# Immigration and the Commissioners of Emigration of the state of New York/Chapter 7

CHAPTER VII.
WARD'S ISLAND
PREVIOUS to the year 1847, the Quarantine law providedProvision for sick emigrants under Quarantine lawfor the care of the sick emigrant. A general tax, levied under State authority on all passengers arriving at the port of New York, was applied to the support of the Marine Hospital at Quarantine. Aliens as well as others arriving here, suffering under contagious or infectious diseases, such as yellow-fever, ship-fever, etc., were there received and gratuitously treated for one year. But no further provision was made from that period for the relief of emigrants not afflicted with any contagious disease, and they had to apply to the Almshouse authorities for admission to their medical institutions.
The whole government and property of the Quarantine hospitals Insufficiency of samewas transferred to the Commissioners of Emigration immediately after the constitution of the Board. But, owing to the want of other buildings, they were at first obliged to send all their patients to Staten Island. In consequence of this, the hospitals there were filled to excess, while, in spite of every precaution, crowds of sick, suffering under milder or non-contagious diseases, or requiring only surgical aid, were exposed to ship-fever, smallpox, yellow-fever, or cholera. These difficulties continued until April 11, 1849, when the Marine Hospital was formally restricted to the reception of contagious diseases. After this step, the Commissioners considered it their first duty to provide for and furnish hospital accommodations for those who suffered from other than contagious diseases, and a refuge for those who were destitute.
In 1847, the pressure for increased accommodations became Pressure in 1847, Temporary accommodationsvery great. Thousands of sick emigrants arrived in the summer of that year, the greater portion of whom were the victims of the Irish famine, and had to be provided for at once, and as well as possible. Several hundreds of them were sent to private hospitals, such as Dr. Williams's and Dr. Wilson's, others to the New ​York City hospitals, and still others to the Almshouse. The convalescent were nursed at the public-stores on Staten Island, the use of which had been granted by the United States Government for a limited period. Others, as, for instance, the passengers of the cholera-ship, the New York, from Havre, were, by permission of the Secretary of War, sent to Bedloe's Island, where temporary hospitals had been erected for their accommodation. These temporary measures, however, were wholly inadequate to the many wants and necessities of the emigrant; and the Commissioners speedily came to the conclusion that, in order to save expenses and provide sufficient accommodation for all their sick, they would have to build their own hospitals and places of refuge.
Choice of Ward's Island for emigrant institutionsWard's Island was the spot which they selected for the location of these establishments. A better choice could not have been made. This island, which consists of about 200 acres, and has the shape of an irregular square, is situated in the East River, north of Blackwell's and south of Randall's Islands, and extends opposite to the city from about One Hundredth Street to One Hundred and Sixteenth Street. Its proximity to the city, and its accessibility at all seasons of the year, its exemption from the inconveniences and annoyances of a thickly settled neighborhood, together with the facilities it afforded of acquiring land of sufficient extent to meet possible future needs at a much more reasonable rate than could be obtained elsewhere, under equally favorable conditions of location, these several advantages induced that selection. The Commissioners have not been disappointed in the result, now that the demands upon the island have reached to a magnitude much beyond their anticipation. As early as June 4, 1847, they tried to buy a tract of about 8 acres of land, with an old stone building originally built for a factory, for the accommodation of the increasing number of their sick, but they could only obtain a lease of the ground. On July 14, 1847, the Commissioners resolved to erect a two-story shed, 200 feet long and 22 feet wide, for the accommodation of those who could not find employment and had not the strength to work. Early First hospital erected 1848 in 1848, they determined to build a hospital, within a short distance of the building used as a refuge. On November 1, 1848, it was finished and occupied. The structure was of wood, ​filled in with brick, having a frontage of 119 feet, and two wings, running east and west, of 40 feet long by 25 feet wide. It contained, besides apartments for physicians, apothecary, and nurses, and the apothecary's shop, eleven large rooms for patients, each of the dimensions of 40 feet by 25, and affording accommodations for 250 beds.
