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TELLS OF HtK WORK, 1>R. MAl'NDKllS OUTLINES DUTIES AT INSANE ASYLUM. ?. WORKED FOR THE BEST Oave up Her Entire Life and Social Pleasure to Do All That She Could to lii-tip "he inmates at the Insane Asylum?Dr. Saunders Explains What She Did in ller Work. The following is the second installment of Dr. Saunders' testimony before the committee investigating the conditions at the State Hospital for the Insane: Mr. Hunter: Dr. Saunders, when did you go to the institution? i>r. Saunders: May 1, 1907. Q. How long have you been there, doctor? A. I have been there continuously uiuco, only when I was off on vacation. Q. What are your duties there. doctor? A. I have charge of the white women's department. Q. White women's department? Doctor, there was something said here time and again with reference to stenographers, Did you object to the stenographer's taking Dr. (iriffin's dictation? Conditional Objection. A. Well now, there was one time when 1 did, but that was a conditional objection. Dr. Griffin frequently caq)e in and without asking the girl to take his work kould begin dictating his notes. So while I was dictaing and while she was still at work for me, he began his dictation, and I said: "Dr. Grililn, I am using the girl now. My work is as important as yours and yours must wait."I heard nothing more of it until his testimony. Q. Doctor, did you attempt to prevent the stenographer from writing up Dr. Thompson's clinical record? A. No, I did not. And I would like to say that I began my writing up in 1909 and it took mo as long as it took Dr. Thompson, and I had finished before he began. And I thought to keep up the work the regular letters ??they must bo first in every case? but I have not objected to their doing bis work and they are doing it as fast as they can, as far as I see. Q. Did you reel the stress of any friction In your work with Dr. Thompson? A. No, I did not. Q. Did you have reasons to feel in your work that there was a lack of cooporation on the purt of Dr. Thompson? A. No, I did not. "When I was away he relieved mo and when he was away I relieved him. When I wanted anything he gave it to me when I wanted It. Q. Woll, did you feel that Dr. Habcock ever discouraged you In your efforts for improvement? A. No, I did not. Q. Did you feol that the regents ever did? A. Up until the 12th of December 1913, I had every reason to believe that the regents approved of my work. Heard No Objections. Q. You did not up until this time? A. Up until December the 12, 1913. I had heard no objections up until that time. Q. Since then how do you feel about it, doctor? A. Well, I felt that I was being weighed in the balance. Q. Have you any plan or system over there by which you buy your medical supplies? A. When I ilrst went to the institution wo did not. Wo gathered up things as wo could from the local market and elsewhere. But recently we have tried to system's^ atize the buying of supplies. We had a little supply room. We took a room that was empty and lilied it up witli shelves and tried to buy in quanity so as to be saving and to buy when il was wanted. Everybody was giver a key and they had the prlvilego ol coming and going as they liked. ] felt that it was an advantage. No body objected; rather they helped m( to do it. Amusement**. > Q. Doctor, what was meant bj amusements of patients? A. Well in every hospital the size of ouri therx, are custodial patients, those foi whom there is no hope of menial re covery. They live there, that ii their home and their community, am of course their days are long an< monotonous, and wo attempt to d< anmottiltiP' f i\r tlinlp nmiiQAmont YVi have dances, moving picture show and automobile rides for them. Tin State does not furnish that to them but it does furnish shows and danc music, and we have various kinds o amusements for them that we can do velop. Q. Have you any reason to believ that the nurses of I)r. Thompson' department are antagonistic to you A. No, I have no reason to believe though I have never tried to tak any authority over them, but I hav always attempted to help them whe I could. When there was an emer gency, or anything when the other were away, I was equally as willin, to help them as I was my own nurse* Q. When you sent the tray of foo to the sick nurse, doctor, did ycu fee that Or. Griffin objected to him taking this food? A. No. I had never had any directions or orders to the contrary. I had always showed a feeling for my own nurses and I had no objection to extending it to l)r. Thompson's. I did not know that ho objected until when a littlo time later Dr. Babcock spoke to mo. Ho did not mention it to mo. Ho took It to Dr. Babcock. Q. Ho did not leave any Instructions? A. No. I)r. Griffin relieved Dr. Babcock on his stays off duty. When ho went away I did tho best I ould. I was tho only one there on