OF THE HOSPITAL

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PUBLIC DOCUMENT .FIFTIETH. No.26.ANNUAL EEPOETOFTHE TRUSTEESOF THESTATE HOSPITALAT TEWKSBURY,INCLUDINGREPORT OP THE SUPERINTENDENT AND RESIDENTPHYSICIAN,For the Year ending September*' ::.;-i-.BOSTONWRIGHT & POTTER PRINTING18CO.,STATE PRINTERS,Post Office Square.1904.a/.30, 1903.

Approved byThe State Board of Publication.

3t. MSSill*/ACONTENTSTrustees' Report,7Superintendent's Report,List op12.Graduates op Training School,18List of Salaried Officers,24Receipts and Expenditures,30Hospital Statistics,.Insane Hospital Statistics,.3251

OFFICERS OF THE STATE HOSPITAL.TRUSTEES.WHITE BELCHER, Chairman,Rev. PAYSON W. LYMAN,Mrs. SARAH D. FISKE,Mrs. ANNA F. PRESCOTT,LEONARD HUNTRESS, l River.Maiden.Melrose Highlands.Lowell.Andover.Salem.RESIDENT OFFICERS.JOHNH. NICHOLS, M.D.,ARTHURERNESTGEORGEK.B.DRAKE, M.D.,EMERSON, M.D.,'.A. PEIRCE,Superintendent and Resident Physician.Assistant Superintendent and Physician.First Assistant Physician.M.DAssistant Physician.HANNAH LOWELL, M.D.HOWARD F. HOLMES, M.D.,.,CHARLES E. THOMPSON,HIRAM P. DINSMORE,.Assistant Physician.Assistant Physician.M.D.,Assistant Physician.Clerk.CONSULTING BOARD OF PHYSICIANS AND SURGEONS.RICHARDSON, M.D.,JOY JEFFRIES, M.D.,M. H.Boston.B.Boston.J. J.PUTNAM, M.DJ. C.IRISH, M.D.,Boston.Lowell.JAMES C. WHITE, M.D.,CHARLES M. GREEN, M.D.OCTAVIUS T. HOWE, M.D.,JOHN M. GILE, M.D.,.HENRY EHRLICH,M.D.,Boston.Boston.Lawrence.Hanover, N. H.Boston.

Commnntoeaitfjd mmtlguutU*TRUSTEES' EEPORT.To His Excellency the Governor and the Honorable Council.In compliance with the requirements of the RevisedLawsofMassachusetts, the trustees of the State Hospital and the StateFarm submitditiontheir fiftieth annual report, relative to the con-and work of the State Hospital, for the year ending-Sept. 30, 1903.The report of Dr. John H. Nichols, superintendent andresident physician, together with the tabulated informationaccompanying the same,this report,giveinall ofwhich are offered as part ofdetail an account of thework ofthehospital for the year.Fromthe statements embodied in and accompanying thesuperintendent's reportitappears that there were admittedduring the year 3,493 persons, or 247 more than were receivedThe whole number of inmateswas 4,688, or 216 more than lastyear.Of these, 606 were insane patients. The largest number under care at any one time was 1,597 and the smallest,1,190, the weekly average being 1,344, or 60 more than lastyear.As showing the relative prominence of the hospitalfeature of the work done at this institution, it may be statedthat, of the total number under care, 3,698 were treated asduring* the preceding year.under careMuring the} earpatients in hospital.During the year now under review there was expended 21.7,963.95 for current maintenance, of whichwasfor salaries,expenses.week. 48,283.55wages and labor, and 169,680.40 for generalThis gives a gross per capita cost of 3.12 per