While this hospital was in the course of construction, the Board became satisfied that still more ample accommodations would soon be needed, and that more especially a proper establishment for children was imperatively demanded. They, therefore, Erection of Nursery building 1848determined to erect a nursery building, to contain, besides dormitories and play-room, a school-room and chapel. By the end of 1848 this building was finished and partly occupied.
As it became essential to have more ground than, under the lease, was in the possession of the Commissioners, and as several lots or parcels of land on Ward s Island happened to be for sale, it was resolved to take advantage of the opportunity. Accordingly, in the month of July, 1848, 12 acres and 22 perches were purchased for $12,289 38. These purchases were continued from time to time, so that by the end of 1849 the Commissioners owned 95 acres 3 roods and 6 perches, for which they had altogether paid the comparatively small sum of 63,818 83. In 1858,Purchases of land Purchases of they held in fee simple 106 acres, with appurtenant water-rights and marsh. In 1864, they bought a piece of land for $7,200, containing 2 acres and 22 perches, lying on the eastern side of Ward's Island, quite separate from their other lands, but very desirable and even indispensable for a landing-place on the eastern or the Sound side of the island, and well adapted for hospital purposes when required. Finally, in 1868, the Commissioners purchased a tract of about 11 acres of land on the south side of the island for $50,000, so that they now hold more than one-half of the island, or about 121 acres, for which they have paid $140,930 62, including the whole of the water front which faces New York City. The remaining portion is chiefly owned by the Commissioners of Public Charities and Correction, a local board exercising the functions of the poor officers of the county.
Much, of course, has been done during the last twenty-two Improvementsyears for the improvement of the island. Temporary and wooden ​buildings have been replaced by substantial brick structures, sewers have been built, walks laid out, sea-walls erected, and not a single year has passed in which the Commissioners have not spent thousands and hundreds of thousands of dollars for the benefit and succor of those who are entrusted to their care. It would be tedious and tiresome to narrate the history of each improvement suggested and carried out for the amelioration of their condition. It will be sufficient to give a description of the buildings and institutions at present comprised in the establishment on Ward's Island. Before doing so, however, it will be necessary to state, in a few words, the history of the connection of the Marine Hospital on Staten Island with the other establishments of the Commissioners, which connection existed for just sixteen years, that is, from May 5, 1847, to April 29, 1863.
Connection of Marine Hospital, Staten Island, with Ward's Island establishmentWhen the Commission was organized in 1847, it had no lands, nor buildings, nor means. Hence it was a wise policy to commit to its charge the Quarantine grounds and hospitals, even saddled with the condition that the Commissioners of Emigration had to receive and gratuitously nurse non-emigrants, such as sailors and sick citizens. In this way, the indispensable means were at once provided for receiving and caring for arriving immigrants, who were affected with various contagious and infectious diseases, among which cholera, small-pox, and ship-fever were widely prevalent. The number of sick was appalling. In the first eight years of the Commission, nearly 50,000 were treated within these hospitals. Since that time, large hospitals on Ward's Island have been erected, owing to which the sanitary condition of the immigrants has greatly improved. Accommodations for all emigrants not affected with infectious diseases being afforded on Ward's Island, the reasons for placing the Marine Hospital in the charge of the Commissioners ceased to exist. There was, in addition, other strong and positive ground for a change; it was unjust to those from whom the emigrant fund is collected to make that fund to contribute towards the support of the Quarantine and the maintenance of the health laws. In years in which the means of the Commissioners were seriously diminished by a decrease of immigration, it was hardly possible for them to maintain those who paid the commutation money. Nevertheless, the Commissioners were ​expected to bear the cost of supporting all who suffered from infectious diseases. This injustice was only repaired by the act of April 29, 1863, which created a Board of Quarantine Commissioners. Since that time, the cases of contagious fever amongst emigrants have been sent to Ward's Island, where the former surgical and isolated wards are devoted to their reception, while the small-pox patients, chargeable to the Commissioners, by an arrangement with the Commissioners of Public Charities, have been received at the Small-pox Hospital on Blackwell's Island, and regularly paid for at a rate agreed upon between both Commissions.
