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the year, has, therefore, added much to the comfort of this household of feeble people, many of whom, however, work with good will, and with pride in the institution and in the standard of cleanliness and good order established by the Superintendent. *


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LONG ISLAND, BOSTON HARBOR, January 31, 1903. To the Pauper Institutions Trustees :

I have the honor to submit to you my report of the Boston Almshouse and Hospital for the year ending January 31, 1903. On February 1, 1902, there were in the institution 720 inmates, 227 of these being hospital patients. Eight hundred and forty-three persons have been admitted during the year, making a total of 1,563 persons cared for. The minimum population, on June 19 and August 12 and 13, 1902, was 622, and the maximum population, on January 31, 1903, 771, averaging 678. These figures show an increase of 6.26 per cent. Over the average population of the previous year. During the past year two important additions have been made to the hospital. The new home for nurses was opened during the summer, and the new hospital wing for patients suffering from pulmonary tuberculosis was occupied in the fall. These two buildings have added much to the progress of this hospital. Each nurse, with the exception of probationers, is provided with a separate room, well furnished, well lighted and well ventilated, which not only adds to her comfort, but is an important factor in the promotion of good health, so necessary to this class of workers. The occupation of this building made vacant one of the cottages, which was poorly constructed and intended only for occupation in summer. This has been demolished, leaving one other cottage, which was put in repair, and is now occupied by the farmer and his family. The new wing of the hospital is, perhaps, the most important improvement which has been undertaken during late years. It provides three excellent wards for the care and treatment of tuberculosis. Each ward is furnished with a sun-room, where patients who are able to be out of bed can sit during the day to read or play games. In addition to this the wards are so placed that they are filled with light and sunshine both morning and afternoon. The hospital consists of a central building, two stories in height, and two wings, containing a diet kitchen and dining-rooms for patients. Above the dining-rooms for patients there is a ward containing eleven beds which was originally intended for women, but owing to the large number of male patients to be accommodated, this ward, as well as the two on the ground floor, is used for the treatment of cases of phthisis among men. Single rooms are provided for the advanced cases, by which their last days may be made more comfortable. After the removal of all the patients to the new hospital wards, Ward B, which had previously been occupied by them, was thoroughly renovated, and all measures possible, short of reconstruction, were taken to disinfect it and put it in a clean condition. The removal of partitions and changes in plumbing have much improved the male wing, so that better hygienic conditions can now be maintained. In the hospital the house staff has been assigned the quarters previously occupied by the nurses, and with the reconstruction of bath-rooms, and installation of shower baths, it has given the staff comfortable and homelike quarters. Owing to the increase in the number of admissions to the women's dormitory, it was necessary to equip a sewingroom in the basement of that building, using the old one for a ward. The present sewing-room cannot be well lighted, and, being in the basement, is not an ideal one, for obvious I’68,SOI)S. The old wooden sewers, from the men's and women’s buildings, have been replaced by iron outlets, extending from the crest of each bank to a point below mean low-water mark, so that the sewerage, instead of remaining on the beach, causing foul odors and an unsightly appearance, is carried away by the tide-water. Two new boilers of 150 horse-power each have been added to the power station, making a total of six boilers. The fire apparatus is in charge of the chief engineer and head farmer. Fire drills are held monthly, and the fresh and salt-water systems are used alternately. The former fire extinguishers have been replaced by modern ones in the old buildings, and the new buildings have been supplied, so that with these and the fresh-water standpipes inside and both salt and fresh-water hydrants outside, the institution is well protected against fire.

I wish to call your attention to several changes and additions which seem necessary in order to keep pace with the demands made upon this institution. A recreation-room where the male inmates can gather, which would combine a smoking-room with facilities for playing games, should be constructed. The removal of the present smoking-room would improve the atmosphere of the building and provide the feeble old men with a welllighted room in place of the damp, dark basement which is used at present. The women's dormitory should be provided with a diningroom large enough to accommodate all the inmates at one sitting, whereas it is now necessary to set the tables three times for each meal. It not only requiles extra assistance, but the food cannot be kept hot and in proper condition to be served to those eating at the last table. The hospital is without a receiving-room, which is a serious handicap. Patients should not be taken directly from the ambulance to the ward, but should be received in a separate room, and, after examination by a physician, be transferred to the proper ward. This could readily be done in one of the basements of the present hospital, where separate rooms could be constructed and fitted with baths and toilet-rooms. The operating-room is too small to accommodate the operators and the nurses who are to receive the operating-room training. It is not aseptic, and therefore is unsatisfactory. At present there are three separate kitchens for as many buildings. This divides the responsibility of cooking, causes more waste, needs more oversight, and, for these reasons, is unsatisfactory and expensive. Should a kitchen be constructed, it should be connected with other buildings by means of passageways, which would allow food to be transported without exposing it to the cold, and would serve as a means of communication between the several buildings, especially in the winter months. The institution has quite outgrown the facilities for administration. I therefore urge that a suitable administration building be constructed in connection with the present hospital building, to be used for executive work only, to consist of offices for the Superintendent, the resident staff and the clerks. Four years ago a building providing for a power plant, bakery and laundry was constructed, but was only twothirds finished on account of lack of funds. It is quite necessary that this be completed. The present laundry facilities are meagre, and the work demanded of this department has increased very materially, especially since the new buildings have been occupied. The ironing could then be done in its proper department, and a suitable assorting room be provided. As has been frequently pointed out by the staff there is need for increased hospital -accommodation. All of the female patients, and several male patients suffering from phthisis, are still in wards of the old hospital. It is quite evident that if the present rate of increase in the admissions of tuberculous patients continues there must be further provision made for their proper housing. It is an injustice to other patients that they should be subjected to the risk of contracting this disease. While pointing out the present needs of the Boston Almshouse and Hospital, which are very urgent, I would state that the two new buildings completed during the year, together with the improvements previously mentioned, have done much to increase the efficiency of the institution. I wish to express the appreciation of the inmates, patients and officers for the untiring efforts of the chaplains in their ministrations to those in their care. To the many individuals and societies who have supplied us so liberally with literature, we express our thanks. The officers have been faithful in their endeavors to provide for those in their care, and the success of the institution is due largely to their faithful work. In concluding this report, I wish to acknowledge the constant support you have given me in the administration of the institution. Very respectfully,


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