Massachusetts. State Board of Charity.

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

During the year 601 cases have been under care. Of this
number, 178 were in residence at the beginning of the year.
The remaining 323 were admitted under the following classifi-
cation, based upon the ascertained progress of the disease: in-
cipient, 14, or* 4.33 per cent. ; moderately advanced, 62, or 19.20
per cent; advanced, 247, or 76.47 per cent. Sex of patients
admitted : males, 178 ; females, 145.

The discharges numbered 320, namely, 176 males and 144
females, classified according to condition as follows : disease ar-
rested, 84, or 26.2 per cent. ; improved, 79, or 24.6 per cent. ;
not improved, 44, or 13.7 per cent ; non-tubercular, 1 ; died, 77,
or 24 i>er cent ; unclassified because of shortness of stay, 35, or
10.9 per cent Number of patients at the end of the year, 181.

The largest daily census was 184, the smallest 171; average,
178.56. The average for 1912 was 173.12, and for 1911, 157.
Average duration of stay of patients, two hundred and three
days. The corresponding average for 1912 was one hundred
and seventy-one, and for 1911, one hundred and sixty-seven.

Out of an appropriation of $82,865 a total of $82,457.55
was expended for the maintenance of this institution. Of the
amount expended, $33,421.43 was for salaries, wages, and
labor; all other expenses, $49,036.12. Weekly per capita cost
of maintenance computed on expenses less sales and refunds
from maintenance, $8.80. Total receipts from all sources other
than the State treasury, $21,918.14. Net cost of maintenance
to the Commonwealth, $60,539.41. Ratio of daily average
number of persons employed to daily average number of in-
mates, 1 to 2.5. For detailed analysis of receipts and expendi-
tures, see pp. 69-80. The Trustees estimate the sum of $88,-
591.28 for maintenance in 1914 (see table at p. 26).

A new pavilion and the extension to the dining-room ell of the
administration building, the two large improvements granted
by the Legislature of 1913, were near completion at the close of
the year, but neither was ready for occupancy. Minor improve-
ments have consisted in the betterment of walks and roads, the
clearing of land, and the completion of better facilities for stor-
ing coal and other supplies. The total expended from appro-
priations for special purposes was $7,818.97. For the coming
year the Trustees submit the following estimates for special
purposes, all of which have been approved by the Board : —

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Parti.] GENERAL WORK OF THE BOARD. 57

1. Addition to the administration building to accommodate

fireproof vault, refrigerator, and garbage room . . $5^15 00

2. Erection of a small outbuilding 800 00

3. Erection of a covered bin for anthracite coal . . 500 00

4. Erection of a new 25,000 gallon cypress tank with 100

feet steel tower 2,584 00



$8,999 00



The first item would provide facilities for compliance with
the law requiring that public records be kept in fireproof vaults.
Items 2 and 3 would supply small but much-needed adjuncts to
the institution plant. The last item would reduce a menacing
fire risk.

Lakeville State Sanatobium, Lakeville.
SuKNER CooiJDGE, M.D., Superintendent,

Total valuation of plant, real and personal, $160,150.80.
Normal capacity of plant, 240. Value per unit of capacity,
$667.29.

Provides hospital care ^d treatment for persons afflicted with
pulmonary tuberculosis. During the year 549 cases have been
under care, representing 549 separate individuals. This total
number of cases is 51 more than in 1912 and 86 more than in
1911. Of the whole number, 179 were in residence at the be-
ginning of the year. The remaining 370 cases were admitted
under the following classification, based upon the ascertained
progress of the disease : incipient, 16, or 4 per cent. ; moderately
advanced, 149, or 40 per cent ; advanced, 195, or 53 per cent. ;
not determined, 10. Males numbered 223 ; females, 147.

The discharged cases numbered 335, namely, 190 males and
145 females, classified according to condition as follows : disease
arrested, 33, or 10 per cent ; improved, 127, or 38 per cent ;
not improved, 61, or 18 per cent ; died, 72, or 21 per cent. ;
unclassified because of shortness of stay, 42, or 13 per cent

Daily average number of patients was 194.85. The average
for 1912 was 172.12. Average duration of stay of patients,
cme hundred and eighty-eight days. The corresponding average
for 1912 was one hundred and fifty-nine days.

With an appropriation of $87,300, a total of $89,100 was
expended for the maintenance of this institution, creating a

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

deficit of $1,800. Of the amount expended, $37,154.35 was
for salaries, wages, and labor; all other expenses, $61,945.65.
Weekly per capita cost of maintenance computed on expenses
less sales and refunds from maintenance, $8,558. Total receipts
from all sources other than the State treasury, $17,758.80.
Net cost of maintenance to the Comn^onwealth, $71,341.20.
Ratio of daily average number of persons employed to daily
average number of inmates, 1 to 2.6. For detailed analysis of
receipts and expenditures, see pp. 69-80.

