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look it up.
the ordinances say that we shall not produce that book unless by order of the Mayor. I may be mistaken in regard to it, but I think there is some such provision.
Mr. RILEY. – Well, an order would be only two or three weeks previous.
Mr. CURTIS. Well, there is something about hospital records in the ordinances, I am sure.
Mr. BRANDEIS. —- Well, let us see what it is.
Mr. PROCTOR. - There ought to be a copy here in this room, where they pass them.
Mr. CURTIS. - I think the provision which I refer to occurs on page 15. We had this matter up three or four months ago, and if I remember correctly it is to be found on page 15. (Examining ordinances.) Yes; it says: “ All records and files, except medical records and files, shall, under the supervision of the officer in charge of the department, be open to public inspection, and any person may take notes therefrom; but this shall not apply to matters which the Mayor is of opinion should not be made public.”
Q. (By Mr. BRANDEIS.) How far have you looked into those hospital records, doctor.
A. I looked over a volume which was there on the table at the time I made my visit.
Q. What period did that volume cover ?
A. I don't remember the date of the earliest record. The last record was entered within a day or two previous.
Q. Which did you examine?
Q. When did you look at those records — the first time you were at Long Island or the second ?
Q. Who was the physician under whose charge these patients appeared to be?
A. The record book lay in the office. I asked no questions as to who was responsible for it. Dr. Cogswell called my attention to it as one of the record books of the institution.
Q. And the record book does not show what physician has charge of the patients ?
A. It may, but my attention was not attracted to that point.
A. No, I don't.
Q. Can you deseribe the book whether it was new or old, or what kind of a looking book it was ?
1. It was a folio volume, with blank pages at the end — I don't remember the number,
Q. That is, it appeared to be the one in use?
Mr. BRANDEIS. Well, this witness has been describing the book. I want the book that he has seen. It is the hospital record which now appears to be in use.
Mr. PROCTOR. You mean the current record ?
Mr. PROCTOR. I don't know. I will take all the information that he has.
Mr. BRANDEIS. Can you give any better description of it, doctor?
The WITNESS. - I should say one of the current books which a few weeks ago had not been completely filled with the records of patients.
Mr. PROCTOR. I am informed that that is the particular, clinical, private history of each particular case.
Q. (By Mr. BRANDEIS.) You say that there were a number of physicians down there, doctor. In the proper management of this hospital what should be the division of duties among the various physicians down there?
A. I should think there should be one physician in charge.
A. If the superintendent is also to be in charge of the medical treatment of the patients.
4. If the superintendent is a physician, it may be considered desirable that he should superintend the medical care of the cises. If he is not a physician, there should be at least two physicians connected with the institution, so that one should be there all the time, and if these two physicians who are in charge, one of them being there all the time, should desire any other assistant, it should be in the way of a medical student, and not necessarily a graduate physician.
Q. And what should be the duty of these assistants ?
A. I am not sufficiently familiar with the needs of the institution to give an opinion; but I have, of course, an opinion in general in relation to the relation which physicians should bear to a hospital.
Q. What is that?
4. There should be, in my opinion, one physician who should be the responsible head of the hospital. He should have an assistant. Upon that assistant should devolre the care of such wirds, or such patients, as the visiting physician, the chief physician, saw fit to assign to liim.
Q. Will you allow to this assistant physician the privilege of prescribing medicines and diets?
A. I should suppose that was his duty.
Q. And you would not consider that the institution was properly conducted if the assistant physician were prohibited from doing that?
I should think that the institution might be properly conducted, but I should think that the assistant physician was in the wrong place.
Q. And if it is in fact that the two assistant physicians there at present are not allowed to prescribe medicines or diets, you would say that those two were in the wrong place ?
A. I should think they had better resign — the assistant physician
certainly. I can conceive that they might make such demands for diet that it would be beyond the power of the institution to comply.
Q. And how about medicine? Don't you think that even in a hospital for the poor they should be allowed to prescribe the medicine?
A. Allow me, sir. You have repeatedly suggested the fact of persons being poor and their not needing as good treatment as those who are not poor. I should discriminate between an institution for paupers and an institution for the poor. I can conceive of giving more luxuries to the poor than to paupers.
Q. Now, doctor, would you consider it a luxury to give a patient such milk as he needed ?
A. I consider that patient should have as much milk as he needed. Q. Even if he were a pauper? 4. Even if he were à pauper.
Q. And if there was a constant shortage of milk, and if during the time of this constant shortage you found this very hospital was selling milk to other institutions, would you think that was a proper conduct of the dietary of the institution ?
A. I should not.
Q. And if, therefore, it is true that during these periods there was a constant shortage, à constant complaint of shortage of milk, and during that same time milk was sent away, you would think it a proper ground of complaint against this hospital?
4. I should
Q. And if Dr. Putnam reported that that was a ground of complaint you would not consider him captious in so reporting ?
A. No, sir
Q. Would you think it an unwarranted luxury if at rare intervals there was ordered, even for paupers at this insiitution, or individual paupers in the hospital, some baked apples ?
