r? mil CATv / /7 J) • <' * ^/f:< 'If"*- 13*71-^*? c*% Document.—No. 24. a^r^ (D® IB (D S3 V d> Sf « X V BOSTON IiUNATIC HOSPITAL. /w Common Council, November 19, 1840. The following Reports having been read, were ordered to be printed for the use of the Council. Attest, Richard G. Wait, Clerk C. C. S1U » Mti 2 BOSTON LUNATIC HOSPITAL. Nov. In City Council, November 19, 1840. The Board of Visitors of the Boston Lunatic Hospi- tal, who were instructed to report to the City Council on the administration and conduct of that establishment, and to inquire and report as to the manner in which the medical duties of the other establishments at South Boston are performed, having attended to the subject, ask leave to REPORT: As to the manner in which the medical duties of the establishments at South Boston, other than the Lunatic Hospital, have been performed,—the Board of Visitors of the latter institution, having no powers of visitation and no control in the manage- ment of those establishments, are of course unable to make any statement from personal observation. They have, however, as the only means of answer- ing the inquiry of the Council, addressed a letter to the Directors of those establishments, seeking the necessary information, and have received their respective replies. A copy of the letter so addressed to them, with their respective replies thereto, are appended to this Report, and the Board desire that the same may be considered as a part thereof, and all that it is in their power to make in relation to those establishments. In regard to the Lunatic Hospital,—when the present Board of Visitors entered upon their duties in January last, the institution had been opened but a few months, and could hardly be said to be fully organized. Personally inexperienced in the man- MM4 1M2 1840. CITY DOCUMENT.—No. 24. 3 agement of such an institution, the Board confined themselves to watching its operation under the man- agement of the officers whom they found there, and who had been appointed by the preceding Council. Indeed an institution for the insane is one, the par- ticular mode of managing which must necessarily be left in a great measure to the Superintendent. The system must be his system. And in all respects the institution must take its character from the peculiar character and tact of the presiding officer. During the whole year, therefore, the Board of Visitors have confined themselves to observing the operations of the Hospital, under its immediate officers, and have personally interfered with the management only where circumstances made it absolutely necessary. As the result of that observation, the Board would state that they have found the house in good order, well cleaned and ventilated, and the clothing, diet, and health of the inmates properly attended to. And indeed in all respects which would pass under the notice of a mere visitor, the Hospital has appear- ed in as satisfactory a condition as could be expect- ed from the character of the inmates and the first year's operation of an institution of the particular character of this. By this is meant that the plain and ordinary duties connected with the house and the inmates have been so performed as to justify no complaint. In some respects, however, important to the en- tire success of the institution, the Board are free to state to the Council, as they have frequently stated, both to the Superintendent and Steward,—it has not operated to their satisfaction. They early discover- ed that there was a serious want of harmony in feel- 4 BOSTON LUNATIC HOSPITAL. Nov. ings and opinions between those two officers. They differed in opinion as to their respective spheres of duty, in their views of managing the domestic de- partment, and in short there was an entire want of harmony between them upon all matters connected with the institution. Such a state of things could not but exert an injurious influence upon its welfare. The Board will go into no detail upon this matter, as they have uniformly refused to do so, in their in- tercourse with the officers. It was sufficient for them that the difficulty existed. They interposed during the year, in the hope of being able to settle it. In this, however, they were unsuccessful, and becom- ing satisfied that the institution could not succeed, whilst the two individuals were together in it, and as the Steward was the only officer over whose ap- pointment they had any control, they felt it their duty to notify that officer that they could not consci- entiously nominate for re-appointment, one between whom and the Superintendent such an entire vari- ance of feeling and opinions subsisted. As the ac- tion of the Board was based on that ground alone, the incumbent at the close of his year, (the fourth of November current,) left the institution. The Board have since placed another individual there on proba- tion for a month, before making any nomination, and they earnestly hope, that the source of difficulty which has been stated, will not again occur. In relation to the Superintendent, as connected with the " administration and conduct" of the Hos- pital, upon which the Board are specially instructed to report, the Board are free to state to the Council, as they have stated to him, that with the best mo- tives on his part and with the most earnest desire to 1840. CITY DOCUMENT.