen was not kept clean, because Dr. Fitz, if I rightly remember, said that when he first looked at the bed linen he thought it was not clean, but a closer inspection convinced him that it was unbleached cotton, and that it was clean.

Now, with respect to the clothing. There is absolutely no evidence, in this case, as I remember the evidence, which says that the inmates at Long Island did not have clothing enough or suitable enough, excepting the evidence of Mr. McCaffrey, who testified to anything, and that of Dr. Parker, who said that a nurse told him and he did not give the nurse's name and probably could not if he tried unless he evolved it, the same as he evolved other things, out of the deep recesses of his imagination. He never gave the nurse's name, so that all the evidence we have of the lack of clothing at Long Island comes from Mr. McCaffrey; and I wish to save Mr. McCaffrey to be dealt with later. I say, then, there is no evidence of a lack of clothing. All the testimony that has been put in here, when reduced to its lowest terms, amounts to a statement by Dr. Parker that an unknown nurse told him that there was a lack of clothing, and the statement of Mr. McCaffrey, who saw everything in all directions at the same time- and he saw a lack of clothing.

They say the floors were not kept clean enough. Mrs. Evans and Mrs. Lincoln both have talked about the lack of cleanliness of the floors, but Mr. McCaffrey comes forward and says that he kept them as clean as he could, and he is, as I understand it. the chief prop of this prosecution. Mr. Tudor, who is a sanitary engineer, a high-toned, truthful man, said that in his opinion the institution and hospital at Long Island were models of cleanliness, and I ask you to place that statement against the statement of Mr. McCaffrey and see to what conclusion you will come.

A further charge was made, Charge No. 4, “That personal cleanli

ness in the care of hospital patients is not enforced." They have rules to make them bathe; they try to make them bathe-I dare say, Mr. Chairman, that the attempt is not always successful. Without any reflections upon the people who go down there as inmates, it seems to me fair to assume that those people are not over accustomed to the use of soap and water; that we should not expect too much from that class of people, because if we did they would not be in that condition where Mrs. Lincoln and Mrs. Evans both say they require so much moral and physical uplifting. So I say, it is easy enough to furnish the water and the soap, but unless you have scrubbing brushes and hose it may not be so easy to get these people clean. I believe in being clean, and I believe in all the proper and necessary means being used to make them clean. At the same time I can see how it is rather difficult to make a patient clean unless you wash him yourself.

Then they say that the food is bad that is the 5th charge, "That the quality of the food is not what it should be for the sick, and that too little care is taken in the preparation of food for the well." That rests. upon Dr. Parker and Mr. McCaffrey, now, as ever, the pillars of this case, and upon Mr. Simpson, who gave Mrs. Lincoln those lovely samples that he said came from ordinary use at Long Island, also pointing out a certain sink that was used for the mixture of a pudding. Now, the Visitors' Report- and let me say in passing that the Visitors' Report, McCaffrey and Parker formed the three legs on which this case is alleged to stand-the Visitors' Report makes absolutely no recommendation involving better food, so far as I can read it. It speaks of food, but at the end it makes certain recommendations, and if you can find there that they say that the food is not good enough for the sick or is not good enough for the well, you will find something that I do not find. The Board of Visitors, as such, make no recommendation in regard to that. Mrs. Lincoln went down there and says that she tasted of the food but once, and that was of the soup, which was good, and I don't think that even she would claim that they went to work and made that soup expecting her down that day.

Then we come back to Mr. Simpson. Well, Mr. Simpson is an unfortunate product of 19th century civilization or uncivilization. He has been an inmate of more institutions more times than any man yet known to history, and he is still in the clutches of the public institutions. I dare say he will always remain there. Mrs. Evans has no confidence in Mr. Simpson, because she says he is a chronic kicker — a chronic high kicker, I might say; that the only time she ever saw him when he was in a state of ecstatic satisfaction was when he was in the Charlestown Almshouse early in the summer, and that was only for once. He had done a lot of kicking at Long Island; he had got into the Charlestown Almshouse, and he was satisfied for a minute and she saw him that minute. But when she saw him the next time he had relapsed into his old condition and was kicking as high and as hard as ever. So we come down, then, to our own testimony, because the Visitors do not object to the food or anybody but Simpson, Parker, and McCaffrey. With Parker and McCaffrey I propose to deal later, and you will pardon me if I do not go into their history and antecedents just now. I say, then, that aside from Parker and McCaffrey, Simpson is the only person who really kicks about the food, and I am informed that he would kick under any circumstances. So it seems to me that that takes Mr. Simpson quietly out of this case.