duty. Ho really left his ward to me, whether tie left it in writing or not. I did tho best I could do for him. Purchase of Supplies. Q. Did you got all of tho supplies that you wanted? A. Oh, yes. Somelimes we were slow in getting them, and I usually got it myself. There was no objection. I always took the bill to Mr. Bunch and he paid it willingly. Q. Did you employ tho stenographer that was out sick? A. Yes, I did. Sho had mumps and I did not feel that It was quite fair to the patients to bring her in. And she was sitting up In her room and I gave tho dictation and took tho typewriter out there for her to do tho work. The other girl was buying tho commission and keeping tho other office work going on. 1 went out to her homo and gave In my work. Q. It Is customary doctor, to buy things through tho treasurer. A. Well, things wo filled around town. At least I do. I go out nnd buy it and givo Mr. Bunch the bill when I got back. That was understood between I)r. Babcock, Mr. Bunch and myself. Now things from a distance, we make up a list. Q. Is that the reason you bought ' tho medicine for Dr. Cooper? A. 1 Well, it is tho custom at tho hospital * that tho officers buy through the 1 treasurer the things that they want. { Dr. Cooper had bought medicine * through the institution before, and 1 1 was talking to him at tho time. He ' said, "Will you buy some for me? I 1 will give you tho money?" And 1 * sent the money of his in the letter 1 and asked tho company to accept ( that as so much payment and charge ' tho rest to tho hospital, which was i done, and I delivered his to him and f kept the rest for tho hospital use. ^ Q. Well, did Dr. Cooper buy this drug through any ono else at the in- * stitution other than yourself? A. 1 vps, I feel so. I know I have gotten 1 doses from Mr. Austin. He always 1 paid for it through Mr. Hunch. ( Work With Other Doctors. Q. Have you had any association , with any other doctors not employed , by tho asylum? A. Oh, yes, I have. Q. Will you tell some occasions, doctor? A. Well, tho first man I ever worked with outside of tho hospital employ was Dr. Stilos of Washing ion. no won going inrougn mo south , in 1909 studying hookworm. Ho , camo to tho hospital, and of course 1 was glad to get anything new I could and I asked him to go through my wards and show mo tho ones that had it, and ho showed mo how to treat all of tho cases that had hookwork infection. Then the next man I had any work with outside of tho employ was Dr. Howard Fox of New York city. lie camo down to study tho pellagra cases and ho did tho first Wasserman work, possibly tho first in South Carolina. He did 20 of my cases. I helped him in 1909. And then I worked with Dr. T.avinder and Dr. Dong of tho marine hospital service, and Dr. Douglas Singer of Chicago came down and looked after my cases. IIo is tho man that has charge of tho Psychopathic hospital. And then Dr. White a year after. I have had very pleasant associations with a great many medical men, not only away from South Carolina, I hut I liavo pleasant associations with any doctor who brings a patient to me. I encourage him to keep up his interest, and I keep up his treatment ' if ho wants it done. The doctors in town como to me, and if I have a troublesome ease I get a doctor if I want. Dr. Watson has been In my department, Dr. Williams, and Dr. Taylor has been In a groat (leal, and 5 Dr. Pope. Q. Associating with thoso doctors and working with them outside of f the asylum, doctor, was that with a ? view of bettering your * Solicited Criticism. r A. Oh, yes, I always ask them? s when I hoard that they woro coming j to Dr. Habcock's I asked them to j como to my ward and give some criticism. I asked thorn. They didn't offer. I wanted them and I didn't mind asking for it. Q. Did you feel that you were benefited for having inquired into it? ' A. Why, yes, I got somebody else's ' ideas besides my own. Q. Did those ideas help you in looking after the inmates of the institution? A. Why, I have felt that c it helped mo materially. Q. What particular time did you ? analyze for the Wasserman test, doctor? A. Well, I did not have a labore atory to work. We fitted up with e anything wo could get, and I am n afraid I offended Dr. Blackburn by - taking some of his things. I bought s some things. 1 took some thinks g from the laboratory and I took ? things from elsewhere, for I have no d other practice and we gathered up >1 everything that we could. The nurses lelped me in that. We had no water >nth or thermometer. So these nirses had to stand there and hold he thermometer in tho water bath, md I was never without their help, jecause 1 could not have done what [ did without their help, ami in addiion to that. Dr. Cocker helped me Q. You felt that the things were here for tho use A. Why, yes, ! did. And anything I had in my department, if anybody wanted it, 1 mve it and if I got it back I was so 'ortunate; if I didn't, I got some noro. Nursing Service Improved. Q. Did you feel that tho reglstraion of the nurses improved the service? A. Why, it helped wonderfuly. We got a better class of nurses uid they were more happy to come, eeling that they were in the class vith other nurses. Of course that mproved our service and they got noro training and there was an advantage all around. Q. Did you put forth any special >ffort to bring this about? A. I did everything that I could. 