—No. 24, 5 promote the interests of the institution, they have yet doubted whether he possessed the peculiar qualifica- tions of order, system, and particularly tact, neces- sary for such a station. This is not imputed to him as a fault, for the station is one which, in the opinion of the Board, requires rare qualifications. And it may not perhaps be fair to form a decided opinion after only a first year's experience. The Board however, feel themselves imperatively bound frankly to state their impressions to the Council, as they have done to the Superintendent. And therefore the Board are bound to say, that the " administra- tion and conduct" of the Hospital, by the Superin- tendent, in those nameless points which can be seen and felt, though hardly expressed, but which are in- dispensable to constitute entire qualification,—have not been such as the Board would have been glad to witness. At the same time, the Board feel as imperatively bound to state the difficulties which the Superin- tendent has encountered. The want of concert be- tween himself and the Steward during the whole pe- riod,—the peculiar character of the inmates and the great proportion of incurable cases,—the consequent difficulty of classification,—the recent organization of the institution, and the labors at the other estab- lishments,—these are points which have been pre- sented to the Board by the Superintendent, and they readily submit them to the consideration of the Coun- cil. They are certainly of weight, and the Board are desirous that the Council should have a fair view of the whole case. In conclusion, therefore, the Board would state as the result of their observations, that in the ordinary 6 BOSTON LUNATIC HOSPITAL. Nov. and grosser matters, the management of the Hospi- tal has been as satisfactory as could have been ex- pected. But in the points of system, order, tact in managing the patients and all the various depart- ments of such an institution, and, in short, in those requisites which are necessary to constitute entire success, the Board cannot say that they have been satisfied. There have, however, been difficulties which have been stated. These the Board have endeavored and shall continue to endeavor to remove. They have only therefore to submit this statement to the Coun- cil, leaving them to take such action as to them shall seem proper. Upon the subject of students, as mentioned in the reports from the other Houses, the Board would state, that upon request of the Superintendent, they have authorized him to have one student, to be lodg- ed and boarded in the Hospital—and they submit it to the Council to determine whether such a course shall continue to be pursued by the Board. In behalf of the Board of Visitors of the Boston Lunatic Hospital. JONA. CHAPMAN, Chairman. 1840. CITY DOCUMENT.—No. 24. 7 (COPY.) City of Boston, Mayor's Office, > November 12, 1840. J Gentlemen, By an order of the City Council, the Board of Visitors of the Boston Lunatic Hospital have been instructed, amongst other things, " to inquire and report as to the manner in which the medical duties of the other establishments at South Boston are per- formed." As the Board have no means of answering the in- quiry so far as regards the institution under your charge from personal observation, they respectfully request of you information in writing, upon the subject referred to in the order of the Council. They desire information, as to the person or persons by whom the medical duties of your institution have been performed;—whether by any others than the Superintendent of the Lunatic Hospital;—whether at any expense to your institution, or the City other than the fixed compensation of the said Superintend- ent,—the manner in which such medical duties have been performed, and all information in your power upon the subject inquired of by the Council. And as the Superintendent of the House under your charge must necessarily have had the more im- mediate oversight of the matter, the Board desire that he may be required by you to furnish a state- ment in writing upon the subject in question, to ac- ' company your report, in order that they may have all the evidence necessary for the report required of them, by the Council. 8 BOSTON LUNATIC HOSPITAL. Nov. Permit me to request of you the earliest reply upon this subject consistent with your convenience. And, I am Gentlemen, With much respect, Your ob't serv't, JONA. CHAPMAN, Chairman. To his Honor the Mayor of the City of Boston. Your communication of the 12th inst. has been received, requesting information as to the manner in which the medical duties have been performed at the institution under our charge at South Boston. With this we transmit to you the report of the Master of the House on this subject, which we are happy to state, is, so far as within the knowledge of this Board, strictly correct, and in their judgment, may be relied on. In the discharge of new duties, it is necessary to make due allowances for the inexperience of the person performing them ; and when it is considered that the duties required of the Physician of the House of Correction, are somewhat perplexing, arising from the situation and character of the patients, it is not surprising that there should arise cases of ap- parent neglect. Complaints have sometimes been made by prisoners of inattention on the part of the Physician; but in many of such instances, it is be- lieved, that the cases were those of assumed illness to avoid labor. Although the Master in such cases 1840. CITY DOCUMENT.—No. 24. 