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THE TRUTH OF THE MATTER.

(Boston Advertiser, May 7.)

Nothing which has been given to the public since the affairs of the Tewksbury Almshouse became prominent has afforded any thing like the exact, full, and trustworthy information concerning its present condition that is given in the report by Mrs. Clara T. Leonard of her recent inspection of the institution, made to the State Board of Health, Lunacy, and Charity, which is printed this morning. It deals with the real question in issue, the condition of the almshouse at the present time, which alone is pertinent to a consideration of the need of present reforms. What the condition was ten years ago is not to the point; nor is its consideration pertinent, as a reflection on the administration of State affairs, if the abuses were then discovered and rectified and no longer exist. For this reform the State administration will be commended, not condemned, by honest-minded citizens.

Mrs. Leonard is a woman whose character and qualifications, even a common and wanton traducer of reputations like General Butler will decry in vain. Her life has been devoted in generous manner to sympathetic, unpaid service of the poor and the unfortunate. She is familiar with the operation of public institutions for their relief; and General Butler's opinion as to what is right or wrong, necessary or unnecessary, prudent or extravagant, in the actual management of an almshouse, is of no more weight against hers than it would be against Florence Nightingale's touching the care of the sick in a hospital. She is not a politician interested in supporting a party. She has no possible interest in sustaining or concealing any wrong or oppression in management. Her sole conceivable motive is to find out the facts, and to do the best for the unfortunate dependants on the State's charity. Her testimony as to the things she undertakes to speak of is worthy of implicit credence, because it is unprejudiced and intelligent. Her word will stand against that of any number of such witnesses as the governor has introduced to vilify the State.

We ask that her candid and extremely interesting report be read and seriously considered. From it may be learned, better than from any proceedings in the green-room, what improvements are practicable and what are chimerical. In the light of the facts she gives, one thing appears very clearly, namely, that the very worst thing that could happen to the almshouse would be a reduction of appropriations. So far from there being too many persons employed, there are not enough. There is hardly one of the real evils connected with the institution which would have existed if the appropriations had not been so niggardly. Mrs. Leonard's report is the report of a truthful woman who knows the facts; and all who are willing to do justice to a State, an institution, and a man grossly maligned by the governor of the Commonwealth, will read and believe it.

Condition of the State Almshouse at Tewksbury in 1883

At the meeting of the State Board of Health, Lunacy, and Charity, on Saturday, May 5, Mrs. Clara T. Leonard of Springfield, a member of the board, submitted a written report of her observations at the Tewksbury Almshouse on Wednesday, Thursday, and Friday of last week. The report was decidedly in contrast with some of the testimony put in by the governor before the committee on public charitable institutions, and it is given below in full:

HON. THOMAS TALBOT, Chairman.

Sir, -- By appointment of the board as a special committee "to investigate the care of the sick and insane and other inmates of the State Almshouse at Tewksbury," I have visited that institution. I arrived there on Wednesday, May 2, at 4.30 P.M., and remained there until Friday, May 4, at 12. I spent the entire time while there in a close personal examination of the premises, and in conversation with inmates of both sexes and all classes.

I found no material change in any thing since my visits in April, 1882, and April, 1881; both of which visits were made by me without my associates or previous notice. Now, as then, I found scrupulous neatness everywhere, in the most remote and little visited parts as well as the more prominent. It is always my custom to inspect beds, both those unoccupied and occupied, taking the beds at random, anywhere. I think I examined more than a hundred beds, including those in remote attic dormitories, where boys and men sleep, and the beds of the insane. On the night of my arrival, I took the keys of a matron, and visited a portion of the insane (fifty-two in all) without her, after they had retired. I found them in excellent condition, but with no change since the two preceding visits, when I carefully examined the insane. I found all beds everywhere in the institution satisfactory. I was assured by inmates of several years' standing, that the beds had always been changed clean sheets, etc. whenever a new occupant was received; and all beds were changed once a week regularly, and oftener when necessary. To this point I gave much attention, and made inquiry of various inmates, with the same answer. The bath-tubs were in sufficient number and good order, just as I have previously found them, with water abundant; except that some tubs needed painting inside. Many patients were being bathed while I was there. This process I always find going on in large institutions much of the time, as different persons bathe on different days, to accommodate all. There is no common pool nor tank for bathing in the institution, and has not been for several years. Formerly they were common in large institutions, but have been given up in Massachusetts some years ago.

