REPORT OF [THE] ROYAL COMMISSION INQUIRY [ON] THE PROVINCIAL HOSPITAL

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   TO THE HONOURABLE THE PREMIER
AND MEMBERS OF THE EXECUTIVE COUNCIL
OF THE PROVINCE OF NEW BRUNSWICK

   Your Commissioners appointed by the Order-in-Council of 7 February 1945 under the provisions of The Inquiries Act being Chapter 10 of the Revised Statutes, 1927, to inquire into and concerning certain statements reflecting adversely upon the management land operation of The Provincial Hospital , the conditions existing therein, and the conduct of the officials land persons employed in said Hospital which appeared in The Standard, a newspaper published in the City of Montreal, as well as the care land treatment afforded patients in said hospital and also to make such findings and recommendations in regard to the premises as may appear proper and advisable-

   Beg leave to report that they entered upon the subjects of inquiry and held seventeen public sittings occupying 63 hours, besides individually playing frequent visits of inspection, always unannounced, to the institution both by day and by night.

   These statements, which we are required to investigate, have their genesis in the advent of three men, Ernest Albert Letteney , Francis Hines and Kenneth Stuart (who in December 1944 had assumed the name of Hines) to the office of The Standard. All had been attendants at the hospital and each made a statutory declaration as to the conduct of the institution. Letteney's appearance at the time was normal. His history, which was unknown to those connected with the Standard, was as follows:

    Mr . Peter Laing , counsel for the Standard, said that on 16 November 1944 Letteney "seemed to be in full possession of his faculties, talked reasonably and did not seem to be excited. If he had appeared then as he did in Mr. Laing's presence before the Commission, he would not have advised going on. Letteney again became a patient in this hospital having been committed since he gave testimony before the Commission, and has since been transferred to an asylum in Nova Scotia where he belongs.

   Francis Hines had been assistant superintendent of The Working Boys' home in Toronto for approximately 8 months. Kenneth Hines, whose real name was Stuart, was an inmate. He left with Francis Hines in company with two other boys from the Ontario Training School at Bowmanville who were wards of The Working Boys Home. Francis Hines admits that he ran away because he had been absent from the Home one night in the company of these boys; he rented a car from a Drive-Yourself station, went to Hamilton and thence to Niagara Falls. About ten miles west of Toronto ran out of gas; slept in the car for the night; had a driver's permit for the car which was forged by one of the boys. Got in touch with the Standard through Stuart and Letteney who, after leaving Saint John had proceeded to Montreal and put some statements in the Standard's hands. He had used the name of F.W. English to advise Letteney that he was coming back to the hospital with a companion who turned out to be a Miss MacDonald of the C.C.F. and who spent the night in the room of John Drummond a patient. He had entered the service of the hospital as an attendant on the 19/20 September. He left the 7/8 of November having got, he says, a number of stolen ward books from Letteney, whose account differs slightly. In any event, between them they abstracted several books, not all of which have yet been recovered by the hospital.

   In consequence of the statements made by these people the Standard decided to send their reporter, Mr. Kenneth A. Johnstone , to investigate conditions in the hospital, which he did in the guise of an attendant. There were serious discrepancies between the statement given by Francis Hines to the Standard and this testimony before the Commission. Letteney repudiated his Montreal statement by two statutory declarations made in Saint John. The Commission do not attach any importance to statements made by Hines or Letteney. The real question for determination is the validity of the statements made and published by Mr. Johnstone and which have been referred to us by the terms of our Commission.

   Kenneth Alexander Johnstone of 3643 University Ave., Apartment 4, Montreal, age 35, unmarried, journalist, told of his association with the National Film Board at Ottawa ; that he had been a newspaper-man since 1934. He was Toronto correspondent of the Montreal Standard in 1942 until he went with the National Film Board in October of that year. In December 1944 he was informed by Glenn Gilbert , editor of the Montreal Standard, after discussing the possibility of a return to that paper, that the Standard had received certain reports concerning the Provincial Hospital at Fairville and wanted him to go there and obtain an attendant's job. On December 14, 1944 Mr. Gilbert showed him declarations of three former attendants, -- Albert Ernest Letteney, Frank Hines and Kenneth (Hines) Stuart, at the Standard office, and also three letters from patients. Johnstone told of talking with Letteney and Kenneth Hines, at the Standard office with Mr. Gilbert, and then receiving instructions to obtain a position at the Hospital and stay sufficient time to prove or disprove the statements of the three former attendants.

   He arrived in Saint John and went to the Selective Service and asked for temporary work at the Hospital and they referred him to that institution; he did not tell them he was from the Montreal Standard. He was hired by H. W. Brownell , chief attendant, on December 18, 1944, who inquired of his education and whether or not he had ever suffered from any mental disease, but did not ask for a character reference. It may be noted that no investigation was made by the Standard into the character or conduct of its three informants He reported for work on December 19, 1944, assigned to day duty on Ward 2, no definite instructions given except to be careful of locking of doors and to see that patients had nothing sharp or matches. He did not see any rules or regulations on Ward nor were they called to his attention. His only physical contact with the patients was with the restraints or helping them dress or undress. Duties were mostly supervisory over patients, escorting them to meals and doing the housekeeping on wards.



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STATEMENTS MADE IN MONTREAL STANDARD

   Your Commission has been furnished with excerpts from the Montreal Standard, prepared by Mr. E. J. Henneberry , K. C., legal counsel for the Commission covering the principal points in the Standard articles. In these quotations the identity of patients is not disclosed, the sobriquets used by Mr. Johnstone being substituted for the real names.

   In Mr. Johnstone's narrative there has been too much acceptance of the statements of patients as if they were facts.

   Take the case of the boys on Ward 9, one of whom showed him where he had hit another man on the nose; another of them showed him a man with two black eyes and denied he did that to him. It may have been so, but Johnstone did not see the occurrences and there is no evidence that any attendant had done so. Moreover it is quite possible that these boys had nothing to do with the injuries of which they were boasting. To rely on the unsupported word of an inmate is dangerous. Yet this sort of "journalism" has been published by the Standard as a substitute for facts.

   When reproached for the publicity which he had given to cockroaches, which he admitted were very hard to keep down, Mr. Johnstone said that he did not know whether he should have put it in or not, but if he had omitted that and other things, "would the article have been of sufficient force to have caused a Commission?" This remark is equally applicable to his description of many of the incidents to which he refers. The Standard in its issue, of 3 February last says "Regrettable incidents might occur in any mental hospital, but they would be the exception, the individual act of a brutal attendant" and "All mental hospitals in Canada are faced with great handicaps. War conditions and inadequate budgets make it impossible for the desired standard of care and treatment to be obtained."

   Nevertheless this hospital has been exploited to the full by the Standard which had the at least tacit approbation of Dr. C. M. Hincks , in making public its accusations instead of calling them to the attention of the Provincial Government. We shall see how promptly the Minister of Health responded to the telegram from Hines and Letteney, Drummond and Wiggins. There is no reason to suppose that if Mr. Johnstone's observations had been laid before the head of the Government of New Brunswick or his Minister of Health that they would not have received adequate attention. By such avoidance of publicity much worry and heartbreak would have been saved to many relatives of unfortunate patients.

   After a thorough investigation of Staff and Records, we report as follows:
Excerpt: "Standard"-Issue of January 27, 1945:
"Marshall was standing at the head of the stairway, counting the patients as they went downstairs. I noted his method of counting was to give each one a good push as he went by thereby hastening the exodus as well as keeping track of the number. As the patients go down two flights of stairs, mingling with perhaps another hundred patients from the wards below, go through an underground passage to the cafeteria, their numbers are checked going and returning to assure that no one takes the opportunity to hide en route."

    Charles W. Marshall , attendant Ward 2, with 10 years' service, denies giving patients a good push when counting them going to and from meals. Questioning of other guards and many patients does not bear out the point that patients were unnecessarily pushed as they were being counted.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"I found that Ward 2 had an unusual combination of patients. It is the admittance ward but has many charity patients who spent all their time there. It is also a recipient of the 'trouble makers' from other wards; I noticed that about eight patients wore hobbles around their ankles which made it very easy to push them off balance should they become violent. Four were strapped to benches and were only released to be transferred to beds, where they were strapped down by wrist and ankle to the bed itself. In addition to newcomers and 'cute ones' I saw about six who could best be described as 'completely degenerated'; the only ability they seemed to possess was that of eating, which they did in a very primitive manner, without benefit of utensil. These particular patients seem to have no control over their bowel or bladder movements, and the stench from their vicinity spreads over the whole Short Hall.

   However, the main bulk of the patients seemed to be made up of middle aged and older men in various stages of mental illness ranging from milder forms of nervous breakdown to complete incoherence. Most of them sit around on benches during the day. A few pace up and down the length of the Short Hall, a few manipulate the polishing brushes on the marble like floor of the Short Hall or the wooden floor of the Long Hall in which only a few favored patients are permitted."

   Ward 2 is the male admittance ward of the Hospital but also houses a great many patients, of all types, who have been there for years. There exists a complete lack of segregation, troublemakers from all wards. The mentally disturbed the mentally deficients, complete imbeciles, alcoholics, epileptics, all are thrown together in this ward. Conditions are as written in the article; however, much questioning has not brought out any admittance of favoured patients. Inspection seems to bring out that the cleaner and quieter patients are allowed in the Long Hall. Eating arrangements for those not allowed to go to the cafeteria are not satisfactory and need correction. There is confusion at mealtime; the food is often cold and of limited variety; the beverage is of poor quality and its distribution primitive. Meals are brought up from the Main Kitchen in large containers and placed upon a bench in the Short Hall. Patients swarm around the container, but some semblance of order is preserved and everyone is fed. Gentler patients seem to obtain food for the idiots who remain on their benches, that is the cereal, soup, hash or stew with pieces of bread, but they never seem to get a beverage. On inspection attendants were observed feeding some of the patients.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"I learned that Ward 2 space consists of this Long Hall, perhaps 150 feet in length and 20 feet wide, the Short Hall, which would be around 60 feet wide, 40 feet deep, and the Old Attic, which I will describe shortly. An additional space called "A" immediately above the Short Hall, is about the same size as the Short Hall, and formerly housed tubercular patients.

   I noticed that the majority of the patients wear a kind of blue denim coverall or overall. Some of the patients, undressing, wrap their other clothing and boots inside the overall, tie it into a bundle and put it away in the office. But the majority are simply stripped to an undershirt, and the clothes are all piled in utter confusion into two lockers at one end of the Short Hall. As Sid Phillips explained to me: 'The first man up is the best dressed'. The 30 odd luckless patients destined for the Old Attic are stripped right to the skin, and then at 5:30 p.m. are conducted down the Long Hall, through Ward 1 to the stairway to the Old Attic."

   Your commissioners visited the Hospital early in the morning and observed the system of the care of patients clothing at night time and the dressing exercises in the morning. Ownership of the various bundles of clothes is not marked in any way and "first come first served" is the rule. There is, however, an adequate supply of clean clothes in the store-room and this is generously distributed by the attendants. In the dressing process the more helpless patients are assisted by other patients.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"The Old Attic consists of two large rooms, a smaller room, an antechamber and a toilet. The two larger rooms contain about 14 beds each, there are three beds in the smaller room and another bed in the antechamber. The place is unheated, the walls are filthy, a curious slime covers the floor, and rat holes are everywhere. I counted eight beds that possessed woolen blankets, the rest were equipped with one cotton undersheet and one thin flannelette sheet. Three of the patients were ankle strapped to their cots, the door of the small room was locked, and the door to the stairway was locked as Sid Phillips and I left the patients to their dreams. During the eight winter days that I spent at the Hospital, it was a constant source of amazement to me that no one collapsed of exposure in the Old Attic."

   The Old Attic, as described, is everything as stated. Walls and floors are in very poor shape. Plaster and lathing are stripped off to the studding and blare walls; large holes in the floor appear in the corners of each room. There are hot air registers in each room which provide a minimum of warmth. Beds have straw ticks and at inspection were equipped with dark gray blankets of cotton and wool mixture and blue and white spreads marked with the Hospital seal. However, both attendants and patients stated that these blankets and spreads had been in use only a short time having replaced flannelette and badly worn woolen ones. Several inspections, both morning and night, bear out the fact that usually about ten or twelve patients are strapped to their beds, bowel movements occur, the windows are kept closed and the stench, together with that from unwashed bodies, the odor arising from the mattresses and the impregnated slime from the floor combine to cause an atmosphere that is disgusting. Examination of patients at night showed evidence of bed-bugs, and in two instances rats were seen scurrying from room to room.

   We are of the opinion that patients requiring restraint (i.e. strapping to beds) should not be put in the Attic where they are locked for the night with only infrequent visits by the night attendant. All patients sleeping in the Attic should be able to leave their beds for the purpose of visiting the toilet as required.

   Whatever may have been the condition as to bedding there is no evidence on record of any patient having suffered any ill effects from the cold.

   We would like to say further that on every occasion when we visited the attic, both during the day and night, we found it to be as clean as it is possible to keep it in its present dilapidated condition. If its use is to be continued for the future, we strongly recommend that more care be taken of the patients whom it is necessary to take there.

   Excerpt:-"Standard" Issue of January 27, 1945:
"Walking to my room that evening with Sid Phillips, I was shown the dungeons underground where unruly patients were formerly confined. Phillips was familiar with conditions at the hospital 20 years ago and was enthusiastic in his praise of the progressive work done under the present superintendent Dr. E. C. Menzies who has headed the Hospital for the last eight years. In his opinion, Menzies has turned an asylum into a hospital. He has replaced unsanitary wooden floors with stone floors that can be swabbed easily. He has brought in medical facilities like X-ray and each new patient is given a thorough medical check- up. He has abolished the strait jacket and the 'crib', which was a coffin like box of slats in which violent patients were formerly confined, taking their meals through the bars like beasts. Restraining straps and the 'needle' are the methods now used to deal with violent types."

   There is no doubt that this paragraph referring to the many improvements brought about in the institution by Doctor Menzies is true, and had the writer of the articles spent more time describing such commendable factors in the Hospital he would have given the public a more just and fair description of conditions as they exist. Also it may be remarked that there never were any dungeons in the Hospital.

   Excerpt:-"Standard"-Issue of January 27th, 1945:
"At 6 a.m. Sid Phillips called me and by 6:30 we were finished breakfast: porridge, boiled eggs, toast, jam, coffee. Aside from the comparatively trivial incident of seeing a cockroach wriggling in the sugar, the breakfast was excellent. I soon got used to the cockroaches which, I was told, are a feature of most institutions."

   This subtle reference to cockroaches is unfair. Your commissioners were able to find only a very few upon inspection and these in some of the very old portions of the building. All possible steps are taken to do away with those that are found.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"I was speedily to learn that Jim occupied an unusual position in the internal life of Ward 2. Now Phillips tossed his keys to Jim and the latter quickly unlocked the straps fastened to the foot of his bed. I noted that they were not around his ankle, and I presumed some time during the night they must have slipped off. Jim also unlocked the window shutters and the straps around the ankles of his room-mate, working all the time with efficient speed. Jim is a sandy-haired chap of about 22, with a long, rather humorous face, large faded blue eyes. He moves with a kind of furtive speed; is hard of hearing."

   "There again I was treated to a display of the quiet efficiency with which Jim worked as he went among the restrained patients, unlocking their '44' padlocks with a key which he possessed, removing the patients from their beds, trundling some of them to the washroom and thence to a bench where they were strapped down again. Although he was handling supposedly violent patients, Jim had no trouble with them, and I noted that one reason for this was that be kept them constantly off balance, increasing their pace to and from the toilet with well timed butts of the knee in the behind. At the least sign of resistance, signs that I was unable to detect, Jim would swing into action. His favourite method seemed to be a knee placed in the groin of a recumbent patient or a clip to the jaw if the patient was erect. In either case, it worked very effectively. I never once saw another patient take aggressive action towards Jim.

   "Looking around the room, I perceived a number of other patients at different chores; collecting straps, shifting beds, helping the least capable patients to get dressed. Benches which had been moved out into the Long Hall to make room for beds were moved back into the Short Hall."

   Reference is here made to a patient, "Jim." There is no doubt that "Jim" is used by the attendants as a helper among the more helpless patients; this is commendable, of course, except that the patient has been allowed too much freedom and authority and undoubtedly as, at times, when left alone in some part of the ward, molested the more helpless patients. He has, by reason of his helpfulness, been trusted with too much authority. No evidence could be produced to substantiate the accusations that the attendants allowed or connived in the brutality of this patient "Jim" or of any other patient.

   Excerpts:-"Standard"-Issue of January 27, 1945:
"As these early morning chores came to a conclusion, the call for Ward 2 breakfast came up the stairs. At the same time the breakfast for those remaining in the Short Hall arrived. During the entire time that I remained, that breakfast was exactly the same. It consisted unvaryingly of porridge with milk but no sugar, very weak tea and bread with a kind of white paste on it which I later learned consisted of a mixture of butter and powdered milk. There was plenty of bread.

   "I assisted in handing this around to the patients who were strapped to the benches or who were incapable of holding a tray. It was a nauseous sight to watch one of the latter pick up a handful of the porridge and smear it over his face in the general direction of his mouth. Most of the porridge seemed to end up over the front of his overalls. I wondered who would get them tomorrow.

   "About ten 'special trays' arrived for patients of other wards who had been sent to Ward 2. These were World War I veterans army or air force patients, merchant seamen, or paying patients. They obtained an egg with their porridge, butter on the bread, and their tea was of a better quality. I noticed that here and there an egg disappeared from these trays before they reached the patient for whom they were intended. Later I learned that there was a small group of very smart characters, called 'Cunningham's Wolves', who usually made their meals off these special trays. If that was their only function it would not have been too bad."

   Breakfast for all non-paying patients is the same, porridge well cooled, with sugar added in the kitchen, bread with butter paste and tea. The porridge is of good quality and well cooled, the bread sometimes quite old is spread with butter and milk mixed into a special mixture in the kitchen. The bread appears at times to be quite stale; when inspected sample loaves were not fresh; at 2:00 p.m. one day it was being cut for breakfast and lunch the next. The beverage is weak, lukewarm, and generally tasteless. This breakfast is the same every day in the war. These conditions can be cured by the employment of a dietitian.