Two major improvements — a pavilion for 30 patients and
additions to the men's and women's wards — were granted by
the Legislature of 1913, the funds for which became available
late in the spring. Work was begun simultaneously, and both
are expected to be ready for occupancy by January 1, 1914.
A shack to accommodate 12 patients was also built during the
year. The funds for this improvement were taken from the
maintenance appropriation.

Future improvements now needed are set out by the Trustees
in the following estimates which are approved by this Board: —

1. Land and equipment for dairy: —

Land, 113 aeres; with two-tenement house
and two bams, including land for ele-
vated spur track $7,000 00

Fifty cows 5,000 00

Cow bam 2,000 00

Remodelling and repairing bams . 1,300 00

Silos and milk-room equipment . . . 700 00

$16,000 00

2. Additions to administration building : —

Bakery $2,000 00

Oven and other equipment .... 500 00
Addition to refrigerator for milk and but-
ter, and porch for nurses . . . 1,000 00

3,500 00

3. Screens for new buildings 600 00

4. Coal trestle 2,500 00

5. Granolithic walk from street to woman's ward 600 00

6. Rendering and canning house 300 00

7. Wagon shed with paint shop 600 00

8. Sewage disposal 1,000 00

9. Wagon scales, 15-ton 500 00

$25,600 00

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Part I.] GENERAL WORK OF THE BOARD. 59

The request for an independent milk supply is repeated from
last year. The advisability of independence and the economy
of institution supply are readily apparent

Additions to the administration building and the coal trestle,
and additional sewage disposal, would increase facilities to
meet a growth in the institution that is already overtaxing the
present plant.

Westmeld State Sanatoeium, Westfield.
Hekrt D. Chadwick, M.D., Superintendent.

Total valuation of plant, real and personal, $166,439. Nor-
mal capacity of plant, 183. Value per unit of capacity, $909.50.

Provides hospital care and treatment for persons afflicted with
pulmonary tuberculosis.

During the year 443 cases have been under care, representing
the same number of separate individuals. This total is 31 less
than in 1912 and 37 less than in 1911. Of the whole number,
170' were in residence at the beginning of the year. The re-
maining 273 cases were admitted under the following classifica-
tion, based upon the ascertained progress of the disease: in-
cipient, 41, or 16 per cent ; moderatdy advanced, 59, or 21.6
per cent ; advanced, 171, or 62.6 per cent ; found to be non-
tubercular, 2. Of the new cases, males numbered 137; fe-
males, 136.

The discharged cases numbered 258, namely, 127 males and
131 females, classified according to condition as follows: dis-
ease arrested, 78, or 30.2 per cent ; improved, 51, or 19.7 per
cent. ; not improved, 58, or 22.4 per cent ; non-tubercular, 2 ;
died, 51 ; or 19.7 per cent. ; unclassified because of shortness of
stay, 18, or 6.9 per cent

The daily average number of patients was 182.6. The aver-
age for 1912 was 176.03. Average duration of stay of patients,
two hundred and twenty-nine days. The corresponding average
for 1912 was one hundred and eighty-five days.

With an appropriation of $88,500, a total of $94,996.91
was expended for the maintenance of this institution, creating
a deficit of $6,496.91. Of the amount expended, $38,257.21
was for salaries, wages, and labor; all other expenses, $56,-
739.70. Weekly per capita cost of maintenance computed on



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

expenses less sales and refunds from maintenance, $9,826.
Total receipts from all sources other than the State treasury,
$26,238.93. !N'et cost of maintenance to the Commonwealth,
$68,757.98. Ratio of daily average number of persons em-
ployed to daily average number of inmates, 1 to 2.4. For de-
tailed analysis of receipts and expenditures, see pp. 69-80.

The Trustees estimate the sum of $127,000 for maintenance
in 1914 (see table at p. 26).

The most important improvement of the year has been the
new power plant and laundry building. By the completion of
this building the eflBciency of the plant is greatly increased, and
a dangerous fire hazard, arising from the old location of the
power plant under the maiji building, has been eliminated.

The Legislature of last year granted an appropriation for
a children's ward, but work was not begun until September. At
the close of the year construction had advanced rapidly, and the
building, which is to house 60 children, is expected to be ready
for occupancy by February 1, 1914.

This Board approves estimates of the Trustees for special
improvements in 1914, as follows: —

1. Coal trestle, — concrete floor and retainmg wall . . $3,926 43

2. Grading, concrete walks and street lighting . . . 2,500' 00

3. Fireproof vault 1,500 00



$7,926 43



These items, though minor in importance, are necessary to
the proper maintenance of the institution. * The fireproof vault
is sought in compliance with existing statutes.