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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.

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For these one hundred and thirty-four patients, I found one head nurse, a graduate of the Boston training-school; three assistants, one of whom is night nurse; and a single matron for the lying-in and children's building, forty-four inmates. These matrons not only have the personal care of these one hundred and thirty-four persons, but cut and make nearly all their clothing, with what help they can get from such persons. The sick include thirteen sick, insane, and idiotic women, and some terrible cases of loathsome disease, sores, ulcers, humors, etc., requiring excessive care and much intelligence. Nearly all the pauper helpers are either infirm, know very little, or cannot be trusted. By day there are only four nurses to one hundred and thirty-four patients, certainly a very small number. I made many inquiries of the women in hospital as to their treatment. Without exception, all who had mind enough to tell any thing said they had kind care; some even with emotion spoke of Dr. Wilkins's and the nurses' goodness.

All my conversation with patients and inmates was held in such a way that the attendants and physicians could not hear what was said of their treatment, and I encouraged inmates to tell me fully all about themselves. Many complained of food, that it was not good, nor to their taste.

The food which I examined seemed of fair quality: the bread not so good as at Monson, but tolerably good, certainly not sour or heavy; milk, excellent; good gruel made with milk; tea reminded me of that in railroad stations, not the best quality. Butter is served twice a day to the sick, and toast for a good many, and crackers; beans once a week, for dinner; roast beef twice a week, salt fish once, fresh fish once, corned beef once, soup once, oatmeal, etc. A few sick get beefsteak, eggs, etc., when ordered by the physician. No one complained that they had not plenty to eat: all said they had. This diet is the same for sick and well, except the few extras butter, gruel, milk, etc. for sick. Some who were feeble said they longed for little dainties. I have found free patients in the Massachusetts General Hospital, whom I have visited there, getting roast chicken, beefsteak, cranberry-sauce, puddings, jelly, egg-nog, etc. At that hospital, however, the average cost of a patient is ten dollars and fifty-nine cents per week; at the Boston City Hospital, eight dollars and seventy-four cents per week. So, for two dollars and nine cents per week, little luxury can be expected. I will discuss the subject of cost more fully hereafter. I think that curable patients would recover better at Tewksbury if they had richer and more tempting fare. A large proportion of all the sick suffer from chronic disease: of these the poor, failing consumptives, those suffering from ulcers, etc., would enjoy fruit and other delicacies which they rarely have; and I felt in talking with them how hard it was that their few remaining days should not have such comfort.

A great want for the sick at Tewksbury is a sick-kitchen for each of the two hospitals, male and female, such as is in use at the Sherborn Prison and at Monson, with a special cook, where food is prepared more suitable than in the great common kitchen. But the appropriation is too scanty to admit of this. It is evident that one hundred dollars and sixty-eight cents per annum is a small sum for the support of an able-bodied man or woman.

It will provide bare necessaries of life, food, clothing, warmth, and shelter. Yet this is .what was the cost per capita at Tewksbury last year. But these people are not able-bodied: three-fourths are sick or insane, or little children in arms, or old, feeble, or crippled. They must not only be warmed, fed, and clothed, but have bodily care, be washed, dressed, fed, and, many of them, have medical attendance, nursing, medicine. It is only in large aggregates that the expense can be brought so low.

Where shall we cut it down? In attendance, when there are only nine nurses to two hundred and eleven adults, and forty infants under three years, or one nurse to twenty-eight persons? Shall we give them less food? Cheaper it can hardly be, unless we cut off milk and butter and tea. I cannot see where to reduce expenses, but I can see very plainly where they ought to be increased very materially.

