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PUBLIC DOCUMENT No. 26.

TWENTY-THIRD ANNUAL REPORT OF THE INSPECTORS OF THE STATE ALMSHOUSE AT TEWKSBURY,

For the Year ending September 30, 1876.

BOSTON:
ALBERT J. WRIGHT, STATE PRINTER,
79 Milk Street (corner of Federal).
1877.

Commonwealth of Massachusetts.

INSPECTORS' REPORT.

To His Excellency the Governor and the Honorable Council.

In compliance with the laws of this Commonwealth, the Inspectors of the State Almshouse at Tewksbury present their Twenty-Third Annual Report.

The reports of the Superintendent and Resident Physician, which accompany this, and are made a part of it, give in detail the statistics relating to the inmates and their condition, and of the expense of the maintenance and management of the Institution, with such particulars in tabulated form as the law requires us to furnish.

It only remains for us to offer such comments and suggestions as may seem of particular importance or interest.

The history of the past year has been on the whole very satisfactory. The average weekly number of inmates has been 74 above that of the year previous. This increase, considering the large number of unemployed, in consequence of the continued stagnation of business, is not surprising; it has, however, at times, crowded the Institution beyond its proper capacity, so that early in the year we notified the Board of State Charities that more were sent here than could be properly cared for, stating that 900 was the maximum number which could be suitably accommodated. On our visits, we have usually found the dormitories too crowded for comfort or health. We therefore approve the suggestion of the Superintendent, that a temporary building be erected to provide for this exigency.

There has been a very gratifying decrease in the percentage of deaths from last year, as appears from the Superintendent's report; this may, as he suggests, result in part from the improved average physical condition of those admitted, they being more largely from the able-bodied. But whatever the cause may be, the fact is one that we are most happy to report.

The great increase in the number of foundlings admitted, and the large mortality that seems inevitable among them, is noticeable; and we are favorably impressed with the recommendation of the Superintendent, that the provisions of the laws be so modified, that these unfortunate infants be sent to an institution having special facilities for their care.

Although the appropriation made by the Legislature for the support of the Institution was less than our estimate of the amount needed, we think that no deficiency will be incurred on the general expense account, as, although the amount of supplies has been as great as we supposed would be required, the decline in prices has largely reduced the cost.

The number of physicians and nurses having been increased, we anticipate that the specific appropriation for salaries will prove insufficient.

The Act of the last Legislature, in regard to the medical supervision of the Almshouse and Asylum for the Insane, having made important changes in the mode of appointing the Resident Physician, his assistants and nurses, in accordance with the provisions of the Act, we nominated to Your Excellency as Physician, Dr. William H. Lathrop, who had previously filled that position by appointment of the Superintendent and Inspectors, since October 1, 1875. We are abundantly satisfied with the manner in which he has discharged all his duties; we consider him, by his character, education, experience, and skill, as well fitted for this important post.

Dr. George E. Putney and Dr. E. Q. Marston were appointed by Dr. Lathrop as his first and second assistants, upon the resignation of Miss Helen M. Marsh, M. D. We believe that his commendation of them is fully deserved, and we desire here to cordially express our appreciation of the valuable services which Miss Marsh, M. D., rendered to this Institution while she was connected with it as assistant physician.

There has been no change or improvement in the buildings to be noted, except the division of a part of the first and second floors of the Asylum for the Insane into single rooms; this is fully described in the accompanying reports, and we believe that it will prove advantageous and convenient in the management of the insane.

We concur with the opinions expressed by the Superintendent, as to the importance of more barn room; we believe that his reasoning on this point is sound, and we trust that the coming Legislature will make the appropriation needed for this purpose. We should also, perhaps, mention that a small wooden building, situated some distance from the main buildings, and used as a pump-house, was destroyed by fire on the 30th of September; the pump was also somewhat damaged. We are now rebuilding with brick. The entire expense of this building and repair will amount to about $1,000.

The floor in the basement of a portion of the Asylum for the Insane, having become much worn, is being replaced with brick, at an expense of about $300.

Without going further into details, we are of the opinion that the affairs of the Institution have been faithfully and skillfully administered by the Superintendent and his assistants for the past year. It was never in a better condition than it is to-day. Under the promptings and instructions of the great teacher, Experience, there has been improvement from year to year in its management, and we believe that any intelligent and candid observer who should now go through all parts of the Institution, would be impressed that the poor of Massachusetts, who make their home within its walls, have little to complain of.

Trusting that it will continue to receive such favorable consideration of the Legislature as its wants may require, we submit this Report.

F. H. NOURSE,
GEO. P. ELLIOT,
W. R. SPALDING,
Inspectors.

ALMSHOUSE AT TEWKSBURY.

SALARIES.

