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REPORT OF [THE] ROYAL
COMMISSION INQUIRY [ON] THE PROVINCIAL HOSPITAL
Image of title page
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
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
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
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
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.
- 18 Sept. 1940 Arrested for theft of jewelry. Suspended sentence, one year.
- 21 Oct. 1940 Assault on grandfather and aunt. Arrested. 60 days in gaol.
- 28 Oct. 1940 Attempted suicide; removed to Dartmouth
Mental Hospital .
- Nov. 1941 Removed to Bridgetown where used as a sort
trusty. Escaped. Followed to Sackville and found to be in Dorchester gaol.
- 20 Nov. 1941 In Watervillle Hospital for harmless
insane. Released after about 4 months.
- 23 Apr. 1944 Employed at Provincial Hospital here.
- 7/8 Nov. 1944 Leaves Hospital.
STATEMENTS MADE IN MONTREAL
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
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
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
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
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
"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
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
"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,
'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
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
'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
"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
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
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
Harry W. Cunningham, chief ward attendant, denies this incident, but it may have
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
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
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
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
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
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
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
"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
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
"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
"'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
Excerpt:-"Standard"-Issue of February 10, 1945:
"But before that I had my first opportunity of seeing the Old Master, Harry Cunningham, in
"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,
"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
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
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
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
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
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.
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
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.
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:
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
Operating Statements for the years ending October 3lst are as follows:
|Previous Year||Admissions||Deaths||Discharges||Popln. Close of Year|
|Fuel, Light, Water,
|Upkeep of Bldg., Plant,
|NET COST OF
Note: After January 1, 1945, the amount of No. 1 reduced to $2.00 and No. 2 increased to
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:
|Number of Patient
|Cost per Patient per
|Cost per Patient per
|Cost per Patient per week, including interest and sinking
|Portion of weekly cost, paid by
Municipalities||4.00||No. 1 4.00|
|Portion of weekly cost borne by
|Net Cost of
|Net Cost of
|Percent of Salaries to Total
|Cost per year per
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:
|Ward Supervisors, R. N.,||13||7|
|Chief Male Attendant||1||1|
|Ward Supervisors, male
|Ward Attendants, Male||32||17|
These salaries include cost-of-living bonus.
THE PROVINCIAL HOSPITAL BRIEF SUMMARY OF
SALARY ANALYSIS October 31, 1941 compared with March 31, 1945
|Registered Nurses:||Min. total salary increased
|Max. total salary increased from||1,116.00 annually-
|Ward Supervisors, R. N.'s,|
|Classification established Sept. l., 1943-One rate
|Total salary increased from||1,350.00 annually
|Min. total salary increased from||636.00 annually-
|Max. total salary increased from||756.00 annually-
|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 salary||876.00 annually-
|Married-Householder||Min. total salary||876.00 annually-
|Male Attendants, number increased from three to twelve, Mar. 1, 1945-
||Single-living total salary||1,530.00|
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
salary range of $120 per annum $10.00 monthly (Higher than female
- 4. Male Attendants: Minimum salary increased $180.00 per annum.
- 5. Ward Supervisors
Male Attendants: Increased $120.00 annually $10.00
THE CONDUCT OF OFFICIALS AND PERSONS
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
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
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
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
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:
Six attendants on night duty-under charge of Night Nurse-695 male patients.
Harry W. Cunningham -- Chief attendant-Ward 2:
|2-Varied types, public 100|
|7-Older-quiet public & 10
|Nurses (Day &Night)||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
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 &
|WARD A-Private Patients||18||1|
|(Some patients are never moved from this ward)|
|One nurse assigned to above wards; one attendant at
|One nurse assigned to above wards; one attendant at
|Nurse in daytime.|
|Nurse in daytime.|
|Treatment Ward (Insulin)|
|One Nurse.||1 (night)|
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:
Mr. Gilbert stated that all funds requested by their budgets had been provided, each year, by
Percy Manchester -- Superintendent of Farm:
- 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
- 4. Direct Supervision of Hospital payroll.
- 5. Supervision of the accounting in connection with the withdrawal of supplies from the
- 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
- 8. Collaboration with Department Heads on routine purchases and with the
Superintendent on other than routine purchases.