1 was even ionised of camping out down at the 3tato house. Q. And since then you find that it ma been an advantage to tho instlutlon? A. Why, I do. Q. Doctor, did you remove the hings which Dr. Hlackburn says you emoved from his laboratory? A. fes, I moved some things. I do not enow that I got everything that he nissod, but I did remove some things. [Daughter.) niii you return them? A. Yes, (ltd, when Or. Babcock told ino that )r. Blackburn was then ready to vork and ho ordered mo to return hem and I returned on the same (lay ho teat tubes and racks, two gradlated pipettes, one bulb, two wire laackets, one water bath and thernomotor and other littlo things, glassware and other things, that 1 (new that he would want. And in idditlon to that, Dr. Ilabcock told me hat I)r. Blackburn wanted some hings, and I was aa willing to help !)r. Blackburn and he was to help nie ind Dr. Babcock gave mo the repuidtion that Dr. Blackburn wanted \nd I sent over two hens, a meat dioppor, two guinea pigs, one beef lonrt. and rubber tubing and tissue )aper. I was very glad to help out, io I sent over the things to him and [ returned the things that I had. Of course I had to get up something elso, which I did, because I did lot discontinue, because I did not Know that there was any objection to my doing It. I thought there was objection on the part that I had takm the things. Q. You were doing all of this for what object, doctor? A. Because last year I went to New York city and I mw the work that they were doing in mental medicine and according to the present (lay work done?conRiderinfi' the present day work an a basis, I found out that they were considering three main causes of Insanity, heredity, alcohol and syphlllis. Of course I could not do anything?we have no outside field work or welfare work after our patients leave the hospital; I could do but little there, and alcohol plays such a small part In my department, because I have had only threo cases in seven years and I determined to find out what per cent, of my cases were syphiletics. I did it for various reasons. Because 1 had some epileptics that developed in adult life. I wanted to do some work In a certain form of mental trouble to see what percentage they showed of syphillis and 1 determined to do the work. I asked I)r. Rabcock. Ho said he had no objection if I wanted to do It. (jot l'p at r? a. in. Q. How did you manago to run your department A. Oh, I got up early and I began work about 5 o'clock and I would work until time to go around and I would work at night. I did that over time. I did not fail to keep up my own work and the girls, tho office girls were good. I took care of tho girls. And the nurses came to tho rescue and did a lot of work that they would not have otherwise done. They all helped me keep it up. Q. How much of tho "606" (lid you uso in your department? A. Well, of the patients that I tested I had only 43 positive. Ten of them was willing to try tho "606" on. The others had organic brain lesions and I was afraid to try it. So I did not give it to but about a dozen of my people. . Mr. Stevenson: Are there cases of that whero it is not judicious to use tho "606"? A. Yes, sir; Mr. Stevenson, I was afraid to uso it in organic brain lesions. There is a certain reaction that is likely to occur in any of those cases that I wanted to avoid Q. How do you determine that they have the organic brain lesion'.? A. Your physical examination before that has told me. Q. Without the physical examination you are likely to give the "GOG" and have a disaster? A. I was careful, because I did not want any accidents to happen, and 1 rather erred on the other side and gave the treatment of life the first consideration. Q. Would it he judicious, in your opinion, to enter upon one of the treatmerts of those cases with "GOG" without a physical examination tc determine whether thero were leslonf or not? A. I would not do It. As to Interference. Q. Well, doctor, there has a lot been said with reference to trespass ing, interfering with other doctors' wards. What have you to say with reference to those statements? You have heard them brought out? A. Yes. Well, frequently I did everything. I did everything that I could for the hospital possible, and I certainly did it with a generous, altruistic spirit. I had no desire to trespass upon anybody's department, and I had no