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There is no vermin in the institution, except sometimes stray bugs, liable to be brought in by inmates, as are also lice of the head and body both. There are cockroaches near the water-pipes, as I have often seen in hotels and private houses. To keep out vermin is one of the most difficult tasks in an almshouse, and is accomplished as well at Tewksbury as could be expected. All my information in regard to vermin I received from inmates. There are some rats seen now and then, as might be expected in a large group of buildings on a farm where they can come in from the fields in search of food; but, from my inquiries of inmates, I thought no more than I have seen in almshouses proportionally.

I found the old women's and old men's wards very cheerful and comfortable, the occupants generally cheerful and contented, so far as human nature is contented in even more luxurious surroundings. There are always some children at the almshouse, a few with their mothers; others sent in from towns in the eastern part of the State, waiting transportation to Monson; also a number of children (perhaps twenty) afflicted with loathsome disease, or hopelessly idiotic. I found the sick children receiving fairly good care; on the female side, very good care. There are no infants at Tewksbury without mothers, and, as is well known to the board, no foundlings since October, 1879; these all being boarded out in private families, with excellent results. In former times the motherless infants fared badly here; because they were cared for by pauper women, ignorant and untrustworthy. In 1879 they ceased to be maintained at the almshouse. I saw a good many feeble, emaciated infants, born with nameless diseases, suffering for sins of parents. The men's hospital is a long brick building, divided by the dispensary into two wards, sick and convalescent. There are three small rooms off the wards for special cases, two of which held six beds and one two beds. In eight of these beds were sick, insane, or idiot men. A small partitioned space off the long or sick ward is used for cases of delirium tremens. I found seventy patients in the long ward, thirty-nine of whom were in bed, the rest able to sit up more or less. None of these are able- bodied. Two paid male attendants only are in charge of these men, many of whom are demented. In the short ward were forty-seven feeble men, three of whom were in bed, with one paid attendant. There has been of late a night watchman for the two wards, but not always; and the sick must have suffered when there was not. At present one attendant has just been dismissed, and his place is unfilled. For these one hundred and seventeen sick and feeble men, three attendants, with such help as can be had from patients, do all the work, cleaning the floors, utensils, etc., bathing the patients, washing and bandaging sores, politicing, giving medicine, food, etc. Any person accustomed to sick-nursing can see how inadequate is the number of attendants, and how difficult it must be to secure proper persons to do so much work for the most repulsive subjects of disease and dementia.

The male attendants were spoken well of by some patients, by some of long term in hospital with praise. Two men, apparently credible persons, gave me instances of attendants striking and roughly using sick men. One of these patients said that attendants had a hard time sometimes with delirium-tremens patients, who were very dangerous and difficult to handle. In my opinion these two wards cannot have proper care without six paid attendants, four for day and two for night; nor would any of our good hospitals probably get along with even that number of nurses. First-class men cannot be had for this position, even at twenty-five or twenty-six dollars per month, which is what they are paid. No attendant should ever be permitted to be unkind to a patient, much less to strike or abuse one, which is horrible to contemplate. But when cheap and insufficient attendants are demanded, we must put up with what we can get, as housekeepers sometimes must with faulty domestics. The surest way to prevent abuse is to have competent men in charge, and enough of them. The appropriation does not permit this.

The women nurses and attendants are respectable and intelligent. They belong to the class of women who earn their living at about the same rate in other avocations; could earn as much, easily, elsewhere and more agreeably, I should think. The women are in three old wooden hospital-buildings and one new brick one, all on the opposite side of the quadrangle from the men's hospital.

Most of the hospital rooms are large wards. Dr. Anna Wilkin has been in charge of these since Feb. 6, 1882; and to her I am indebted for much valuable and trust-worthy information in regard to the institution. Miss Wilkin is faithfully devoting her time and skill to the alleviation of suffering.

I found her hospital in as good condition as the structure of the buildings will permit. They are old and cheap, with the exception of the brick one, but not uncomfortable, and are very clean. In the women's hospital and the maternity, ward, I found ninety-four women, fourteen sick infants, twelve new-born infants, and fourteen children between two and three years old, most of whom had mothers in the almshouse.