   Special trays should not be sent to Ward 2 to cause envy amongst other patients. These patients, ex-servicemen and army, navy and air force personnel, should not be kept in Ward 2 and then some patients could not boast to the Commission that they daily steal most of the food from other patients. This condition lean only be overcome by a segregation of those 'paying patients' who are incontinent and dirty and must at the present time be kept on Ward 2 because of the crowded condition of the Institution and inadequate staff.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"The 'wolves', I soon learned, were headed by Jim. In their ranks were Les, Bill, Mack, and, to a lesser extent, Kurt. These lads, all between the ages of 15 and 25, carry out a great deal of the active leadership in such chores as taking the laundry downstairs, strapping down patients, washing them, taking patients to the infirmary, riding herd on the cafeteria group, dressing and undressing patients; and they were always very much on deck for any violence. In fact, I soon learned that they were the chief instigators of most of the violence and beatings-up that took place."

   A number of the patients who are physically strong and healthy are used as workers in the Wards, particularly in Ward 2. Over a period of time they have become trusties or as the writer of the articles calls them, "favoured patients." This is as it should be: work and more work for able- bodied patients is the proper plan, but we suggest that these patients should be more adequately supervised in their activities. If this were done, acts of violence among the patients could not be so common as is apparently the case. This supervision can only be given when more adequate staff can be procured.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"I saw that Jim has his rivals for the favored unofficial position of chief assistant to the attendants. Young Mack, a hard faced kid of about 17, is one rival. Like Jim he is a kleptomaniac, but otherwise seems pretty bright, with that veneer of hardness that comes from an early kicking around. Bill is a big overgrown kid of 15. He has worked in the woods, and hopes to get back there. But he is a sadistic young brute, with that cruelty which young children often show. He tries to egg others into quarrels and is constantly trying out his by no means inconsiderable strength on the more helpless. The attendants watch his efforts with a humorous eye.

   "However, Bill is a sissy when he compares to Kurt. Kurt is a white faced, cruel looking lad whose parents pay for his confinement. He is in this ward because he has escaped before. He wears shackles around his ankles, but gets around with the agility of a cat despite them. He has considerable spending money and buys the favor of the attendants with little presents, candy, cigarettes."

   'Mack' is one of the more active patients of Ward 2 and is of great help to the attendants in the control of the ward. Aged 18, he has been an inmate since he was 9 years old. Full of life and energy but with low mentality, this combination of qualities makes him unruly and unmanageable at times. He can be depended upon to be in the centre of any unusual activities.

   Testimony is mixed on 'Kurt.' Some attendants say he is agreeable, kindhearted and generous; but we think his conduct at times is unnecessarily meddlesome. All attendants testify that they never sat by and saw him strike patients.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"This morning I watched Kurt in a performance which I learned to expect as a regular ceremony every morning, almost setting-up exercises. He sidles over to a corner by the door where little Ricky sat huddled. Ricky is a helpless, watery-eyed idiot, with bristly hair on his head and practically no chin, an open drooling mouth. He sits all day on his bench, feet crossed Japanese fashion.

   'Turn your head this way, Ricky' said Kurt, in a wheedling fashion, and tilted ,up the idiot's head invitingly. Ricky smiled at the unexpected attention. Dancing on his toes like a boxer, Kurt delivered a short right hook to the exposed jaw. Ricky cried out. Kurt tilted the head to the left and delivered a quick left hook and as Ricky cried a second time Kurt trotted away with that same lithe step of a shackled cat.

   "I was aghast at this attack and turned to the other attendants to see what swift retribution would follow. They were laughing heartily -- -Marshall, Jeffries and Phillips. In the days that followed as the same performance was repeated over and over again by Kurt against his casually selected victim, I learned that Kurt was a specially privileged person. Never once did I see him so much as reprimanded for his brutal assaults against helpless idiots. He never tackled any of the huskier patients who might have returned better than they had received, and he took great pride in his ability to draw blood by a judicious blow to the nose or cheek bone. I learned that this little idiosyncrasy was shared by moot of the 'wolves'. They seemed almost embarrassed when their attacks did not produce blood."

   This incident of striking 'Ricky,' an imbecile, by 'Kurt' is hard to prove. Attendants Marshall, Jeffries, and Phillips are firm in their denials that such an attack occurred. However, with over a hundred patients endlessly milling about in restless activity and the understandable lassitude of the attendants in such an atmosphere, it can be easily seen that such incidents can occur. If Johnstone saw it, he should have stopped it. He seems to have forgotten that he had responsibilities as an attendant and was not entitled to act only as an observer.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"The attitude of the attendants towards such unprovoked attacks was one that puzzled me considerably, until I had some conversation with Cunningham. Then I realized that it was merely a reflection of his attitude, which could be summed up in his words to me when I spoke to him about the ailments of one of his patients. 'They're not human, laddie-they're animals', he said. 'They'd be better off dead. And you can't trust one of them, not one of them.' Thus he summed up 25 years of experience in a mental hospital.

   "If you accept Cunningham's thesis, then what the animals do to each other is a matter of indifference, so long as they do not wreck the place. And if four persons have to look after 110 patients, they must rely upon the co-operation of some of these patients to carry out the various chores and to police the rest. I was told during my first day that I did not have to worry about being attacked by a patient, for other patients would aid in restraining a violent one. The 'other patients' were the 'wolves' and I soon found that they did not bother waiting for a patient to become violent before they attacked him. Frequently they would provoke one of the irritable ones, just for the opportunity of giving him a trouncing and breaking the monotony of the eventless days in Ward 2."

    Harry W. Cunningham chief attendant of Ward 2, denies that he made such statements. He, as chief, has full charge of this entire ward with its varied type of inmates and his patience is often tried because of serious overcrowding of such a miscellaneous group of patients. His conduct is understandable at times. Both he and his attendants try to get along with as little trouble as possible with all patients.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"There are quite a few like old Mr. Kay and Louis. Old Mr. Kay got Mr. from me if from no one else, simply because he's just that kind of a dignified and courteous old gentleman. He's 76 and he worked hard all his life. He worked too hard, and his brain has tired out on him, so he forgets immediate events. But he remembers the past, his youth, his first wife ('a better woman never lived') and his second wife. He remembers the farm and he keeps telling you that he ought to be getting back home for there's a pretty bad acting mare there and only a young lad to look after her. He says that he just dropped in for the night, and if you told him that he's been there for more than one night, he would find that hard to believe.

   "Every night we have to show Mr. Kay to his room. He sleeps down in Ward 3 and the attendant there has put a number 14 on the door. So Mr. Kay thinks he is staying in room 14 at the Admiral Beatty. He occasionally complains about the service and he wonders how he is going to pay his bill with no money. He left his money, he says, with his sister."

   "Everybody likes Mr. Kay and the only baiting he suffers is when Jim occasionally mischievously accuses him of spitting tobacco juice on the floor. The old man been raised like a pig?'

   "But even Mr. Kay has his problem; it's simply one of slow starvation.

   "Each group is given practically 20 minutes for meals in the cafeteria. With perhaps 150 patients lined up for their trays, and the strongest ones first, old fellows like Mr. Kay inevitably are shuffled to the last. By the time Mr. Kay has his tray, half of the others are through eating. He has no teeth, and eating is tough going; even the stew that appears with regularity on the menu. Mr. Kay is usually just at his second mouthful when his plate is seized, dumped, and he is bundled back into line to return to the ward."

   This reference to "Mr. Kay's problem-"simply one of slow starvation" is unfounded and unfair. Mr. Kay was a new patient and had arrived at the hospital at just about the same time as Mr. Johnstone commenced his duties as an attendant on Ward 2. If Mr. Kay did miss any meals it was due to the carelessness and inefficiency of the attendant Johnstone who had charge of the company of patients with whom Mr. Kay went to the cafeteria for his meals. However, Mr. Kay stated to the commissioner that "he always had plenty to eat" and this fact is borne out by the additional fact that in the time between his admittance to the hospital and the sitting of the commission, according to his monthly weight record, Mr. Kay had gained 15 pounds.

   We are convinced from frequent observations, that the patients are not unduly hurried at mealtimes.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"But the 'wolves', though they terrorized the place, were just a handful of the patients in Ward 2. And they didn't terrorize everyone. Johnny, for instance, is a lad that the 'wolves' leave severely alone. Johnny is just 18. After working for nearly two years at Goose , in Labrador , he came home and went out on a 'lemon' spree. Lemon extract does queer things to people, and Johnny tried to cut his own throat. He shattered his Adam's apple into several pieces but he survived to find himself in a mental hospital. He escaped once but was brought back. Now he is kept shackled. Johnny's case might offer an interesting study in the social background of mental sickness. He left school before he learned to read and write and he started making his living at a pretty tender age. His family disowned him; his father married a second time. Johnny and I had many talks together and I grew to respect the shrewd practical intelligence with which he discussed his own position and his future. He wants to become an auto mechanic, and you get the feeling that with half a chance this lad might become a pretty solid citizen some day. But he has plenty of energy and all the impulsive violence of his age. There is no legitimate outlet for such energy in Ward 2. Johnny said he received 14 hypos in his first month upon returning to the hospital. He received two in one day when I was there. Under Ward 2 therapy he has a much better chance of becoming a confirmed maniac that he has of ever taking his place in normal society again."

   Johnny is an unfortunate case, but we think that Mr. Johnstone's sympathy has outrun his judgment as to what Johnny may be capable of doing in the future. He has since escaped from the institution. We do not think that any reliance can be placed on Johnny's statement that he received fourteen hypos in his first month There is nothing to support the suggestion that he has a chance of becoming a confirmed maniac.

   Excerpt:-"Standard"-Issue of January 27, 1945:
"And now, having completed my first full day at the hospital, I can look back at my routine as an attendant. While it might vary slightly from day to day, it consists mainly of shepherding of groups of patients as they fulfil various chores or make trips to the cafeteria, hospital, dentist. Apart from that, the attendant just sits and looks on. He relies upon one of the 'wolves' for the active bossing of the various jobs, and aside from dressing wounds received in fights, he is not actively concerned with the welfare of the patients. I am told that there is an occupational therapy ward in the hospital, but apparently no patient in Ward 2 is deemed fit for its ministrations. The great majority of the patients lie in bed 12 hours, rise and dress, and then sit on a bench 12 hours. Unless they are members of the various little cleaning groups, they have no other occupation, no other diversion. The same deadly pattern is repeated day after day, excepting Tuesday bath day and Friday shave day. I wonder how long it would take a sane person to lose his mind with this routine?"

   This review of attendant's daily routine is an accurate picture of life on Ward 2 and the average daily duties of attendants.

   Had Mr. Johnstone inquired he would have ascertained that the hospital had lost the services of all of its occupational therapists due to enlistment in the armed forces. It has not since been possible to obtain anyone to fill this position. Therefore there is no excuse for the statement that "apparently no patient in Ward 2 is deemed fit for its ministrations."

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Kurt, incidentally, worked out on a new kid today, a big overgrown baby faced lad. He drew blood with the first blow and retired satisfied. The kid never got up from the bench where he was seated when Kurt sidled up in his usual fashion and jolted him with a short right hook to the nose. He seems to exercise almost the same hypnotic fascination for his victims that a snake wields over a rabbit.

   "Wiping his bleeding nose with his hand, the kid threatened to get his father to hit Kurt back, but Kurt shut him up with the threat of a repeated dose.

   "This particular attack took place right outside Cunningham's office in the Long Hall, and when I drew it to Cunningham's attention, he said, 'Pay no attention, laddie. It serves him right.'"

   Harry W. Cunningham, chief ward attendant, denies this incident, but it may have occurred.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Returning from the canteen, I was just in time to see my first 'needle' administered. Johnny was the victim. He had finished mopping the floor with two other patients and was bouncing about, full of beans. Jeffries told him to sit down where he was. That spot happened to be right among the idiots with the casual bowel and bladder movements, so Johnny asked if he could go to the other end of the room. He said,'I don't want to sit with those guys.' Jeffries repeated his command, and Johnny still argued.

   " 'O.K.' said Jeffries, 'strap him to the bench'. Johnny did not struggle as he was strapped to the bench, but as soon as the 'wolves' moved off, he reached down and broke the straps. 'It's the needle for you, my boy', said Jeffries, and instructed that fresh straps be put on. Johnny was really burning when I caught his eye as he was about to break the fresh straps. I shook my head negatively at him and he immediately became quiet, dropped the straps he was about to break. A few minutes later Phillips entered with the needle, partly filled with the usual apomorphine hyoscine solution, injected it into Johnny's upper left arm. Fifteen minutes later Johnny was stretched out on the floor, head in his own vomit.

   "I asked Jim to lift him to the bench and later he was carried to a bed."

   This paragraph brings very definitely forward the question of the administration of the drug apomorphine and hyoscine.

   'Johnny' was given two injections of apomorphine and hyoscine by attendant Marshall on December 21, 1944. Although Mr. Cunningham, chief ward attendant, was not on the ward at that time, Marshall testified that Cunningham told him that there was a P.R.N. Order on 'Johnny'. Testimony of Dr. Fischer states that he gave a verbal order to Cunningham regarding injections for 'Johnny'. Contrary to standing rules, no written order was given for such injection of drugs to 'Johnny' and Dr. Fischer takes responsibility for this oversight. Marshall testified that before his first injection ' Johnny ' was excited and walking up and down the ward and the second time he was strapped to the bench and excited. The lack of attention of the other attendants to 'Johnny' tends to prove that in this instance, injections were given as punishment and not as a sedative.

   A great deal of time was spent in hearing evidence concerning the administration of this drug. From this evidence one fact becomes clear, that in a few instances the drug had been given to patients by attendants, without written instructions or orders from a physician, for misbehaviour, and that patients sometimes lacked attention after receiving the drug.

   We recommend that greater care should be taken of the patients immediately following their receiving the hypodermic injection of the drug. This would do away with the possibility of a repetition of the incident reported by Johnstone in his article and admitted by attendant Marshall in his evidence. The evidence of some of the attendants undoubtedly suggests that the drug was sometimes administered as a punishment for the misbehaviour of patients. This may have been the case upon a few occasions but it is not the general rule and it is quite contrary to the policy of the authorities.

   It should be pointed out that the term "punishment" is used very loosely and is often misunderstood, and what may have been intended by some who used it was rather the term "deterrent " and as such we understand this drug and other forms of restraint are used in similar institutions.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Johnny slept through the lunch hour, so he missed the gory encounter between Pete and Georges. Pete is a short, well built, truculent character, with a hair-trigger temper. He doesn't go around bullying other patients the way Kurt does, but is quick to start a scrap, given the slightest provocation. Georges, on the other hand, is a rather bewildered individual of some education, who is constantly nagging the attendants and others who will listen with petty little requests or complaints. He was formerly in the R.C.A.F.

   "The fight flared up suddenly from a conversation at lunch. Pete came to his feet with a quick bound, and before Georges could even drop the plate he was holding, swung a terrific right that lifted Georges right out of his chair and dropped him with a crash on the stone floor. Blood was spouting from Georges' face like a fountain as he staggered to his feet to meet Pete's rush. He was groggy, however, and was only able to cling desperately to his opponent before the two were separated by Jeffries and Jim. I stood by meanwhile with open mouth.

   We hustled Georges into the lavatory and put a gauze bandage over the two inch long gashes on either cheek bone. This afternoon the cuts will be stitched.

   "Georges was in a pretty dazed condition as we led him to a bench in the Long Hall. And I noticed on returning to the Short Hall that Pete was seated on a bench with his head in his hands. The fury of his own outburst had exhausted him."

   No witness could remember this having happened. But anyone knowing the conditions existing in a mental hospital ward, could believe it did happen. We attach no blame to anyone for it.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"The old men give you another kind of feeling, a feeling of deep compassion, mingled with a burning anger towards a system that condemns these work-worn, broken-down human machines to end their days in such a place. The old men are usually quiet, meek, polite and a little dazed. Some have been able to salvage their sense of humour. They remember the days of their vigorous youth, the farms they have worked and the trees they have felled. But they find it difficult to recall the circumstances that brought them here, and they are often panic-stricken that some horrible mistake has been made. The bullying of the 'wolves' and the outbreaks of violence that periodically occur also produce these sensations of terror in the minds of the old men. I can still hear the quaver in old Mr. Will's voice as he said to me: 'My God, I've worked hard all my life. Am I to die like this?'

   "In contrast to the old men are the young lads from whom the 'wolves' are drawn. They are full of energy and devilment, and generally are no harder to handle than a group of the same age on a sandlot or hockey rink. Despite the vicious expression which their energies too often take, you can't help feeling a strong bond of sympathy with these kids. They want to do things but there is nothing to do. They want to admire people, but the attendants reject such hero worship roughly.

   They want trust and they want sympathy, but a mental hospital, apparently is no place for such feelings. With a horrible fatalism you watch these youngsters receive their training in precisely all the habits and vices that will assure a lifetime's career in this or other mental hospitals. 'You can't trust one of them, not one of them,' says Harry Cunningham and eventually the young lads accept this as a tribute.

   "But the great bulk of Ward 2 patients are neither old men nor youngsters, neither are they complete idiots. They are men in their middle years, and they come from all parts of the economic machine. There are many farmers and woodsmen. Many are French-speaking. There are merchant seamen, men from the Armed Services. There are men from the urban centres: Saint John, Fredericton , Moncton . Workmen, tradesmen, a few scattered professional men. But mostly they are poor, and mostly they come from the farms and the woods."

   This description of the many varied types of patients and their habits and ambitions, represents a true picture of the inmates of Ward 2. A cross-section of life and mental conditions it presents the real problem of Ward 2 and also Ward 5. Shortage of attendants, lack of recreation, idleness, scarcity of treatments, cramped quarters, absence of segregation, all play their part in creating the conditions that exist.