Another injustice which the State perpetrated against the State Injustice to CommissionersCommissioners of Emigration is the following: On September 1 and 2, 1858, a furious mob had violently attacked and destroyed all the buildings and hospitals on the Quarantine grounds. The loss of property amounted to several hundred thousands of dollars. A committee was appointed to assess the damages, which awarded Award to Commissioners on account of Quarantine riots diverted to other purposesto the Commissioners of Emigration, for the destruction of their account of personal property at the Marine Hospital, the sum of fourteen thousand dollars, payable in bonds, and issued to them by the Supervisors of the county of Richmond. Of the sum thus raised, the whole was expended for strictly Quarantine purposes, except a small balance of about $500. An additional sum of $107,521 was also awarded to the Commissioners of Emigration for the destruction of their buildings, houses, and hospitals, but the Supervisors of Richmond County, claiming that the Commissioners of Emigration were merely trustees for the people of the State, refused to issue or deliver them to the Commissioners, and deposited them with the Treasurer of the State.
Application was made on the part of the Commissioners for a mandamus to compel the Supervisors of Richmond County to issue these bonds to them, in accordance with the award under the act. It was, however, held by the Court of Appeals that, inasmuch as the Commissioners of Emigration were trustees of the people of the State, a delivery of the bonds to the people was a substantial compliance with the law. In other words, the judgment of the Court of Appeals substantially made the State a present of more than $100,000 of the funds of the poor emigrant. ​An application to the Legislature for the transfer of these bonds to the Commissioners proved equally futile. "If, however," says the Report of the Commissioners for 1864, "for any reason these bonds should be retained by the State, then it is most respectfully submitted that, as they are given as compensation for destruction of buildings, etc., erected at various periods from funds contributed by alien emigrants, for whom the Commissioners are the agents and trustees, or from moneys borrowed on mortgage for and applied to those buildings and improvements for which these bonds were given, they should be regarded as the proper fund to pay off the encumbrances on the property of the Commission, without demanding payment of any portion of it from the Emigrant Fund." Since that time these bonds have been applied to the payment of expenses incurred in the erection of the new Quarantine Station and buildings on the West Bank, and the Commissioners have in consequence received no advantage whatever from the award.
Another illustration of the arbitrary way in which the State of New York disposes of the emigrant funds is the following:
​paid off, and the amount realized from the sale was directed to be applied towards the erection of the new Quarantine structure on the West Bank. Thus, since 1858, although the Commission has received no benefit from the lands on Staten Island, and although, since the appointment of the Quarantine Commission, the Commissioners of Emigration have been relieved of the duties which formerly devolved upon them, yet they have been called upon during the past eleven years to pay the interest on the whole $200,000, of which $150,000 was debt incurred in support of the Marine Hospital, and acknowledged as such by the Legislature. All applications to the latter for the refunding of the interest thus paid, amounting to $115,000, by the State to the Commissioners of Emigration, so that the emigrant money maybe applied to its legitimate purpose, have thus far proved of no avail, and the Commissioners of Emigration, although desirous of getting rid of the debt unjustly saddled on them, are magnanimously allowed to continue to pay the yearly interest on $150,000, with money diverted from its original object for the benefit of American citizens.