Said farm was between 350 and 400 acres; in average years produced the following:
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:
|3,017-bags (75 lb.)||Potatoes.
|548-bags (75 lb.)||Carrots.|
|138-bags (75 lb.)||Beets.|
|3,400-bags (75 lb.)||Turnips.|
|2,300-gallons||Milk-fed to stock.|
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.
THE CARE AND TREATMENT AFFORDED PATIENTS
IN SAID HOSPITAL
To obtain testimony as to the care, treatment and operation of the Institution, the following
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
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.
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
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
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.
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
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
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.
J. B. M. Baxter, Chief Justice, Chairman
L. M. Pepperdene, Commissioner
E. B. Sweeney, Commissioner.
APPENDIX INSPECTION PROVINCIAL HOSPITAL
Saint John, N, B.
C. A. BONNER, M.D.,
DANVERS STATE HOSPITAL, HATHORNE, MASS.
Inspection Dates: April 2, 3, 4, 5, and 6, 1945
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
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
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
OFFICERS OF THE INSTITUTION
|E. C. Menzies, M. D.|| Miss Catherine
Handrahan , R. N.|
Manager|| Miss Mary
|H. B. Gilbert|| Occupational
|Medical Staff|| Mrs. E. Marian
| W. J.
D. ||Chief Attendant|
|E. V. Sullivan, M. D.||F. W. Brownell|
|J. A. Gallant, M. D.||Chief Engineer|
|Part-time Medical Staff|| A. M.
|A. D. Branch, M. D., Pathologist||Building
| J. B. Gosnell , D. D. S.||H. C. Brownell |
|L. A. Donovan, V. S.||Farm
|Superintendent of Nurses||Percy
|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.
II. MEDICAL STAFF
The medical staff consists of the four physicians previously mentioned and a visiting or
consulting medical staff as follows:
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
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
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.
| H. A. Farris , M. D.||B. W. Lunney , M. D.|
| *A. B. Walter, M. D. ||Otolaryngology|
|Surgery|| L. DeV.
Chipman , M. D.|
| George F. Skinner , M.D.||Ophthalmology|
| *R. M. Pendrigh , M. D.||R. T. Hayes, M. D. |
| *J. P. McInerney , M. D.||*Enlisted in
| T. E. Grant ||Genito-
|Gynecology|| J. K.
Sullivan , M. D.|
| G. B. Peat, M. D. ||Roentgenologist|
| G. M. White , M. D.|| E. A. Petrie , M. D.|
|* Joseph Tanzman , M. D.|
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
Each physician has his office and there are stenographic facilities. There are sufficient examining
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
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
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
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.
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
- 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
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
- 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
- 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.
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
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
- 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
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
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
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.
VI. SERVICE DIVISIONS
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.
I visited the engineering department. The equipment is coal-burning and the usual appliances for
efficiency are in operation in this department.
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.
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.
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.
Many patients were employed in the sewing room and considerable work is done for the hospital.
Mending is also done in this section.
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 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.
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
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.
IX. NURSING SERVICE
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
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
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.
(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
(b) Patients are interviewed by the physicians as time permits.
(c) Relatives are received in the lobby for interviews.
(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.
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.
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.
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.
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 is used in
(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
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
Image of Male Ward Service
Image of Female Ward Service
Patient's valuables, as mentioned before, are cared for by one person, who is entrusted with this
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
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.
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
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
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
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.
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.
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:
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
- (1 ) Poor classification and serious overcrowding, and construction not suited for proper
- (2) The unrestricted and unfortunate evil of restraint, both by implement and by
- (3) Food service and distribution leaves much to be desired.
- (4) An entire lack of preventive community work.
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.
- 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
- 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
- 10. The lack of therapy or occupation to take up the time of patients who remain idle for
- 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
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.
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.
The departments of a mental hospital may be divided into the following departments:
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.
- (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 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.
Ward Service, Male
There should be a graduate nurse for each ward and sufficient attendant nurses to assist on each
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
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
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.
I did see that the carpenter shop is quite useful and many patients have happy employment
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.
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.
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Report of Royal Commission Inquiry: the Provincial Hospital.
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Abstract: Royal Commission on the Provincial
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".
J. B. M.
L. M. Pepperdene
E. B. Sweeney
Résumé : Commission royale d'enquête sur l'hôpital
Au début de 1945, une série d'articles ont paru dans le journal
Contrairement à ce que laissaient entendre les articles publiés dans
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. 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
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.
J. B. M.
L. M. Pepperdene
E. B. Sweeney