Penikese Hospital, Penikese Island.
Franc H. Pabeeb, M.D., Superintendent,
This institution is administered directly by the Board. Total
valuation of plant, $109,465.48. Normal capacity, 19. Value
per unit of capacity, $5,761.34.

Provides hospital care and treatment for persons afflicted
with leprosy. During the year 17 patients have been under
care. This total is the same as last year and 4 more than in

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PartL] GENERAL WORK OF THE BOARD. 61

1911. Of the nxunber cared for, 15 were in reflidence at the
beginning of the year, 2 were admitted and 2 were discharged,
leaving 15 patients on November 30, 1913. Of the cases dis-
charged, 1 died and 1 was released under the authority of
chapter 73, Acts of 1913 (see p. 14, ante)y as no longer a
menace to the public health. The two cases admitted were
males, both suffering from the tubercular form of the disease.
One case, suffering from the anaesthetic form, was released
after examination and before admission to the hospital.

Of the patients remaining in the hospital at the dose of this
year, 11 were suffering from the disease in the tubercular
form, 2 in the antesthetic and 2 in the mixed forms. Seven
are known to have had other communicable diseases before com-
ing to the hospital Of this number 5 had had smallpox. The
average age of the patients was thirty-ei^t years; 10 were
married ; 4 of the total were females. All of the patients, with
one exception, were of foreign race and nationality; the ex-
ception had English blood, but was foreign bom. Four pa-
tients gave their birthplaces as the United States, all being
Chinese. The races represented are as follows: Italian, 1;
Portuguese, 4; Chinese, 4; Russian, 3; Lettish, 1; Japanese, '
1 ; English (British West Indies), i.

Continuing the policy of placing this institution on a hos-
pital basis, instead of an isolation colony, the Board has been
striving this year to provide every patient with expert medical
service and the attendance of a hospital nurse at all times for
this purpose. Two nurses have now been added to the staff.
The additional service has increased the confidence of the pa-
tient and lightened the heavy burden of care. At the same
time it has made it possible for the resident physician to devote
more time to an intensive study of each case.

The year's experiment with the plan of keeping the hospital
in close relationship with institutions engaged in scientific re
search has exceeded expectations. The studies carried on at
this hospital are likely in the near future to add much to the
world's knowledge of a disease which for ages has menaced the
human race.

With this experiment at Penikese in mind the Board is all
the more convinced that every State institution for the care and

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

treatment of sick or defective persons should be made a station
for intensive scientific research. Many institutions of learning
stand ready to furnish talent of a hi^ order whenever the State
will make clear that it welcomes researcL

Several improvements have been made during the year,
resulting in better methods of caring for patients. The new
administration building, which replaces a building burned in
January, 1912, houses the administrative force much more
safely and comfortably than did the old wooden structure.
Repairs have been made on the bam and sheds, so that these
buildings are now staunch enough to withstand the high winter
winds. Quarters for the nurses have been fitted up in the old
hospital building, in such manner that necessary contact with
patients is lessened and the danger of infection accordingly
somewhat reduced. The conditions under which the administra^
tive staff must work are, however, still far from satisfactory.
Facilities must be had for carrying on cleansing and treatment
under a centralized system before the staff can be safeguarded
properly. Such centralization is sought in the Board^s request
for a disi)en8ary and hospital building, referred to in a later
paragraph.

The small laboratory in the administration building fitted
up early in the year affords excellent facilities for preliminary
tests and experiments, wych are later supplemented by further
study in the laboratories of the Harvard Medical School.

One constant source of danger from fire has been greatly
reduced by the installation of electric lights. This improvement
eliminates the oil lamp which was a source of double danger
in the benumbed and bandaged fingers of patients. This small
power unit also furnishes refrigeration and artificial ice, —
two necessities in this isolated location. It is now possible to
keep perishable stores for a suflScient length of time to make
buying in larger quantities expedient. The making of ice re-
duces a heavy expenditure for purchase and transportation to
a moderate outlay for power and labor.

Last year the Board asked an appropriation for a shoal-draft
service boat, and in previous years has requested . funds for
the dredging of a channel from the wharf to deep water. Both



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Parti.] GENERAL WORK OF THE BOARD. 63

items primarily involve a question of economy, though the proc-
ess of going ashore in a skiff in rough weather is also hazardous
and subject to accidents that would be far less likely to happen
with a proper landing. During the past two years eelgrasa
has increased about the present wharf to such an extent that
a catboat cannot be driven through it by engine power at low
tide. This growth threatens to close the approach completely
for powerniriven boats. The only remedy appears to be the
dredging of a short channel as recommended.