To return, however, to Ward's Island, where, since 1863, all Buildings on Ward's Island.the hospitals and refuges of the Commissioners are concentrated. We shall first give a brief description of the different buildings erected there in the course of years by the Commissioners for the use of the emigrants and the several employees. These buildings are:
The New Hospital.—This is the chief building of interest on Verplanck Hospitalthe island, it having been constructed upon the most approved plans for perfect ventilation and all necessary comforts for the sick. It consists of a long corridor, 450 feet in length and 2 stories in height, from which project 5 wings, each 130 feet long and 25 feet wide, and 2 stories high, except the centre wing, which has 3 stories. It is used exclusively for non-contagious diseases and surgical cases. The corridor affords ample room for exercise for convalescent patients, as well as a connection for the separate wings. The corners of each wing are flanked with towers, which have upon their tops tanks for water; below and attached to each ward are bath-rooms and water-closets. The rooms are heated by ​hot air, which is forced through registers by a large fan-wheel. The same power is used in the summer to secure a current of cool air through the wards. Projecting from the corridor in an opposite direction from the wings is a fire-proof building, which contains the boilers, three in number, the engines, etc. The cook-room, with 18 steam-kettles and ranges, where the cooking for the entire island is done, and above this the bakery, with 4 ovens, of a capacity each of 300 loaves of bread; also the washing-room, with machinery for washing and wringing the clothing, and 63 washtubs. On the upper floor are the drying and ironing rooms. The building also contains a basement-room for storing flour, vaults for coal, and dummies for hoisting purposes. The hospital proper has accommodation for about 350 patients. The rooms are ventilated by pipes connected with the main chimney, into which the steam is exhausted, thus forming a perfect and powerful draught. The basement is used for storage, and, in cases of emergency, as sleeping quarters for inmates of the Refuge.
NurseryThe Nursery.—The home of the children, to the right of the new hospital, is a frame building, three stories and basement, with Mansard roof, 120 x 190 feet. The basement contains the dining-room, play-room, and bath-room; the first floor, the matron's rooms and sleeping-rooms; the second floor, sleeping-rooms, also the school-room and recitation-rooms; the third floor is mostly occupied by the Catholic Chapel and ante-rooms attached. This building was completed only in 1868, having been thoroughly renovated and a new roof put on. The school is conducted by teachers from the city, under the supervision of the Board of Education, and has every convenience for the comfort of the scholars. The chapel is a neat and commodious room, and will seat comfortably about 500 persons.
​are used entirely as sleeping-rooms. It is, as its name indicates, a refuge for destitute immigrants, chiefly women and children, and will accommodate 450 persons.
New BarracksNew Barracks.—This is a plain brick building, three stories and basement, size 160 x 44 feet, with projection in the rear for boiler-rooms, bath-rooms, etc. It is devoted entirely to destitute male emigrants. The basement is used for exercise and protection in cold weather; the three upper floors for sleeping-rooms. Each floor is supplied with water-closets, bath-rooms, etc., and the building is heated with steam. It will accommodate 450 persons.
Dispensary BuildingDispensary Building.—This building is of the same size and appearance as the Nursery building, and, like it, was, in 1868, completely and thoroughly repaired. The basement is used for storage, kitchen, etc.; the first floor for the dispensary, apothecary, and clerks' apartments, dining-room for officers, and wash and bath rooms; the upper floors furnish sleeping-apartments for officers, also wards for males with chronic diseases. The capacity of the building is 250 patients.
New Dining HallNew Dining Hall.—This was formerly two stories high, 25 x 125 feet. It was enlarged in 1868 by the addition of another building of the same size, connected with the old room by arches, thus giving four rooms of a total capacity of 10,000 square feet. This is used as a dining-room for the inmates of the Refuge, and will comfortably seat 1,200 people.
Male Fever-WardsFever-Wards for Males.—These are in four brick buildings, one story and basement, each 25 x 150 feet, with bath-rooms, kitchens, etc., attached. They have each a capacity of forty-five patients.
Male Surgical WardsSurgical Wards for Males.—This is a three-story brick building, 25 x 125 feet, and is used for male surgical cases. It has a capacity of 120 patients.
Protestant ChapelProtestant Chapel Building.—Is a two-story brick building, ​25 x 125 feet. The first floor is used as medical ward for women; the upper floor is a Protestant chapel and reading-room. The chapel, in general design and finish, is like the Catholic chapel. The reading-room is furnished with a large number of periodicals and papers. The first floor will accommodate forty-five patients.
Boys' BarrackThe Boys' Barrack.—A two-story building, will accommodate eighty persons; size 25 x 125 feet.
Female Fever WardsFever-Wards for Females.—A three-story brick building, 35 x 125 feet; will accommodate 120 patients.
