Massachusetts. State Board of Charity.

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rendered to the state board of charity, together with such certifi-
cates or other guarantees as the said board may require.

Section 3. The said overseers, either by one of their own num-
ber or by their duly appointed agent, shall visit at least once in
every three months at their homes or other place or places where
they may be living, each mother and her dependent children who
are being aided financially or otherwise by said overseers, and after
each visit shall make and keep on file as a part of their oflBcial
records a detailed statement of the condition of the home and
family and all other data which may assist in determining the
wisdom of the measures taken and 'the advisability of their con-
tinuance; and said overseers shall at least once in each year re-
consider the case of each mother with dependent children with
whom they are dealing, and enter their' determination with the
reason therefor on their official records.

Section 4. This act shall apply to all mothers and their de-
pendent children, whether or not they or any of them may have a
settlement i^dthin the commonwealth, who shall have resided in the
commonwealth not less than three years. No person shall acquire
a settlement or be in process of acquiring a settlement while re-
ceiving aid hereunder.

Section 5. The state board of charity shall hereafter supervise
the work done and measures taken by the overseers of the poor of
the several cities and towns in respect to families in which there is
one child or more under the age of fourteen, whether or not such
family or any member thereof has a settlement within the com-
monwealth; and for this purpose may establish such rules relative
to notice as they deem necessary and may visit and inspect any or
all families aided under this act, and shall have access to any
records and other data kept by the overseers of the poor or their
representatives relating to such aid; and said board shall, in its
annual report to the legislature, report upon the work done by its
own agents and by the overseers of the poor in respect to such
families any of whose members are without legal settlement in the

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20 STATE BOARD OF CHARITY. [P. D. 17.

commonwealth; and shall make a separate report on the work done
by the overseers of the poor in respect to such families in which all
the members have a legal settlement in the commonwealth.

Section 6. In respect to all mothers in receipt of aid hereunder
the city or town rendering the aid shall be reimbursed by the com-
monwealth, after approval of the bills by the state board of charity,
for one third of the amount of the aid given. If the mother so
aided has no settlement, the city or town shall be reimbursed for
the total amount of the aid given after approval of the bills by the
state board of charity as aforesaid. If the mother bo aided has a
lawful settlement in another city or town two thirds of the amount
of such aid given may be recovered in an action of contract against
the city or town liable therefor in accordance with the provisions
of chapter eighty-one of the Revised Laws and acts in amendment
thereof and in addition thereto.

Section 7. For the purpose of reimbursing the cities and towns,
as provided in the foregoing section, there shall be appropriated
from the treasury of the commonwealth the sum of fifty thousand
dollars for the operations of the first year.

Section 8. All acts and parts of acts inconsistent herewith are
hereby repealed.

Section 9. This act shall take effect on the first day of Septem-
ber, nineteen hundred and thirteen. [Approved June 12, 1913.

Acts of 1913, Cbapter 797.

An Act relative to the payment by the commonwealth to
cities and towns of certain expenses incurred for sick

PERSONS.

Section 1. Section fifteen of chapter eighty-five of the Revised
Laws as amended by chapter five hundred and fifty-five of the acts
of the year nineteen hundred and eight, is hereby further amended
by striking out the word " five '', in the nineteenth line, and insert-
ing in place thereof the word: — seven, — so as to read as fol-
lows : — Section 15, The reasonable expense which is incurred by
a city or town under the provisions of the preceding section within
five days next before notice has been given as therein required and
also after the giving of such notice and until said sick person is
able to be removed to the state hospital shall be reimbursed by the
commonwealth. If the state board of charity considers it expedient
to order the removal to the state hospital of a person whose physical
condition is such as to require attendance, then the reasonable ex-
pense incurred for such attendance, as directed by the state board
of charity, shall also be reimbursed by the commonwealth. The
bills for such support shall not be allowed unless they are indorsed



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PartL] GENERAL WORK OF THE BOARD. 21

with the declaration that, after full investigation, no kindred able
to pay the amount charged have been found, and that the amount
has actually been paid from the city or town treasury, nor unless
they are approved by the state board of charity or by a person des-
ignated by it; and not more than seven dollars a week shall be
allowed for the support of a person in a city or town hospital.

