REPORT OF THE SUPERINTENDENT OF THE BOSTON ALMSHOUSE FOR WOMEN AND AGED COUPLES, CHARLESTOWN.

CIIARLESTOWN DISTRICT, BosTON, MASS., January 31, 1903.

To the Pauper Institutions Trustees :

The following report of the Almshouse for Women and Aged Couples, for the year ending January 31, 1903, is respectfully submitted: Few changes have taken place during the year; the population has been somewhat increased, and the general health record has been unusually good. Good order has prevailed, and there has been willing performance of daily duties on the part of the inmates. We have greatly appreciated the new steam laundry machinery which has been installed, giving much better results and relieving many hands for other duties. The whole house has been kept in order by minor repairs. The widening of the street on both sides in front of the institution deprived us of 6,748 feet of land, and necessitated moving back the lodge and building a new fence on the institution side. A new fence will have to be placed on the garden side in the spring. Our garden was unusually successful both in the quality and quantity of its produce, and we have raised tomato, cabbage, and celery plants, and lettuce for early use in a hot-bed. We would again most cordially acknowledge the kind ministrations of the clergymen, who are always so ready to come to us, and thank the many friends who have given us frequent and very pleasant entertainments. I would recommend that during the coming year the large women's dormitory on the fourth floor be improved in various ways, and that beds with springs and mattresses, such as we now have in the infirmary wards, replace the present straw beds throughout the entire house. I wish especially to thank my officers for their good and loyal work through the year. My grateful acknowledgments are due the Board for their sympathy and support.

Respectfully,

SARAH G. WEEDEN,
Superintendent.

REPORT OF THE VISITING MEDICAL STAFF OF THE LONG ISLAND HOSPITAL.

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

The past year has been one of continued progress. The patients have been more carefully studied, the details of their diseases more systematically recorded, and the hospital has been used more than heretofore for purposes of medical teaching, to the benefit of patients, of the cause of medical education, and of the community at large. It has been a source of gratification to the Visiting Staff to observe the constantly widening influence of the hospital and a deepening public interest in its aims. We have from time to time alluded to the injustice of a law which places the chronic sick in a different social category from those acutely ill. We hope that public sentiment may in time be aroused to a realization of this injustice, leading to action which will ultimately establish the City Hospital for Chronic Diseases on a medical rather than on a social basis. The general question has been further complicated during the past year by legislation regarding notification in cases of tuberculosis of the lungs and the enforced isolation of many such cases at this hospital.

The opening of a detached building containing fifty-one beds for the treatment of patients with tuberculosis has in a measure relieved the congestion of the wards of the general hospital. This building is, however, already insufficient for the demands made upon it; it accommodates no women and not all the men. The result is that both men and women with tuberculosis are still in the general wards — a source of danger to other patients. In justice to patients already in the hospital, no more persons with tuberculosis should be admitted. If more are sent by the authorities, immediate action should be taken to increase the facilities for their proper treatment. There should be no delay in the construction of new and adequate wards. If this be not done, the situation will soon be the same as before the construction of the new hospital for tuberculosis. We would therefore urgently recommend either that the number of patients suffering from tuberculosis be sharply limited, or that speedy provision be made for the proper care of an increased number. The statement made in our report for 1901 still holds good : “When the new ward for tuberculosis is completed, patients suffering from that disease should no longer be admitted to the general wards, nor should any persons with tuberculosis be allowed to remain in the Almshouse Department. The separation of this from other diseases should be complete and should be so maintained.” A further matter to which we wish to call the attentiou of your Board is the present method of transportation of patients to and from Long Island. Investigation has shown that discomfort and hardship, if not actual suffering, have been occasioned by the inadequate provisions made for the conveyance of the sick. Delay in reaching Long Island is inevitable, and patients, often in late stages of disease, are subjected to this often dangerous delay, regardless of the degree of their illness. The present system is wholly out of accord with our idea of care of the sick; such inadequate provision for their comfort would not be tolerated in the hospital wards, and should not be during their transportation from the city to the hospital. In our last report we urged the necessity of a special pathological building. The need for such a building, which should combine the purposes of a morgue and a laboratory, increases with the general developments of the various departments of the hospital. It is to be hoped that work on this building may soon be begun and hurried to completion. Several changes have taken place in the Visiting and Resident Staff during the past year. Dr. Franklin W. White, after a faithful service, resigned his position of Assistant Visiting Physician, because of stress of other professional work. Dr. Edwin A. Locke has been appointed in his place. Dr. George A. Waterman has been appointed an Assistant Visiting Neurologist. The position of Assistant Physician at the hospital has been abolished and its former incumbent, Dr. J. G. W. Knowlton, has begun private practice in Boston. Dr. George C. Wilkins, Assistant Superintendent and Physician, resigned January 1, to enter private practice at Manchester, N. H. Dr. Simon F. Cox has received the appointment of First Medical Officer to the hospital. The Resident Medical Staff will hereafter consist of the First Medical Officer and four House Officers. The nursing and general care of the patients has been increasingly satisfactory, and the general efficiency and usefulness of the hospital thereby enhanced.