desire to monopolize. The opportunity arose where I could help) and I helped, but 1 was as willing to call on others as I was willing to be called on; and they didn't object at that time and I felt that they either consented, or their silenco gave consent. (J. When did you hear the first of it? A. I did not hear anything of it until the 11th of December. Q. Well, can you account for their objection at the time that they did? A. No, I do not. know why. Q. Doctor, I wish you would Just go ahead and tell us what you did there, in the dining room and in your own ward and everywhere; Just tell us as hastily as you can all that you really did do. A. Well, as I say, when I went to the hospital 1 came in with the full understanding that I was to give all of my time and that I was given charge of the white women's department to be sure and I felt that I was given the privilege or the liberty of developing it as I liked, and, as I said before. I did it from a spirit of generosity. I had 110 desire to encroach on tho department* of others or monopolize at all. And during my seven years' service my one thought was for my patients and the others as I could. I had charge of tho white women. Naturally I did more for them than tho others, but I helped where I could. I saw no reason why I should not help them when I could, especially when 110 one objected. For Bigger Tilings. Tho patients were well cared for and happy and the nurses were happy and contented and I had assurances that my work was approved of by some good men and women anyway, and they came around and saw the work I was doing and they rathor encouraged me, an I had no reason to believe it was disagreeable to anybody. Now, of course, so much has been said about the disagreement and tho petty personalities and such things, and I would liko to say that on my part there has been something else in addition to this. Wo may have had our disagreements?I do not deny that?but along with that there cortntnlv Unci hnon n floulrn t r> rnnpli nut J ?~ ~ ~ w" V M % for bigger things and Improve the conditions among the insane. As I told you, I eaino to the hospital in 1907 and I was willing to give generously of tlmo and effort. It never occurred to me that I would get more pay for it, which I did not. I did not consider the money. And though my time at the hospital has not rippled along like a summer brook, it has not been unhappy. No Outside Interests. Q. Have you had the Institution at heart at all times, doctor? A. Well, I felt I had. I have nothing else. I have no outside practice. I have no social life or anything like that. I spend my whole time in the institution except occasionally. I have recreation in the form of music. Q. I believe you said the superintendent, l)r. Habcock, had encouraged A. Oh, yes, I never had any objection on tho part of Dr. Ilabcock. Q. Did you have any objections coming to you from any of the other ? A. No; not until the 12th of December did I hear it. Q. Was any complaint made to you, doctor, from tho board of regents in reference to your work over there? A. No, I have never received. up until tho 12th of December, any criticism or any instructions or orders for work there from any of tho board of regents, from them or from any of the members. They never told me to do or not to do things. Of course I was always good as I could be In taking them around when then wanted to go in my department, but otherwise I had nothing to do with the board of regents. They went in my department and they went in the others, and they asked me to go and I always went when I was requested. Dr. Iiabcock frequently conducted them through my department. Q. Will you tell us about the regulations you have with reference to your own department, record of i cases? A. Record of caRes? Q. Yes, ma'am, you keep a record? A. Yes, I keep records. Case Histories Described. Q. Give us an idea of those records please. Have you any of those records with you? A. Yes, I have several. And this particularly J ! want them to seo (producing rocord) and I want them particularly to sec | this one, please, (produces another record). Now, every doctor has his or her own idea of examination o( patients. In my own department 1 watched un all I could and I had formed my own Ideas. Q. Doctor, will you just take one and review it for us, please; just for ' the benefit of those that .haven't them7 A. Well, in every case, when ' the patient comes into the hospital ' the nurse immediately receives her I always see her if possible. I encourage some member of the familj : to come along and to give what his tory they will. Now by history 1 mean family history and the personal history. And 1 go over all of the Information I can. It Is frequently hard to do, because the family of the people often are not?they do not know, they do not know the application that a certain symptom would mean, what