9 relies on the opinion of the Physician, still he re- marks, that on personal investigation, he has been satisfied that the complaints of illness, were, in some instances, feigned or imaginary. That there has been any wilful neglect on the part of the Physician, this Board do not believe;— and they are happy to state that the attention of Dr. Butler to the duties required of him at the institu- tion under their charge, is on the whole satisfactory. Respectfully, yours, &.C. LUTHER FAULKNER, ^ GEO. DARRACOTT, | Directors BILLINGS BRIGGS, } of the URIEL CROCKER, GEO. W. GORDON, Boston, Nov. 16, 1840. House of Correction. House of Correction, South Boston, ) November 16, 1840. ) Gentlemen, In obedience to your request I shall as briefly as possible answer the several interrogatories con- tained in your communication of the 14th inst. as to the manner in which the medical duties have been performed at this institution. In answer to these inquiries, 1 would state that the Superintendent of the Lunatic Hospital was ab- sent upon a tour in the country two weeks during the summer, and has since been confined to his 10 BOSTON LUNATIC HOSPITAL. Nov. house by sickness two weeks, with these exceptions he has visited the sick daily; during his absence, Doctor Terry, assisted by Doctors Lane and Blake, students of Dr. Butler, attended to the duties of Phy- sician, and their services met with my entire appro- bation. Whenever I have found it necessary to call for medical aid, either Dr. Butler, or his students, Doc- tors Terry or Lane, were at hand, excepting in one instance, and this was after he made his usual morn- ing visit. I was then under the necessity of calling upon Doctor Stebbins, who charged one dollar for the visit. The Resident Physician has in some instances made delays when called upon by the inmates to ex- tract teeth, thereby causing much suffering to the applicant, detention in their labor and detriment to the interest of the institution. Also some complaints have been made by prisoners that their cases were not thoroughly examined, and when they applied for medical aid or assistance, they were turned aside without receiving any attention. Such cases I per- sonally investigated; and in justice to the Doctor I feel bound to state, that in some instances I was sat- isfied that they were feigned or imaginary. But re- cently I have had no complaints, and am happy to state, that the abovenamed complaints appear to be remedied, and that the present Physician discharges his duty as well as could be expected from any man with so little practical experience as he has had in an institution of this nature. Very respectfully, your ob't serv't, CHARLES ROBBINS, Master House of Correction. .1840. CITY DOCUMENT.—No. 24. 11 Directors' Office, House of Reformation, > November 16, 1840. > Sir, Your letter of the 12th instant, in which you re- quest certain information relative to the subject of medical attendance at the House of Reformation, has been laid before the Board of Directors, and I am directed by the Board to state that since the ap- pointment of Dr. Butler to the office he now holds, he has personally attended on all cases of sickness which have occurred in the institution since his ap- pointment, and without expense to the institution. The manner in which the duties have been per- formed by Dr. Butler, will appear from the enclosed communications which have been received from the late and present Superintendent of the institution. I am, sir, Respectfully, your ob't serv't, JOHN L. DIMMOCK, Chairman. To the Hon. Jonathan Chapman, Mayor of the City of Boston. To the Board of Directors of the House of Reformation. Gentlemen, In compliance with your request that I should give information in writing as to the person or per- sons by whom the medical duties have been perform- ed, whether by any other than the Superintendent of tho Lunatic Hospital, whether at any expense to the 12 BOSTON LUNATIC HOSPITAL. Nov. institution or the City, other than the fixed compen- sation of the said Superintendent, the manner in which such medical duties have been performed and all other information in my power to give, will make the following statement. Since I have been at the House, now nearly a month, medical aid has been asked but once, and was promptly rendered by the Superintendent of the Lunatic Hospital. In relation to the period previous, I am only able to speak from information obtained of Miss Groves, the Matron of the House. On careful inquiry of her, she informs me that the medical duties have been performed by the Superintendent of the Luna- tic Hospital in person, except when he was absent for a short time from the city, and then they were performed by Dr. Fisher, Director of the House, whether at an expense to the City or the House, she has no means of knowing. The manner in which the duties have been performed, she informs me was entirely satisfactory. On examination of the journal of the house, and also upon inquiry, I learn that for more than a year past, there has been but very little serious sickness at the House. I have no further or other informa- tion to give touching your points of inquiry. All which is respectfully submitted. SILAS JONES, Superintendent. P. S. Since the above report was made, I have been informed by Dr. Fisher, that he made no charge for the sevices performed by him mentioned in the above. SILAS JONES. 1840. CITY DOCUMENT.—No. 24. 