OFFICERS AND EMPLOYES

Remaining at the end of the year, their positions and compensation per year.

This is to certify that the foregoing is a true schedule and appraisal of the personal property and real estate at the State Almshouse at Tewksbury, belonging to the State of Massachusetts, September 30, 1876.

The appraisal was made by us, and is correct, according to our best judgment.

(Signed) PEDRICK & CLOSSON,
Appraisers.

Then personally appeared before me Wm. R. Pedrick, and made oath that the foregoing schedule and appraisal is correct, according to his best knowledge and belief.

Essex ss. Before me this second (2d) day of October, 1876.

(Signed) A. W. HARMON,
Justice of the Peace.

SUPERINTENDENT'S REPORT.

To the Inspectors of the State Almshouse at Tewksbury.

Gentlemen: -- In submitting the Twenty-Third Annual Report of this Institution, it is my pleasant duty to congratulate you upon its general condition, and the continued prosperity which has attended it.

As a final retreat for the diseased in mind, whose care, or even relief, has been abandoned by experts, and whose physical state tends only to decay and death, and as the only State Almshouse, which is its true character and designation, for more than a million and a half of people, its population, in ordinary times, must be made up of the infirm, the sick, and defective, of whom many can never be expected to leave its walls.

Under these circumstances, no reasonable person can expect the rate of mortality to be the same as in ordinary communities. Liable, too, as is such a population, to a sudden access of illness, both from within and without, it is not easy to maintain, on every day of the year, and in every variation of the atmosphere, a sanitary condition thoroughly satisfactory to ourselves. But constant effort in this direction has accomplished results which are certainly gratifying to us, and which, perhaps, are the best that can be attained with our present means.

The mortality for 1876 has been 276 out of a total of 3,001 supported, or 9 per cent., while in 1875 it was 325 out of a total of 2,926 supported, or 11 1/10 per cent.

While the presence during the year of an unusual number of able-bodied persons has probably tended to this large decrease of 2 1/10 per cent, in the death-rate, it is in part offset by the inevitable decease of the foundlings, who, I regret to say, have been sent hither in greatly increased numbers. No less than 82 have been admitted during the year, of whom 70 have died; while in 1875, 27 were received, all of whom died.

Exclusive accommodation, and the kindest of nurses, have been provided for these little unfortunates, as in former years, while the care and watchfulness of their medical attendants have been unceasing; but all has been in vain. In view of these facts, I would respectfully recommend such legislation as will require the municipal authorities to commit them to the Massachusetts Infant Asylum, where the State has made ample provision for their support, and which has special facilities for their nurture, both in the institution itself and in private families.

In consequence of the action of the Legislature of 1876, our medical department was reorganized, during the summer, by the appointment of William H. Lathrop, M. D., as resident physician; of Geo. E. Putney, M. D., as first assistant; and Enoch Q. Marston, M. D., as second assistant; and by the employment of nine nurses. This necessarily involves an increase in the amount required for salaries, which fact seems to have been overlooked in making the appropriation for that item.

For the greater comfort of the insane, and for the seclusion of such as desire or need it, forty-nine rooms have been constructed by partitioning off a portion of each hall, three of which are to be used for reception-rooms, and the rest as dormitories. For the condition of the hospital and the insane department, I respectfully refer you to the report of the physician of the Institution. But I must once more call your attention to the pressing need of suitable accommodations for cases of "delirium tremens," which are now sent here in increasing numbers. This is absolutely required for their own safety, and for the comfort of the sick and infirm, who are liable to be seriously disturbed by their outcries.

You are familiar with the appearance of the buildings and the farm, from your weekly visits, and I need not go into details respecting either.

With the exception of potatoes, the crop has been fair, and the products are stated in detail in Table No. 5. A large deficiency in milk has to be supplied by purchase, $2,773.23 having been expended for this purpose during the year. I cannot believe this policy either judicious or economical. We can make better milk than we can buy; we can secure it in a fresher condition. We need the manure for the farm, and we desire to till as much land as possible to secure supplies for the inmates, which must otherwise be paid for from our appropriation. We have labor which we wish to utilize, and it can best be done in working the soil. Twenty more cows could be procured at a first cost of less than one-third of what is yearly spent for milk. But the want of barn room is an insuperable obstacle. In fact, so limited are our accommodations, that we have insufficient room for our carriages and root-crops. The operations of the farm generally are confused by this difficulty, and the yearly gain by supplying the need would soon pay for it in full. I would therefore urge most earnestly, that you make application to the Legislature for the authority and means to build a barn with a suitable cellar and carriage-house.

The buildings are in good condition within and without, except that they will need a thorough repainting, with repairing of spouts, gutters, etc., during the present year.

