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sumption is considered a “dangerous and infectious disease,” which should be isolated under the law, sends to us a certain number of quarantined cases. Unquestionably, too, and fortunately, the growing interest in the eradication of tuberculosis has induced persons, who formerly would have lived and died at home, to go to a hospital, either for the chance of recovery themselves or to avoid exposing their families to contagion. It is presumably to this cause that we chiefly owe the increase of tuberculous patients at Long Island beyond any estimate which could have reasonably been made in December, 1900. The report of the Visiting Staff will show how serious they consider the present inadequacy of accommodation for such patients, involving, as it does, danger to others. Persons already suffering from other diseases, and whose vitality is, therefore, lessened, are especially open to infection, and in justice to them we need to increase, as soon as possible, the accommodations for tuberculous patients. Need of More Hospital Accommodation. — The need of further general hospital accommodation is still great. In two infirmary wards in the men's building and two in the women's building there are 100 men and 120 women, most of whom should be in the hospital. These men and women are seen daily by a doctor, and a nurse is in attendance at the men's building three times during the day to give out medicines, change surgical dressings, etc., while in the women's building this is done by one of the matrons. The conditions in these infirmary wards are not, however, true hospital conditions. Recently the pressure on the women's building to receive new inmates, as well as patients sufficiently convalescent to be transferred from the hospital, was so great that ten beds were made up in the hall on the second floor. At the same time the infirmary wards on the first floor could not contain all the feeble or crippled women, some of whom were so infirm that the matron was obliged to consult one of the doctors before sending them to the upper dormitories. Changes in Administration Building. — The space left vacant in the hospital by the removal of the nurses is used for the resident doctors, giving them better quarters than heretofore. More room and accommodation is still needed in the hospital building, however, the front portion of which now serves as administration building for the island, but is inadequate for the purpose. A request will be made during the ensuing year for a loan of $7,500 to enable us to make such changes as are necessary, the Superintendent's plan being to build a new front to the present hospital, affording rooms for administration, dining-room, and dispensary. The rooms in the present building, thus set free, could be used for hospital purposes. Need of New Dining-room and Sewing-room in the Women's Building. — The capacity of the women's building has been strained to the utmost during the past year. The dining-room is too small for the present number of inmates, which may now be regarded as a normal population, likely to increase with the growth of the city population. The tables have to be set three times for each meal, occasioning much extra work, and also giving colder and less attractive meals to those last served. It is earnestly hoped that an appropriation for central kitchen and connecting subways, and for the enlargement of the dining-room may be granted, that there may be relief from the present inconvenient conditions, which no administrative efficiency can render satisfactory. The majority of the occupants of this building are infirm old women, some of them lame from chronic rheumatism, and some of them paralyzed. To gain sufficient room on the main floor of the building for those too infirm to go safely over the stairs, it became necessary to turn to dormitory use the ward used recently for a sewing-room, and to place the sewing-room, at all events for the present, in the basement. The superintendent has adapted this basement, as well as its location will permit, by laying a wooden floor over the cement, with air space between, and installing steam coils and electric light. Although the room can be made thoroughly warm and dry, it is difficult to ventilate it, and the daylight is insufficient. It is not, and cannot be, a satisfactory sewing-room. Occupation.— More effort has been made by officers than is apparent in the results, to interest inmates and patients in Occupation. Those who respond to such stimulus, or who do not need it but naturally seek occupation, are noticeably happier and more content than their fellow-inmates who sit with hands folded—but the latter are not aware of this. Many of them have been paralyzed, and are in consequence languid and inert. Many feel that they are tired after the work and unsuccess of life, and take perhaps more enjoyment in quiescence and inaction than appears possible to us. It is difficult to interest some even in occupations that usually give pleasure, such as the care of birds or plants. Nevertheless, it is the earnest desire of the Superintendent and of the Trustees to interest more of the population in work; so far as is possible in productive work for the institution, and when that cannot be secured, in occupations that shall at least give pleasure and interest to the worker). Classification. — The classification of a large almshouse is by no means the simple matter that the word implies. The physical condition of inmates has to be taken into account; — if a man is too feeble to go over the stairs, or if he should be especially guarded from draughts, or if he is able to walk but a few steps, his place must be chosen with reference to his disability, whatever has been his previous record. Also, the present behavior of inmates must be as much taken into account as their past civil history, and justice (which they can recognize as justice) must be done to each. If, however, classification is difficult to arrange in a great group of people associated together by the fact of sharing a common home, a degree of natural classification arises as spontaneously as among the passengers of a great steamer on an ocean voyage. In each ward of the women’s building are one or two women who are ready to read aloud the morning paper to the others. The head matron arranges that the first reading of the daily paper shall be assigned week by week to each ward in turn. One of these women who thus contributes directly to the pleasure of others is very deaf. Each of the blind men and women have one or more friends voluntarily devoted to their care and comfort. One blind man is read to by five or six comrades and they also take daily walks with him. Several of the feeble-minded are befriended in the same way. There are always in the population certain men and women who, by their unconquered interest in the drama of life, whether on a wide stage or a narrow one, keep up the spirits of all about them. There are many, too, who, removed from the temptation of drink, are like men and women freed from slavery ; their good qualities, formerly obscured, reassert themselves, and they are kind, patient, and uncomplaining, and among them are many good and cheerful workers. Classification by institutions rather than in institutions is being more and more secured by the removal of different groups of persons to special homes or institutions. The State Hospital for Epileptics, the Massachusetts School for the Feeble-minded, with its Custodial Department, the Massachusetts State Sanatorium for incipient tuberculosis, and the Medfield Insane Asylum for the chronic insane, receive some patients who would formerly have been retained in an almshouse. We hope that the accommodations for the adult feeble-minded in the Custodial Department of the Massachusetts School may be yet further increased, to keep pace with the needs of the community. We have still in the almshouse several young feeble-minded women and men, , who would be more appropriately placed in that department, where their limited powers might be more fully drawn forth and utilized and their lives thereby made the happier.