STATE HOSPITAL AT TEWKSBURY.8Ifthis total expenditure forfrom[Oct.maintenance there shouldbe deducted the amounts received by the State for articles soldand the sums collected from cities and towns and from theUnited States, there would remain a net outlay from the treasury of the State of 181,123.42.The annual inventory, which is required by chapter 84,section 7, of the Revised Laws of Massachusetts, has beentaken by Charles H. Littlefield of Lawrence. The appraisal ofthe real and personal property connected with this institutionand belonging to the Commonwealth shows a total valuationof 1,111,309.60, classified as shown in a table submitted bythe appraiser and accompanying this report.Undermade byspecial appropriationsthe Legislature forpermanent improvements in the institution plant there hasbeen expended during the year the sum of 35,200, as shownby tables accompanying this report.With the money thus expended a new pump of large workingcapacity has been procured and installed, and the one heretoforein use has been put in repair to serve as auxiliary or substitutein case of need.A new underwriter's fire pump has been installed in the engine room.Greatly improved fire protectionhas thus been secured. An extension to the women's dormitoryis under way and will soon be completed.A building for surgical operations has been erected near the south-eastern angleof the old quadrangle.now readyIt isfor plastering.Concurring with the recommendations of the superintendent,the trustees present, as the most urgent needs of the institutionbeyond present maintenance:awardfor consumptiveseparate from the present hospital forisolationwomenand treatment of contagious diseasesattendants,whoarenow poorly;a;provided for;women,wards for thehome for maleand additionalland for cultivation and pasturage.Wenote the call to our assistant superintendent, Dr. ArthurK. Drake,tobecome superintendent of the Lowell GeneralHospital, as affording not only evidence of his accomplish-mentand as an administrator, buta testimony to the estimate in which this institutionas a medical officeralso asisheldas a theatre for the training of hospital superintendents, of

PUBLIC DOCUMENT — No.1903.]26.9which we have furnished several within recent years to otherinstitutions.In presenting thefiftiethannual report, a brief survey of thecourse of the institution's historyis feltThemarked the last halfby the middle of theto be suitable.oreat influx of foreign immigration whichcentury had begun to makeitself feltdestituteOne consequence was the State provision for manypersons who could not be made a municipal charge.To meetthiscentury.need the Legislature of 1852 appropriated 100,-000 for three State almshouses, to accommodate not less than500 each. Selection of site was to be made withregard tothe centres of the several pauper districts and to the general''suitability and health of the sections."The locations chosenwere Tewksbury, Bridgewater and Monson. The meagre ap-propriation necessitatedthe erectionThe Tewksbury Almshouse wasofwoodenstructures.opened for the receptionof inmates May 1, 1854, in accordance with proclamation ofGov. Emory Washburn. In twenty days from that date it hadnearly 800 inmates, and in the first seven months 2,193 wereadmitted, the weekly average being 705.The populationfirstgradually increased until the winter of the financially disastrous year of 1857,whenfor a short timeIt then gradually diminished until thewar.Byitexceeded 1,200.outbreak of thethe end of the civil war the authorities hadcivilbecomeconcerned that a classification of the inmates of the three Statealmshouses would be conducive to better care and control.1866 the institutionatMonson was madeInthe State PrimarySchool, to which juvenile wards of the State were to be sent.The Bridgewater Almshouse was made a workhouse for theemployment of those whose vices and self-indulgence compelledtheir temporary separation from society.The Tewksbury institution, besidesbeing a place for harmless and chronic insane,it had already become, was to be a State asylum for thosewho, through misfortune and poverty, had become dependenton State care.asAtfirstBoard ofthe government of the institution was vested inso-called inspectors.At presentvested in a Board of seven trustees, two ofthe governmentwhomareaiswomen,

STATE HOSPITAL AT TEWKSBURY.10[Oct.and who also have charge of the institution at Bridgewater,now known as the State Farm. This Board was established in1884, and, with varying changes in its personnel, has sincebeen in control. Of the Board, as then appointed, its presentchairman, Mr. Belcher, and Mrs. Fiske, still continue theirThe superintendents in succession have been Isaacservice.H. Meserve, 1853-59 Thomas T. Marsh, 1859-83; C. IrvingFisher, M.D., 1883-91; Herbert B. Howard, M.D., 1891-97;;John H. Nichols, M.D., 1897-.ByMarsh the hospitalthe end of the administration of Mr.feature which is now recognized in the name of the institutionhad become so prominent that it was judged necessary to vestThatthe superintendency in the hands of a skilled physician.the successive choices of the trustees for this office had beenmade appears fromthe fact that Dr. Fisher was takenbecomesuperintendent of the Presbyfromterian Hospital of New York, and that Dr. Howard was takenfrom it to become superintendent of the Massachusetts GeneralHospital, where these officers still continue.It may be furtherstated that from among our assistant superintendents Dr.Nichols was promoted to the superintendency of the StateHospital Dr. Gile was called to the professorship of theoryand practice at the Dartmouth Medical College Dr. Ranneywellthis institution to;;to the superintendency of the Lakeside Hospital at Cleveland,O.;Dr. Howland to the superintendency of the State Colonyfor the Insane at Gardner, Mass.;and Dr. Drake to the super-intendency of the Lowell General Hospital."What this institution, whose origin and course of develop-mentisthus briefly outlined, has becomeport whichwe herewithThis Board desires to recorditsitsmanytwomembers.shown by there-sense of the loss suffered inthe death of Jacob H. Hecht of Boston, forofissubmit.many yearsThey gladly bear testimonyadmirable qualities of character.topast oneMr. Hecht'sIn the welfare of thecommitted to the care of this Board he felt adeep interest, with the purposes of whose establishment he wasin thorough sympathy.Broad-minded, warm-hearted, publicinstitutionsspirited, catholic inprivatemeanstemper and generous in contribution ofdeath must be regarded asto charitable uses, his