The clothing of all in the hospital is of very cheap material, but decent and sufficient, except for children and infants. The excessive economy practiced does not allow as much soft flannel as these should have, nor proper outside garments for these little ones to get full benefit of the fresh air in cool weather.

The insane-asylum contains two hundred and thirty-five patients, all women; sixteen more insane women sick in hospital are counted as there in this report. For these are employed four female and three male attendants, or seven attendants to one hundred and fifty-one patients when all are in the asylum. To-day there is one attendant to every thirty-three and four-sevenths patients. These patients are in large wards. It will easily be seen, that seven attendants cannot distribute themselves among sixteen wards on four floors, so they get on as they can. The insane patients are most of them very demented, all chronic cases, capable of little work; yet they, with the female attendants, make all their clothing and clean their apartments. Every thing is beautifully neat, and is exactly as it was in 1881 and 1882, when I visited them; the persons, hair, and clothing of the insane are in excellent order, as I have always found them. Now, the very small number of attendants necessitates a great evil, the care in part by men of these insane women. Because the insane women are too strong when refractory, as they often are, for women to manage them, unless a greater number of women were employed, men are absolutely necessary. Some violations of decency occur, of which I have had ocular demonstration; women exposing themselves in a shocking manner before men. Twelve women attendants would be a small force for these wards, and at least that number should be employed. Men should never have the personal care of women, of course; yet these women in charge could never deal with their patients unless four or five attendants were available in a ward, to aid each other in case of a struggle.

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There are to-day forty-four paid employees in the institution for eight hundred and ninety-eight persons on May 1. This was the full number by inventory. I counted persons in different wards as I went, with the help of matrons. Those in both hospitals and insane buildings are exactly correct; the others nearly so. Population there varies from day to day, and is now about nine hundred. There are one hundred and forty-three women and children not sick, with two attendants, one a night watch, one for day, in the wards in the main building, and two hundred and thirty-three men and boys in the opposite wing, with two attendants. The employees are as follows, in full:

Superintendent, head matron, assistant superintendent, clerk, three physicians, one engineer, one baker, seven attendants for insane, two attendants for old men (not sick) and boys (two hundred and thirty-three persons), three cooks for nine hundred inmates, two employees in charge of laundry, five female and three male sick-nurses, two matrons for one hundred and forty-three women, and about forty babies who are not sick, one watchman, one gatekeeper, one teamster, one gardener, six farm-laborers, one carpenter, forty-four employees.

This is about the usual number.

As in private families, days' work are done during the year by masons or other workmen on repairs. The names of such employees even for a day appear in annual reports. So when a nurse or a doctor leaves, and is replaced by another, both names appear on the lists. It would be equally true to say that a private family kept five servants, when they never kept more than one, if, as it sometimes unfortunately happens to be the case, that number of changes occurred during the year, as to say that the State almshouse had sixty-four employees last year; forty-four or forty-five was the actual number. No person of adequate experience or judgment would see any place to reduce this force. True humanity and regard for the interests of the poor at Tewksbury would add seven or eight good attendants, and this I hope to see done. Every inmate I have talked with speaks of Capt. Marsh favorably, some with great affection. Not one admits to me that they ever knew him or Dr. Lathrop to do an unkind thing; though, as I have said, there is some complaint of occasional harshness by male attendants.