   These can be remedied but only by a large expenditure of money, as dealt with in our subsequent recommendations.

   This mention of rats is worthy of attention. Johnstone, admitted that he was relying upon the word of patients. Upon our inspections of the institution, we saw few rats; there are some but chiefly in the basements and the Old Attic. This is understood when we realize that this is one of the oldest sections of the Institution and has received very little attention in the matter of renovations since it came into being nearly 100 years ago. Adequate means are taken to deal with the pest by the employment of a professional extermination.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Today old Man Larry had to be patched up after an encounter last night with Len. From all reports, he had it coming for Len is a quiet, mild-mannered kid with a ready smile.

   "After dressing the cut over Larry's eye, Cunningham called Len in and asked him how the attack had occurred. Len readily admitted striking Larry but claimed that for six nights in a row Larry had been getting up and moving around, waking up everyone else in the room. Finally, he, Len, could stand it no longer, so he struck Larry.

   " 'Will you behave yourself if I send you back in that room tonight?'asked Cunningham.

   "Len agreed to do so, providing Larry didn't disturb him again, so Cunninghan dismissed him, saying in conclusion: 'Well, that's all right then, Laddie. But next time, don't hurt your hand on him.' "

   This incident is true in all particulars including the remarks by Cunningham, chief ward attendant.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Another patient was brought to the ward today, but he is apparently a repeater, who had been moved to Ward 9; raised some hell there, and was shipped back to Ward 2. He seemed quite happy to be back. 'A cute one' said Cunningham grimly 'Strap him to a bench.'

   "This lad's name was Paul. His wild-looking yellow hair was streaked down his face, but otherwise he looked friendly enough. 'I love you Mr. Cunningham,' he said as they brought him in.

   "Despite his straps, Paul settled down happily enough, and proceeded to read aloud from a French paper. He gave this up after a short while, and started to sing some French songs, in a not bad voice, and certainly not too noisily.

   "Kurt told Paul to stop. Paul went right on singing. I doubt he knew he was being spoken to. Kurt shuffled over in front of Paul and carefully punched him in the face. Paul continued singing. Kurt punched him again. Paul kept right on hardly missing a note.

   " 'He doesn't understand English. Leave him alone' advised Georges, whose face was still bandaged from his encounter with Pete.

   " 'Mind your own business, Georges, or you'll get hurt again', said Phillips, who had been watching the Kurt-Paul encounter with amused interest.

   "Kurt tried a third punch at Paul, but the latter seemed blissfully unconscious of the fact that the Ward Bully was working on him. No blood was in evidence and finally Kurt retired in disgust. 'Aw, you can't make him stop', he said.

   "At this point, Phillips arose and went into the office, returning in a few minutes with the now familiar needle and its 'soothing syrup' of apomorphine and hyoscine, injected the drug into Paul's arm. Fifteen minutes later Paul was dozing and vomiting and the ward had returned to its usual dull quiet of soft undertones and whimpers."

   These make mention of a patient 'Paul' and give a graphic description of another of these attacks by one patient upon another.

   The attendant Phillips admits seeing the patient 'Kurt' in some manner interfering with 'Paul,' but placed no real importance on it. He did, however, at the close of the incident give 'Paul' an injection of apomorphine and hyoscine. Another case of an inexperienced attendant giving an injection upon the instructions of the chief ward attendant, but apparently without a direct order from a physician.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"Playing cards with Johnny today again, I asked a lot of questions about the hospital. Did they ever see movies, or have any entertainment. The group around me looked hard at me to determine whether I was kidding or whether I, too, was crazy. What about a radio? Well Ward 3 has a radio and if you are a privileged patient in Ward 2, you can go into the Long Hall and hear it. But for the vast majority confined to the Short Hall, the radio of Ward 3 was just a distant murmur."

   This shows the lamentable lack of any healthy entertainment for patients on Ward 2; this is a lack which should, we feel, be easily overcome.

   Excerpt:-"Standard"-Issue of February 3, 1945:
"After breakfast the men lined up for church service, the Catholics preparing to leave for another part of the building to take part in Mass. As the last of the group was filing through the door, an old man by the name of Jasper came running down the hall. He pushed aside one patient standing in the doorway, and Melanson spoke sharply to him. The old man answered back, trying to explain his haste.

   "Thereupon Melanson, his face contorted with rage, made a savage rush at the old fellow, pushed him back through the door and across the hall up against the door of one of the bedrooms in Ward 9. He hit the old man one hard blow on the side of the face near the right eye, then twisted him around and pushed him down the hall, saying to me: 'Strap him to a bench'.

   "I took Jasper into the office and gave Melanson's instructions to Fred Brigden who openly sympathized with Jasper. 'I hate putting these on you' he said. But Jasper replied: 'I guess it was my own fault, I shouldn't have spoken back to him.' And he dabbed at his watering and blood- shot eye with a handkerchief.

   "Brigden told me that after nine years' experience he found that such brutality just made things more difficult, for the attendants, that he had no trouble getting along with the patients by using a little common courtesy. He put the straps on Jasper very loosely and the old fellow remained tied to a bench until I let him up after dinner to go to the lavatory. Melanson then permitted him to go without the straps."

   This incident of attendant Melanson striking the patient 'Jasper' is borne out by the evidence. It is one of those regrettable incidents which need not have happened had there been more staff available. It appears that both the attendant and the patient got excited over something, words followed and the attendant exercised his authority by having the patient put into restraint straps, admitting it to be a "kind of punishment." The patient placed little importance upon the incident and one would gather that this was an isolated occurrence on Ward 9.

   Excerpt:-"Standard"-Issue of February 10, 1945:
"I found that Stapleford shared Brigden's point of view in contrast to Melanson's which was more akin to Cunningham's attitude towards patients. Stapleford treated his patients with a refreshing courtesy and gentleness, and in return they behaved like lambs for him.

   "However, the presence in Ward 9 of the three graduate wolves, Sam, Pete and Joe is not calculated to help the atmosphere any. As in Ward 2, they know all the ropes and all the rackets. They may be bad kids, but I would hesitate to say that they are hopelessly bad. They perform prodigious efforts for a little praise and encouragement. And they display the handiwork of their brutality with genuine pride.

   "'See this fellow,' said Pete to me, dragging forth a bemuddled fellow with his nose flattened over his face. 'I broke that for him', he said boastfully, pointing to the smashed nose.

   "Joe on the other side of me, tugged at my elbow. 'Look at the old fellow leaning against the wall there. Look at those two shiners. I did that.' And he looked at me as though he expected high praise.

   "Sam who was standing by, looked mortified. He drew my attention to the extensive Christmas decoration that were hanging from the walls and ceiling. He had contrived them."

   Stapleford's testimony and questioning of patients bear out the point that courtesy and kindness is respected by the patients. Questioning of patients did not bring out the truth or untruth of Pete and Joe's statements as to their punishment of other patients.

   Excerpt:-"Standard"-Issue of February 10, 1945:
"Joe told me that he was glad to get out of Ward 2 because one of the night attendants had a predilection for 'stretching' patients: a process of tying the patients' arms over his head in bed which leaves the arms numb all the next day. I saw Phillips at lunch today and he told me that they had given Paul a needle last night and another this morning; that he was getting worse."

   The only evidence of 'stretching' patients was given in connection with activities of the attendant Letteney, who admitted that he had upon one occasion 'stretched' a patient. It is certainly not a general practice and is definitely against the rules of the institution.

   Excerpt:-"Standard"-Issue of February 10, 1945:
"A festive air reigned in Ward 2 when I got back, as the Christmas presents were being distributed. Only one needle was given to Eddie who quarrels a lot but never comes to blows. Last night, two needles were doled out.

   "Harry Cunningham opened the parcels in the office, went through them quickly for forbidden articles and then entrusted them to the 'wolves' for safe delivery. As far as I could see most of the parcels reached their destination more or less safely. One parcels intended for one of the idiots was completely stripped by the 'wolves' and the spoils of cigarettes, candies, fruit and nuts were divided up among them.

   "Kurt did not share in this orgy, for he received several big parcels, and he distributed his largess handsomely. It was typical of his curious character that he should give away most of his presents and then, a short time later, punch one of the idiots a couple of solid blows in the face.

   "'Why did you do that,' I asked. 'For exercise,' he said. It is worth pointing out here that Kurt goes quite openly about this morning exercise of his, and the attendants have ample time to interfere with him if they wished. I have never dared risk their censure by interfering when other attendants are present, but I have stopped Kurt several times when, I have been the sole attendant on the floor.

   "Jim and Mack have certainly had a field day today, rifling every parcel that they deliver. Mack gave me one of the three decks of cards which he obtained this way, and I passed the deck on to Johnny who, like so many others, had received nothing. Later he was greatly touched to get a parcel from his sister, who is in an Orphans' home.

   "We took the bracelets off Jerry today, and his first move was to try and pull the clips from his throat. He started the bleeding again, so we had to tie him down once more. I tried feeding him with a spoon, but he spit the food out as fast as I offered it to him. He says nothing, just stares with a wild, unseeing stare.

   "Paul also ignores his food. He chatters away, but with considerably less strength, for he has gone more than 24 hours now without food or drink.

   "A new lad, Mel, arrived in his army clothes. He was undressed and Jim and Mack rushed the clothes into the office, went through them rapidly to remove three packages of cigarettes and a big box of raisins. Later, they gave the raisins to Cunningham.

   "Dinner was a rare treat for the patients today. Huge plates of turkey with all the trimmings and plum pudding, too. I was furious to see old Mr. Kay as usual get just one mouthful before his plate was taken away.

   "I became somewhat uneasy Sunday when one of the attendants asked me whether I was connected with a newspaper; and when two patients, well known for their outspoken condemnation of conditions at the hospital, approached me at the dance yesterday, I could see that it was only a matter of hours before the rumor spread to Ward 2. When that happened I did not want to be anywhere handy to Ward 2 discipline."

   These refer to the distribution of Christmas parcels, &c., and are of little importance. If there were any such irregularities as mentioned here, they can be accounted for by lack of adequate staff.

   Excerpt:-"Standard"-Issue of February 10, 1945:
"But before that I had my first opportunity of seeing the Old Master, Harry Cunningham, in action.

   "We were dressing Jerry for a visit to the doctor, and I was holding the hand which Jerry usually uses to reach his throat. He made no attempt to do so while I held him and, in fact, seemed too utterly exhausted to struggle after 48 hours without food. He merely lay passively, with that far away expression on his face.

   "Cunningham looked in to see how we were coming along. He noticed the relatively gentle hold which I used on Jerry's wrist, then pushed me to one side, saying: 'This is the way to do it, laddie.'

   "He seized Jerry's hand and wrist, jerked that arm straight and twisted it up the socket. Jerry screamed in agony. Then Cunningham, swung Jerry's arm behind his back at the same time punching him in the stomach. That doubled Jerry up effectively. On the other side, Jim, not to be outdone by Cunningham, kneed Jerry in the groin and slapped him about the face.

   "'Careful of his neck. Don't start it bleeding,'" was Cunningham's only warning to Jim.

   "Cunningham punched Jerry once more in the kidneys, and as they dragged the unresisting patient to his feet, Cunningham swung a neat right to the side of Jerry's face. I remember that Jerry cried out twice after his first scream, but did not struggle in any way.

   "'That's the way to handle the cute ones', Cunningham said to me as they dragged Jerry over to the hospital bed upon which he was to be wheeled to the infirmary.

   "I noted a last bit of brutality on Cunningham's part as he forced Jerry down on his back on the bed, despite the fact that Jerry's hands were strapped together behind his back. The patient was finally tied down with two sheets and Cunningham pulled one sheet across Jerry's chest so tightly that I wondered he could breathe.

   "Not once during all this did Jerry make one move to struggle or free himself. I knew from my own effort at holding Jerry's arm that he had exerted no force at all against me."

   A most unfortunate incident which the attendant Cunningham admits occurred, but denies that there was any brutality or hitting of the patient by himself or anyone who was assisting him at the time.

   'Jerry' was undoubtedly a difficult patient to handle, as is admitted by the attendant Johnstone in his article, and he had to be handled with firmness. It is asserted in the article that a patient 'Jim,' himself a dangerous patient, was Cunningham's chief assistant, in this incident, but both Cunningham and the attendant Jeffries deny that 'Jim' assisted them. The evidence was somewhat contradictory and it is possible that 'Jim' was somewhere in close proximity holding a 'watching brief' and Johnstone may have thought that he was assisting. Johnstone says that the handling of 'Jerry' was brutal, that blows were struck, that 'Jerry ' screamed, but both Cunningham and Jeffries, who are men of long experience deny the accusation.

   To substantiate the articles appearing in the Montreal Standard, its management produced the following witnesses:

    Barren Edward Woods-(Called by "Standard") Age 17 on July 6, 1944. Attendant on Ward 2 and Ward 5 from January until October 1944. His testimony was mostly concerned with patients and the authority of some over others but could not recall any brutality. Never reported to Cunningham any acts of roughness or any irregularities he claims he saw. Evidence mostly of sixteen year old boy unaccustomed to such patients and their symptoms. Mentioned 'Jim' roughly handling a patient.

    George Wedge -(Called by "Standard") Age 18. Was sixteen when first hired as attendant in 1942 for eight months; then returned in 1943. Was on Ward 2 and Ward 5 daytime and on Wards 4, 5, 6 and 7 at nights. Did not recall any evidence of brutality either by patients to one another or by attendants. Gave injections but always with doctor's orders, obtained by phoning to nurse or under authority of patient's Order Sheet. Had read instructions in case of fire. Never saw soiled clothes given to patients in morning. Mentions 'Jim' striking another patient.

    Maximilian Leger-(Called by "Standard") Attendant March 1942 to April 1944. On duty in all wards on Male Side. Told of several instances of patients being struck by other patients including 'Jim' striking two other patients. Reported this assault to Dr. Fischer. Reported also to Dr. Menzies patients abusing others. Gave drugs but only upon calling night supervisor. Considered other wards good. Saw attendants stop patients from hitting other patients. Thought six attendants were necessary on Ward 2. Did not receive any particular instructions but just picked up his duties.

   Albert Ernest Letteney-(Called by "Standard") Employed April 24 until November 8th, 1944. This man was first questioned on March 8th and after much rambling testimony was ordered returned to the Saint John General Hospital , to be kept under surveillance incommunicado. He was a patient there having been picked up by the local police suffering from an overdose of drugs. Attempts were made to get a clear story of his past history and the events leading up to his going to Montreal and giving his story to the Montreal Standard, together with Frank Hines. He told of his experience in Ward 2, concerning patients, the giving of hypes, of 'Jim' striking patients. He told of the declaration he made in Montreal and contradicted the declaration made in Saint John to Mr. G. Earle Logan , K. C. His disconnected thoughts and furtive air gave the impression of a very unreliable witness and not much credence is given to his testimony.

   On March 13th above-named witness was again examined. He told of sending a telegram to Premier McNair regarding conditions at the Hospital. He was asked about a declaration made in Mr. Kelly 's office but did not recall it or even going before Mr. Kelly. He told of receiving a wire from Frank Hines signed " F. W. English " saying two patients were arriving, which turned out to be Hines and Miss MacDonald. Hines showed Miss MacDonald, a news reporter for the C.C.F., through all the Men's Wards one night and took her, at 3 :00 a.m., to Letteney's room where she, stayed until 9:00 a.m. His remembrance of both affidavits was very shaky and his evidence was badly shaken with denials and cross-denials. He told of being shadowed by some person known as Graham who has never been identified, if he existed. Evidence totally unsatisfactory and impossible to believe in any particular.

    Alyre Melanson -(Called by "Standard") Attendant October 1942 until January 1943, Ward 5. Received no instructions when first coming on duty. Four other attendants beside himself on that ward. Told of Doiron, an attendant, striking patient, but did not report it. Told of Leger, an attendant, bothering patient and then giving him injection. Did not report this to superiors. Saw another patient given injection by Leger for punishment, but did not report to superiors. Saw Leger push old man who fell and cut his face. Often saw Mr. Brownell, chief attendant, on ward, but did not report any of above occurrences.

    Vincent Babin-(Called by "Standard") Attendant April 28, 1941. until July 1942,-October 1942 until April 1943,-August 1943 until December 1944. Worked on Wards 2, 3, 5, 8 and 9. Told of existence of 'Happy Gang' later known as the 'Wolves' in 1941. Told of new patient being beaten by this gang but he was stubborn. Cunningham was present. Told of other patients being beaten by gang but did not report it. Told of McGuire, attendant, striking patient in Ward 8. McGuire readily admitted using force on this patient who was very agitated, removing his clothes, attempting to get out of window; stated blow was necessary to protect himself and other patients. Balance of testimony concerned patients quarreling amongst themselves. We regard him as a rather unreliable witness.

   Francis Hines-( Called by "Standard")
Age 20. Attendant last week in September 1944 until November 10, 1944. Was Assistant Superintendent of Working Boys' Home, Toronto, for eight months. Ran away from there with Kenneth Hines (true name Stuart) and two others. Told of leaving Hospital, going to Montreal to discuss conditions with Provincial Officers of the C. C. F. and then visiting Montreal and being taken to the "Standard " by Letteney. There they discussed with Mr. Glenn Gilbert and made the declarations mentioned in Letteney's testimony. Denied that he had cards printed "Dr. F. W. English, Psychiatrist", or "Reverend Frank Wallace." Placed all complaints in Ward Books after October 5th. Said he had given liquor to Letteney while in Hospital. Told about patient Drummong suggesting that Ward Books and bottle of apomorphine and hyoscine be placed in Crankshaw's hands (a lawyer in Montreal). Said Letteney was very peculiar individual, his nerves were bad; if agitated would holler and pound on the wall. Much questioning took place regarding declaration Letteney made to Montreal Standard and many differences of testimony were uncovered. Told about going to Main Kitchen one night and having cook show him cockroaches in food; said cook's name was Wilson. (Wilson was later brought to stand-said he never saw or talked to Hines and never worked at nights.) Told of making complete reports regarding restraints which were initialed by Chief Attendant, also of patients being mistreated by the "wolves." Mentioned 'Jim' as being one of the sadistic patients who abused other patients without interference from attendants. Told of taking three report books which Letteney gave him so that he could prove drugs given and not recorded, checked on all recorded injections for five months against amount of drug issued to Ward and found discrepancies which he did not report. Told of talking to Assistant Night Supervisor, Miss Alcox , who further confirmed his belief that the administration of this drug should be in trained hands and not free on the ward for the use of any attendant. (Miss Alcox in direct testimony denied making this statement or any other attributed to her by Hines.) Told of conditions in Old Attic but said no patients had ever complained. Told of reading report on patient Gallant's death and of going to morgue with patients Wiggins and Drummond and attendant Stuart, unwrapping corpse, and Wiggins marking diagram of body with crosses which denoted alleged bruises and broken neck. Told how they took body out of hamper and turned it over without supporting the head. Explained how patient Drummond suggested sending telegram to Premier McNair.