1903.]PUBLIC DOCUMENT — No.a distinct public loss.We26.11shall not soon forget his graciouscourtesy, his unfailing friendship and his largeness and justnessof view respecting the matters to the joint consideration ofwhich we are called under the trust reposedin us by theCommonwealth.The vacancy occasioned by the death of Mr. Hecht has beenfilled by the appointment of John B. Tivnan of Salem.In reviewing the year, we are impressed anew with theand the administrative efficiency of the superintendent,JohnH. Nichols, to whose wise and constant oversight andDr.outlook no small part of the success attending the work of theLoyally seconded as he is by a capableinstitutions is due.medical and executive staff and by a large corps of nurses andassistants in the various departments of service, whose earnestco-operation with him is cordially recognized, the trustees feelthat the institution enters upon its second half-century wellofficered, and with promise of large usefulness in dealing withthe ills to minister to which it was established and has beensupported by the Commonwealth.fidelityEespectfully submitted,WHITE BELCHER.SARAH D. FISKE.J.ANNAF.PRESCOTT.PAYSON W. LYMAN.LEONARD HUNTRESS.J.A.JOHNSMART.B. TIVNAN.

STATE HOSPITAL AT TEWKSBURY.12[Oct.SUPERINTENDENT'S REPORT.Tothe Trustees of the State HospitalandStateFarm.I have the honor of presenting to you thefiftiethannualreport of the State Hospital.The records show 4,688 people cared for and 3,493 admisThe lowest daily census was 1,190 onsions during the year.October 10 and 15, and the highest daily census 1,597 onFebruary 10 and 11. The weekly average was 1,344, which60 more than last year.The cash disbursements were 217,963.95, makingweekly per capita cost of 3.12.isagrossIncome.During the year 1,575.10 was turned into the State treasuryThe State Board of Charity, throughfor articles sold, etc.the State adult poor department, has collected 34,217.93 fromtowns, cities and individuals and 1,047.50 for United Statescases boarded here, thus making a net outlay for running theinstitution of 181,123.42.Farm and Garden.Our cropowingof ensilage corn has been ver} light this year,to the unfavorable seasonsiderable increase in theonions,amountbut there has been con-;of hay, potatoes, cabbage,beets and most of the smaller garden vegetables.There was also a good yield of apples for the "offyear."Hospitals.Wehave been remarkably free from the usual contagiousdiseases this year, there being but one case of diphtheria,of measles and 6 of whooping-cough.have been treated 3,698 patients,1In our hospital wards— 2,654males and 1,044

