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Organization at Long Island. — The almshouse and hospital at Long Island is, as last year, under the charge of Dr. Arthur S. Hartwell, superintendent. After consultation with the superintendent and with the Visiting Medical Staff, the resident medical service of the hospital has been reorganized. For several years previously the responsibility for the care of patients in the hospital had been divided between two physicians, one of whom filled also the office of assistant superintendent of the institution. Since January 1, 1903, this responsibility rests solely on the first medical officer, Dr. Simon F. Cox, who has four house officers working under him, while the general duties relating to the whole institution are performed by the assistant superintendent. This position is now filled by Mr. George F. H. Murray. Maintenance Appropriation. — The appropriation for the maintenance of the Boston Almshouse and Hospital at Long Island for 1902 was $114,500, of which $114,358.27 was expended, leaving a balance of $141.73. The income for the institution was $4,045.05, which would make the actual cost $110,313.22. The average number of inmates (hospital, men's and women's buildings) was 678, which would give $3.13 as average net cost of each inmate per week. Since February 1, 1901, the accounts have been so kept that the maintenance expense of each department of the institution is known, and the relative expense of an inmate living in the men's or women’s building, and a patient in the hospital, can be estimated. The weekly per capita cost of inmates of the almhouse is $2.38. The weekly per capita cost of hospital patients is $6.37. Reasons for Increased Cost of Maintenance of Almshouse and Hospital at Long Island. — Two causes contribute to the increased per capita cost at Long Island. First, the development of the hospital and medical service; Secondly, the changed character of the population. The number of inmates remaining at Long Island on January 31, 1903, is 738 as against 992 on the same date in 1893, a decrease of 25 per cent. in ten years; while in the population of the city there has been an increase of 25 per cent. during the same years. In inverse ratio to the decrease in population there has been an increase in the per capita cost per week from $1.64 in 1892–93 to $3.13 in 1902–03. In addition to the larger cost for fewer numbers, which is true in regard to any institution, the population at Long Island is an increasingly feeble one, and more paid assistance is therefore required.

Among the 738 persons on Long Island on January 31, 1903, the proportion of sick persons is unquestionably larger than in 1893. It is largely due to the operation of the vagrant law of 1898, under which vagrants may be committed for an indeterminate sentence under two years to the State Farm at Bridgewater, that the numbers are lower than formerly.* This elimination of the vagrant works a double good. It is for the good of the individual vagrant, because enforced labor is the best regimen for him, and is more likely to spur him into self-support than life in an almshouse, where the standard of required work is necessarily low. It is good for the almshouse, because it removes a turbulent element and maintains a more even and stable population. It leaves the almshouse, however, without the working power of the able-bodied men and women, who were formerly counted on for much daily labor, and the officers of the almshouse find it impossible to get the work done as formerly by a small paid staff of officers and many inmate helpers. (See chart on page 50.) Fewer inmate workers are available, and more paid officers are a necessity, resulting in the increase of the per capita cost.

That expenditure of money is best, however, which best secures its end. We believe that the increased per capita cost of almshouse inmates is justified if we can secure thereby the welfare of hospital patients, and a comfortable and peaceful home for old people.

Nurses’ Home and Training School. — The new Home for Nurses, which was opened on June 12, is pleasantly situated, and provides comfortable rooms and a pleasant parlor overlooking the sea. It affords a comfortable home for the nurses, whose work involves unremitting effort, courage and patience, and is, perhaps, of a more depressing character than nursing in a more general hospital, inasmuch as many of these

* In the report of the Superintendent of the Almshouse for the year ending January 31, 1894, he says: “From my observation the increase (in admissions and the daily average) is not among the worthy, deserving class of our inmates, but from men of another stamp, young and able-bodied, some of them wishing to work, but the majority determined to do as little as possible.” . . . “Of 969 men admitted during the past year (1893–4) 702 were not over forty-five years of age, and most of them strong and healthy, with trades.” . . . “The presence of this large body of lawless young men, under no particular restraint, makes it very uncomfortable for the old men.”

It should be noted that the year 1893–4 was one of exceptional distress from want of employment throughout the country, and that the proportion of able-bodied men in the almshouse during that and the succeeding year was undoubtedly affected by the fact. Since 1894–5 the number of admissions shows general decrease, with slight fluctuation, as is shown in table on page 40.

patients are dying in old age after sad lives. The effort to comfort and cheer, as well as care for the physical welfare of a patient, taxes both mind and body, and we earnestly desire to secure as healthy and happy lives as is possible for our nurses. That the Training School is doing satisfactory work is indicated by the desire of the Superintendent and Superintendent of Nurses to secure graduate nurses from our own school for head nurses in the hospital, and by the fact that of fifty-three graduates of the school, forty-five are reported at work, as shown on pages 21 and 22. Opening of Hospital Wing. The new wing of the hospital, for patients suffering from pulmonary tuberculosis, was opened November 13, 1902. It contains fifty-one beds, and the cost to the city of building, equipping and furnishing this wing was $45,152.48, or $885.33 per bed. Five members of the Joint Standing Committees of the City Government on Finance and on Public Institutions visited Long Island on the occasion, and inspected the new wards. The new wing has two wards, containing twenty beds each, on the ground floor, so placed as to receive as much sunshine as possible, with separate dining-rooms for each ward. There is also a diet kitchen with a small electric cooking plant. On the second floor there is a smaller ward with eleven beds, occupied by men in a less advanced stage of the disease. The wards are heated by both direct and indirect radiation, and are provided with stationary tubs and shower baths. The plumbing is isolated from the wards. So great is the pressure upon any hospital admitting patients suffering from pulmonary tuberculosis that, although the Superintendent has devoted the three new wards to male patients, several male phthisical patients and all the female phthisical patients remain in the main hospital. Thus we have not accomplished the object of placing all patients suffering from pulmonary tuberculosis in a separate wing of the hospital, as we had hoped when, in December, 1900, the request was made for an appropriation for such construction. At that time there appeared every probability that a municipal hospital for the treatment of tuberculosis would be built, and that at Long Island we should henceforward receive a lessened, rather than increased, proportion of consumptive patients. This proposed hospital was not built, and the proportion of tuberculous patients to patients suffering from other diseases has greatly increased. The ruling of the Boston Board of Health, by which con

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