    Zephyr Leger-(Called by Commission)
Attendant October 1941 until March 1943 or '44. Denied irritating patient and then giving him injection, just threatened him with it. Denied giving patients injections as mentioned in testimony of Alyre Melanson, nor did he remember any of the incidents in that testimony.

   Glenn Gilbert-(Editor of Montreal Standard)
Told of articles published in his newspaper based on stories told by Letteney and Hines who brought Drug Book and six Ward Books, bottle of drug, land letters written by patients Drummond and Wiggins. Letteney and Hines sent to him by John Crankshaw , K.C. On stand was given copies of Letteney's declarations (Montreal, Exhibit No. 16) (Saint John, Exhibit No. 17) and asked if they were not greatly contradictory, to which he agreed. Did not inform any Provincial Authorities of alleged conditions but did send reporter Johnstone to see Dr.Hincks, president of the Mental Hygiene Council , and after discussion Dr. Hincks advised that the most good would come from publishing the articles. Gilbert told of financial arrangements with Letteney, Hines and Stuart. Stated that he believed Letteney to be mentally ill and that Kenneth Stuart would be a rather questionable witness.

   Arising out of the Montreal Standard Articles was the story of 'Paul' who died on January 9, 1945. His parents had retained A. M. Robichaud , K.C., to investigate and ask the Premier to order an exhumation of the body. A very lengthy examination of Staff and records was held, starting with Dr. Gallant , resident physician who told of receiving 'Paul' as a patient on November 30, 1944 and pronouncing him dead on January 9th, 1945. In the interim, he had seen the patient occasionally. Evidence was brought out that the first official authorization of apomorphine and hyoscine was on December 26th, 1944. Dr. Gallant told of this drug, how it was mixed and the dosage; that it was prepared in the dispensary and sent to the wards in bottles. He said he never saw vomiting caused by use of this drug. Dr. Fischer was called and told of examining 'Paul' to obtain mental picture, sending him to Ward 9 and then ordering him back to Ward 2 when he became restless. He took responsibility for the injections even if they did not appear on patient's order sheet land said he took the word of Cunningham and Mr. Brownell and the nurses to order injections without seeing patient. Dr. Fischer did not see patient after December 26th. Evidence was also heard from Marie Kerr ., R.N., Dr. E. V. Sullivan , Mrs. E. MY. Johnson , R.N., assistant superintendent of nurses, Charles Marshall, Abel Melanson , S. H. Phillips , Lyle McGuire, , J. A. Mason , M. G. Reid , Charles Harrison , all attendants, Mary Perry , Florence Daly , both R.N.'s., and Dr. E. C. Menzies.

   We find that 'Paul' died of acute, delirious mania. His symptoms agreed with all known medical facts and the disease ran its usual course. His condition was noted on December 26th, his prognosis was bad and the physical exhaustion progressed until death on January 9th, 1945. We find that he was given the very best attention by the physicians, that nothing was left undone by any of the staff, that the medication prescribed was that indicated by common usage for this malady. Therefore, we did not recommend to the Premier that the body be exhumed for further examination.

   Arising out of the declaration by Letteney to the Montreal Standard was a reference to the death of one Joseph Gallant. All records were produced and the Staff thoroughly questioned. Evidence was given by Dr. Fischer that Gallant was admitted from Lancaster Hospital , was a soldier, and a patient from January 15, 1942 until death on October 11, 1944. Diagnosis on admittance was general paresis of the insane, his pathological report was Wasserman 4 plus. Treatment given was malarial chills, nine in all, discontinued on March 21, 1942 with no effect. Patient became worse than before and Dr. Fischer reported on October 28, 1943 that malaria treatment was unsuccessful in this case. From then on until January 10, 1944 he was mentally not changed and his outlook poor. He deteriorated from then on until his death. Further testimony was heard from H. W. Cunningham, chief attendant, Ward 2 , attendants Walker, McGuire, Reid, Florence Dupuy , R.N., Marie Kerr, R.N., D r . E. V. Sullivan, Dr . E. C. Menzies, and Dr. C. L. Emerson . We find that the patient died of General Paresis of the Insane, that he was given every attention by Staff and that absolutely no criticism of the Hospital can be considered in this case.

   While the Commission was sitting, Miss Ezella Hachey , West Bathurst , N. B., asked inquiry into the death of her brother, Omer Hachey . All records were produced and the staff questioned. Dr. Fischer testified that Omer Hachey, a soldier, 26 years of age, was admitted on March 12, 1945. He was confused, restless and resistive, and was placed under restraint. He managed to free himself and attack an attendant. This was on March 14th. On March 15th Dr. Fischer transferred him to Ward 8 with diagnosis of acute delirious mania. Dr. Sullivan testified that his condition supported all of the known symptoms, frenzied outburst, refusal of food, varying temperature. He failed rapidly and died of manic exhaustion on March lst. Other witnesses were Dr. Gallant, Dr. Arnold Branch (who performed an autopsy), Dr. (Major) G. E. Wilson , psychiatrist M. D. No. 7, attendants Cunningham, Harley, Reid, McGuire. He received every care, his treatment was as indicated for this malady, his case was hopeless. Therefore no criticism of the Hospital is found. Miss Hachey told the Commission that when her brother's body was received, there were bruiselike discolorations around one eye.

   Lyle McGuire-Attendant Ward 8.
Returned to stand to tell how patients were prepared for burial, how their jaws were tied up and bandages placed across the eyes, and taken down to basement. Room has no equipment or refrigeration to hold bodies.

    N. Louis Brenan-(Called by Commission)
Proprietor of Brenan Funeral Service, has had dealings with Hospital for 50 years. Said room where bodies are kept is much too hot. Said putting strap around face leaves dark mark that undertakers cannot eliminate. Has asked that the practice be discontinued as it always causes marks which look like bruises received before death. Told of conditions of bodies before embalming which could be taken for bruises. Never saw any bodies at the Hospital giving indication that they had been used with violence before death.



section "2"



THE MANAGEMENT AND OPERATION AND CONDITIONS EXISTING IN SAID HOSPITAL

   The Provincial Hospital at Fairville is under the direction of Hon. F. A. McGrand , M.D., Minister of Health and Social Services. The direct supervision is under E. C. Menzies, M.D., with H. B. Gilbert as Business Manager. As at October 31, 1944, the population was 1285 compared to 1258 on October 31, l943. Statistics for the last ten years are as follows:
AdmissionsDeathsDischargesPopln. Close of Year
Previous Year
1935919293102151 959
193695934180214 1006
19371006352105207 1046
1938194633483265 1032
19391032416100233 1117
1940111741595285 1152
1941115246395310 1210
19421180417 842953248
19431248429114305 1258
19441258459128304 1285

   On October 31, 1929 patients numbered 782; on October 31, 1944 this number had increased to 1285 so it can be readily seen how great a strain there is upon the institution and staff. During the period 1935-44, admissions totaled 3921, deaths and discharges were 3555; the increase in the daily average population has been steadily mounting and if the experience of post World War 1 days is repeated there will be a startling upturn in the number of patients for several years to come.

   Operating Statements for the years ending October 3lst are as follows:
Revenue Earned:From MunicipalitiesFrom Paying PatientsMiscellaneous RevenueTOTAL
19431944
$225,162.80$230,074.10
54,922.0863,305.16
2,323.572,643.88
$282,408.45$296,023.14
SALARIESSUPPLIES:ProvisionsFuel, Light, Water, PowerAll otherUpkeep of Bldg., Plant, GroundsTOTALNET COST OF MAINTENANCE
EXPENDITURE:
19431944
162,412.73172,538.81
119,864.94128,954.22
72,456.3280,098.55
65,495.1570,819.94
21,112.6229,031.63
$441,338.76$481,443.15
$158,930.31$185,420.01
Average Daily PopulationNumber of Patient DaysMaintenance ExpendituresCost per Patient per dayCost per Patient per weekCost per Patient per week, including interest and sinking fundPortion of weekly cost, paid by MunicipalitiesPortion of weekly cost borne by ProvinceNet Cost of MaintenanceNet Cost of MaintenancePercent of Salaries to Total CostCost per year per patient
19431944
1,243.41,270.
453,853.464,879.
$441,338.76$481,443.15
97.24$1.03½
6.817.25
8.398.55
4.00No. 1 4.00
4.39No. 2 4.55
$158,930.31$185,420.01
35.01c39.99c
35.837.1
$354.93$377.77
Note: After January 1, 1945, the amount of No. 1 reduced to $2.00 and No. 2 increased to $6.55.

   We believe that the statistics will show that in no Province of Canada is the percentage of wages to overall expenses as low as it is in New Brunswick.

   Frequent inspections have shown that the Hospital is understaffed as regards those dealing directly with the care and treatment of patients. According to the last wage and employee schedule, the following facts are evident:
NURSES:Ward Supervisors, R. N.,Registered NursesATTENDANTS:Qualified Female AttendantsAttendants, FemaleChief Male AttendantWard Supervisors, male attendantsWard Attendants, Male
BudgetedEmployed.
137
85
1210
2825
11
1211
3217

   One of the reasons for shortage of staff has been the rate of pay compared to other Institutions, but this complaint should now be eliminated for on March 1, 1945, the following increases in salary were effective:


THE PROVINCIAL HOSPITAL BRIEF SUMMARY OF SALARY ANALYSIS October 31, 1941 compared with March 31, 1945

Registered Nurses:Ward Supervisors, R. N.'s,Female Attendants:Male Attendants:Ward Supervisors:
Min. total salary increased from$996.00 annually-$1,350.00
83.00 monthly-112.50
Max. total salary increased from1,116.00 annually- 1,350.00
93.00 monthly-112.50
Classification established Sept. l., 1943-One rate only
Total salary increased from1,350.00 annually -1,470.00
112.50 monthly-122.50
Min. total salary increased from636.00 annually- 737.76
53.00 monthly-61.48
Max. total salary increased from756.00 annually- 928.56
63.00 monthly-77.38
Qualified Female Attendants:
Classification established March 1, 1945. Min. to990.00 annually-1,050.00
Max. 82.50 monthly-87.50
Single-Living in. Min. total salary876.00 annually- 1,410.00
73.00 monthly-117.50
Married-HouseholderMin. total salary876.00 annually- 1,500.00
73.00 monthly-125.00
Male Attendants, number increased from three to twelve, Mar. 1, 1945- Single-living total salary1,530.00
monthly127.50
Married-Householder
total salary1,620.00
monthly135.00

   These salaries include cost-of-living bonus.
Note: Increases granted since November 1, 1944 effective March 1, 1945:
  • 1. Registered Nurses $120.00 annually-$10. monthly.

  • 2. Female Attendants -- No increase in this classification.

  • 3 . A . classification-Qualified Female Attendants (Practical 1 Nurses) established at a salary range of $120 per annum $10.00 monthly (Higher than female attendant's schedule).

  • 4. Male Attendants: Minimum salary increased $180.00 per annum. $15.00 monthly.

  • 5. Ward Supervisors Male Attendants: Increased $120.00 annually $10.00 monthly.



section "3"



THE CONDUCT OF OFFICIALS AND PERSONS EMPLOYED:

   Dr. E. C. Menzies became superintendent of the hospital on the 1st November 1934. He began by opening the doors at night so that patients would have access to bathrooms. That involved the possibility of patients getting into altercations and it has increased minor accidents, but has worked well, despite the shortness of staff.

   He established an open-door ward for a group of about 100 male patients. This permits them to have full access to the grounds in the daytime. These patients are in the last stage preparatory to going out. He has plans for further extensions of this character.

   He set up temporary male and female infirmary wards at first staffed with one or two nurses, but now expanded in a different location to permanent infirmary wards. He has obtained the services of local practitioners who are specialists in surgery, gynecology, genito-urinary, eye, ear, nose, and throat, in metabolism and internal medicine and radiology. He also set up an X-ray department, a laboratory, a dental room and an operating room with a sterilizing room. Along with this he set up a minor medical and surgical room for use as an out-door department. The work of management and construction was all done by his staff.

   The next year, with the aid of the Department of Health, every patient and all of the staff were X-rayed and 350 to 400 open tuberculosis infectors found. Wards were set up as isolated units irrespective of mental condition. Eventually the number was reduced to about 80 patients in two departments, No. 8 and "K." During that time there were admitted over 200 additional tuberculosis patients.

   He established the first Sakel treatment in Canada,-the hypo-glycemia treatment, or insulin reaction. To this, later on, he added electric shock therapy as well as the malaria treatment.

   The repairs and alteration of the buildings had to be done while occupied by patients. This gave occupation to both chronic and recoverable patients under staff supervision, work which was very beneficial to the patients. He suggested the acquisition of the Simms Building as a Nurses' and Staff House. It is connected with the institution by a tunnel. All the work of remodeling was done by patients and the staff, furnishing accommodation for about 50 women and 20 men. He also fixed up quarters in the old building for two doctors. In addition another old attic was repaired and quarters thus provided for vocational therapy. He obtained a trained vocational therapist with an assistant. One has since married and the other enlisted and he has not been able to replace the staff.

   Repairs to the building proceeded in three stages first,-plumbing, bathrooms and wiring. The Old Attic is an example of the first stage. There the plumbing and wiring is done, but on account of shortages he has not been able to get any further. The second stage was a fairly complete repair of the plaster and woodwork and some painting. The third stage has been accomplished in the lower wards on the Women's Side, where there has been complete renovation that will last. About two-thirds of the total repair work has been accomplished.

   He renovated a ward on the Men's Side that he intended to use for male imbeciles who were ambulatory. The ward is complete with a serving room, but he cannot use it because he has not sufficient staff. It would relieve Ward 2 conditions enormously if he could make use of it.

   He created two cafeterias, provided a modern admitting and treatment ward for women, and rebuilt the two cross-halls of Wards 2 and 5 the latter one by contract labour, the only case where work was not done by staff and patients.

   Then there is an Old Women's Ward; that is fairly well equipped to cope with the problems that they present. There is a quiet public patients' ward, and there are two wards for noisy, destructive patients who for all practical purposes arc incurable. They are permanent patient's some of them have been there for thirty or forty years. There is a ward for idiot and imbecile female children. There is an isolation ward for the tuberculous female children. There is a, medical and surgical ward for women. There is a ward for women paying $7.00 a week, and that has a room in addition for the incontinent, unpleasant type in that grade. There is a ward for women who pay $12.00 a week and a ward for fairly quiet permanent patients. That is the Women's Side as it exists today.

   The Men's Side is not so well segregated. There is a ward, well-equipped and covered with sanitary tile for idiots and imbeciles, and another section of the same ward designed for elderly men. This, as has been said, he is not in a position to use for the purpose that he designed it for. He also has plans for a separate admitting ward for men, similar to the one on the Women's Side, and knows exactly where that can go and where every tub and toilet and wash-basin is going to be. It is a matter of getting the time, of evacuating patients from it, and taking care of them in some other place. The same thing applies to the old Attic. In six weeks with the patients out of there and somebody to look after them, that can be made as sanitary as any ward in the building; it has direct connection to the basement by a stairway and is intended as an extension to the men's open-door ward. This cannot be done until he can get more staff. Ward 2 is therefore carrying not a double but a quadruple load.

   Even if all that has been outlined were done, the superintendent says that the overcrowding is so tremendous that conditions would still be far from satisfactory. He estimates that at least 400 additional beds are needed and points out that the institution is overloaded by people who have become a little senile and that owing to ward conditions there is often no one to give them home care. Institutions which should look after them, dump them on the Hospital, and it is impossible to get them to take these patients away.

   With no medical centre in Saint John, he points out that it is difficult to get interns, and without them there is no reserve from which to draw and train older men to stay permanently.

   He felt that there was no effective public opinion in the Province demanding that more money be spent on the care of the insane. Having served under two governments, he gave it as his considered opinion that both had been in advance of public opinion, rather than behind it.

   From 1934 to the outbreak of war, he built up the number of trained nurses from nothing to about 20, and also made increases in both male and female attendants. The payroll more than doubled during this period. With the outbreak of war the staff disintegrated. All his doctors joined the active forces. By 1943 he had lost practically all his experienced nurses including the head. Many of the staff went into the armed forces or into war work. The competition of highly paid Federal agencies and the 8 hour day, now universal in all hospitals, made it very difficult for his institution to compete. It was only last Fall that the wage scale was revised, but so far this has had little effect.

   For almost a year Dr. Fischer, Dr. Sullivan and himself ran the hospital, while the demands upon the institution increased. The army sent men for treatment and although 90% of them have apparently been cured, more cases are being sent in for early prophylactic treatment.

   Instead of closing down the treatment wards, the medical and surgical wards, which would have gained some space, he decided not to abandon curative work and thinks the results have proven that he was right. Last year there were 459 admissions,-36 were completely senile, 10 were victims of old age, 37 were divided into classes of idiots and imbeciles. That left 376 theoretically curable, out of which number 304 were returned to their homes. Probably 50 will come back in a year; 70 or 80 in about five years, and the rest have a good chance of remaining cured. This is as good a record as that of any mental institution.