Lunatic AsylumLunatic Asylum.—Is a three-story and basement brick building, 25 x 125 feet in size. The basement is divided into close rooms for men or women, while the upper rooms are sleeping-apartments for both sexes; on each side are yards for the exercise of patients. This building will accommodate 125 persons. It is, however, not adapted to the proper treatment of lunatics, and will be replaced by one suited to the purpose.
Physicians' ResidencesPhysicians' Residences.—Three in number, built together, and completed in 1868; are substantial brick houses; total size, 65 x 45 feet; three stories and basement.
Superintendent's HouseSuperintendent's House.—Three stories and basement, brick, 64 x 75 feet. The two large and spacious parlors on both sides of the hall serve as reception and dining rooms for the Commissioners and their guests, while the upper part of the building is occupied by the Superintendent. Just opposite is the
Deputy Superintendents' HouseDeputy Superintendents' House.—Two stories and basement, frame, 27 x 44 feet; was thoroughly repaired in 1868.
Store-HouseStore-House on Dock.—Frame building, one story, 28 x 85 feet; used for storage.
Boat-House.Boat-House on the Dock.—Frame building, 20 x 30 feet.
StableStable.—A new stable was built in 1869, large enough to ​accommodate all the livestock required for the uses of the institution; also a new building for containing
Workshops, for the various branches of labor used on the workshops, Workshopsisland. Both of these buildings are constructed neatly and substantially of brick.
The minor buildings consist of ice-house, dead-house, fowl-house, lumber-shed, tool-house, and gardener's house.
Ward s Island is reached from the foot of One Hundred and Access to Ward's IslandTenth Street, by taking passage on a row-boat of the Commissioners, running to and from that point, or by a steamboat chartered by them, which leaves Castle Garden every day at one o clock P.M. A sick or destitute emigrant who desires to go to the island has to apply at the Ward's Island Department at Castle Garden. After an examination has established his title to the privileges of the island, he receives a permit, which contains his name, age, nativity, date of arrival in this country, the name of the vessel, and the cause of application, which permit is delivered on landing and kept on record by the proper officer. Upon reaching the island, all the new-comers are brought to the reception office, where they have to pass a medical examination, which serves to determine whether they are to be sent to the Refuge or to the Hospital. After this examination and a thorough washing and cleaning, which in most cases is indispensable, they are admitted in the proper place.
The Ward s Island Institution is divided into the Refuge and Administration of Ward's IslandHospital Department, the general care of which is entrusted to a standing committee of six members of the Board, appointed annually by the President. The charge of the various departments devolves upon the Superintendent, under the general supervision of this committee. It is, however, hardly possible to separate one department from the other. The relations between them are so intimate, that the institution, although actually divided into two departments, appears and works as an integral whole.
The Refuge Department, under the immediate direction of Refuge Departmentthe Superintendent, has charge of all cases of destitution, ​including those newly arrived emigrants who, though in a healthy condition, are prevented from proceeding on their travels from want of funds or other causes. The inmates of this department perform a considerable amount of labor for the benefit of the institution, such as farming, grading, building stone walls, etc., etc. This department includes also those persons who from age or disease are infirm and incapacitated for labor; and, moreover, affords a refuge for all those persons discharged from the hospital who have no home or cannot obtain employment. A large number of persons of these different classes are constantly provided for during the winter season.
The buildings embracing the Refuge Department are plain but substantial, and well adapted to the purposes for which they are designed. Every possible provision is made for health and comfort. One of the buildings shelters the male sex, another the women and children. For nursing women and children without parents or protection, there is the nursery, in charge of a matron. It contains a school-room, where all newly arrived emigrant children at once have an opportunity to learn the English language. Boys from ten to fourteen years of age occupy their own quarters, and are employed on light, out-of-door labor.
Superintendent's dutiesIn addition to the care of the Refuge Department, the Superintendent has charge of the entire property of the Commissioners of Emigration, and co-operates with the Medical Board in carrying out all measures affecting the well-being of the inmates; orders the supplies for the island, and is the chief executive officer to whom the heads of all the departments are obliged to report. As his duties are of a weighty responsibility and onerous, it requires not only talent and ability, but also a considerable experience to perform them.