• Section 2. So much of any act as is inconsistent with this act
is hereby repealed.

Section 3. This act shall take effect on the first day of Decem-
ber, nineteen hundred and thirteen. [Approved June IS, 191S.

Rbsolvbs or 1913, Chapter 14.

Resolve to autiiobize the state board of charity to prepare
and publish a manual op laws concerning the charities
of the commonwealth.

Resolved, That the state board of charity is hereby authorized to
prepare and publish a manual of laws concerning the charities of
the commonwealth, and may expend for this purpose, a sum not
exceeding six hundred dollars. [Approved February 26, 191S.

In addition to the foregoing, the field of the Board's activi-
ties is indirectly affected by chapter 114, an act relative to
vagabonds, etc. ; by chapter 266, an act providing that certain
needy persons shall not. be termed paupers ; by chapter 457, an
act to authorize continuances in cases against children; by
chapter 404, an act relative to trespassing upon the land of
certain public institutions ; by chapter 467, relating to evening
school attendance of illiterate minors; by chapter 620, an act
relative to penalties for drunkenness; by chapter 670, an act
relative to the reporting of cases of contagious diseases to the
State Board of Health ; by chapter 692, an act establishing the
financial year of towns; by chapter 779, an act relative to
school attendance and the employment of minors; by chapter
796 of the acts and chapter 124 of the resolves, both relating
to provision for separate custody of defective delinquents; and
by chapter 831, an act to regulate the labor of minors.

THE STATE INSTITUTIONS.

The State institutions under the supervision of the Board
are: the State Infirmary, at Tewksbury; the State Farm, at
Bridgewater; the Norfolk State Hospital; the Lyman School



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22 STATE BOARD OF CHARITY. [P. D. 17.

for Boys, at Westborqugh; the Industrial School for Boys, at
Shirley; the State Industrial School for Girls, at Lancaster;
the Massachusetts Hospital School, at Canton ; the North Read-
ing State Sanatorium; the Rutland State Sanatorium; the
Lakeville State Sanatorium; and the Westfield State Sana-
torium.

The supervisory powers of the Board over these institutions
extend to the right of investigation and recommendation as to
any matters relating to the institutions, but the administration
of each is vested in a separate Board of Trustees.

The State Infirmary and the State Farm are controlled by
one Board of Trustees. Its membership is as follows : John B.
Tivnan, Salem, Chairman; Helen R. Smith, Newton; Leonard
Huntress, Lowell ; Galen L. Stone, Brookline ; Nellie E. Talbot,
Brookline; Francis W. Anthony, Haverhill; Walter F. Dear-
bom, Cambridge.

The Norfolk State Hospital for the care and treatment of
inebriates, is administered by the Board of Trustees of the
Foxborough State Hospital, composed as follows: Robert A.
Woods, Boston, Chairman; W. Rodman Peabody, Cambridge;
Philip R. Allen, Walpole ; Timothy J. Foley, Worcester ; Frank
L, Locke, Maiden; Edwin Mulready, Rockland; William H.
Prescott, Boston.

The Trustees of Hospitals for Consumptives administer the
four sanatoria, but have no powers over the tuberculosis wards
of the State Infirmary. The Board is constituted as follows:
Walter C. Bailey, M.D., Boston, Chairman; Albert C. Getchell,
Worcester; Arthur Drinkwater, Cambridge; Sylvia B. Knowl-
ton, Newton; Daniel L. Prendergast, Brookline; Simon Swig,
Taunton ; George A. Dunn, Gardner.