13 To the Directors of the House of Reformation. Gentlemen, Having been requested by your Clerk to state my opinion of the manner in which the medical du- ties of your institution have been performed, and by whom, would state, that they have since the appoint- ment of Dr. Butler, been performed by him per- sonally, in a most faithful, zealous, and successful manner. GEO. F. HASK1NS. Boston, November 13, 1840. To the Board of Visitors of the Boston Lunatic Hospital. Gentlemen, The Directors of the House of Industry have received your communication of the 12th instant, calling for information respecting the performance of the medical services required at that institution, and in relation to the expenses of such services. In exercising the general supervision confided to this Board, the Directors statedly visit the House semi-monthly, and also make frequent occasional visits and examinations. They have seen no cause to doubt that the sick have received all proper care and attention. They have supposed that the medi- cal duties were well performed by the Superintend- 14 BOSTON LUNATIC HOSPITAL. Nov. ent of the Lunatic Hospital, or under his supervision and responsibility. So far as they have had inter- course with Dr. Butler, they have been pleased with him and with his apparent devotion to his duties. For more particular information, however, in regard to the performance of medical services, reference may be had to the accompanying statement of the Superintendent of the House of Industry, furnished by request of your Board. The Directors are not aware that any expense for medical services has been incurred beyond the sala- ry of the Superintendent of the Lunatic Hospital, unless the board of a medical student be so consid- ered. The present and some past attending Physi- cians, considered a resident student, to act as House Physician, necessary. In order to a better understanding of this subject, it may not be improper briefly to state the former arrangement for the medical care of the House of Industry. Before the establishment of the Boston Lunatic Hospital, an attending Physician of the House of In- dustry, of good standing in his profession, resident in the City, visited the House daily, examined all the patients requiring his attention, made all prescrip- tions, and left his directions either with the nurses or with a student or medical assistant. His annual sal- ary was #300, and the office was so much sought that the only difficulty in filling it was in deciding between good candidates. Being, like the Superin- tendent and other officers, appointed by the Direct- ors and responsible to them, the harmony so neces- sary in such an institution was secured. In addition to his duties at the House, the Physician was fre- 1840. CITY DOCUMENT.—No. 24. 15 quently called upon to examine and give his medical advice in cases where applications were made for the admission of persons too sick to be removed to South Boston,—of others with contagious diseases, whose admission would be improper,—and on the other hand, of persons feigning disability, whose im- position could only be detected by a skilful Physi- cian. Under the present arrangement, the Directors have no advantage of the services of the attending Physician in such cases. While the Directors have great respect for the judgment of those who devised the present arrange- ment, and are by no means prepared to recommend its discontinuance after a short trial, or to urge any plan of their own, they respectfully suggest the con- sideration of the former arrangement, should the Government decide on a change. In behalf of the Directors, Very respectfully, your ob't serv'ts, ARTEMAS SIMONDS, ) _ THOMAS HOLLIS, \ Committee. Boston, November 17, 1840. To the Directors of the House of Industry. Gentlemen, Your communication of the 13th instant, is at hand, in which you request me to make a written statement which was proposed to you by the "Board of Visitors of the Boston Lunatic Hospital," relative 16 BOSTON LUNATIC HOSPITAL. Nov. to the medical department at the House of Industry, how the duties have been performed, and by whom, under the arrangement now existing. First, As " to the manner in which the medical duties have been performed," I must confess, I do not feel that I am in every respect a competent judge, therefore shall withhold my opinion. Second, As to " the person, or persons by whom the medical duties have been performed." Dr. Terry and Lane, gentlemen students of Dr. Butler's house, had the principal charge, having made most of the prescriptions and attended to all, or nearly all of the midwifery cases. Occasionally Dr. Butler visits the Hospital, &c, in company with them, and some- times alone, likewise in the absence of the above named gentlemen, particularly Dr. Terry, he visits the Hospitals daily and prescribes for the patients. Dr. Butler has had from one to five students, most of them somewhat irregular in their attendance and time of service, excepting Dr. Terry and Lane ; the latter gentlemen has recently left, and Dr. Coffin, a young medical student has taken his place, and boards at the House of Industry. The principal surgical operations have been per- formed by Doctors Hay ward and Butler. Dr. Fish- er frequently visits for the purpose of examining the patients laboring under pulmonary complaints, but at whose expense the above named gentlemen at- tend I am unable to say. Soon after Dr. Butler took charge he appeared to be aware of the difficulties of performing his various duties at the different institutions, to the satisfaction of all parties, and said that it would be impossible for him to attend to all of the patients himself 1840. CITY DOCUMENT.—No. 24. 17 After consulting with me upon the subject, he proposed visiting the Houses of Industry and Cor- rection alternately, one month each, commencing at the House of Correction. For reasons unknown to me, that arrangement has not been carried into effect, so far as our establish- ment is concerned. Which is very respectfully submitted. DANIEL CHANDLER, Superintendent House of Industry, House of Industry, Nov. 16, 1840, 9