   He also pointed out that because of the lack of psychiatrists in practice in the Province, he has had to do a great deal of outside visiting and examinations. There must be a man for this outside work or a material increase in the staff.

   Dr. Menzies traced the history of the building, part of which is nearly 100 years old. New Brunswick was the first province to take its insane out of the gaols and workhouses and put them under medical care. It became necessary to acquire the property known as the Annex, but it raised the problem of a divided institution. The quiet types are culled out for the Annex. His possible solution of the problem of overcrowding was to construct a building at the Annex capable of housing at least 400 beds, where strong, healthy, incurable patients would be placed. Many of these are prone to escape, are violent, noisy and destructive. The old building can be made absolutely modern and sanitary at small expense. It should be reserved for those who are curable. A hydro-therapy building could be constructed on the present site and this would reduce the necessity for mechanical restraint. This, too, would require additional staff.

   Dr. Menzies then explained the routine for admitting a patient as follows: "He is sent to ward by the admitting doctor. He is undressed, examined for vermin and marks on body or injuries, deformities, etc. He is weighed and bathed. His clothing its sent to the laundry and marking room, and is all checked on a clothing list. All valuables are listed and sent to the office where they are kept in pockets in locked files. There is also a petty cash account set up."

   "The patient is kept in bed till complete examination by the doctor. There is a pulse, temperature and respiration chart kept for the first week,-discontinued if this physical condition is normal. Specimen of urine is sent to the lab. Complete blood-count and hemoglobin is done. An X-ray of the chest is done land read by Dr. Petrie. A blood Wasserman is taken, together with spinal fluid if indicated. He is inoculated for typhoid; that is very necessary here in Saint John because there is always a little typhoid floating around. Medical files are set up in the main office, also a correspondence file, starting with a copy of the committing doctor's report. His name is added to the card index for regular medical examinations. We have a large number of patients and only a few doctors and it is very easy for a man to become a forgotten man, but with our card index system the doctor receives every week a list of patients whose turn it is to be examined. In addition, of course, if anything turns up it is reported. But these people undergo routine examination and in that way we are sure we don't miss anybody. Then there is any other pathological or specialist examination as indicated by the first examination. That ends up with a conference in my office regarding the treatment and conduct of the case in the light of these findings. The patient is sent to the dentist. "

   It has taken ten years to get from ten to thirteen thousand case reports tabulated and arranged, and a case report can now be got if it were 60 years ago.

   To have patients assisting as attendants is up to a certain point a valuable thing, but one patient must not exercise any authority over another. The more occupation a patient can get, the better. He does not approve of a patient putting on or taking off restraints; has not seen it done, but cannot say what happens when his back is turned.

   To get around all the wards involves walking one and a half miles. It takes him three hours.

   Occupational therapy touches the whole institution and is most desirable. He has not been able to get it restored.

   Except for a short period he has never had more than three doctors where there should be six or seven. There should be 128 attendants; at present, there is about half that number.

    Frederick W. Brownell-Chief Attendant:
Age 67 years, employed in Institution for 51 years. Is general supervisor of the Male Side; works from seven until seven with two hours off. Hires all attendants, gives them their instructions. Visits all the wards, sometimes several times daily. Told of his daily routine; turns night report into Dr. Menzies' office. He overlooks the following wards and attendants:
No.
WARD 1-Private Patients28Attendants1
2-Varied types, public 100
115Attendants4
3- Semi-Private24Attendants1
4-Quiet16Attendants1
5- Varied-Public83Attendants3
6- Older-Quiet49Attendants1
7-Older-quiet public & 10 boys58Attendants2
8-Infirmary58Attendants3
Nurses (Day &Night)2
9- Varied,public106Attendants4
10-Workers100Attendants2
ANNEX105Attendants3
Six attendants on night duty-under charge of Night Nurse-695 male patients.

   Harry W. Cunningham -- Chief attendant-Ward 2:
Served 25 years on April 9, 1945, starting when he was 22 or 23. Has been on Ward 2 for 20 years, day duty. Gives instruction to new attendants; was instructed how to give drugs at class which was held about, 8 years ago. Said he instructed attendants as regards restraints and never permitted attendants to be violent in their treatment of patients. Said there were no privileged patients; never saw 'Jim' brutal to other patients; denied that 'Jim' had the '44' keys to unlock restraints. Testimony shows that Rule 3, regarding restraints, was not known; Rule 4 was not enforced-patients often slept in their clothes.

   Chairman of the Commission remarked that he (Cunningham) and others have, in a sense, built up their own system and never referred to regulations or bothered with them at all. Cunningham answered that they do the best they can under circumstances. Said he did not know anything about patients going to Old Attic, as he worked days. Didn't know whether any attendant went up to Old Attic between 5:30 p.m. and 5:30 a.m. Said Old Attic needed remodeling which Dr. Menzies is going to do at first opportunity. Said he never saw more rats than usual. Never heard of 'Wolves' or 'Happy Gang'. Said the only privileged patients were those allowed to stay up until 9:00 p.m. Never saw patient 'Kurt' strike another patient. Never saw patient worked over by other patients and does not remember him asking for Doctor. Would tell any attendant that you couldn't trust any patient of any type. Said attendants did the shaving, took care of sick, did the dressings. Patients help feed other patients and that some of the idiots could go hungry. Could not suggest better method of feeding patients on Ward 2. Never made a report on condition of eating utensils; thirty-five to forty eat on ward; the attendant decides who goes down to Cafeteria.. Gave very plausible explanation of 'Len's' fight with 'Larry' and his remarks after, none of which were believed by the commissioners. Denied cruelty to 'Jerry'-who was being prepared to go to the Infirmary. Said both he and 'Jim' handled him very carefully. Denied striking patient as told by attendant Vincent Babin. Again denied that he knew whether or not 'Jim' had keys to '44' locks. (That morning, April 4, 1945, the restraints were taken off by 'Jim'). Said it could be possible that there was only one drinking cup for 100 patients. Said he didn't know what he would do without the help of patients 'Jim' and 'Mack.' Did not know why they didn't use Ward 2A which could accommodate at least 35 patients. Denied all the evidence from different witnesses about brutality on his part.

    Grace Teressa Lewin . -- Superintendent of Nurses:
Has charge of nurses, female attendants, switchboard operators and serving-room staff. On duty at-8:00 a.m. Reads night report and then makes rounds of all wards. Often makes rounds in afternoon. Has considerable office work to do, interviews all applicants for positions, makes up the staff hours and duties. Gives instructions to new attendants. Supervises eleven female wards as follows:
PatientsAttendants.
WARD A-Private Patients181
B-Old Patients462
C-Admittance Ward423
(Some patients are never moved from this ward)
One nurse assigned to above wards; one attendant at night.
D-Semi-Private282
E-Treatment272
F-Working581
One nurse assigned to above wards; one attendant at night.
G-Violent733-1 (night)
H-Violent784-1 (night)
Nurse in daytime.
J-Mixed1064-1 (night)
Nurse in daytime.
K-Infirmary653-1 (night)
5 Nurses
L-Children201-1 (night)
Treatment Ward (Insulin)
One Nurse.1 (night)
Told of reports from wards including the 4:00 p.m. records and their details. Said on Women's Side some patients are shut in room alone instead of using restraint. Attendants should be from 17 to 50 but had one l4 years old. Did not know that attendant 17 years of age was in charge of violent ward at midnight, alone. Said Civil Service allowed forty of staff should have fifty, now has thirty-six. Has fourteen nurses; needs twenty.

    Thomas John Taylor -Supervisor of Kitchen & Cafeteria:
Held position for seven years. Has two senior cooks, four assistant cooks and eight girls. Said never varied on breakfast menu. Dr. Menzies used to see menus but it fell through. Arranges menus but nobody ever supervises. Admitted changing menus from those on menu board. Said not much cream on milk but had been an improvement in last two weeks. Patients get 120 gallons a day. Stated several times he needs more patient help in kitchen but never gets them. Mr. Brownell should remedy this condition.

    Henry Bradford Gilbert-Business Manager:
For six and one-half years responsible to the Superintendent of the Institution. He explained his duties under the Provincial Hospital Act of 1936.

   Part II-Section 9, which are as follows:
  • 1. Purchasing of all supplies.

  • 2. The direct supervision of accounting in connection with the accounts payable.

  • 3. The direct supervision of Hospital Revenue accounting-Municipal and Playing patients.

  • 4. Direct Supervision of Hospital payroll.

  • 5. Supervision of the accounting in connection with the withdrawal of supplies from the stores.

  • 6. The keeping of such records and analyses as are required for an intelligent control of the financial and business affairs of the Hospital.

  • 7. The checking of all entries made by clerks under the direct supervision of the Business Manager-Receiver of Revenue, Records Clerk, Admission Clerk & Duties-Population Records-Patients' Trust A/C -- insofar as they relate to the business affairs of the Hospital.

  • 8. Collaboration with Department Heads on routine purchases and with the Superintendent on other than routine purchases.

   Mr. Gilbert stated that all funds requested by their budgets had been provided, each year, by the Government.

    Percy Manchester -- Superintendent of Farm:
Said farm was between 350 and 400 acres; in average years produced the following:
3,017-bags (75 lb.)Potatoes.
548-bags (75 lb.)Carrots.
138-bags (75 lb.)Beets.
3,400-bags (75 lb.)Turnips.
2,400-lbs.Squash.
9,600-lbs.Cabbage.
200-tons.Hay.
1,500-bushelsOats.
25,227-gallonsMilk.
2,300-gallonsMilk-fed to stock.
32,582-lbs.Pork.

   Has staff of six. Only uses 16 patients on farm. Says farm is short of labour. Large part of land is clay soil. Needs proper root cellar as present facilities are far from satisfactory. Building silo this year,-absolutely necessary for maturing hay light in proteins.

    Dr. L. A. Donovan ,-Veterinarian:
Herd of 81 cattle with one bull. Hogs are Yorkshire, of good quality; all garbage fed is cooked to satisfaction of federal authorities. Cows are of good stock, mostly grade cattle, milked by milking machine and all milk is pasteurized. Barns are in good shape but very crowded; by next fall, with natural increase in herd, additions will be necessary. He gave description of farm, soil and livestock, and said he was pleased with the general operation and results, both in volume of milk and other products produced and the natural increases in pigs and cattle.



section "4"



THE CARE AND TREATMENT AFFORDED PATIENTS IN SAID HOSPITAL

   To obtain testimony as to the care, treatment and operation of the Institution, the following were called:

    Dr. H. D. Reid -- Chief Medical Officer, Veterans Hospital , Lancaster :
Visited all patients of theirs a month or six weeks ago (From Apr. 3) and none made any complaints and did not see any evidence of abuse. Made this time at suggestion of Dr. Bain , Director of Medical Services Ottawa, who was evidently disturbed by the articles in Montreal Standard.

   Dr. C. L. Emerson-
Is the Official admitting patients from the Municipality of the City and County of Saint John. He visits the Hospital unannounced at all times of day and night and stated that he never had seen brutality at any time either between patients or between attendants and patients, nor had he seen anything that he would not expect to see in an Institution of this kind.

    Rev. F. J. LeRoy-
Chaplain for the Provincial Hospital-Church of England since 1925. Has always found officials and attendants co-operative; felt that patients were treated kindly; never saw any altercations with patients. Felt hospital was a very finely kept institution, comfortable and clean.

    Rev. William Percy Haigh-
As Rector of Carleton Parish, a frequent visitor to all wards; found doctors and staff always co- operative; never saw any disturbances between patients or attendants. Said he knew Ward 2 well; had been there when patients had gone to bed; never saw rats there; saw nothing out of place.

   Rev. F. M. Lockary- A Catholic Chaplin of the Institution for eighteen years; told of the wonderful change since Dr. Menzies took charge. Said that he always found a spirit of co-operation and testified further that, based upon reports of his past and present stewards, never once has known of abuses in administering necessary physical violence.

   Dr. F. A. McGrand-Provincial Minister of Health:
Told of receiving telegram dated November 6, 1944 signed by Hines and Letteney (attendants) and Drummond and Wiggins (patients) reporting that brutality was rampant at Institution and urging immediate personal visit. Said he arrived at Fairville on the 9th but both Hines and Letteney had left the employ of the Hospital. Told of interviewing Wiggins, Drummond and another patient, attendants Jeffries and Mr. Brownell. Did not believe stories told by Wiggins and Drummond. Said he went through most of Institution that day and said that the most urgent need was more staff. He told about raising wage-scale, running newspaper advertisement all over the province, asking the Minister of Health at Ottawa for personnel to be assigned through that Department. Dr. McGrand, in response to questions, said that his department had had no correspondence with Ottawa about the transfer of servicemen to other Hospitals. In response to questioning as to the number of ex-servicemen now in the institution, Mr. Gilbert, business manager, said that there were 22 Active Force, 5 POW, 6 Sailors (or 33 from this War) and 18 from World War I. The count is down a little as it usually runs: Present War 40-Last War 20. Dr. McGrand was also asked about the use of apomorphine and hyoscine and said he did not consider the dosage as administered dangerous or harmful.



section "5"



OBSERVATIONS BY COMMISSION

   We find that during the year ending October 31, 1944, 302 patients were seen at the Dental Clinic. Admitted to the Infirmary were 324 female patients and 238 male patients for medical and surgical treatments; 2112 treatments were given for minor medical and surgical ailments. Throughout the year there was an average of 70 patients under treatment in the tuberculosis ward.

   In the same period, 78 patients were given hypoglycemic treatments with 55 recovering; 23 patients received electric shock treatment of whom 2 recovered. Only 16 cases received therapeutic malaria, a decline of 50% over the previous year.

   Care and treatment is good in every department of the institution, but due to the shortage of experienced medical assistants and other competent help the number of patients under treatment of one kind or another is down to a minimum. The wards are clean and neat and order and discipline is well maintained. This condition is especially true on the Women's Side and is the rule rather than the exception on the Men's Side. Wards 2 and 5 are the only two that really need immediate attention to relieve overcrowding and allow segregation so that active types of patients will not retard the care of other types.

   Feeding on the wards for semi-private patients is well-handled, the food is of good quality, well prepared and hotly served. Feeding of patients on Wards 2 and 5 should be investigated and conditions corrected, (supervision over Kitchen Menus should be re-introduced but will probably not be successful until the dietitians return from Active Service or others are appointed).

   The two cafeterias, situated in the basement, are poorly equipped; the hot-plates and serving tables are makeshift at their best. The one for working patients is especially unsatisfactory in its arrangements and should be completely refurnished and renovated. The menus should be given more supervision and greater variety can be given with little additional cost. The whole feeding situation should be checked and rechecked and a competent dietitian be engaged at once; a competent woman is urgently needed to restore this department to its rightful place, as part of the therapy of relieving the mentally unstable. At the Annex, the kitchen was clean, bright and sweet smelling; the ice boxes, pantries and dining room were spotless; in fact the Annex sets a standard for housekeeping for the Institution.

   Some wards evidently need a prepared schedule of ventilation because of overcrowding; other wards need radiators checked for better heating. It is suggested that the entire system be checked this summer for greater efficiency. In many inspections, fixtures were noted broken or out of order, faucets leaking, plaster cracked and crumbling and many minor repairs needed, and it is suggested that the Building Superintendent be notified of such work through work orders originated by Ward Attendants.

   The attendants on the Women's Side are found to be intelligent and sympathetic and doing a good job; however, in Ward L-Female children's Ward-it was noted that all ambulatory patients were restrained by the feet. On one day of inspection two windows were open in the ward and the children, lightly dressed, were actually cold. They are bathed whenever necessary, generally seven or eight times a day, get special diets as required, and all of their physical requirements are looked after.

   The ten little imbeciles in the small ward off Ward 7 present a sorry picture. The room is dark and dreary and quite unsuitable. We feel that these children should be housed in quarters which are clean and bright and which have been especially constructed for them. This is a matter which requires the sympathetic study of those who will be charged with the responsibility of planning for the provision of additional quarters for the excess population now in the Hospital and the task of engaging additional staff capable of taking care of this type of patient. There is only one satisfactory remedy for the present condition of these children and that is more accommodation.

   Much testimony has been given on the subject of restraints and frequent inspections have shown many patients regularly restrained. This Institution must have a policy of limited physical force, but there must be strict rules against its abuse. We feel that the Chief Attendant or Nurse on the wards should order restraint and that the name of the patient and the time of restraint should be registered in the Ward Book. In Ward 2 mostly, we feel that restraint has been freely used; perhaps it is because of the many and varied types of patients, but one cannot escape the fact that at times restraint has been used as punishment without authority.

   Much testimony has also been given on the injections of apomorphine and hyoscine. Dr. Menzies and Dr. Fischer explained its properties and dosage which, if given as directed, would not prove harmful. It is believed that in the past some unscrupulous attendants have given injections for punishment so as to make their own duties easier. It is noted that on Ward 2, only one injection was given during the month of February and only fourteen during March a drastic decrease compared with the preceding month.



section "6"



RECOMMENDATIONS

   1. That Dr. Menzies, Dr. Fischer, Dr. Sullivan and Dr. Gallant be given special commendation for the manner in which they have carried on during the past five years in spite of shortage of staff and decided increase in patient population. When possible, by the lifting of Wartime restrictions, consideration should be given to substantial pay increases for all four, in order that they may be amply compensated for their years of study, training and experience, and in appreciation of their many long hours of overtime aud added responsibilities.

   The supervision of the renovation of the building, the attendance of details of management, and general dealing with details other than of a medical nature should be entrusted to a lay assistant superintendent who would relieve Dr. Menzies of those concerns. He now has to give too much of himself to deal with matters which are not in the psychiatric field where his talents are more useful.

   2. That all patients, veterans of World Wars I and II, suffering from war-induced disease, be transferred to a Veterans Hospital. Veterans and their families always present peculiar and distinct problems and the interests off all concerned would be better served if such patients were transferred to St. Anne's Hospital .

   3. That a competent architect be engaged to consult with Dr. Menzies and Dr. McGrand and immediate steps be taken to make renovations and alterations, that will eliminate conditions in Ward 2 and the Old Attic. Serious study should be given to the segregation problems, consideration given to the providing of hydro-therapy equipment and provision made for separate rooms on violent wards for disturbed patients.