Dr. Wilkin thinks Capt. Marsh one of the best and kindest men she ever knew. I believe that he has been maligned, and feel great sympathy for him. This venerable and still active man of seventy-eight years would inspire respect in any one who met him now, having had no previous account of him. He belongs to a past generation, and there are modern ideas and improvements which could be better carried out by a younger man. It would be an advantage to have a professional man of the organizing talent of Dr. Quimby of the Worcester asylum in charge of the State almshouse. While I have confidence in the medical management of Dr. Wilkin, I cannot say the same of the other physicians. There is a slipshod condition of things in the men's hospital which even the small appropriation does not excuse. Dr. Lathrop, though a man of polite manners, and spoken of by all as amiable and gentle, seems to me to lack force and energy, and is by no means thorough in his work; nor is his male assistant wholly satisfactory, so far as I can judge. I recommend a change in both those officers, and if possible, would endeavor to retain Dr. Wilkin, who is, I think, just such a woman as is needed. I examined the hospital bills, and find the apparently large sum of $1,439 for medicines last year. This includes trusses and supporters, infants' food, and flaxseed for poultices, bought in large quantities by the barrel, making up large items, and incorrectly charged as "medicines," because purchased from a druggist.

I made inquiry about the care of the dead (of male inmates of long standing), two or three of whom gave full accounts, not varying. I also asked Dr. Wilkin about this. I asked no other persons. Male patients die and are "laid out" on the beds in open ward, as there are no private rooms for the purpose. Females are, when liable to die, placed in a private room, as the new hospital has separate rooms. They are then placed in a coffin, and taken to the chapel until buried: all seems to be done decently. The men who told me were not likely to state things too favorably, judging from some other things they said. Every dead body is viewed by a physician before being taken out of the bed. Further than this, I know nothing about the subject. It has been my desire to make a most thorough and careful examination of this institution, to satisfy my own mind and other people of the real condition.

To this end I have talked most freely with, and cross-questioned, various inmates, and have given out in the wards, in advance of my coming, that I wished to hear the truth. One nice old Irishwoman said she had been here, "off and on," for twenty or more years. "No, dear," she said, "I never was ill-used, nor see nobody ill-used; but you know there's quare people here, and many things they say." Another woman, smart and intelligent, but a victim of intemperance, said she had been "in and out for eight years;" and Capt. Marsh "has been a father to me, and I was always well used." I heard no complaints from women, except some trivial ones, such as are common in the world, not one of abuse. I have investigated drawers, cupboards, closets, baggage-rooms, etc. All are in first-rate order, trunks marked; few paupers bring trunks or have good clothes, but wear State clothes. Their few effects are done up in bags, ticketed and numbered, and kept on shelves in good order to return to them. Some of the insane women wear their own clothes, nicely marked and of good quality: one had her own sheets and pillow-cases. She has had her own things every time I have been there; in fact, I see no changes, no "fixing up."

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In carefully considering the expense of the institution, I am at a loss to know, in reducing it by cutting down the number of attendants, who it is proposed to dispense with. Shall it be the engineer, or the baker, the three cooks, or the teamster? Are there too many personal attendants to take care of the food and clothing and other property of the State distributed among these irresponsible inmates ? Nineteen of these for eight hundred or nine hundred sick or idiot or infirm or aged or insane or infants, or so intemperate, vicious, or broken down that they cannot live in the outside world; and every one except a few temporary boys, about twelve or fourteen in number, belong to one of these classes. The wages paid these attendants and officers are moderate. That some kind of persons could be found to take their places, there is no doubt. But thirty dollars a month for a training school nurse or male attendant is moderate. So is twenty-five dollars per month for a female attendant to insane, when we consider the excessive number in charge of each attendant. An ignorant, unskilled female servant-girl gets half that sum, and is worth about one-sixth as much for service. Shall we cease to cultivate the farm or garden? Shall we give up repairs? The law of the State allows three dollars and twenty-five cents per week per capita for care of the insane in our State asylums, but there is not much sick-nursing needed for those. The Tewksbury paupers need full as much expense as the insane, and the institution is in fact a great hospital.

I never expected to be ashamed of Massachusetts, but I am now ashamed. This rich and prosperous State, year after year, cries out, "Cut down pauper expense;" and persons are found who point to some of the poorest-kept almshouses in the State as a model for Tewksbury. The taxes are paid in chief by the rich. The poorer class do not pay in taxes even the proportionate cost of the protection by police of their persons and property. For the purpose apparently of justifying this parsimony, gross misstatements are spread upon the columns of every paper in the land; and the proud old Commonwealth receives insult and cries of shame from States like New York and Ohio, when I read in their own recent reports of insane in county almshouses chained naked in outhouses, wallowing in their own excrement, sexes mingling and bearing fruits of shame and neglect time and again.