The three training or industrial schools fall under the control
of the Trustees of the Massachusetts Training Schools. The
Board is as follows: Carl Dreyfus, Boston, Chairman; James
J. Sheehan, Peabody; Mary Josephine Bleakie, Brookline;
Matthew Luce, Cohasset ; John F. Scully, Arlington ; Elizabeth
G. Evans, Boston; Charles M. Davenport, Boston; James W.
McDonald, Marlborough ; Lewis M. Palmer, South Framingham.

The Massachusetts Hospital School is administered by the
following Board of Trustees: Edward H. Bradford, M.D.,

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Part I.] GENERAL WORK OF THE BOARD. 23

Boston, Chairman; Leonard W. Boss, Mattapan, Secretary;
Walter C. Baylies, Taunton ; William F. Fitzgerald, Brookline ;
Alfred S. Pinkerton, Worcester.

In addition to the eleven State institutions which the Board
supervises is Penikese Hospital, the Massachusetts hospital
for the care and treatment of persons afflicted with leprosy.
This institution is administered directly by the State Board of
Charity. For the sake of uniformity and comparison, all twelve
institutions are grouped together in this report.

X UMBERS.

The total niunber of cases under care in these institutions
during the year was 19,506. Of the total number 15,063 were
males and 4,443 were females. Ten thousand and sixty were
received for hospital treatment; 2,182 were juvenile delin-
quents; 6,140 were adult offenders, mostly chronic drunkards;
and 1,124 were indigent persons, having no legal settlement
and not included in the above classifications. Of the hospital
cases, 3,213 were suffering from pulmonary tuberculosis; 1,623
were insane.

Capacity
Three institutions, namely, Lyman School, the Industrial
School for Boys, and the North Reading State Sanatorium,
showed an excess in daily average attendance over normal
capacity. All of the remaining nine, with the exception of
the State Farm, are practically full, the attendance at times
exceeding proper facilities for care and treatment. The In-
dustrial School for Boys is in process of increasing its normal
capacity to meet the pressure of commitments. Two of the
sanatoria, showing an excess last year, appear this year in the
decrease column. This condition is temporary, however, and
arises out of the construction of new buildings included in
the normal capacity but not fully occupied at the end of the
year. The marked increase in commitments to Lyman School,
noted in 1912, has continued throughout 1913, so that the
overcrowding has become serious. The trustees ask this year
for a new cottage to house 30 boys. The Industrial School
for Girls has been somewhat relieved bv the transfer of cases



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24



STATE BOARD OF CHARITY. [P. D. 17.



to Sherborn. Serious overcrowding at the State Infirmary
must continue unless provision can be made elsewhere for the
insane and the feeble-minded. The State Board of Insanity
and this Board unite this year in recommending the im-
mediate establishment of an additional school for the feeble-
minded. The accompanying tabulation indicates the fluctua-
tions of daily attendance above and below the normal capacity
for inmates for each institution.



Capacities of the Several State Charitable Institutiona for the Fiscal Year
ending November SO, 1913,



iNtTZTUTXONS


Normal
Capacity


Larcest
Number
prseent

at

Any One

Time


Smallest
Number
prseent

at

Any One

Time


Daily
Average
Number
preeent
during
the Year


Increase
of Daily
Average

over
Normal
Capacity


Decrease
of Daily

Average
over

Normal
Capacity


State Infirmary ....


. 2^6


2,595


2,170


2,312.87


-


23.13


State Farm ....


3,100


2,706


2.488


2,592.00


-


508.00


Norfolk State Hoapital


97


93


41


58.25


-


38.75


Lyman School for Boys


8S3


439


382


408.39


25.39


-


Industrial School for Boys


180


192


172


182.26


2.26


-


Industrial School for Girls


312


332


288


308.00


-


4.00


Massachusetto Hospital School .