importance to attach to It. Anyway, it Is equally hard to get information, but wo keep on and get what we can from the family. If the patient is admitted by a county officer, I send a list of questions back to him and the family and ask them to answer them. If there are any interesting symptoms, I write to the doctor and ask him to give me his history and what he did. After I have gotten that we return to the patient. The nurse immediately makes out a card. That card includes a lot of Information for the hospital's benefit. We put down certain facts or data, the ward, the physician, who admitted her. the height, the weight, the color of tho eye, pulse, morning and afternoon respiration and temperature. Then wo put down whether or not she has vermin, because that Is a great source of trouble to us, because we do not like to cut their hair. It is troublesome, because so many do como with vermin. Then we examine for bruises and marks and scars and so on, because we are frequently accused of mistreating patients and that kind of thing by people who do not know, and we take a record to show in exactly what condition they come, showing that they do come to us bruised, because in their low vitality. which they usually are, In their restlessness, they frequently bruise themselves and their ecorts to help themselves causo skin bruises. We put down list of valuables, if there is anything particularly valuable accompanying the patient. We take the money and valuables. Then the nurse sends a specimen of urine to tho laboratory. Then after that I make the physical examination fol-1 lowing a list of details that I have, and it is quite an interrogative form of history taken. Anyway it is a book of questions that wo write out that we have, and I do any interrogative form of history from that. I simply get these questions and write it out according to my own ideas. I try to state facts without attaching nuy man's opinion, because in medico legal cases a lawyer is always disagreeable because 1 haven't put down the facts that he wants and another comes along and wants his view of the fact and I put down everything as I see it. The physical and neurological examinations are made at a single sitting, or with a single examination. The mental examinations extend over a longer period of time. There are some cases that we can diagnose with a single examination. There are others that take time. We have those diseases that ?re rather difficult of classification, that we mark as inconclusive and watch for a period of months before we are satisfied but frequently we come to a conclusion much more quickly. In other cases of lowest inaction, or frequently for my own satisfaction, I have a blood examination made, filling out a blood chart that I had made up myself. We always, as I say, have tho nurses securo the urinary examination, frequently the blood examination, then every patient sees the dentist as soon as she come in. If she is admitted today she goes to the dentist the next day. I usually keep a list ahead. Now, that is all systematic work that is gone through with every case. Double Vaccination. Every case at the time of her admission is vaccinated against smallpox, no matter whether sho has been vaccinated previously or not. Every case young enough, and usually not over 4 0, is vaccinated against typhoid fever. I do whatever examination is necessary, watching them from time to time, and every case I jot down little notes on the case, certainly I put down every change for better or for worse, and every accident is noted and how it came about. This I write homo to the family. I economize as much as I can, and when I write out these things I have tho office girl to write out a statement of her own composition. Sho states the facts to the familv. Every case as soon aa It is admitted is given special care, because it is a terrible break from their homo to the hoapital and it is the tendency of a great hospital is to lose sight of the individual; and the tendency is to individualize as much a spossible and make them feel welcome, because a great many of them feel that they are not. And we write the family the next day, because that it the first i break from home and they are isoi lated, with a certain amount of sadness, and wo always write them at home how they are getting along and i we write them frequently until they ' get accustomed to it. The patient is i i irequenuy more nappy man 1110 ram1 ily. We try to allay their anxiety by writing as often as possible, and I I givo them my address on a little card and tell them what they may exs pect, the treatment that they will get, the ward on which they are plac: ed. I encourage them all to let me i know of any suggestion that they , wish carried out and I will do it if . I can, and If I can not I tell them frankly why. r Q. Well, doctor, the members o! the family at times come to visit the [ patients? A. Oh, yes, I encourage them to come as much as they like. because they frequently? Q. You admit them to see the?