But Mr. Pilsbury — and everybody compliments Mr. Pilsbury for his testimony, privately and publicly-testifies that the Commissioners buy good food, good stuff, that it is delivered by competitive bids to the various institutions, and that the superintendents are ordered to send back anything which is not good. That would seem to dispose of that. The Visitors do not object.

And we are now left to confront the sink in which the pudding was mixed. It seems to me, Mr. Chairman and gentlemen, that what Dr. Cogswell says about the sink-mixed pudding disposes of that as an element in this case, although Mr. Farmer's gorge did rise when he was told about it. Let me read to you a word from what Dr. Cogswell says in regard to it, on page 2877:

To show you what I thought of this sink and the propriety of using it for the purposes we do, I will say that I am in the habit of drawng my Sunday ration of baked beans from the inmates, bean-pots; that I often eat their meat; that I ate a portion of nearly every bread pudding that was served, and always found them good. The pudding referred to was sour, because the bread was sour- not because of any trouble with the place in which it was mixed.

And he further says, just above:

If inmates relieved themselves as in a spittoon I never knew it, and they must be curious people who would do such a thing, knowing that they eat food prepared in it five days in the week.

Now, nobody saw them doing it, not even McCaffrey, whose eagle eye was looking out for such things all the time. He never saw any one spitting in the sink and only got it second-hand, and I imagine that they might have people mean enough at Long Island to tell such things when they were not so.

The sixth charge made by Mrs. Lincoln is

That sufficient paid assistance is not employed in the hospital, and that the grade of nursing is not so high as in similar institutions in this and in other States, where less dependence is placed on help furnished by inmates.

Let me say a word with regard to help furnished by inmates. Will you be good enough, Mr. Chairman and gentlemen, when you come to consider this case, to consider why, so far as they can be employed, it is not a just and proper thing to employ the inmates as nurses? It is one of the evils, they tell us, of this system we are now defending, that we do not employ the inmates enough. Why, then, should they blow hot as to that and blow cold as to employing inmates in the nursery, in the hospital, to do such things as they can do? It does not take a very high grade of intelligence to give a person a glass of water, and that, it seems to me, in itself does not require trained nursing. And the subject of trained nursing I will take up in a moment, when I get to it. But with respect to the nursing and the assistance I wish to refer you again to Dr. Cogswell's testimony on page 2880, where he says:

All this talk about an average number of patients to a nurse is nonsense, unless you know the character of the cases to be nursed.

That must be so. I could take care of 100 if they were all well, and the sicker they got the fewer I could take care of, and the time would come, I suppose, when I would not be competent to take care of one. Of course it depends on how sick they are and what their diseases are.

In some cases five patients to a nurse would be too many, while in other instances fifty would not. For example, April 28, Mr. Morphy, our nurse in Ward A, reported thirty-one patients under his care. Mrs. Lincoln and her friends would at once exclaim, Overworked nurse, neglected pacients! Some facts: at 8 A. M. that day I visited the ward; found two patients asleep in bed, the nurse playing checkers with a third, and the other twenty-eight not in evidence anywhere, out around the island for a walk or over at

Loafer's Hall for a smoke, I presume. Nor is this an isolated instance. For the past year our daily average of patients confined to their beds has not been over thiriy.

And that is out of an average of 150 patients in the hospital.

They say we correspond to Tewksbury in the class of cases treated. I sy we do not, any more than that all large general hospitals treat about the same diseases.

Tewksbury came into this case with my Brother Brandeis' opening, and it has been held up to us as a model and a pattern ever since. I do not object to it - I am glad of it if it is something to which we can properly refer. But what do we say as to Tewksbury as compared with Long Island? Everybody says now and there cannot be any question about this that they are mostly chronic cases in the hospital at Long Island. Dr. Richardson says so, Dr. Fritz and Dr. Harris say so. They have rheumatism, old age, syphilis, and other things, with every now and then an acute case, and every now and then some one dies. But Long Island and Tewksbury do not correspond. One cannot be a marker for the other. At Tewksbury last year the average number of acute cases was forty per cent. of all; at Long Island it was only 24 per cent. There are not so many nurses needed, then, if there are not as many acute cases. The deaths at Tewksbury were 35 per cent. from acute diseases and 65 per cent. from chronic; at Long Island they were only 12 per cent. from acute diseases and 88 per cent. from chronic. The death rate at Tewksbury, which is our model, was 1.05 per cent. last year, while at Long Island it was only .75 per cent. Now. if Tewksbury is our model, and if the patients are the same, what do you say about the better care? You have 1.05 per cent. as the death rate at Tewksbury, and only .75 per cent. at Long Island. If there is to be any comparison to be drawn from these institutions as kindred institutions, is it not all in favor of Long Island as the place where they get better care and better attendance?