270


257


202


235.83


-


34.17


Rutland State Sanatorium


354


861


337


348.00


-


6.00


North Reading State Sanatorium


174


184


171


178.56


4.56


-


LakeviUe State Sanatorium


240


215


176


194.85


-


45.15


Westfleld State Sanatorium


183


193


168


182.60


-


.40


Penikese Hospital


19


16


14


14.74


-


4.26


Totals


7,648


7,583


6,609


7.016.35


-


-



Cost of Maintenance.
The combined appropriations for maintenance were $1,620,-
359. The total expenditures on the same account were
$1,635,236.60, creating a net deficit of $14,877.60. Of the
sum expended, $599,930.30 was for salaries, wages and labor;
all other expenses, $1,035,306.30. For the coming year the
Respective Boards of Trustees submit estimates for maintenance
appropriations, as shown in Table I., all of which are approved
by this Board. To the tabulation is added for better compari-



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Parti.] GENERAL WORK OF THE BOARD. 25

son the Board's own estimate for Penikese Hospital. Estimates
for special purposes will be considered later in this report
under each of the institutions separately.

Comparative View of Movement of Population and of

expendituees.
The movement of population in the twelve institutions men-
tioned in the foregoing pages is shown in brief but comparative
form in Table II. Inmates are classified by sex, while the
daily average attendance appears in a column adjoining the
average number of oflScers and employees. The average num-
ber of persons employed, shown in this table, is obtained from
an exact analysis of the pay rolls reducing all employment to
a basis of days. Table III. affords a comparative view of ex-
penditures at all the institutions, classified as " current " and
" extraordinary." Tables II. and III. are drawn in accordance
with the statistical form adopted by the National Conference
of Charities and Correction, May 15, 1906.



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26



STATE BOARD OF CHARITY. (P. D. 17.



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STATE BOARD OF CHARITY. [P. D. 17.



The Institutions Severally.
A brief statement relating to the general supervision of
each institution will be followed by comparative and more de-
tailed consideration of financial administration.

The State Infirmary, Tewhshury.

John H. Nichols, M.D.y Superintendent.

Numbers.





Sanb


Insane


ToiiOJB


INMATES


1


1


1


1


S


a


1




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1


1




879


256


370


1.505


207


521


728


1.086


777


370


2.233


Admitted during year .


2.812


480


852


4.144


1 ^


59


96


2.849


539


852


4.240


Diaclurged during year .


2,726


489


787


4.002


48


69


U7


2.774


558


787


4,119


Number November 30. 1913 .


966


247


435


1.647


196


511


707


1.161


758


435


2,354



Ciasrification of discharges: deaths, 597; removals, 3,522.
Number of maternity cases, 134; living births. 131.

Total valuation of plant, real and personal, $1,687,866.98.
Value per unit of capacity, $722.54. Provides almshouse and
hospital care for indigent persons not chargeable for support
to any city or town. During the year 6,473 persons have been
under care, 482 less than in 1912, and 596 less than in 1911.
The largest daily census was 2,595, the smallest, 2,170; the
daily average being 2,312.87. For the preceding year the
corresponding figures were 2,573 and 2,074, with a daily
average of 2,283.44. Xormal capacity of institution, 2,336.

Of the whole number cared for, 6,191, of which 4,490 were
males and 1,701 females, or 05 per cent., were treated as hos-
pital patients. In this number were 1,081 cases of tuber-
culosis (926 of which were cases of phthisis), 5 of diphtheria,
1 of typhoid fever, 4 of scarlet fever, 12 of whooping cough, 15
of measles, 35 of chicken pox. Of the 597 deaths, 202 were
from tuberculosis. Six hundred and sixty-one surgical opera-
tions were performed. Of the 926 cases of pulmonary tuber-
culosis in the consumptive ward, 824 cases were males, 102
females. Of this number, 26 were discharged as disease ar-



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Part I.] GENERAL WORK OF THE BOARD. 31

rested, 6 apparently cured, 263 relieved, 202 died, 130 not
relieved.