   4. A serious over-crowding of the Institution now prevails and this condition will become more acute in post-war years. To relieve this congestion, it is recommended that serious study be given to statistics covering past admissions from various counties, racial origin and religions. At present they are approximately 350 patients of French origin. Far from friends and visitors, loneliness and inability to understand English clearly, natural bewilderment adds much to their mental confusion. Therapy is disturbed and hopes of early and complete recovery are lessened. Humanitarian as well as economic reasons point to the conclusion that the best interest of a goodly share of our population would be best served by the erection of a modern psychopathic hospital located in the north central section of our province.

   It is obvious that there must be an increase of accommodation in some locality. We call attention as well to the recommendation of Dr. Menzies that another building should be provided at the Annex site. We think this is a matter for the careful consideration of the government which must weigh the relative advantages of an institution on the North Shore with a separate overhead against the slighter separation which would be involved in Dr. Menzies' recommendation.

   5. Much idleness is evident in all wards and studies should be made for a solution of this problem. Every effort is made to keep patients active and working where possible, thus aiding in their mental recovery as well as being of value to the institution. More men should be used on farm, in the kitchen and on maintenance work; but again we must recognize that the shortage of experienced attendants makes this difficult and results in many patients having to be kept on the wards who could otherwise be employed.

   In the past occupational therapy activities were very successful, and as soon as possible, this department should be re-opened with an increased number of therapists and its activities enlarged and broadened.

   6. The mentally deficient children and imbeciles in the Institution are a problem of management and a challenge to man's love of children. It is recommended that provision be made by the erection of a building on the Annex property to properly house these young unfortunates. In such a location, the children would be away from the turmoil of institution atmosphere and would have sufficient space for out-door life and sunshine. Special attention should be given to schooling and occupational therapy and their religious training should be a special interest of the various chaplains.

   7. Your Commission recommends that for the protection of the Institution and the staff from unfounded rumors, post-mortems be held when requested by the superintendent, or any members of the outside Staff. It is also recommended that the mortuary facilities be improved.

   8. As soon as possible additional medical staff should be obtained. Your Commission is of the opinion that a minimum of six qualified psychiatrists should be employed. No man can do his best work when he is on call in an institution of this kind twenty-four hours of the day continually. We further recommend that residences be provided for Doctors on the permanent staff at or near the Institution.

   9. In the past, various standing orders issued by the superintendent for the guidance of the staff in the performance of their duties have been typewritten and tacked on the wall of the ward attendants' offices. This has not proved satisfactory. We strongly recommend that a booklet containing all standing orders and rules be printed and a copy given to each attendant.

   10. In order that the use of restraints shall not be abused, it is recommended that a Doctor, a Registered Nurse, the Chief Attendant, or Ward Supervisor only shall have authority to order that a patient be placed in restraint and that the name of the patient and the time in restraint shall be registered in the Ward Book. That all restraint equipment not in use shall be kept under lock and key. That no patient requiring restraint shall be housed in the Attic.

   11. It is strongly recommended that the administration of drugs be restricted to Doctors, Registered Nurses and Ward Supervisors. That separate Drug Books be kept in each ward office and that the standing rule which requires that a record of the administration of drugs be entered in the Ward Book at the time of administration be strictly adhered to; and furthermore that a summary of all drug entries be furnished the Superintendent each day.

   12. For the protection of patients, the public, and the Province, it is strongly recommended that a Board of Governors of not less than five members be appointed by the Premier and Executive Council. This Board could offer much practical aid, advice and encouragement to Dr. Menzies and the Institution. It would accomplish much to foster in the minds of the public the realization that the subject of mental disease is not to be shunned, that some of the mentally ill can be cured. Such a group would encourage the desire to extend to a greater number the modern methods of treatment now in use, which would result in a much greater number being returned to the outside world as possible healthy and useful citizens.

   Your Commission had as Legal Counsel, Mr. E. J. Henneberry, K. C., and we take this opportunity of expressing our thanks to him for the large amount of work he has done which has both saved the time of the Commissioners and helped to make the investigation as thorough as possible.

   Your commission engaged the services of Doctor Clarence A. Banner of Danvers State Hospital , Hathorne , Massachusetts , (operated by the Commonwealth of Massachusetts Department of Mental Health, -- an institution of 2325 beds dedicated to the care and treatment of all types of mental ills) to investigate this Institution. Dr. Bonner made a very thorough inspection of the Hospital, examining very carefully every aspect of its management and administration, and the care and treatment of the patients. We are very grateful to him for his exhaustive report, which we present as an Appendix to our Report.

   We herewith submit a copy of the Evidence given before the Commission. DATED AT SAINT JOHN, NEW BRUNSWICK, THIS 27th DAY
OF JULY, A. D. 1945.

   Signed:-
J. B. M. Baxter, Chief Justice, Chairman
L. M. Pepperdene, Commissioner
E. B. Sweeney, Commissioner.





APPENDIX INSPECTION PROVINCIAL HOSPITAL
Saint John, N, B.
-BY-
C. A. BONNER, M.D.,
DANVERS STATE HOSPITAL, HATHORNE, MASS.
Inspection Dates: April 2, 3, 4, 5, and 6, 1945



section "1"



I. ORGANIZATION AND ADMINISTRATION

   
  • 1. Location: St. John, New Brunswick (Fairville)
    Type of construction: Kirkbride with farm, called the" Annex", about two miles from the main hospital.
    Acreage: Approximately ten acres for the main building. Approximately 350 acres of farm land at the "Annex."
    Capacity: Approximately 900.
    No. patients in residence: 1,283; percentage of over-crowding: 35%
    Annual No. commitments: 467; the admitting rate for 1935 was 293; the admitting rate for 1944 was 459, a gain of 166 patients over this period.
    Type of patient: All types of patients are received at the hospital on commitment, including idiots, imbeciles, those suffering from various psychoses, and those cases sent by Court warrant (criminal insane).
    Routine or special inspection: There is no routine or special inspection made of the hospital by outside officials.

  • 2. General Organization.
    Organization plans: The hospital is headed by a medical officer, the Superintendent, in whom is vested the major responsibility. There is a business manager.
    Duties of the business manager of the Provincial Hospital: The Provincial Hospital Act 1936 being Chapter 34 of the Acts 1, Edward the VIII, (1936). Part II Administration and Control, Section 9. The financial business and affairs of the hospital shall be in charge of the business manager who shall be appointed by the Governor in Council, and who shall be responsible to the Superintendent.


    OFFICERS OF THE INSTITUTION

    SuperintendentTechniciansBusiness Manager Occupational TherapistMedical StaffChief AttendantChief EngineerPart-time Medical StaffBuilding SuperintendentFarm SuperintendentSuperintendent of Nurses
    E. C. Menzies, M. D. Miss Catherine Handrahan , R. N.
    Miss Mary Haigh
    H. B. Gilbert
    Mrs. E. Marian Gibbon
    W. J. Fischer, M. D.
    E. V. Sullivan, M. D.F. W. Brownell
    J. A. Gallant, M. D.
    A. M. Irving
    A. D. Branch, M. D., Pathologist
    J. B. Gosnell , D. D. S.H. C. Brownell
    L. A. Donovan, V. S.
    Percy Manchester
    Mrs. Grace T. Lewin, R. N.

  • 3. Trustees
    There are no trustees or other supervisory board. The Superintendent is directly responsible to the minister of public health who is placed in office by election.

  • 4. Superintendent
    The policy of the Superintendent is to maintain good medical care.
    Plans for future of institution: Include the remodeling of several wards, the inclusion of hydrotherapy as treatment, the construction of an occupational therapy building. The hospital wards are visited frequently by the Superintendent.
    System of control: It would appear that the large burden of responsibility is borne chiefly by the Superintendent himself.

  • 5. Appointments of the staff are made by the Superintendent Department Heads are appointed by the Superintendent.
    Personnel having to do with care of patients: On the male service by the chief attendant; on the female service by the Superintendent of Nurses.

  • 6. Recognition or approval of hospital: I understand from the Superintendent that the hospital is approved by the American Medical Association.

  • 7. Assistant Superintendent: There is the position of Assistant Superintendent, but it is vacated at the present time.

  • 8. There is no Clinical Director.



section "2"



II. MEDICAL STAFF

   The medical staff consists of the four physicians previously mentioned and a visiting or consulting medical staff as follows:
MedicineAnestheticsOtolaryngologySurgeryOphthalmologyGenito- urinaryGynecologyRoentgenologist
H. A. Farris , M. D.B. W. Lunney , M. D.
*A. B. Walter, M. D.
L. DeV. Chipman , M. D.
George F. Skinner , M.D.
*R. M. Pendrigh , M. D.R. T. Hayes, M. D.
*J. P. McInerney , M. D.*Enlisted in Canadian Army.
T. E. Grant
J. K. Sullivan , M. D.
G. B. Peat, M. D.
G. M. White , M. D. E. A. Petrie , M. D.
* Joseph Tanzman , M. D.

   The visiting who have served staff is made up of a well-recognized group of medical men faithfully upon call.

   The resident medical staff: Dr. W. T. Fisher is a very well trained psychiatrist, having had his education and psychiatric training in Germany. He is a member of the American Psychiatric Association and seems to have an excellent grasp of his subject. He accepts a large responsibility in psychiatric diagnosis and treatment, giving the electro-shock therapy treatments and the insulin treatments.

   Dr. E. V. Sullivan is a physician of long experience, who for several years has been a member of the staff of the Provincial Hospital. His work is largely on the infirmary wards and his special forte is administering to the physical ailments of these patients. Dr. Sullivan is exceedingly kind and careful and his notes on patients are faithfully set down immediately after his rounds.

   Dr. J. A. Gallant makes ward rounds and besides his other duties has charge of the morning clinics. This consists of all of the minor surgery and other related duties.

   Extra-mural activities
The Superintendent is often called to examine Court cases and to see other cases in consultation sometimes having to go long distances in order to comply with requests. He also has prepared and read many papers before the various medical organizations.

   Living accommodations are provided within the hospital for these physicians.

   Medical Staff Book: At this time, because of the shortage of physicians, formal staff meetings are not held, but Dr. Menzies and Dr. Fisher plan to meet at eleven o'clock each morning and to discuss new admissions from the standpoint of diagnosis and treatment. Notes of these conferences are not kept in a book but notations are made in the case records.

   General impression of staff: There are but three physicians mentioned and the Superintendent. My impression is that they are hard workers and that the medical spirit was good.



section "3"



III. PSYCHIATRY

   1. General
Each physician has his office and there are stenographic facilities. There are sufficient examining rooms.

   Quantity of work in relation to personnel: It is obvious that the three physicians and the Superintendent cannot possibly give adequate medical attention to nearly 1,300 patients.

   Quality of work in relation to personnel: In consideration of this topic, it is my opinion that the three physicians and the Superintendent are working hard and faithfully in the face of great difficulties. The rate of discharges from the hospital is good. Admissions for 1944 were 459. Of this group, 83 fell into the classification of mental defectives or of senility. This leaves 376 patients of a curable type, and ,of this number, 304 had been able to go home after treatment.

   Attitude of hospital toward psychiatry: The newer forms of treatment are in constant use, that is, electro-shock therapy and insulin treatment.

   Diagnostic psychiatry: Little opportunity for discussion of differential diagnosis is offered since there are no formal staff meetings and by force of circumstances about all the opportunity for diagnosis rests in the conferences mentioned above between the Superintendent, Dr. Menzies, and Dr. Fisher.

   Therapeutic psychiatry: There is no department for hydro-therapy nor for occupational therapy, and very little recreational therapy.

   Paroles: Patients who are trustworthy and have made progress in their illness are permitted the freedom of the grounds, and the hospital does have open wards so-called.

   Visits: These patients are permitted to go home. The above shows an excellent rate of return of patients to the community.

   Discharges: Of the total number of patients permitted to leave the hospital on visit as improved or recovered, it is estimated within the year about fifty will have to be returned; the others will make a good adjustment.

   Boarding-out: There are no facilities for boarding-out patients. These are homes used as stepping-stone to own, or as an end toward the patient's securing work and re-establishing himself in the community. These boarding homes where the plan is in operation are subsidized by the hospital.

   Escapes: I do not consider that the escape rate is much different from what would be expected in a hospital of this size.

   Accidents: I not an accident form is used and this form is sent to the chief attendant or nursing superintendent, then to Dr. Menzies' desk, where he reads and initials it before filing in case report. In this way a careful review of accidents may be made, the full nature of the accident described, its cause and a study of these accident reports helps very much in determining the methods of prevention. I am enclosing a copy of one of our forms, which may be helpful.

   Frequency of notes: The plan of noting is do make an admission note, including a physical and brief mental examination. Weekly notes are made for three months and then monthly notes for the remainder of the year, then yearly notes are made. Notes of treatment are recorded in the case record. I checked many records and found that the noting was in good order. The notes are very brief but concise and to the point. Elaborate notes cannot be made with such a staff shortage.

   Storage of records: The records are filed in steel cases and are readily accessible.

   Psychology: There is no psychology department. A psychology department is an important part of any mental hospital, providing psychometrics and psychological studies of patients.

   Social Service: There is no Social Service Department. A Social Service Department is a valuable part of a mental hospital, aiding in history taking and the supervision of patients in the community, helping toward their adjustment, securing positions, and under supervision to perform the more important social service case work in connection with the care and treatment of patients; to assist in the investigation of cases pending before the courts in which psychiatric problems are involved; and to perform related work.

   Occupational Therapy: At one time the hospital had a head occupational therapist and an assistant. There is no department in operation at the present time.

   Industrial Therapy: By industrial therapy is meant the manufacture of various articles and usually refers to the activities of male patients. These articles are useful in the hospital and include, for example, such activities as broom-making, weaving, shoe-making and repair, etc. It requires separate space and is very helpful for not only the patients but does provide useful material for hospital use. There is no section for industrial therapy excepting what is done in the carpenter shop.

   Hydrotherapy: There is no hydrotherapy department. There are a few tubs but they are not being used because of the shortage of help. There are also a few pack beds not in use for the above reason. Hydrotherapy is an extremely important part of treatment, particularly for the large group of continued care patients, and also for new admissions.

   Admission routine: New admissions are examined at once by the admitting physician and a note is made in the record of the mental and the physical condition. The new male patients, who are admitted to Ward 2, are thrown in with a large group of different types of patients ranging from the very low-grade mentally to excitable and noisy patients. Conditions are not satisfactory for new admissions of this ward. Conditions are more satisfactory for new admissions in the female ward. The new admissions are first met by the physician and later by the nurses and attendants. Valuables and personal effects are cared for in a separate office. Commitment papers are checked at the time of admission.

   Classification of patients: I do not regard the classification of patients, especially on Wards 2 and 5, as satisfactory because there are so many different types. Plans are at hand to remodel Ward 2 so that it may better serve the function of a reception ward.

   Seclusion: Seclusion as defined by being cared for in a so-called quiet room is not used to any extent. There are no rooms that are particularly suited for the influence of sedation by being segregated in this fashion. Restraint by use of straps is extensively practiced.

   Disposition of patients after one year: In consideration of patients having the hospital on visit, it is a good plan to review the records yearly. In so far as the noting was concerned, I believe that this feature of case record work was concise and satisfactory.

   Medical Library: There is no medical library as such. In the Superintendent's office are a few volumes. Personnel: There is no librarian. Use: The physicians make use of such volumes as are available. Control: No Comment. Records: No comment. Proper indices available: No comment. Journals kept bound: No. Is library properly indexed: No. Is there an abstract service: No. Amount of money budgeted: Unknown.

   Patients' Library: There is a room set aside for patients' books and these books are brought to the wards. In the past, the occupational therapist has acted as librarian.

   Attention to relatives: The visiting days are Saturday and the hours are from 2:00 to 4:00 P.M. and Sunday from 2:00 to 3:00 P.M.. The residents of St. John are expected to use these hours. Visitors from outside may come at any time. From observation, I should say that the staff was courteous in the treatment of relatives. A record is made of visitors. There is no special time for telephone calls. There are no separate reception rooms. The visitors congregate in the lobby and then are taken to the wards.



section "4"



IV. GENERAL MEDICAL AND SURGICAL

  • 1. Organization.
    This is a separate service and it is on a very good level. There is an operating room and all facilities for medical and surgical activities. The ward coverage on the infirmary wards is satisfactory. It is in charge of graduate nurses with ward help such as orderlies and attendant nurses.

  • 2. Medical
    Diagnostic equipment: There is good diagnostic equipment for ordinary conditions. This equipment is used by the house staff and also by the consulting staff in medicine and surgery.
    General medical health of the patients: I believe these patients receive excellent care in the face of physical illness. There seemed to be sufficient beds for these medical and surgical patients and the drug storage is well cared for and kept under lock and key. The medical records are dictated directly after rounds are made in the morning and great care is exercised by Dr. Sullivan to see that a good record of medical progress is made. Consultants now receive an honorarium for their work at the hospital. Patients are immunized against typhoid and I did not find records of any epidemics.

  • 3. Surgical
    The surgical work of the hospital is done by the surgeons on the courtesy of staff of the hospital and whenever an operation is indicated they are called in. I understand that there is a very good spirit existing between the courtesy staff in St. John and the hospital itself. There is equipment for all special forms of surgery.

  • 4. Obstetrical
    No.

  • 5. Clinics.
    The clinics so-called are largely the care of patients suffering from minor surgical conditions and are done the first thing in the morning. They are brought to the infirmary ward and care is given them by the physician on duty. In this instance, it was Dr. Gallant, who was in charge of this activity.

  • 6. X-Ray
    A great deal of X-ray work is done in this hospital and for all current conditions and once a year the chests are done on every patient to determine the existence of tuberculosis.

  • 7. Physical Therapy.
    I did not notice any provisions for physical therapy department, that is, the use of ultra- violet, high frequency sinusoidal current or hyperpyrexia cabinet.