Medical administration—its changes.The medical administration of Ward's Island from the year 1847 up to the present time has experienced various changes until it assumed its present form, which experience has proved the most efficient. When the service was first organized on Ward's Island, the office of Superintendent and Physician was united in one person. Dr. John Snowden, who first occupied this position, a few months after his appointment fell a victim to his untiring ​devotion to the sick under his care. On April 19, 1848, Dr. E. Greene was appointed his successor. The largely increased hospital service, however, soon demanded the exclusive attention of a physician-in-chief, devoted solely to that duty. The former office of Superintendent and Physician was therefore divided. Dr. Theodore A. Tellkampf, in May, 1849, was appointed to the chief medical office, while Dr. Greene remained Superintendent of the Refuge Department, subordinate to the Physician-in-Chief in all matters respecting the sanitary and hygienic condition of the institution, as well as the economical affairs of the Hospital Department.
The institution was in a very bad condition, when, on June 6, 1849, Dr. Tellkampf took charge of the Hospital Department. He organized it with the efficient aid of the Ward's Island Committee, within a comparatively short time. Competent physicians, the majority of whom had been already assistant physicians or surgeons in other hospitals, were appointed. The places of incompetent orderlies and nurses were filled as speedily as possible by others, selected carefully from among the inmates of the hospital who had recovered. In order to secure an efficient corps of orderlies and nurses, they received monthly pay, after having been trained for their various duties. A head orderly and a matron were appointed.
The so-called contract system was abolished with great difficulty, Supplies but since its abolition all articles requisite for the Hospital, for instance, medicines, meat, milk, vegetables, etc., have been of the best quality. The wards were newly furnished, and iron bedsteads introduced. A hospital kitchen was arranged; though deficient in some respects, an experienced cook with two or three assistants managed to supply all the patients—gradually increasing from 600 to about 1000—with the best diet, in full, half, and quarter rations, as ordered.
The Croton water was introduced, and a wash-house built and Croton waterfurnished with all the modern improvements.
The various departments of the Hospital, namely, the Medical, Surgical, the Lying-in Department, and the Department for Diseases of Children, were meanwhile organized, each divided and subdivided; and all sick immigrants—curable as well as ​incurable cases—were admitted, except the insane and those suffering from small-pox.
Besides the more usual divisions, others were arranged, one for patients suffering from petechial typhus (ship-fever), another for cholera patients—the Asiatic cholera prevailing at that time—and still another for about 200 children infected with prevalent ophthalmia. In order to prevent the spreading of this contagious disease beyond the institution, the children were discharged from this division only when completely cured. A temporary building was erected for post-mortem examinations. All persons on their arrival at the institution were examined first by the Physician-in-Chief, and subsequently by the physician du jour, and those found to be sick were sent to their respective wards, after having complied (if possible) with the regulations made in regard to cleanliness, dress, etc.
In the spring of 1850, the Physician-in-Chief, who, in organizing the Hospital Department, had the direction of the economical affairs of that department as well as the direction and supervision of the treatment of all patients, and who performed, besides, all surgical and obstetrical operations, except such as he could entrust to his assistant-surgeons, proposed that his senior assistants should now be appointed physicians, to have charge of departments or divisions, subject to certain regulations and restrictions, and that each should have an assistant. This proposition was approved of by the Ward's Island Committee, but not formally acted upon by the Board, owing to the occurrence of some vacancies (two in the Ward's Island Committee, namely, one by the death of the Hon. David C. Colden, the other by the resignation of George E. Kunhardt, President of the German Society, both of whom had evinced a great interest in the organization and welfare of the institution).
Adoption of English plan of visiting physiciansThis change in the composition of the Board resulted in a new course of action. While the Physician-in-Chief was convalescent from petechial typhus, from which disease the majority of his assistants, one after the other, had also suffered, the Board resolved to introduce a so-called new plan—in fact, the old English plan—according to which visiting physicians and surgeons living from six to eight miles from the island, and young resident ​physicians, were appointed. The Physician-in-Chief, after having urged in vain that the hospital service required a permanent medical staff residing on the island, and that the contemplated change, for many weighty reasons, was objectionable, and sure to lead to most deplorable results, declined the position offered to him under the new system, and resigned.