The continued scarcity of labor, and the interpretation of the recent law of settlement by the Supreme Judicial Court, is likely to throw upon the cities and towns a much larger number of state paupers than can be received in this Alms- house, with its present accommodations. The maximum number that can be retained here, with prudence, is about nine hundred. More than that will increase the sickness and mortality, and endanger the health of all. We shall incur a heavy responsibility if we permit this Institution to be over-crowded, by any neglect of our own to give timely warning.

I therefore suggest that temporary accommodations for several hundred more be provided by erecting a temporary building, at a moderate cost, on the western side of our inclosure, of one story and a half in height. This will be sufficient for an exigency, as we can feed and clothe without difficulty, and lodging-room is the one thing requisite.

When this panic has passed over, such a building could be used for a chapel, of which, or even a substitute therefor, we are entirely deprived, unless we occupy, at exceeding inconvenience, one of the halls of the insane asylum.

The appropriation for 1876 was $92,000, being $16,000 for salaries and $76,000 for general purposes, of which $67,279.52 was expended in the three quarters ending Sept. 30, 1876, leaving an unexpended balance of $24,720.48. Of the amount expended, about $300 was required for rebuilding the cellar wall of the barn, and $1,000 more will be required for restoring the pump-house and repairing the pumps, damaged by the fire of September 30. Although the appropriation was less by several thousand dollars than the aggregate of those for 1875, we have succeeded in greatly improving the diet of our inmates, and in expending the $1,300 just named, for permanent improvements, with the probability of incurring no deficiency for account of general expenses, unless unexpected additions should be made to our numbers. But as we were not apprised of the intention of the Legislature to limit the appropriation for salaries to $16,000, and as the Act was not passed till several months of the calendar year had elapsed, and especially as the Legislature, by subsequent action, provided for an additional number of medical officers and nurses, without providing means for their compensation, it is probable that the sum appropriated for salaries will be insufficient for that purpose.

The whole number supported during the year has been 3,001, which is less by 756 than appears in Statement No. 2; 724 of the latter number being nominal admissions under the Act of 1860, and 32 being nominal transfers.

The average weekly number has been 918, an increase of 74 from the average of last year.

The number of persons sentenced to the State Workhouse is 263, and with them have been transferred 16 infants of mothers sentenced. Two hundred and eighty-four persons have been transferred to the Primary School at Monson.

The number of deaths has been 276, being 49 less than last year.

There are remaining in the Institution, at the present time, 798 persons, being six more than at the beginning of the year. The remainder have been removed by the General Agent of the Board of State Charities, or discharged at their own request.

Dividing the gross expenditure, $89,639.57, by the average weekly number, 918, we have $97.65 as the annual cost of each inmate, which is a weekly cost of $1.88.

The close of the year reminds me of my obligations to my associates, who have faithfully served the State in their several spheres, and to yourselves, gentlemen, for your unceasing interest in this Institution, and your unfailing support in the administration of its affairs.

THOS. J. MARSH,
Superintendent.

Statement No. 1 .

Statistics of Department of the Insane.

Statement No. 2.

Of the 2,965 admitted during the year, there were from --

The following table shows the number admitted each month, sex and age: --

Statement No. 3

Nativity of Inmates.

Statement No. 4.

Cash Disbursements.

Statement No. 5.

Products of the Farm.

Sweet corn, 200 bushels.
Potatoes, 1,800 bushels.
Cabbage, 8,000 heads.
Hay, first crop, 79 1837/2000 tons.
Hay, second crop, 55 130/2000 tons.
Parsnips, 100 bushels.
Tomatoes, 100 bushels.
Carrots, 80 bushels,
Onions, 275 bushels.
Beets, 75 bushels.
Melons, 1,300.
Beans, 25 bushels.
Squash, 5,000 pounds.
Lettuce, 2,000 heads.
Cucumbers, 100 bushels.
Apples, 175 barrels.
Ice, 100 tons.
Manure, 160 cords.
Cider vinegar, 5 barrels.
Cider, 26 barrels.
Celery, 300 heads.
Pease, 42 bushels.
Greens, 50 bushels.

The Meats slaughtered from the Stock of the Farm amount to --

Beef, 1,161 pounds.
Veal, 1,031 pounds.
Calfskin, 15 pounds.
Hides, 406 pounds.
Pork, 15,091 pounds.

Dairy Products, Etc.

Milk, 23,822 gallons.
Eggs, 1,077 dozen.

Statement No.6.

Commonwealth of Massachusetts in account with Thomas J. Marsh, Superintendent

Statement No. 7.

Appropriation for Repairing Barn.

Commonwealth of Massachusetts in account with Thomas J. Marsh, Superintendent.

Statement No. 8.

Appropriation for the Alteration of the Asylum for the Insane Rooms.

Commonwealth of Massachusetts in account with Thomas J. Marsh, Superintendent.