More urgent than these improvements, however, is the need
of a dispensary and hospital building which will centralize
cleansing and treatment in one place under proper hospital
conditions. Experience in the administration of Penikese Hos-
pital fully demonstrates the need of specially adapted facilities
for the care and treatment of lepers. It is essential that the
enforcement of cleanliness with regularity of treatment be
brought about without unduly exposing the staff of officers
whose duty it is to bathe these patients, treat them and bind
up their woxmds. The Board therefore asks for a one-story
structure containing bathing facilities, dispensary and space
Jot X-ray apparatus, with adjoining wings for bed cases. The
outside estimate for this building, equipped and furnished, is
$40,000.

With an appropriation of $22,650, a total of $23,390.83 was
expended for the maintenance of this institution, creating a
deficit of $740.88. Of the amount expended, $9,329.62 was
for salaries, wages, and labor; all other expenses, $14,061.21.
Total receipts from all sources other than the State treasury,
$87.03. Ratio of daily average nimaber of persons employed
to daily average number of inmates, 1 to 4.7. For detailed
analysis of receipts and expenditures, see pp. 69-80.

FINANCIAL ADMINISTRATION OF INSTITUTIONS.

The Board in its supervision of the financial administration
of the several State charitable institutions — the plant and its
upkeep and maintenance — inspects each institution through
paid officers at least once each month and through its own com-
mittees and individual members at frequent intervals.

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

Monthly analysia is made of all articles of food, coal, hay,
and grain purchased, and tabulated results sent to each institu-
tion. In addition, sundry tables covering the year's operations
have been prepared.

The following tables are designed to show in detail the finan-
cial condition of each institution. A convenient summary of
the State's proper^ represented by each institution is followed
by an analysis of receipts and a similar analysis of expendi-
tures. Finally a detailed analysis of expenditures is followed
by a comparison of all appropriations and the expenditures
made therefrom.

I. Inventory.

Inventory of State property represented by the institutions
is shown in Table IV. This tabulation is in four parts. Parts
I. and II. exhibit realty; Part HI. shows personalty; Part IV.
summarizes the whole.

From Parts I. and II. it appears that on November 30, 1918,
the twelve State Charitable Institutions returned $4,977,895.75
in real estate, $304,613.78 of this amount being land, and
$4,673,281.97 representing buildings. Chattels real and other
items of betterment are not separately considered ; hence water,
telephone, fire, and sewerage systems are to be found in the
miscellaneous columns under the head of " buildings."

Part m. shows the uniform analysis of personal property
adopted by the State Auditor, to the amount of $1,077,519.21.
The total valuation, real and personal, as shown in Part IV.,
is $6,055,414.96.



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STATE BOARD OF CHARITY.



fP. D. 17.



Table IV. Pabt IV. — Inventory of the State Charitable InstUutioru —

Concluded.





SUMlfABT








Total
Inventory


INSTITUTIONS


Real
Estate


Personal
Estate


Total Real

and Personal

Estate


State Infinnary . . . .

State Farm

Norfolk State HoQ)itai .

Industrial School for Boys

Maasaohusetta Hospital School
Rutland State Sanatorium
North Reading State Sanatorium .
Lakeville State Sanatorium
Westfield State Sanatorium
Penikeee Hospital ....


11.436.342 90
1.337.090 00
73.051 68
884,513 11
185,506 39
309,143 23
271.479 87
513.353 00
116.824 72
125.659 75
131,520 52
93,410 58


1251,524 06
386,947 13
23,943 52
95.483 20
42.929 28
53.900 48
44.592 26
53.357 03
39,377 80
34.491 05
34.918 48
16,054 90


11,687,866 98
1,724.037 13
96,995 20
479,996 31
228,435 67
363,043 71
316.072 13
566.710 08
156,202 52
160,150 80
166.439 00
109.465 48


11,687,866 96
1,724,037 13
96.995 20
479.996 31
228.435 67
363.043 71
316.072 18
566,710 03
156,202 52
160,150 80
166.439 00
109.465 48


Totals


14.977,805 75


11.077,519 21


$6,055,414 96


$6,055,414 96



II. Receipts.
Table V. is'designed to show every item of income to each in-
stitution from whatever source for whatever purpose, excepting
certain private funds, casting all together for ready comparison.
The tabulation also shows such of the receipts as under the l&w
are available for maintenance purposes in 1914. According to
this table the total receipts from all sources were $2,246,746.74.
Of this amount, $2,050,347.09 was received from the State
treasury, and the remainder, $196,899.65, came in on account
of the institution, through board of patients, sale of products,
or otherwise. Of this latter figure, $147,662.65 is available
for maintenance purposes in 1914.



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

III. ExPE]!<a)ITUKES.

Table VI., divided into four parts, shows all expenditures of
whatever nature on account of the several institutions. Part I.
deals with maintenance only. Part II. exhibits outlays for
special purposes, divided into four headings, namely, " land,''
"buildings,'' "furnishings and equipment," and "miscel-



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