The new plan, however, was carried into effect by the appointment of eight physicians and surgeons as visiting physicians to the institution, who formed together the Medical Board of Ward's Island.
This system soon proved its inefficiency, but was, nevertheless, Inefficiency of same, and appointment of resident physicians and assistants, 1855kept up until 1855, when the Medical Department proper was again placed under the charge of a resident physician-in-chief, with two assistants, and the Surgical Department under the charge of a surgeon-in-chief, with the same number of assistants. This system has been in operation for the last fifteen years, with the simple change of one instead of two assistants in each department. The general supervision is exercised by the Medical Board, consisting of a Consulting Physician, Physician-in-Chief, and Surgeon-in-Chief. These offices are now filled by the following gentlemen: Present Medical BoardDr. J. Murray Carnochan, Surgeon-in-Chief; Dr. Ernst Schilling, Consulting Physician; Dr. George Ford, Physician-in-Chief; Dr. August Reimer, Assistant Physician; and Dr. John Dwyer, Assistant Surgeon; the three latter forming the resident medical staff. The former have been connected with the institution for a long series of years.
The regular routine business of the Hospital is about equally divided among the resident medical staff. A number of wards constitute the department of one physician or surgeon, to which his labor and attendance are mainly devoted. The Physician-in-Chief has the general supervision. The assistants have to report to and to consult with him, and to carry out his suggestions or orders. The Medical Board meets regularly every fortnight, to Medical Boardconsult upon all matters relating to the Hospital and the welfare of its inmates; to deliberate upon general questions of health, and such suggestions as may be received from different quarters; to consider and decide upon changes and improvements, and to discuss new or difficult cases in practice. A record is kept of all its ​transactions by the Secretary of the Board. The Surgeon-in-Chief, however, pays regular visits to the island, performs all necessary operations, which amount to a considerable number annually, and gives all directions and instructions to his assistant.
Hospital businessThe Hospital itself is visited regularly every morning by the resident medical staff; prescriptions are sent to the apothecary, and all directions regarding the diet or care of patients given to the attending nurses. Whenever required, two or more daily visits are of course made to patients by the attending physician or surgeon. The number of buildings, their isolation and peculiar structure, allows a perfect classification of all kinds of diseases. Thus, there are buildings appropriated to contagious diseases, while others contain exclusively non-contagious maladies; a means by which the spreading of an epidemic is not only prevented, but the chance of an outbreak lessened, because every case, as soon as detected, is immediately sent to its proper place, and all possible sanitary precautions, such as fumigation, disinfection, administered.
For the same purpose, the Refuge Department is daily inspected and examined by the Assistant Physician for the detection of any case of sickness, and its immediate transfer upon discovery to the proper medical ward.
Diseases treated on the Island.All kinds of diseases are treated on the island, with the exception only of small-pox cases, which, as stated above, are sent to the Hospital on Blackwell's Island, erected for the purpose by the Commissioners of Public Charities and Correction.
Lunatic AsylumThe Lunatic Asylum on Ward's Island has been in successful operation since 1861, but, as the present building does not sufficiently answer the purpose, it is intended to replace it by a new and appropriate structure, having room for from 250 to 300 inmates.
Number of patientsTo show the importance and magnitude of the institution, it is only necessary to state, that, during the twenty-three years of its existence, 207,862 inmates, or about 9,000 annually, have been treated and cared for at an average cost of $1 85 each per week. The labor of the institutions on the island is performed by 88 officers, clerks, nurses, and employees, who together receive a yearly salary of $32,581.
Croton waterThe island is amply supplied with Croton water, which is carried from the city by a pipe across the river to a large reservoir. ​The main sewer, but lately finished, passes from north to south, and has largely added to the sanitary condition of the island, as all the effluvia are washed out by it, and immediately carried off into the river.