There are now in the Almshouse at Long Island and in that at Charlestown 17 blind persons, of whom 12 are blind only, 2 are blind, with defective hearing, and 3 are blind and deaf. Nine of these are over fifty years of age. For young or teachable blind persons an almshouse cannot be a fitting home. Each officer and each matroll in such an institution has as much as he or she can do, and cannot devote the time to teaching the small industries and occupations which the blind should learn as soon as possible after the loss of sight. Each month that passes in inactivity lessens their power of learning and also their desire to learn. Under the act which provides for the instruction of the adult blind in their homes by the Perkins Institution and Massachusetts School for the Blind, we have had the valuable help of teachers from that institution, but in several cases too long a time had elapsed since the loss of sight, and the instruction had to be abandoned. Also, this instruction cannot be given daily.
There is now at Long Island a blind man of gentle and good character, forty-five years of age, who from fourteen to twenty years of age was at the Perkins Institution for the Blind, but who has passed twenty-two and a half years of his life in the almshouse. He has had a friend in the almshouse, of good character and education, who devoted himself to his comfort. This friend was always beside him to help him, and his death, two years ago, was an irreparable loss. He has also had a kind friend outside the institution who for a number of years consecutively went nearly every week to Long Island to read to a little group of blind men, and through her he has heard and enjoyed such books as Chittenden’s “Reminiscences of Lincoln,” “David Copperfield,” etc. He is used to his daily life, and can make his way about the familiar buildings and grounds, and since the death of his friend another man has stayed by him faithfully. He is now in ill health, and the Superintendent thinks that removal or change might be too much for him. But had he been able to go at twenty-one, when he first entered the almshouse, into some institution for the training of the blind, his life might have been a happier one.
In the same way it is desirable that no young or teachable deaf person should be retained in an almshouse, where there can be no adequate teaching. There is in the almshouse at Long Island a woman now over forty years old who is generally accounted deaf and dumb. Her mother died at Long Island, and she herself has been in and out of the almshouse during the last ten years. She is busy all day, and the head matron says “we could not keep house without Mary.” She can hear a little, and can make herself understood by those who have known her long. The matron thinks that when she first entered the almshouse she might have been capable of being taught to understand and express herself with tolerable clearness, and thus perhaps have been self-supporting. Rutland Patients. – The city has maintained this year ten patients in the Massachusetts State Sanatorium at a total cost of $1,284.59. These patients’ are suffering from incipient tuberculosis, and are unable to pay for their own Support. Although our accommodation at Long Island for phthisical patients is now increased, as before reported, we cannot accommodate all who apply, and, as it is evident that the sanatorium at Rutland, receiving only incipient cases, and, with a maintenance cost of $9 a week per patient, must be able to afford conditions which our hospital, with a maintenance cost of $6.37 a week per patient, cannot afford, we would urge the desirability of maintaining at the State Sanatorium certain patients suffering from incipient phthisis who apply to the City of Boston for treatment. The Almshouse at Charlestown. — This is in itself a cheerful building, allowing of something much nearer to home life than is possible at Long Island. This homelike character is borne out by the steady fulfilment of the same duties by various elderly men and women, whose places in the household activity are well known and acknowledged, and who acquire the sort of dignity which attaches to work well done. There are a number of women who sew and mend well, and 128 pairs of stockings were knit by eleven or twelve of them during the year. Among about eighty women, there are usually hardly more than seven or eight capable of doing a half-day's work at washing or ironing; sometimes fewer. Possibly forty more of the women are able to wash and iron their own clothing, which is both a satisfaction to them and a help to the institution. The laundry machinery, installed during