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For these one hundred and thirty-four patients, I found one head nurse, a graduate of the Boston training-school; three assistants, one of whom is night nurse; and a single matron for the lying-in and children's building, forty-four inmates. These matrons not only have the personal care of these one hundred and thirty-four persons, but cut and make nearly all their clothing, with what help they can get from such persons. The sick include thirteen sick, insane, and idiotic women, and some terrible cases of loathsome disease, sores, ulcers, humors, etc., requiring excessive care and much intelligence. Nearly all the pauper helpers are either infirm, know very little, or cannot be trusted. By day there are only four nurses to one hundred and thirty-four patients, certainly a very small number. I made many inquiries of the women in hospital as to their treatment. Without exception, all who had mind enough to tell any thing said they had kind care; some even with emotion spoke of Dr. Wilkins's and the nurses' goodness.

All my conversation with patients and inmates was held in such a way that the attendants and physicians could not hear what was said of their treatment, and I encouraged inmates to tell me fully all about themselves. Many complained of food, that it was not good, nor to their taste.

The food which I examined seemed of fair quality: the bread not so good as at Monson, but tolerably good, certainly not sour or heavy; milk, excellent; good gruel made with milk; tea reminded me of that in railroad stations, not the best quality. Butter is served twice a day to the sick, and toast for a good many, and crackers; beans once a week, for dinner; roast beef twice a week, salt fish once, fresh fish once, corned beef once, soup once, oatmeal, etc. A few sick get beefsteak, eggs, etc., when ordered by the physician. No one complained that they had not plenty to eat: all said they had. This diet is the same for sick and well, except the few extras butter, gruel, milk, etc. for sick. Some who were feeble said they longed for little dainties. I have found free patients in the Massachusetts General Hospital, whom I have visited there, getting roast chicken, beefsteak, cranberry-sauce, puddings, jelly, egg-nog, etc. At that hospital, however, the average cost of a patient is ten dollars and fifty-nine cents per week; at the Boston City Hospital, eight dollars and seventy-four cents per week. So, for two dollars and nine cents per week, little luxury can be expected. I will discuss the subject of cost more fully hereafter. I think that curable patients would recover better at Tewksbury if they had richer and more tempting fare. A large proportion of all the sick suffer from chronic disease: of these the poor, failing consumptives, those suffering from ulcers, etc., would enjoy fruit and other delicacies which they rarely have; and I felt in talking with them how hard it was that their few remaining days should not have such comfort.

A great want for the sick at Tewksbury is a sick-kitchen for each of the two hospitals, male and female, such as is in use at the Sherborn Prison and at Monson, with a special cook, where food is prepared more suitable than in the great common kitchen. But the appropriation is too scanty to admit of this. It is evident that one hundred dollars and sixty-eight cents per annum is a small sum for the support of an able-bodied man or woman.

It will provide bare necessaries of life, food, clothing, warmth, and shelter. Yet this is .what was the cost per capita at Tewksbury last year. But these people are not able-bodied: three-fourths are sick or insane, or little children in arms, or old, feeble, or crippled. They must not only be warmed, fed, and clothed, but have bodily care, be washed, dressed, fed, and, many of them, have medical attendance, nursing, medicine. It is only in large aggregates that the expense can be brought so low.

Where shall we cut it down? In attendance, when there are only nine nurses to two hundred and eleven adults, and forty infants under three years, or one nurse to twenty-eight persons? Shall we give them less food? Cheaper it can hardly be, unless we cut off milk and butter and tea. I cannot see where to reduce expenses, but I can see very plainly where they ought to be increased very materially.

The clothing of all in the hospital is of very cheap material, but decent and sufficient, except for children and infants. The excessive economy practiced does not allow as much soft flannel as these should have, nor proper outside garments for these little ones to get full benefit of the fresh air in cool weather.

The insane-asylum contains two hundred and thirty-five patients, all women; sixteen more insane women sick in hospital are counted as there in this report. For these are employed four female and three male attendants, or seven attendants to one hundred and fifty-one patients when all are in the asylum. To-day there is one attendant to every thirty-three and four-sevenths patients. These patients are in large wards. It will easily be seen, that seven attendants cannot distribute themselves among sixteen wards on four floors, so they get on as they can. The insane patients are most of them very demented, all chronic cases, capable of little work; yet they, with the female attendants, make all their clothing and clean their apartments. Every thing is beautifully neat, and is exactly as it was in 1881 and 1882, when I visited them; the persons, hair, and clothing of the insane are in excellent order, as I have always found them. Now, the very small number of attendants necessitates a great evil, the care in part by men of these insane women. Because the insane women are too strong when refractory, as they often are, for women to manage them, unless a greater number of women were employed, men are absolutely necessary. Some violations of decency occur, of which I have had ocular demonstration; women exposing themselves in a shocking manner before men. Twelve women attendants would be a small force for these wards, and at least that number should be employed. Men should never have the personal care of women, of course; yet these women in charge could never deal with their patients unless four or five attendants were available in a ward, to aid each other in case of a struggle.