- A. Oh, yes, whenever they come. Q. You have rules of your own, doctor, with reference to admitting anyone on certain days or at certain times? A. Well, It is the custom of the institution to have visitors every day except Sunday, from 9:30 to 12 in the morning, and from 2:30 to 4 in summer and to 5 In winter. Itelatlves Visit Putleuts. Q. In fact you would admit anyone that was a patient?any member of their family any day that they go there? A. Oh, yes. Q. Ho you recall refusing any one at any time, doctor? A. No, I do not. I do not recall anybody now. If I did it was for some special reason. Now, I reserve the right to ask them to stay away if I find the patient is not improving or comfortable. You have a good many patients that have ideas against their own family; and certainly it is right to keep them comfortable whether the family in comfortable or not. They are the first consideration. IUit certain near relationships are always admitted. I always extend courtesy to the couaty officer, too, if he is interested. Q. Did you ever at any time haw* any one appeal to the superintendent and insist on your letting him see them? A. Oh, yes, I always tell them when they are not satisfied with that decision to go to him. Whenever they are dissatifled with anything, I say that is not final. Q. That is merely In carrying out your rule with regard to the welfare of the unfortunates? Occasional Objections. A. Oh, I always refer thJngs that, they don't like to Dr. Babcock. If we can get along, all right: hut tf not, I refer them to Dr. Babcock. Q. Such as that does occur occasionally? A. Oh, yes, occasionally; but it does not often happen. The people are usually reasonable. Q. Doctor, your patients as beat they can, seem to appreciate your work for them? A. Oh, yes. I feel that they aro very happy and get along very comfortably., Q. They impress you that they appreciate what you are doing for them? A. Oh, yes, 1 think so. Q. Well, speaking of admitting those patients?when you first take them In?there is somewhat of a disadvantage to the doctors who do not not reside on the premises along this line, is it not? A. I do not know about that. I am always on duty. I always receive mine. When I do not. Dr. Babcock or Dr. Thompson always receives them for me and take dows history for me. Receiving Patient*. Q. Then who takes down history for those who reside In the city and are not there when the patient is brought in? A. I do not know. I da not unless it is something special that they want me to take down and than I do. Q. Then you do? A. I take down any reports or telegrams or anything and make a little note of it and send If t r\ h a rl ono rf m Ar? iv w/ wuv uv-j/m t Hi ou v. Q. Whoso duty is that, doctor, on each department when a patient Is brought in? Ib that physician's duty to receive the patient? A. To roceive the patient? I feel tliat it Is my duty to receive mine. Q. Whoso duty is it to receive the patients on the male department? A. Well, those there when they are there. When they are not, we do it. Q. Dr. Thompson? A. Ho is always on duty. Wo are on constant duty. We spend the whole time. V ? WESTON HILL PASSED. House Provides Medical Inspection For Schools of State. The Weston bill providing for a system of medical inspection for school children and students in the colleges of the State has been passed to third reading by the House by a vote of 52 to 30 after unsuccessful efforts had been made to exempt various counties from its provisions. The members of the House who voted for the passage of the bill to third reading were the following: Ayes?Speaker Smith, Atkinson, Barnwell, Bethea, Bolt, Boweri, Boyd, Brice, Burgess, Courtney, Dantzler, DeLaughter, Dick, Eppa, Evans, Greer, Harper, Haynsworth, Hunter, Hutchinson, Hutson, James, Kibler, Kirk, I^ee, Liles, Lumpkin, McDonald, McQueen, Malpass, Martin, Massey, Melfl, Miller, Nicholson, Pn t n Pftcr una p?? T"> J? tv l j v i - m. A. vg UUOf X Jrun, IVUilUy | U 1(1(1 10, Riley, Robinson, Sanders, W. M. Scott, Senseney, Stevenson, Sturkte, Thompson, Vender Horst, Welch, Youmans, Zeigler?52. The members of the House who voted against tho passage of the bill to third reading were tho following: Nays?J. W. Ashley, Drowning, Clement, Creech, Fortner, llaile, Hall, Hardin, H. F. Harrelson, M. C. llarrelson, Irby, Jones, Kelly, Kennedy, Kirby, Miley, Mixson, Moore, Murray, Nelson, Rlttenberg, Robertson, W. W. Scott, Stanley, Strickland, Summers, Tindal, Walker, , White, Wilburn?30. , ? CJrtve up Her Lite for Others. A nurse who volunteerod for service in the isolation ward of a Champaign, 111., hospital, where University * ' of Illinois, students afflicted with i scarlet fever needed care, died Wedi nesday of the disease. She was MIm