PUBLIC DOCUMENT1903.]females.Of— No.132G.Amongthe diseases treated were 489 casesof phthisis, 12 of typhoid fever, 132 of syphilis,nosis,and 894these, 2,804 were classified as medicalas surgical cases.1of trichi-33 of malaria, 5 of erysipelas, 78 of pneumonia, 21of influenza and 2 of parotiditis.—There were 443 deaths,321 males and 122 females. Ofwere due to phthisis, 25 were from cancer, 7 general paralysis, 1 trichinosis, 34 cardiac disease, 3 gangrene, 31pneumonia and 15 cerebral hemorrhage. Thirty-one deathswere of patients under one } ear of age, 1 between one andfive, 148 over sixty.There were 118 births,6Q males andthese, 150—53 females. Three hundred and forty-seven surgical operationswere performed. In the out-patient department 1,308 caseswere treated,In the hos1,006 medical and 302 surgical.—consumptives 397 cases have been treated during thewere discharged well, 158 improved, 44 not improved,116 died, and there were 76 remaining in the hospital at theend of the year.pital foryear:3Further information concerning diseases treated, surgicaloperations performed, out-patient cases, etc., can be found inthe tables under hospitalstatistics,beginning page 32.Department for the Insane.There have been admitted during the year 109 patients thenumber of patients has been 505 the numberremaining Sept. 30, 1903, was 496. There were 59 deaths,21 males and 38 females.Eight were discharged recovered,5 much improved and 10 improved.The infirmary tables show 179 cases treated, of which 147were medical and 32 surgical.;daily average;—Medical Staff.On Junewas1,Dr. Harold C. Goodwin, whose special workin our insanedepartment, resigned to accept a positionwith greater responsibilities at the State Hospital for InsaneConcord, N. H. Dr. Goodwin had been with us for threeand one-half years, and we have already learned that he iscontinuing his excellent record and is judiciously respondingto the duties and requirements of his new position.at

STATE HOSPITAL AT TEWKSBURY.14[Oct.Dr. George H. Maxfield, of our interne* service, was alsocalled to the State Hospital at Concord, to take a position asassistant physician.have been preHolmes,Dr. Harry P. Robinson,sented to Dr. Howard F.Dr. Edward S. Ward, Dr. Ralph Putnam and Dr. Charles F.Thompson.Dr. Holmes and Dr. Thompson have since been appointedto our medical staff, Dr. Holmes taking charge of the Hospital for Consumptives and Dr. Thompson assuming duties inthe laboratory and in the insane department.Before the completion of this report Dr. Arthur K. Drake,Certificates of satisfactoiy service as interneassistant superintendent, tendered his resignation, to take effectNovember1, inorder to accept a call to become superintendentof the Lowell General Hospital.Dr. Drake has been connectedwith this hospital as physician for over six years, and hissatis-factory services in the various positions which he has held hereassures us that nothing but success will followfieldhimin hisnewof work.An article by Dr. Wright and Dr. Drake, on "A Case ofExtreme Malformation of the Heart," was published in "Transactions of the Association of American Physicians " also apaper read by Dr. Emerson before the Massachusetts MedicalSociety onInfant Feeding " was published in theBoston;''''Medical Journal."Training School for Nurses.From the trainingschool for nurses, whichnow completesitstwelfth year, the following nurses have graduated this yearMiss Harriet M. Cilley, Miss Minnie Anderson, Miss EmilyBurns, Miss Annie Ross, Miss Mabel I. Barnesdale, MissAlberta Johnston, Miss Edith Huntress, Miss Adella Friden-Miss Edith M. Curtis, Miss Nora F. Keating, Miss MayM. Truex and Miss Ora Lamey.The usual number of lectures and recitations have been conducted, and a substantial improvement has been made in wardservice, class work and in all modern training school andstine,nursing methods.

PUBLIC DOCUMENT — No.1903.]1526.Improvements made during the Year.Anew pumpof 1,500,000 gallons capacity per twenty-fourhours has been placed in our pumping station, and the old onerepaired so that there will be no future danger of a shut-downin thatAdepartment.new connection withadditional shut-offs has beenmadebelow our standpipe, so that in case of diminished pressurewater could be forced directly from the pumping station intojustthe supply pipes around the institution.Anewunderwriter'spumpfirewith capacity of 750 gallonsper minute has been set up in our engine room, with supplypipe from a group of old cisterns in the centre of the yard, andwith delivery pipes running to hydrants, giving ustional protection in case ofmuchaddi-fire.Continuing the work on the cold storage plant, a compressorand pump have been installed and have been in operation sincelast spring.After a certain amount of experimentation andoperation for the sake of clearing the pipes, we began torefrigerate in certain portions of the system, and have hadsatisfactory results.Regular refrigeration in the large stor-we anticipate most satisfactoryand vegetables.The mortuary chapel has been completed and furnished, andgreatly appreciated by friends of the hospital and of theage rooms has just begun, andresults in preserving our fruitisdeceased patients.Anandisextension to the women's dormitory has been erected,nownear completion.has a good, light basement.It isThetional dormitory space and a sittingOntwostories in height,first floor willroomandfurnish addi-for the agedwomen.the second floor will be a children's dormitory and also dayroom.In the tower at the extreme endisan iron fireproofand the sanitary sections for each floor.A surgical building has been erected in the south-east cornerof the main court, between the women's asylum and the men'shospitalthe partitions have been erected and the building isnow ready for plastering. This building will contain an operating room, two recovery oi etherizing rooms, a wide corridor,sterilizing rooms, lavatory and surgeon's room.It is built ofstaircase,;