Finally, we beg to express our appreciation of the continued coöperation of your Board with the Visiting Staff, without which the further development of the hospital would be impossible.

Respectfully submitted,

E. W. TAYLOR, Secretary.
For the Visiting Staff.

REPORT OF THE VISITING PHYSICIAN OF THE
BOSTON ALMSHOUSE FOR WOMEN AND
AGED COUPLES, CHARLESTOWN.

BosTON, February 2, 1903.

To Sarah G. Weeden, Superintendent, Almshouse for Women and Aged Couples, Charlestown :

DEAR MADAM, - I have the honor to submit my report as Visiting Physician of this institution for the year ending January 31, 1903, briefly, as follows:

The health of the inmates has been generally good; no epidemics have prevailed, and there have been but few cases of acute disease. As in past years some cases have been transferred to the Long Island Hospital for treatment.

There were five deaths during the year; of these, 4 were females and 1 male, from the following causes: Chronic diarrhoea, 2.; apoplexy, 1 ; Bright's disease, 1 ; valvular heart disease, 1 ; average age of decedents, 76 +.

I have again to thank you and the chief matron, Miss Phillips, for the cordial coöperation given me in caring for the health of the inmates.

Respectfully yours,
R. W. SPRAGUE, M.D.

LONG ISLAND HOSPITAL TRAINING SCHOOL FOR NURSES.

This Training School is established to give a systematic two years’ course of training and practice to women desirous of becoming professional nurses. The school is connected with the Boston Almshouse and Hospital on Long Island, in Boston Harbor. The hospital buildings are new and modern in all their appointments, and contain three hundred beds. The Superintendent of the Almshouse and Hospital has the general supervision of all matters relating to the school, and application for admission should be made to him. The Superintendent of Nurses has the immediate charge of all the nursing in the hospital, of all persons employed in the wards, and also is responsible for the instruction and management of the pupils in the Training School. The course of training requires two years, and includes general medical, surgical, maternity and infant nursing. A fixed course of instruction is given, including lectures and demonstrations on practical points by the medical and surgical staff, recitations on these and from text-books, but chiefly the daily instruction from the Superintendent of Nurses and the graduate head-nurses, and the accurate daily drill in the wards and operating-room. The instruction includes the general care of the sick, the making of beds, changing bed and body linen, managing of helpless patients in bed, etc.; bathing, prevention and dressing of bed sores; the making and applying of bandages, applying of fomentations and poultices and minor dressings, cupping, the administration of enemas, and use of the female catheter. The pupils are also given lessons in massage. Maternity nursing is taught by practice in the confinement rooms, which includes digital examination of patients. Instruction is also given the pupils how to act in the various emergencies which arise in childbed. Pupils are taught how to cook and serve food for the sick in a proper manner, the feeding of helpless patients, and the feeding and preparation of food for infants. Instruction is also given in the best practical methods of supplying fresh air, of warming and ventilating sick-rooms in