  • 8. Pharmacy
    There is no large central pharmacy. There is a small pharmacy but there is no pharmacist. Here preparations are made and dispensed and records are kept. There did not seem to be any large amount of obsolete drugs on hand. I believe a hospital of 1,300 beds, plus a quota of employees, should have a pharmacist. This would permit the doctors to give this certain time to the care of patients.

  • 9. Laboratory
    There is a laboratory for the usual routine forms of laboratory examination. This is presided over by a technician. Any special blood work that has to be done can be done readily at the St. John general hospital where a splendid spirit of cooperation exists between the two hospitals. There is an occasional autopsy and this is performed by Dr. Branch of the St. John Hospital. As understand it, permission is usually obtained through the coroner. Transportation of bodies is cared for by undertakers. Whenever there is any doubt in reference to the cause of death, the coroner is called. There are no clinico-pathological conferences.

  • 10. Deaths and critically ill.
    The relatives of a critically ill patient are notified by letter, by wire or telephone. The hospital has an arrangement for State burials.
  • 11. Dental
    Personnel: One part-time dentist. There are good facilities for clinical work. There is no special arrangement for X-ray in the dental office.



section "5"



V. CARE AND HANDLING OF PATIENTS

  • 1. Employees
    Ward coverage is done by records in the ward book and by reports. There is no manual as such, but from time to time orders have been issued and these are available on the bulletin board. I am told that a manual will be gotten out so that each employee may have one for his guidance.
    Suicidal patients are given special attention, day and night.
    Uniforms are provided the male attendants. These are very attractive and satisfactory.
    Attitude toward patients: Throughout my period of observation, I saw no unkindliness nor unkindly attitude of any employee toward a patient.

  • 2. Ward care.
    On those wards that have been remodeled, the appearance was excellent. The same holds true for certain of the so-called front wards. The wards housing disturbed patients were fairly clean but a great deal of painting is necessary in order to bring them up to the desired standards.
    Vermin : I saw but few cockroaches and these in the basement, and but one rat on my tour of inspection. I understand that a professional exterminator is now employed.

  • 3. Attractiveness
    On the front wards every attempt has been made to have the wards attractive with curtains, etc. The disturbed wards so-called are rather bare and unattractive.

  • 4. Lighting
    Lighting conditions are satisfactory. I was able to make my night rounds by means of the lighting available.

  • 5. Personal care
    Clothing: Clothing is furnished partly by the hospital and partly from the relatives. The hospital uses an overall-like material for many of the male patients. There is a good system of supply from laundry to the wards and I felt that in most instances the patients were properly clothed.
    Laundry: The laundry is a well-functioning unit and I should judge that the clothing on the whole was satisfactorily cared for, both from the sanitary and the stand-point of appearance.
    There were clothes rooms on the wards. In many instances these were in fairly good order. There was also evidence of their being used for storage of boxes and other supplies apart from clothing.
    Bathing: All patients are bathed at least once a week and at other times whenever necessary. All of the bathing is done on the ward bathrooms.
    Personal hygiene: Patients are shaved twice a week and the haircutting is done by the attendants. I saw no special "beauty parlor" so-called for the female patients.
    A chiropodist is called whenever there are foot troubles needing his attention.

  • 6. Facilities for recreation and exercise
    There are very few facilities for recreation and exercise. It is reported to me that the patients do go for walks in the good weather when there are sufficient employees to supervise them. There is no recreational director. The games permitted are ping-pong and certain table games; otherwise there are no facilities in this respect.
    Music and entertainments: There are occasional entertainments. Facilities for the movies have been present, but, due to some plan of construction in the auditorium these had to be discontinued.
    Smoking: Smoking seems to be permitted all over the Hospital. There is a smoking room for women patients at special times. This promiscuous smoking is a fire hazard but the institution is well-sprinkled and the superintendent feels that there is adequate protection in this respect.



section "6"



VI. SERVICE DIVISIONS

   Farm
At the farm, called "The Annex", there are buildings for both male and female patients. I felt that the supervision here was especially satisfactory. At the Annex there is a dairy barn, a piggery, a barn for storage of farm implements and supplies. The farm is under the supervision of a part- time head farmer who besides managing his own farm manages to get a very satisfactory output from the farmland belonging to the hospital.

   Engineer
I visited the engineering department. The equipment is coal-burning and the usual appliances for efficiency are in operation in this department.

   Grounds
Generally speaking, the grounds around the hospital were neat and clean. Patients will throw material out, but this is cared for by a detail who act in the capacity of groundskeepers. The grounds are surrounded by grass and trees and some shrubbery. The roads were in fair condition. There are exercise yards that are used in the warm weather.

   Industrial Building
There is no industrial building as such. The carpenter shop serves to employ a number of patients who seemed quite happy and diligent. The Superintendent tells me he has a building which he believes can be used for this purpose later on, by means of reconversion.

   Employees' Quarters
I visited the employees' quarters. These consisted of two separate houses, one for male and one for female employees. I felt that conditions were very good and homelike in these quarters.

   Sewing Room
Many patients were employed in the sewing room and considerable work is done for the hospital. Mending is also done in this section.

   Kitchen
The kitchen is modern in appearance and has the usual appliances to feed large numbers of persons -- ranges, kettles, and a large meat roaster. The floor is tile and the upkeep is good. There is a central supply room where all goods that are purchased are received and records are kept. This is under the supervision of the business manager.

   Fire Protection
Fire protection is by sprinkler system throughout and the Superintendent believes it to be satisfactory and efficient. He also indicated that there were proper exits taking into consideration the protection offered by the sprinkler system. Fire drills are held every two months.

   Requisition for repairs or projects
These are approved by the heads of the various departments and checked by them. The Superintendent plans repairs or large projects. There are plans on a five-year basis.

   Supervision of employees is largely done by the Superintendent and the cost accounting is done by the business manager. There was no central stock-room but the stock that is received is controlled by the department heads. I believe the Superintendent confers frequently with the chief engineer and the building superintendent.



section "7"



VII. DIETETICS

   There is no dietitian in the hospital at the present time so that diets are gotten out by the kitchen personnel without this supervision. The waste is sent to the annex as swill. I do not find that any records are kept of the waste. Dining room service is cafeteria. I have spot-checked more than fifty cases and found in all but two instances that there had been a gain of weight by patients while in residence. This points to satisfactory nutrition.

   Condition of food received: Food sent to the wards for distribution on trays for patients unable to go to the cafeteria is sent in ordinary containers and not by means of modern food trucks. Method of transportation to wards is by car from tunnel; by means of dumb-waiters to other wards. Practically all of the wards have hot plates so that food may be re-heated. Facilities for washing dishes are adequate.

   Service to patients: The large group of continued-care patients is served their meals in two cafeterias. One of these is in the basement. One cares for the quiet willing type of patient; the other cares for male patients who are working out and disturbed female patients. These cafeterias, to me, were unsatisfactory because of location. The tables are painted and covered with battleship linoleum. I think that if funds are available, a food service building for employees and patients is a more satisfactory arrangement. The food distributing centers or bars are small and quite congested. Stools are utilized as chairs. There is moderate supervision during the mealtimes.



section "8"



VIII. RESEARCH WORK

   With but three physicians to carry on the medical work needed for a population of 1,300 patients, there is little or no opportunity for research work.



section "9"



IX. NURSING SERVICE

   1. Organization.
The set-up is 32 male attendants, 14 registered nurses, and 36 attendant nurses. There is approximately a fifty per cent shortage in the nursing situation at this time. Under usual conditions, the Superintendent plans on having a well-trained graduate nurse in charge of the entire nursing service. At the present time, a graduate nurse who is not in good health is endeavoring to carry on this work, under great difficulties. On the female service, they are bringing in from time to time young women who act as ward maids on the better wards.

   There is no training school. At the present time there is no real program for teaching. There is no training school committee.

   Bedside care: The bedside care, from the nursing standpoint, I considered good on the infirmary wards.

   Careful notations were made by the nurses on duty and the records were satisfactory. At least one of the nurses has had thorough psychiatric training, in addition to a general hospital training (Miss Daley).

   Physical facilities for nursing: On the infirmary wards every facility is offered in terms of records, office space and the careful notation of bedside charting.

   Nurses' living quarters are in the home, described before this. For recreation a tennis court is provided, and music.

   Stockrooms and supply rooms are adequate.

   Sterilizing opportunities were adequate.

   Telephones were at each desk.

   Affiliations in hospitals: None.

   Active alumni association: None.

   Affiliations with outside groups: Unknown.

   Affiliations with professional groups: Unknown.



section "10"



X. TEACHING

   (a) There is very little opportunity for the teaching of nurses or attendant nurses at the present time because of the extreme shortage of physicians, but three doctors being available, excluding the Superintendent.

   (b) Patients are interviewed by the physicians as time permits.

   (c) Relatives are received in the lobby for interviews.

   (d) Public-

   (e) Hospital employees not listed above. At one time students from the University of Toronto came to the hospital for practical teaching and occupational therapy.



section "11"



XI. RELIGIOUS WORK

   The religious work is very well cared for at the hospital and includes the various denominations. Clergymen who are interested in mental patients and can give time to this project are of very great value. Many patients benefit greatly in a spiritual way by having talks or interviews with their respective clergymen.



section "12"



XII. PREVENTIVE PROGRAM

   1. Child guidance clinics or habit clinics.
There are no child guidance clinics or habit clinics operated by the institution. Examinations are sometimes made upon call by members of the staff.

   2. School clinics.
This type of clinic is to determine the mental status of children three or more years retarded, and to plan special classes for them in training. There are no school clinics.

   3. Out-patient work
Outpatient work as defined means what the hospital is doing in the community to provide facilities for the examination of persons needing psychiatric diagnosis and care. There are no formal arrangements for clinics of this kind. The Superintendent and other members of the staff, but particularly the Superintendent, is called to do consultation work, such as usually would be done in an out-patient clinic.

   Examination of prisoners: This type of examination is done by the Superintendent, when called to do so by the Court.



section "13"



XIII. GENERAL PUBLIC RELATIONS AND EDUCATION

   There seems to be no relation to civic organizations, that is, in the form of any organizations presenting regular entertainments for the patients socially.

   Relation to churches: It would seem that many members of the clergy have visited and do visit the hospital at regular intervals.

   Public or hospital publications: The hospital does not have a publication.

   Annual reports: The hospital does have an annual report, which gives a good picture of each year's activities, both in the medical and in the business field.

   Relation to local medical groups: There is evidently a good spirit, of co-operation between the local medical group and the hospital.

   Relation to schools and colleges in the community: It has been previously mentioned that the hospital does take students in occupational therapy for training.

   Relation to other hospitals in the community: There is a plan in which the Provincial Hospital is enabled to use the facilities of the very excellent pathological department at the Saint John General Hospital.

   General or special talks: It is known that the Superintendent has, upon invitation, given papers and talks before various organizations.



section "14"



XIV. LAWS

   Boarding-Out Patients
The hospital does not have an arrangement whereby patients may be boarded out in the homes, funds being provided by the hospital. This plan is an excellent one in this way, that in properly selected homes and under the supervision of the hospital, many convalescent patients are readjusted from the hospital back into the community, and by this means are enabled to procure positions. Each patient boarded out in this fashion helps to relieve overcrowding and is one means of providing a steady out-flow of patients from the hospital to the community.

   Restraint
Restraint is used in
(a) Emergency.
(b) Violence.
(c) Homicidal or suicidal types of patients.
(d) Postoperative cases, in the sense of medical restraint.

   Restraint is used very freely. Patients are restrained by means of straps with padlocks. In some instances, the patient may be sitting down and restraint is applied by means of the side of the bench or chair in which the patient is sitting. Other patients are restrained by the ankle to fixed pieces of furniture, and restraint is applied to patients who are in bed. The arms are fixed at the wrists to the bed and, in some instances, there seemed to be a strap which acted as a restraining feature extending over the body and fixed to the bed. So far as I can determine, restraint seems to be applied without order of the physician. These appliances are kept at hand and applied by the attendants, in accordance with their judgment. Restraint of this type is an obsolete practice and in its place methods of treatment should be planned beginning with:
  • (1) A better classification of patients with segregation of those patients who are very disturbed and who in turn may disturb other and larger numbers of patients.

  • (2 ) The utilization of occupational therapy and hydro-therapy.

  • (3) The planning of work for patients of this type in so far as possible.

  • (4) Getting these patients into the airing court or out to walk.

  • (5) I believe that restraint applied in this form and as freely as it is applied, and apparently without supervision, causes the patients to chafe and to become restless and rebellious. I recommend reduction of mechanical restraint as quickly as possible. Remodeling to create hydrotherapy suites and occupational therapy departments will take an appreciable length of time.

   Chemical Restraint
Chemical restraint is used freely in the form of apomorphine 1/20 to l/50 gr. plus l/100 hyoscine. The hospital has been accused of using this combination of drugs very freely in the past but at the time of my visit it evidently had been cut down considerably, though conditions may require an increase from time to time. I personally do not like this combination of drugs because of the action of the apomorphine, and I certainly do not think that it should be administered excepting when absolutely necessary, and then only upon the order of the physician and a careful record should be kept of every administration. I agree that chemical sedation is necessary at times, and I also agree that competent men have certain drugs of choice.

   Implements of restraint were kept in the clothes rooms and not under lock and key.

   Restraint Record and Book
I do not find that there was any record kept of restraint. I believe that restraint should be recorded by name of the patient and by hours, and it should be applied only upon order of the physician.

    Image of Male Ward Service

    Image of Female Ward Service

   Patient's Valuables
Patient's valuables, as mentioned before, are cared for by one person, who is entrusted with this particular duty.

   The Provincial Hospital is nearly one hundred years old. It has a long history and has developed many outstanding men in Canadian psychiatry. In structure, it is second-class, brick exterior, and all together housing about 1,300 patients. From time to time wards have been remodeled and attempts have been made to bring various parts of the institution up-to-date. The infirmary wards are very well re-constructed and are modern in every respect. A place for the operating room had to be devised, as well as many other medical, drug and examining rooms.

   A great deal has been done by the Superintendent in terms of sanitation. Toilet fixtures have been arranged and a great deal of study has been made in relation to plumbing and the disposition of sewerage. The Superintendent has been seriously hampered, especially in these war years, by an extreme shortage of help. However, despite this, he has managed to carry on . It did seem to me that a great deal of time has been spent in administration of this kind with the result that the large backlog of patients in the continued-care group has suffered, that is, these patients have no form of occupational therapy, hydrotherapy, and very little in terms of recreation. It has appreciated that one man cannot spread himself over such extensive property, accomplish remodeling, and at the same time have in mind the needs of this continued-care group. However, one of the serious weaknesses of the hospital lies in the fact that these patients do not have sufficient supervision, nor do they have organized plans of treatment.

   Restraint, as observed by the inspector, is of many years ago and should have been long ago replaced by more modern plans of care. Restraint perhaps is the homicidal type of case, under the ward arrangements is not adequate, perhaps, is necessary, but on the whole it is regrettable indeed to find restraint so extensively carried out when more humane forms of treatment have long ago been the acceptable device for the care of the mentally sick.

   Classification of patients
It is recognized that this institution has to receive all forms of patients from the lowest type of idiot to the civilian who has unfortunately been overtaken by mental illness, but who in all other respects is harmless and to be regarded as a person who is sick, to the wildest types of paranoid individuals capable of doing extreme harm both physically and by means of letters, inuendos, and other schemes to disturb the morale of this administration.

   Food Situation
As to the kitchen and main cafeteria, the kitchen, as has been stated, is modern in appearance, apparently above the basement level. It is my feeling that there is too much congestion in the food service section, even though the food be of good quality and well prepared. I tasted the food in all parts of the institution and it did seem to me to be well prepared and palatable. A great deal of criticism has been directed toward the dietary because of so many preparations in liquid forms, that is, stews, soups, etc. There is much to be said on this point from the standpoint of economy and digestability. Foods of this kind have a proper place in an institution and there are many patients who cannot take other types of food because they are edentulous, but there must be a satisfactory balance between solid foods and stews and soups. A great deal of criticism was made of the breakfasts, especially the monotony. This seems largely to be true. Breakfasts consist of the one type of porridge, day in and day out, with bread and butter (when obtainable), coffee, and sometimes dried fruits (see sample of menu). It must be appreciated that foods are difficult to obtain in this war period and perhaps certain allowances can be made under the circumstances. It appears to me that the planning of the food was largely left to the head cook. There is no dietitian at the present time in the institution and no one excepting the head cook to supervise the preparation of food and the planning of the menus.

   I think that the matter of food deserves a great deal of study in this institution, both from the standpoint of menue-planning and the distribution of foods to the dining rooms, the distribution of foods to the wards, the lack of thermo-containers, and the discrimination that is made between those patients who are termed "private"and divided into several classes, and those patients who are supported by Dominion or Provincial funds.

   I recommend a modern building situated as centrally as possible above the street level and being designed in such a way that the kitchen itself be centrally located, that is, between the employees' dining room section and connected with it, and the patients' section. In this type of service building, ventilation is obtainable, there is an air of cheeriness in the dining room sections because the sunlight is permitted to flood the entire areas, and the picture in contrast surely leaves one in a very critical situation as it relates to the presence of basement food service sections.

   Criticism has been directed toward those more or less helpless patients who are fed by means of a tray. Some of these patients are said to have placed the tray on the floor and to have eaten from it in this fashion. I know that many of the patients are fed by tray service and I dare say that in some instances the tray has been placed on the floor and the patients have eaten in this way. Tray service, without question, is necessary in dealing with a group of patients unclassified as these patients are on some of the wards, but tables should be provided and the patients should be permitted the privilege of sitting down at their meals.

   Housekeeping and Personnel
On the so-called good wards, the housekeeping was satisfactory. On the disturbed wards, as one can and will well recognize, this is indeed a difficult chore. An effort was made to maintain sanitary conditions, but on Ward 2 for male patients, where there was a mixture of all types of patients, and with a marked shortage of personnel, conditions were not good. The patients in all instances were properly clothed and an effort was made to toilet the untidy patients. In this group especially was a large number of mental defectives, who frequently soil themselves and their clothing, despite efforts to keep them clean. The clothes rooms on many of the wards were in fairly good order. On other wards the reverse was true. The housekeeping should be very carefully supervised.