Most of all, Irish citizens of Massachusetts, legislators and voters, grudge to their own countrymen, and nearly every inmate of Tewksbury is of foreign birth or parentage, largely Irish, -- grudge to these, I say, the poor sum of one hundred and nine dollars per annum per capita when sick or crippled or feeble or infant or insane.

Political feeling should never enter into questions of charity; but if one party asks for a just and fair expenditure, and another calls for meager and inadequate one, in a spirit of niggardly and selfish greed, the God who hears the cry of the poor shall avenge their cause as he did the wrongs of the slave, and the party who goes for the wrong shall surely fall. This report has been written entirely since four P.M. of Friday. No person has previously seen it, or had any knowledge of what I have written; nor has any suggestion been made to me in regard to it. Such as it is, it is all my own. The short time I have had, and my inability to confer with any one about it, writing it alone at my room in a hotel, makes it more imperfect than I could wish. I would have been glad of a week of time at least to write and revise at leisure. It is my wish that my statements should be given to the Legislature as well as to this board; therefore I have given facts known to most of my associates. The attempt to cut clown the appropriation for the State Primary School at Monson fills me with great alarm. I am very familiar with the interior work of that institution, and know that it would be wrong to reduce expense there. If it is ever done, the children would have poor food and clothing, and unsuitable persons in charge. Very cheap service and overworked employees mean always inferior work done. There is much hope for the young, therefore more harm can be done by parsimony at Monson than at Tewksbury. Here, again, we find Irishmen in the Legislature oppressing their own people, and unwilling to spend a fair sum in their care. If the administration of public charity falls into the hands of a governor, there is a danger of office in charitable institutions being made a reward for political service. We have only to turn our eyes to other States to see this actually in practice. The care of the insane and other dependents has been shockingly mismanaged, because committed to politicians. Massachusetts has steadily progressed in the contrary direction, giving the charge of the poor into boards holding long terms of service, and intrusting a portion of the work to women, who have no part in politics, and who work without compensation and from benevolent motives.

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It is easy, when it is sought to produce a certain impression rather than to know the truth, to take exceptional instances as general conditions, to show all the evils and none of the good, to base falsehoods upon a slender foundation of truth. This is the most dangerous form of slander, and this is what has been done at Tewksbury. And probably many good people to-day believe that people with foul diseases bathe in the same water as others, which is utterly false; that nurses beat and ill-treat sick women; that people have short allowance of bad food, when food is abundant and good, though too coarse for the sick and feeble, for the most part. Tender hearts ache to think of the suffering there, when in their own towns the paupers never were half so comfortable or well cared for as people have been for the past few years at the State almshouse. The poor of Springfield cost in the almshouse two dollars and forty-eight cents per week each; yet all the seriously sick poor are sent to the City Hospital, at a cost of about twelve dollars per week each, and all children are boarded out in families as the law requires. This law is disobeyed in Lowell and other cities; and children are kept with adult paupers, many of whom are persons of the same character found in our prisons.

With the management of my own city almshouse, I have been familiar for some years, since the Union Relief Society and Children's Aid Society also work in common with the overseers of the poor; by which co-operation the standard of poor relief has been much raised, the people of the city being willing to pay for what is reasonably comfortable and for competent attendance. Great care should be exercised to prevent pauperism from being made too attractive by undue expense. To attain the just medium is our duty, and should be our desire. In conclusion, I would say, that most of the abuses at Tewksbury belong to past years, and have been gradually reformed. I speak of it as I have known it since my first visit there, April 15, 1881. We deal with things as they are. Like all human institutions, I think it can be improved, but gradually and by temperate and well-considered action. All of which is respectfully submitted to my associates, asking that it may be presented to the Legislature.

CLARA T. LEONARD.