STATE HOSPITAL AT TEWKSBURY.16brick, with terra-cotta partitions,[Oct.cementiron girders witharches for supporting the floor.Furniture for the asylum for insanemenhas beenmade dur-ing the year, but delays in piping, in grading, and other furniture have preventedus from occupying the building thusfar.Theold carpenter's shop has beenthe south ofintotwooriginal positionitsmoved fromsections,;itsmoved about 400the old stable was dividedformersite,and placed asextensions on either side of this other building.whenfinished, willmakea stablethe needs of the institution forWorkfeet toThe whole,and carriage house ample formanyyears.on the cellar wall will soon be completed.The oldsheds adjoining the stable have been moved, to be eventuallyconnected with the barn as a yard shelter for stock.woodenAnotherbuilding, in the south part of the yard and at one timeused for a boys' ward, has been moved away.Improvements suggested.Owingto the constantdanger of outbreak of contagiousdis-eases in so large an institution as this, wards for isolation andtreatment are needed.It is also urgent that steps be taken for providing a ward forconsumptive women. These cases are at present in one of thewards of our women's hospital, and improved conditions wouldbe most beneficial to them, and at the same time remove aspecial danger from the other patients in the women's department.More land is needed for cultivation and pasturage.The accommodations for the male officers are now inadequateand unsatisfactory, and a special buildingisneeded to improvethese conditions.Ancertainadditional appropriationwork nowisrequired for completion ofin process of construction.We deeply regret that, owing to ill health, our chaplain, theRev. E. W. Pride, has been with us only a small portion ofthe year, but we are eagerly looking for improvement and forhis return to hisaccustomed duties.The Rev. H. C. WilliamsThe untiring at-has supplied the pulpit during his absence.

PUBLIC DOCUMENT — No.1903.]1726.tentions of the Rev. Father Duffy and the Rev. Father Siroisin the wardsmable valueand at the regular services have been of inestibringing comfort and promoting contentmentinamono their charges. Numerousbooks and periodicals have been contribfor which we expressour thanks.We would inform our friends that we are gladto pay expressage on all such contributions.uted bygifts ofmany kind friends during the year,I wish to expressassistance, kindnessmygratitude to the trustees for theirand encouragementin allmywork.Yours respectfully,JOHNH. NICHOLS,Superintendent.

STATE HOSPITAL AT TEWKSBUKY.18[Oct.GRADUATES OF TRAINING SCHOOL ATSTATE HOSPITAL.Miss Lillie Fletcher (Mrs. MacDonald),.Tewksbury, Mass.Miss Albina Manning,MissBoston, Mass.Heathy Stewart,Boston, Mass.Boston, MassMiss Alice Dillon,Miss Hildegarde Backman,NewMiss Catherine M. Scott,Tewksbury, Mass.Miss Annie Horne,MissMiss.Miss NellieS.Miss.MaryMary.Boston, Mass.Deceased.Moncton, N. B.Redmond,Miss Jessie Figgat,Miss.Maude Rourke,Emma Scullion,York, N. Y.E.Richardson,E.Mitchell (Mrs.Brookline, Mass.Roanoke, Va.Boston, Mass.Cole),.Lowell, Mass.Miss Christina Germain,Cleveland, Ohio.Miss Annie G. Kelley,Tewksbury, Mass.Miss CatherineJ.Meikle,Miss ElizabethMcCadslandCook (Mrs.Miss Florence N.Tewksbury, Mass.Miss Jessie Willina Meikle,(Mrs. French),Grant),.Tewksbury, Mass.Tewksbury, Mass.NovaScotia.MissHelen A. West,Miss Flora MacPherson,Tewksbury, Mass.Miss Jessie A. Baker,Haverhill, Mass.MissAmyJ.BakerScotland.(Mrs. Jenness),.Miss Linda Nase,Helena KELLEY(Mrs. Lancaster),Miss Dora Vincent,Miss Annie Calder (Mrs. Taylor),Miss.MissMaryJ.MissKateE. Gilson,.Miss Caroline E. Hdtt,Kingston, Jamaica.Boston, Mass.Young,Mrs. Annie J. Burtt,Washington, D. C.Brookline, Mass.Boston, Mass.Tewksbury, Mass.Michigan.Deceased.Vermont.