Statement No. 9.

Commonwealth of Massachusetts in account with Thomas J. Marsh, Superintendent.

Thos. J. Marsh, Superintendent.

This may certify that we have examined the foregoing account of Thomas J. Marsh with the Commonwealth, and find the same correctly cast and properly vouched.

F.H. Nourse,
GEO. P. Elliot,
WM. R. Spalding, Inspectors

To the Honorable Board of Inspectors, State Almshouse.

Gentlemen: -- The Institution during the past year has been free from epidemics, and, especially during the summer, has enjoyed an unusual immunity from disease. The cases presented for treatment are very largely of a chronic and incurable character; but they, perhaps, as well as any, appreciate the benefits conferred upon them.

Our hospital is certainly a good one, -- agreeable, comfortable, and well adapted to its purpose. At certain times, however, the ventilation is not sufficient, and additional facilities in this respect would greatly improve the air of the wards. Screens for the windows and doors are needed in summer as a protection from mosquitoes and flies. We very much need, also, a few single rooms for the isolation of offensive and noisy patients.

The number of motherless and deserted infants sent to us of late has been unusually large. There have been 82 during the last year, whereas there were only 27 in the previous year. They have presented the usual physical characteristics of this class of children, with the usual results, though special efforts have been made for their welfare.

A better building -- as good for the purpose as any that we have -- has been assigned for their use; an excellent nurse has been employed to take care of them; they have been supplied with the milk of a single cow, selected for the purpose; and during a part of the year their milk has been brought from another farm, reputed to yield unusually good milk; patent foods of various kinds have also been tried, all without any marked difference in the ultimate result. As most of these infants who come to us are mortally diseased at birth, it is hardly to be expected that they will survive their early infancy, though a mother's care would undoubtedly save some.

The Legislature of 1875 appropriated $2,500 for dividing the Asylum into rooms. It has not been thought advisable to change the whole building in this way, but lines of single rooms have been constructed on one side only of the halls, in the first and second stories, leaving the third story unchanged. The same number of insane can be accommodated as heretofore. These rooms are not intended for the constant confinement of patients, but particularly for the isolation at night of those who ought not to sleep in a general dormitory, and also those who in the day-time have temporary maniacal attacks.

During the year the diet of the patients in the Asylum has been somewhat improved, and a larger supply of clothing given to them. By this means, their comfort has been increased, and it is believed their health also has been materially benefited.

I would suggest for the improvement of the Asylum, an increased number of attendants, as we have now but four, and I would advise also the introduction of water-closets in the older half of the building.

After six years' continued service here, Miss Helen M. Marsh, M. D., presented her resignation, May 27, and it was accepted upon the appointment of her successor, July 14. She very soon went to Europe for purposes of investigation and study, taking with her the best wishes of her patients and associates in this Institution. In their behalf, I take this occasion to acknowledge our indebtedness to her faithfulness and skill.

Dr. George E. Putney was appointed first assistant physician, July 14. He is a graduate of the Harvard Medical School, and has had experience as a physician in the Boston City Hospital. Dr. E. Q. Marston was appointed second assistant physician at the same time. He is also a graduate of the Harvard Medical School, and has had experience in private practice. Both of these gentlemen have come to us through the introduction and recommendation of their former instructors, and those best acquainted with their professional character. They have applied themselves with zeal and industry to the work of the Institution.

The nurses in the Hospital and attendants upon the insane are worthy of praise for faithful attention to their arduous duties.

We are indebted to Dr. Moses G. Parker of Lowell for valuable counsel and assistance in the treatment of diseases of the eye and ear.

To Dr. W. W. Godding of Taunton a word of thanks is also due for professional advice rendered with regard to the insane.

For myself, I beg leave to express to you, and to the Superintendent, my appreciation of the unvarying confidence which has been extended to me in the work to which I have been assigned.

The accompanying tables of statistics are herewith also submitted.

Very respectfully,
Your obedient servant,
W. H. LATHROP,
Resident Physician.

State Almshouse, Tewksbury, October 1, 1876.

Statement No. 1.

Births and Still-births.

Statement No. 2.

Statistics relating to Children under One Year Old when Admitted.

1. Children with Mothers.

Discharged during the year, 92 Died during the year, 17 Remaining in Institution, September 30, 1876, 18 Total, 127

2. Children without Mothers (Foundlings).

Ages when Admitted.

Length of Time spent in the Institution.

(MISSING PAGES 34 and 35)

Statement No. 5.

Time spent in the Institution by Sane Inmates who have Died.

DEATHS OF INSANE.

Statement No. 6.

Time spent in Asylum by those who have Died.

Statement No. 7.

Ages of Insane who have Died.

Statement No. 8.

Diseases of Insane who have Died.