   The Old Attic
A room in the upper section of the main building, unfinished, and crowded with low cot beds-so crowded that it is and was difficult for one to make his way about. It has been charged that this section was unheated, but there were evidences of a plan to heat this section by means of radiation. At the time of my visit, this area had been scrubbed out with a solution containing a disinfectant, which gave off a strong odor. Toilet facilities seemed totally inadequate for the thirty patients who slept in this section. The Superintendent recognized the inadequacy and the inappropriateness of this dormitory and had intended as soon as possible to have had it remodeled and re-finished, but on the whole it is a very undesirable place to house human beings.

   The housekeeping at the annex was excellent. Everything was clean and shiny. The patients were well clothed and the clothing rooms were in good order.

   The kitchen was clean and the preparation of food quite satisfactory.

   Personnel
There is a grave shortage of personnel in practically every department of this institution, but on the ward service it has reached a very dangerous level. It is particularly dangerous because the Provincial Hospital has to receive all types of commitments which have been previously mentioned. The criminal insane so-called is a special group that requires segregation and special supervision. They are dangerous and oftentimes their type of mentality is such that they influence other patients who without this influence might conform and might get along is very satisfactory fashion. The same holds true for the mental defectives as a group. They should be segregated by themselves. They should have the kindliest of supervision and guidance. In certain wards these patients are thrown in with others who are much keener mentally and who it seems have at times been abusive to them. The mental defective of the lower grade is an entirely helpless individual and no words are too strong to express the absolute need of their being kept by themselves under special arrangements of ward space and nursing care.

   The shortage in the medical service is so great that they cannot possibly give adequate care to the number of patients, there being in all but four physicians to the nearly 1,300 patients.

   I would add to some of the above thoughts, this thought, in reference to administration. I would say that the Superintendent had worked hard and long and that he had devised many plans to remodel and that the backlog of chronic patients, for this reason, had suffered. On the other hand, he has, because of his keen mental alertness, created a good medical discipline, carrying on such modern forms of treatment as electric shock therapy and insulin therapy, with good medical care of the physically sick. Thus one sees a paradox, in an institution nearly one hundred years old, on the one hand the newest forms of medical treatment carried out intensively, and on the other hand sections in which the care of patients is quite primitive.

   Department interrelationship
There does not seem to be any cohesion between the various departments. The Superintendent has taken upon his shoulders the almost impossible burdens of administration, planning reconstruction, active medical effort, both in the institution and in the community, subject to call by courts and consultation, the undertaking a task which is impossible of fulfillment in the sense of leading to the best care of the individual patients or the patients as a whole. In other words, the administration of a hospital the size of the Provincial Hospital should include a cohesiveness between such departments as the farm, the engineering, the nursing, the medical, the business administration, maintenance, (ward supervision, male and female)-all of these departments must be closely joined in ideas and in operations. Each department, it is true, has separate functions and yet these functions should flow together in a stream, and this stream should have but one goal, namely, the pooling of the abilities of personnel in these departments toward the common good of all patients of all types. There does not seem to be a unity as one views the departmental structure. Under normal conditions, department heads should sit in conference at least once a week and at least for an hour to an hour and a half period. Here each department head should be given the opportunity of expressing himself, of placing before the Superintendent any ideas which he may have. Here the department head should have the opportunity of ironing out any differences or misunderstandings which may exist with other department heads. There cannot be looseness and misunderstanding, and if these characteristics do exist, it means an improper functioning of the total organization.

   Again in reference to personnel, I will set up what I consider an adequate number and type for the medical group and for ward service, since these two groups are all important in relation to the care of patients, and since in this instance severe criticism has been directed toward this feature of the hospital. As I see the great weaknesses of the institution, they lie in:
  • (1 ) Poor classification and serious overcrowding, and construction not suited for proper classification.

  • (2) The unrestricted and unfortunate evil of restraint, both by implement and by medication.

  • (3) Food service and distribution leaves much to be desired.

  • (4) An entire lack of preventive community work.

   Below I have endeavored to analyze in terms of classification the types of criticism as it appeared in the public press. In the several installments, such factors as were brought up for criticism fall into certain related groups or under certain definite headings, and these I present below:
  • 1. Roughness of some attendants toward patients.

  • 2. Restraint as applied by straps.

  • 3. The lack of proper supervision due to shortage.

  • 4. Improper classification of patients according to type.

  • 5. Lack of bedding, that is, blankets in "Old Attic" so-called.

  • 6. Criticism of ward care, especially odors, and to some extent the appearance of certain wards.

  • 7. Abuse to patients by certain attendants.

  • 8. The attitude of certain attendants toward patients, that is, fatalistic.

  • 9. That roughness and abuse of certain patients toward others was tolerated by certain attendants.

  • 10. The lack of therapy or occupation to take up the time of patients who remain idle for long hours.

  • 11. The promiscuous use of sedation by hypodermic injection of the mixture of hyoscine and apomorphine. During the period of my inspection there were but few hypodermic injections for the purpose of sedation. Unfortunately, I do not have record of the complete number before that time, but these records are available at the hospital.

  • 12. A great deal of criticism directed toward Ward 2.

  • 13. The appearance of vermin, such as cockroaches and rats.

  • 14. Dietary-the monotony of breakfast and the prevalence of liquid or semi-liquid foods.

  • 15. A process called "stretching," whereby a patient's arms are restrained over the head, leaving the arms numb the next day.

  • 16. Theft-the stealing of property belonging to patients by other patients.

   It must be remembered that in the care of the insane there is always a group of very difficult patients, and I refer to the group which is untidy, demented, denudative, destructive and restless because of the inroads of their disease. These patients, even under the best of conditions, would leave any hospital open to criticism by a critical observer. There must and should be a fair way of presenting criticism, keeping in mind such serious features as the lack of help, a fifty per cent shortage. On the other hand, one might well visualize the Provincial Hospital on a five-year basis, or certainly within a ten year basis, or making such changes within its inner structure that a proper classification of patients can be made, that the integrity of this classification can be preserved, that the supervision may be of high order, such as to sustain intelligent humane care and kindliness, that the food and service sections should be arranged in accordance with the above recommendations. It is recognized that this will be a costly procedure. However, in order to preserve a public trust, money must be expended that the welfare of the patients come first and leave as little opportunity for criticism as possible. The Provincial Hospital, by the development of a plan of this kind, might well receive an orderly inflow of patients and an outflow back to the community. It should and can be the center of mental health activities for the province. By the development of out-patient work in mental health, by a union with the Saint John General Hospital in the development of an out-patient clinic, one has the picture of this institution becoming an outstanding opportunity.

   Many times I have mentioned the fact that the Superintendent impressed me as being a high- grade medical man and a hard-working physician with deep interests at heart, as it related to the development of this hospital. He finds himself at the moment in a very unhappy position and is seriously hurt. It was not easy at times to confer with him because of his feeling of injury and his feeling that because of this injury he could not carry on longer. I attempted in such ways as I could to persuade him that it was his duty to head this institution during this trying period and for the duration if possible. No person in public life is free from criticism and no person, particularly having charge of a large body of mentally sick persons, can be entirely immune, no matter how much labor is expended. The very nature of our work with this type of illness oftentimes lends itself to public criticism and, in many instances, we do not have the opportunity of rebuttal. We must accept criticism and divide the criticism into two parts-that which is deserved and that which is undeserved. That which is undeserved should be sifted and relegated to one side. The criticism that is deserved leads to the development of a better institution. A mental institution exists for one purpose and that is the best care than can be given to any and all types of cases, regardless of the comfort and security of any employee.

   Business Manager
I spent considerable time with Mr. Gilbert discussing his methods of accounting, purchasing and general relationship to the institution. I find that under the law his province is quite restrictive. He seemed to have a thorough knowledge of his work and of the financial set-up, including the payroll. I asked questions concerning the quality of food and materials purchased. His answer was that his policy was to get the best he could at the best prices. In other words, for the most part, purchases are made on bid and many of the purchases are made through local shopkeepers. In order to remedy some of the criticisms which appear above in this writing, I believe that the business manager should have more administrative responsibility, should be more closely identified with all of the other departments, particularly engineering, maintenance, farm and food. I have mentioned again many times the burden of the Superintendent at the Provincial Hospital. I believe that if this burden had been better distributed it would have given the Superintendent, an eve to the marked weakness in the functioning of the hospital, namely, the case of the large number of chronic cases, the alleviation of restraint: the better planned diet and food distribution. In other words, it seems to me that the Superintendent of a large institution, while he should not be cloistered, and while his office should not be inaccessible, yet his greater function is to make plans, plans of development, betterment, a study of his personnel that this personnel may be fitted into the schemes of betterment, and that this process the institution may move forward, both in its intramural activities and in its extramural activities. A Superintendent, bound by many details of administration, is entirely devoid of this opportunity of planning for better patient care: that is, if his time is to be spent in remodeling, reconstruction, the location of sewers, planning of pipe lines, sanitation, ventilation-all of these features are far removed from the humane aspect, of the medical officer.

   Community Relationship
Every facility of a mental hospital offers an opportunity for good community relationships or for the opposite, namely, poor community relationships. The latter leave a hospital in such a position that in a sense it has no friends, or but few friends, or in a general way, it is misunderstood and unrecognized. Every officer and every employee of an institution can be a messenger of goodwill if the spirit of the hospital is of such a nature that an employee can go into the community with the feeling that his institution is doing the best that it can under any given set of circumstances. On the other hand, an unkind word by an untrained telephone operator may make for unfriendliness and even enemies.



section "15"



RECOMMENDATIONS

   The departments of a mental hospital may be divided into the following departments:
  • (a) Medical

  • (b) Administration

  • (c) Kitchen and Dining Room Service

  • (d) Domestic Service

  • (e) Ward Service, Male

  • (f) Ward Service, Female

  • (g) Industrial and Educational Department

  • (h) Engineering

  • (i ) Repairs

  • (j) Grounds

   I strongly recommend that an Advisory Board consisting of from five to seven members be set up these members coming from various sections of the province and being representative individuals; that meetings be held monthly and at that time that the Superintendent make a complete report embodying all the departmental activities during the month; that this Board inspect the hospital, or parts of it, at the time of its meeting; and that a committee be established to visit the hospital between meetings. This Advisory Board would be extremely helpful to the Superintendent in bringing before the Board the problems of the institution and it would also serve to have inspections made and thus the Board would be advised as to conditions at all times. The writer fully realizes that this report is written in one of the most severe shortages of personnel that we have ever known and the writer understands fully that it is impossible to go forward in the face of such a shortage. However, with a change of conditions, these plans can well be carried out.

   The medical staff should consist as a minimum of the Superintendent, an Assistant Superintendent, one senior physician for the male ward service, one senior physician for the female ward service, one assistant physician, male ward service, one assistant physician, female ward service, one senior physician for out-patient work as described in the foregoing report.

   Administration
I believe that the business office should take over part of the administrative load under the direction of the Superintendent. This step might well include supervision of food, kitchen, and dining room service, engineering, repairs and farm.

   Kitchen and Dining Room Service
Kitchen and dining room service should have at least two dietitians, one to supervise the preparation of food in the large kitchen, and the other to have charge of special diet preparations and to assist the above-mentioned dietitian.

   Domestic Service
No comment.

   Ward Service, Male
There should be a graduate nurse for each ward and sufficient attendant nurses to assist on each ward.

   Ward Service, Female
The female service should have a Superintendent of Nurses and two assistants in the form of supervisors, a graduate nurse in charge of each ward, and sufficient attendant nurses to assist on each ward.

   Ward Service Female
The female service should have a Superintendent of Nurses and two assistants in the form of supervisors, a graduate nurse in charge of each ward, and sufficient attendant nurses to assist on each ward.

   It seems to me that a minimum of one ward employee to eight, patients should be set up in the overall ward service quota. The overall ratio, including all personnel on a 24-hour basis, should be at least one person to eight patients, or taking the figure 1,300 and dividing by eight, would mean 163 persons employed in ward service. The ward personnel includes attendant nurses, graduate nurses, supervisors and teaching personnel. The modern mental hospital is gradually planning to have a well-qualified graduate nurse with an R. N. degree and a B.S. in Ed. degree, and that this one person have the full responsibility of nursing on both the male and the female service. Many hospitals have not as yet been able to carry out this plan, but it is a plan of very great merit. I recommend, also, that as many graduate nurses and female attendants as possible be employed on the male service. I find that their presence is very helpful in the kindly care of male patients.

   Industrial and Educational
There should be at least three occupational therapy workers, that is, a head occupational therapist and two assistants, and six students. There should be a man in the position of industrial therapist, who is capable of teaching patients to make practical implements for use in the institution, such as brooms, weaving, etc.

   Engineering
No comment.

   Repairs
I did see that the carpenter shop is quite useful and many patients have happy employment here.

   Farm
It seems to me that many more details could be devised if transportation could be provided from the main building to the farm so that patients who are now idle, inactive or rebellious, would be permitted to work off this energy in useful employment.

   Grounds
Details also could be devised to work upon the grounds in healthy, out-of-door employment.

   In conclusion, the following points should be brought out, in addition to previous statements in reference to Dr. Menzies' period. He was one of the first, if not the first, to introduce malarial treatment in certain forms of mental illness, and this treatment is being used routinely.

   Because of overcrowding and the shortage of help, Dr. Menzies has had a very heavy burden and has certainly done the best he possibly could with what resources he had at hand, and I again commend him for his hard and faithful work.

   (Signed) C. A. Bonner, M. D.
CAB :MES


About the electronic version
Report of Royal Commission Inquiry: the Provincial Hospital.
[electronic resource]
New Brunswick. Royal Commission Inquiry [into] the Provincial Hospital.
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1998
Note: Images of the print version have been included.
About the print version
Report of Royal Commission Inquiry: the Provincial Hospital.

New Brunswick. Royal Commission Inquiry [into] the Provincial Hospital.
Queen's Printer
Saint John
1945 Print copy consulted: Provincial Archives of New Brunswick, RG30 RS621
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Revisions to the electronic version
2/25/99 Editor Elizabeth Hamilton, Project Manager, SchoolNet project no.1269, University of New Brunswick Libraries.
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    Abstract: Royal Commission on the Provincial Hospital

       In early 1945 , a series of reports appeared in a Montreal newspaper, The Standard . The stories were written by a reporter, hired as an attendant at the Provincial Hospital in Fairville , New Brunswick. The reporter, Kenneth Johnstone , went to work undercover in the hospital, because three disgruntled ex-employees had sent letters condemning the hospital's practices to The Standard's editorial staff. It is evident that those who ran the hospital and those politicians in whose constituency these wrong-doings allegedly occurred were greatly distressed by the bad publicity. The commission was created to counter the allegations made by Johnstone and the three former employees. The former employees were easily dismissed as either criminal, mentally ill, or, interestingly enough, having links with members of the CCF . However, Johnstone's allegations would take more effort to dismiss.

       Unlike the stories that appeared in The Standard, the commission found that the hospital's "care and treatment [was] good in every department of the institution." Any problems that did exist were a function of inadequate staffing resulting from war-time shortages, rather than any structural defects.

       From their findings, the commission made a series of recommendations, rather banal though they were. The following are some examples of those recommendations: four doctors should be given special commendation for outstanding work during the war years and "substantial pay increases"; World War II veterans should be moved to a veterans hospitals; another building should be constructed to handle the overcrowding problem; there should be a minimum of six psychiatrists on staff; and, the establishment of a Board of Governors to be appointed by the Premier and Executive Council was "strongly recommended".

       h.c.

       Commissioners:
    J. B. M. Baxter
    L. M. Pepperdene
    E. B. Sweeney




    Résumé : Commission royale d'enquête sur l'hôpital provincial, 1945

    Au début de 1945, une série d'articles ont paru dans le journal montréalais The Standard, sous la signature de Kenneth Johnstone. Il avait été engagé comme préposé par l'Hôpital provincial de Fairville, au Nouveau-Brunswick. Il l'avait été sous un faux nom, car trois anciens employés mécontents avaient écrit au rédacteur en chef du Standard à propos des pratiques répréhensibles de l'établissement. Les administrateurs de l'hôpital et les politiciens de la circonscription où les actes répréhensibles avaient supposément eu lieu ont été très perturbés par toute la mauvaise publicité de l'affaire. La commission a donc été créée pour contrer les allégations du journaliste et des trois anciens employés. Les allégations des anciens employés furent rejetées du revers de la main comme émanant de criminels ou de personnes déséquilibrées ou qui provenaient-ce qui est très révélateur de l'époque-de personnes ayant des liens avec des membres du parti CCF. Mais les allégations de Johnstone ne purent être aussi facilement balayées sous le tapis.

       Contrairement à ce que laissaient entendre les articles publiés dans The Standard, les commissaires ont constaté que l'établissement "prodiguait des soins et des traitements de bonne qualité dans tous ses services". Si des problèmes existaient, il n'étaient attribuables qu'à la pénurie de personnel occasionnée par la guerre, plutôt qu'à des lacunes de l'administration.

       Suite à leur enquête, les commissaires ont formulé une série de recommandations plutôt anodines. Voici quelques exemples de ces recommandations : il fallait reconnaître officiellement le travail exceptionnel de quatre médecins pendant les années de guerre et leur accorder "des augmentations salariales substantielles"; il faudrait transférer des anciens combattants de la Seconde Guerre mondiale dans un hôpital d'anciens combattants; il faudrait construire un nouveau pavillon pour régler le problème d'engorgement; il devrait y avoir parmi le personnel au moins six psychiatres; enfin, les commissaires "recommandaient vivement" que le premier ministre et le Conseil exécutif nomment un conseil des gouverneurs de l'hôpital.

       Commissaires:
    J. B. M. Baxter
    L. M. Pepperdene
    E. B. Sweeney