PUBLIC DOCUMENT — No.1903.]Miss Annie Grant,192Q.Cambridge, Mass.Miss Annie McAusland,.Brookline, Mass.Miss Florence A. LaFleur,Rome,Miss A. Estelle DeCatur,Lowell, Mass.Italy.Miss Eenah Belle Austin,Boston, Mass.Miss Miriam H. Crowell,Roxbury, Mass.Miss Urania E. Augusta,Roxbury, Mass.MissMissMaryMaryH. Meikle,E.Tevvksbury, Mass.Patrequin,Providence, R.Miss Louisa D. Haise,I.Cambridge Springs, Penn.Miss Clara E. Dowding,.Providence, R.I.Maggie Matheson,Miss Harriet M. Cilley (Mrs Deane),Miss Ora Lamey,Boston, Mass.Miss Emily Burns,Tevvksbury, Mass.Miss.Miss MinnieI.Anderson,MabelI.NewYork.Lynn, Mass.Barnesdale,Miss Alberta Johnston,Boston, Mass.Ithaca,Miss Annie Ross,MissPeterborough, N. H.Providence, R.I.Brookline, Mass.Miss Edith M. Huntress,Tewksbury, Mass.Miss Adella Fridenstine,Cleveland, Ohio.Miss Edith C. Curtis,Syracuse, N. Y.MissMissNora F. Keating,Mary M. Truex,.Tewksbury, Mass.Long Branch, N.J.

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PUBLIC DOCUMENT1903.]— No.2326.Schedule A.Real and Personal EstateLive stock,. 13,434 20.Produce of farm on hand,.7.373 50Produce of garden on hand,3,658 33Carriages and agricultural implements,Machinery and mechanicalfixtures,8,346 8299,760 25.Beds and bedding, inmates department,34,535 93Other furniture,41,495 221etc.,inmates' department,Personal property, superintendent's department,Ready-madeDry goods,22,566 668,414 98clothing,2,516 01.Provisions and groceries,4,348 31Drugs and medicines,Fuel,2.374 71.20,779 683,200 00Library,Buildings,Real estate \ Land,.1789,200 00.49,305 00.838,505 00 1,111,309 60Thisisto certify that the foregoing list is a true scheduleand appraisalof thepersonal'property and real estate at the State Hospital at Tewksbury, Mass., belongingto theCommonwealth,Sept. 30, 1903.(Signed)Then personally appeared before memadethe aboveCHARLESnamedoath that the foregoing schedule and appraisalknowledge andisH. LITTLEFIELD.Charles H. Littlefleld, andcorrect, according to his bestbelief.(Signed)NEWTONP. FE.YE,Justiceof the Peace.

24STATE HOSPITAL AT TEWKSBUKY.[Oct.Schedule B.List of Salaried Officers employed at State Hospital.Superintendent and physician, per year,.Assistant superintendent and physician, per year,Assistant physician, per year,.Assistant physician, per year,Assistant physicians (two)each, per year,,. 3,000 00.1,500 00.1,200 00.1,000 00600 00Assistant physician, per year,Pharmacist, per month,.700 0045 00.Clerk, per year,1,400 0035 00Stenographer, per month,Housekeeper, per month,Assistant housekeeper, per month,Superintendent of nurses, per month,Night superintendent of nurses (two), each, per month,Nurses (sixty), per month,. 12Supervisors (three), per mon

atConcord,N.H.Dr.Goodwinhadbeenwithusforthree and one-halfyears, and we have alreadylearned that he is co