4. Baked apples are not a necessity:
Q. I asked you whether you would consider it an unpardonable luxury?
A. I should not.
Q. And should you consider that he was captious and unwarranted in suggesting an enrichment of the dietary so as to allow baked apples to be occasionally given there under the advice of the physician ?
A. I should think baked apples, or at least apples, for an institution of that sort were unnecessary. If Dr. Putnam says it is desirable that they should have had them and the superintendent was not willing to buy them, or the Commissioners were not willing to buy them, I should say that Dr. Putnam might obtain gifts from his friends which would be sufficient to supply them.
Q. You don't know that we have learned in the past that they have no authority to accept gifts for the amelioration of the poor at the island?
A. I don't consider baked apples necessary for the inmates.
X. I should consider that baked apples for a sick person might be recommended. Q. What did you say?
'or a sick person. I would not consider a baked apple for a sick person a luxury.
Q." It was in reference to the hospital that I asked you the question.
Ă. I didn't understand that you were referring simply to the hospital.
Q. Oh, it was his advice in reference to the hospital.
A. I would agree with him that a supply of apples for hospital patients might serve a very useful purpose.
Q. And would you think that beefsteak should be allowed to be prescribed by physicians ?
A. I would.
Q. Would you think it an unwarrantable luxury at times to order a chicken broth for a patient?
A. I should not think it unwarrantable.
Q. And if Dr. Putnam recommended that in a more liberal diet they should be allowed that, you would not think that he recommended something that was improper or that was subject to just criticism ?
A. I should not.
Q. If Dr. Putnam reported upon examination of the institution in February or March that the supply of surgical instruments was insufficient, would you deem his judgment on that of value ?
A. Not of so much value as if he was a surgeon.
Q. Would you deem it proper that the physician in charge of the cases, whoever it might be. should be allowed to prescribe the medicines that the patients should have ?
A. I should say so, decidedly. If the patients are under his charge, he should prescribe for them.
Q. If the patients are under his oharge, you think that he should be allowed to prescribe the medicines which the patient could have?
A. It should be his duty.
Q. And he should not be interfered with by others who have not charge of those patients ?
A. No, sir; unless he was ordering medicines which were so expensive, and wbich were of doubtful value, that a larger draft upon the funds was made than was considered advisable.
Q. Well, what medicines would you consider were too expensive?
Ă. Well, cerium, which is said to be worth its weight in gold. There are medicines which are so expensive that they are not worth prescribing
Q. But, so far as the ordinary medicines are concerned, you would consider that the physician should be allowed to prescribe the medicines for the patients under him?
I do. Q. And if he is not allowed to determine what medicines they shall have, then it is not a wise administration of the hospital?
A. I consider it unwise to restrict the physician in the treatment of his patient by ordinary measures.
Q. If Dr. Putnam, after examining the hospital records as they are kept there, during a long period of time, pronounces those records to be unsatisfactory, would you consider his opinion reliable ?
A. I should want to know what he meant by “unsatisfactory."
Q. That they were proper records to be kept in a hospital of that nature?
I conceive of a difference of opinion in regard to that. Q. What is your opinion in regard to how lospital records ought to be kept ?
A. It depends upon the purpose of the hospital. There is a very great difference in the keeping of hospital records. My own feeling, of course, from my point of view, is, that the records of the cases should be as complete as possible.
Q. And why is that done?
A. It is done to present as complete a history of the case as possible, in order that it may be useful in comparing it with other cases that something may be learned from an accumulated mass of testimony that could not be learned from isolated instances.
Q. And in the general management of a hospital, isn't something looked to beyond the care and welfare of the particular patient, in trying to keep up the general standard of the hospital, and to keep tắe men who work in it up to a high standing ?
A. It is very desirable to do so.
Q. And isn't a hospital that deesn't have any records in danger of becoming slipshod in its treatment, and the patients to suffer from it.
A. I think all institutions which are not under outside supervision are liable to become lax.
Q. And isn't it for that reason, also, that a Board of consulting llysicians might be of some effect in that hospital ?
A. They might or might not be of effect.
A. If they were paid to go there, they would probably be of more benefit than if they were obliged to volunteer their services, except in rare instances where philanthropic motives might actuate them.
Mr. BRANDEIS. – I think that is all, doctor.
Q. (By Ald. LEE.) When did I understand you to say that you first went to Long Island to visit it?
A. Early in the summer. The exact day I have forgotten.
Q. Now, something was said here about the arrangements that you made to visit the island. Now, I want to ask you this question : Did you make your arrangements to visit Long Island to meet your own convenience, or was it in accordance with some agreement with Dr. Cogswell by fixing the date that you should come to suit him ?
A. My own convenience.
Q. And you meant when the first call was made on you your engagements were such that you couldn't go that day, but the next day you would go?
A. No, he asked me to assign a time.
A. I have no further grounds for an opinion. I assisted at his graduation from the Medical School by examining him, and upon hearsay know that he has held a conspicuous position since graduation — as one of the City Physicians. Those are my only means of knowing his qualifications.
Q. Have you ever heard his ability questioned among any of the profession?
A. I have not.
Q. (By Mr. BRANDEIS.) Dr. Cogswell does not take part in any of the proceedings you physicians have from time to time in the Medical
ou Society, does he
A. I think likely he does.