Now, much has been said in this case about a training school for nurses. 1 am astounded at that claim. As I understand it the object of training school for nurses is to make the best nurses possible, and, as I understand it, that is accomplished by our city of Boston in its magnificent hospital, filled with acute diseases, and where they do not receive chronic patients under any circumstances. That hospital has a department devoted to the training of nurses, and if it is a good thing and I think it is why is that not the place to train nurses, and not down in a pauper institution where they have chronic diseases? If a nurse were trained to treat chronic diseases, she would fall down the minute she struck acute cases. They haven't the facilities, they haven't the patients, and the city of Boston spends its money for a training school in the place where it ought to spend it—at the City Hospital.

Moreover, Mr. Chairman and gentlemen, we go a step farther, and from the evidence of the prosecution in this case, we say that we do not need trained nurses, for Dr. Parker - who walked back and forth with his hands on his hips, day after day, and his hair a-plush testified under cross-examination that he never saw a case at Long Island where a trained nurse was necessary. I refer you, Mr. Chairman and gentlemen, to page 403, the last answer made by Dr. Parker at a certain hearing- as saying that he never saw a case down there that required the services of a trained nurse. Of course Brother Brandeis got at him in the intermission, and when he came back afterwards. he pulled out of him with forceps some cases where he thought trained nurses would be a good thing. But that was his spontaneous outburst that they didn't need a trained nurse. Indeed, every one of the other doctors and it is about the only place where they do agree with Dr.

1

Parker said they did not need trained nurses down there, excepting Dr. Putnam, and Dr. Putnam is not a surgeon; he is a children's physician a good man enough, I guess; I have nothing to say against

him.

"That women and children

Now, they say, as the seventh charge are kept in an institution for men." Well, of course it is a good thing to separate the sexes in an institution like that. You will not hear me say a word against that. I am going to discuss that question a little more fully when we get to the subject of classification. But we say that we do it as well as we can, and when the new dormitory is done down there, which was begun, as I am informed, before this investigation started one of the few things that was, they will say we shall be able to put the women in one building and the men in another, as they ought to be, and then the city of Boston must provide a building in which to place the mothers and their children. When that is done you will have the complete separation of sexes in buildings, which the prosecution in this case demands.

The eighth complaint is, that, "There is no telephone connection between Long Island and the city of Boston.” Now, you will not hear me lift my voice for a moment as to the lack of necessity for a telephone. That is a necessity. They ought to have it. But as I am informed and as appears in this case— the telephone cable cannot be run on poles down to Long Island, as might be inferred from the claim that it should be put up in a minute when the cable broke. Cables do break. The Atlantic cable has broken a good many times. A new cable was necessary. An expert said that the old cable could not be patched up, that they must have a new one, and that $4,500 was necessary; and here the charter of 1885 bobs up and says the Commissioners have no right in themselves to make a contract for more than $2,000 — that the City Government or the Mayor must take care of it and the Mayor did furnish the funds finally, and it was put in operation, and has been in operation ever since. We say we are not to blame for that. We did all we could about it. We used it before it broke, we had to get it fixed and we had to wait for somebody to do it for us, and when it was fixed, we were glad to use it. In view of the fact it is not just that that charge should now be held up against these Commissioners.

We now come to No. 9" That no attempt at classification is made." We deny that. The question of classification is a vexing question. It is not easy. There are certain things which can be done, and there are certain things which are done. Mr. Pilsbury has testified- and nobody has contradicted him that they are now classified so far as the Commissioners are able, with the facilities at their hands, according to the physical condition of the inmates. The sick are separated from the well, the infirm are separated from the able-bodied. The males, as I have stated, under those conditious and circumstances, are separated, or will be, from the females. The children and their mothers are to be placed by themselves, and that is now done as well as possible with the present facilities. When you go a step farther you get into difficulty, because this classification, about which they speak, involves work for the able-bodied. Now, I will agree that work for the able-bodied is an exceedingly good thing, that if a man eats at the public crib he ought to do some work for the public at whose crib he But I say that these three lay Commissioners took the advice of the Corporation Counsel not by a certam specific opinion delivered to them, but by one delivered to a city official, Mr. Frank Morison, lately deceased, where Mr. Babson said and rightly, as I think that it was doubtful whether they had the right to employ them or punish them if they refused to be so employed.

eats.

I well remember, Mr. Chairman and gentlemen, when I was in the Law Department, in 1892, I think, Mr. Bailey and I sat down and