Of the 134 births at this institution during the year, 68 were
males and 66 were females. Of this number there were 131
living births, namely, 65 males and 66 females. Among the
mothers of these children, 47 were bom in the United States,
20 in Ireland, 9 in England, 28 in the British Provinces; 30
were foreign bom. Eight hundred and twenty-four of the
whole number under care were insane.

Of the 4,240 new admissions, 2,375, or 56 per cent., were
from Boston. Those native in Massachusetts numbered 987,
or 23.2 per cent. Two thousand five hundred and thirty-
four were foreign born, representing 38 different countries.
Eight hundred and fifty-two, or 20.9 per cent., were under
twenty-one years of age.

With an appropriation of $444,200, a total of $444,130.56
was expended for the maintenance of this institution. Of the
amount expended, $155,533.42 was for salaries, wages and
labor; all other expenses, $288,597.14. Weekly per capita
cost of maintenance computed on expenses less sales and re-
funds from maintenance, $3,675. Total receipts from all
sources other than the State treasury, $24,546.70. Net cost of
maintenance to the Commonwealth, $419,583.86. Ratio of
daily average number of persons employed to daily average
number of inmates, 1 to 7. For detailed analysis of receipts
and expenditures, see pp. 69-80. The Trustees estimate that
$471,000 will be necessary for maintenance in 1914. (See
table, p. 26.)

The women's special ward, nearing completion at the close
of last year, is now occupied and houses 35 patients. The
new building for male employees was still unoccupied at the
close of the year, though authorized in 1911. It is, however,
now at the point of completion, and will house 40 employees.

The pathological laboratory and the extension to the adminis-
tration building are both under way, but neither improvement
was ready for occupancy at the close of the year.

Perhaps the most noteworthy fact in the year's work at
this institution is the rapid extension of clinical laboratory
work, and the further intensive study brought to bear upon the



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32 STATE BOARD OF CHARITY. [P. D. 17.

more trying problems in treatment. Largely among these prob-
lems has been the treatment of syphilis. As reported last year,
much encouragement has been derived from the use of an
arsenical preparation. This treatment was continued during
the past year, showing a high percentage of cases benefited.
The conclusion from the year's experience is that though cure
cannot be guaranteed by the use of this agent, it is probably
the most powerful agent now known for combating this destruc-
tive disease. Its use has been of further benefit to the admin-
istration by making treatment of many of these cases feasible
by isolation within the general wards, thus relieving congestion
in the wards specially provided.

At a later page of this report will be found an account of
the work which the Board's committee on social service has car-
ried on during the year with cases in the maternity wards.
This work, an experiment at the outset, is rapidly adding proof
to the axiom that an institution is never in itself, unaided,
a cure for the problems of citizenship, but is at best but one
link or step in a process of treatment which must involve pre-
institution study and after-care.

The number of children at this institution increases in steady
ratio. So great has finally become the overcrowding that the
Trustees this year ask for a building to house 100 boys. The
Board withholds its approval from this proposal, believing it
to be an improper development of the Infirmary. Some chil-
dren there must be, but so far as proper classification will allow,
they should be removed to special institutions. Consequently
the Board again urges the establishment of an additional school
for the feeble-minded and the immediate development of exist-
ing schools to their maximum. This improvement would re-
lieve the State Infirmary of many of the feeble-minded children.
The Board also asks the establishment of a hospital for the
treatment and temporary care of sick State minor wards. Such
a hospital, aside from filling a great need in the Board work
with children, would relieve the State Infirmary of a large
number, now sent there because there is no other place for them.

Mention has been made in previous reports of the complica-
tion which arises in the functions of this already complex in-
stitution by the presence of the insane. It is a fact that these

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Part I.] GENERAL WORK OF THE BOARD. 33

patients perform much of the labor of the institution, aiding in
keeping the per capita cost at its present low level, besides de-
riving from such employment considerable benefit to them-



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