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On examining the books we find that a large number of the patients are chronic invalids, who find the hospital a cheap and comfortable boarding-place. No one can blame them for going there, if it is permitted; they are not responsible for the laxity of the management. They simply pay what is required, and do not realize that they are living at the public expense. It is the fault of the board of managers, who exclude the right class of persons, and make a small and partial payment a sufficient reason for admission, and the lack of any payment a cause of exclusion, in all well utilized hospitals, chronic inmates and semi-invalids are excluded and most cases discharged when found to be incurable. The reason for this rule is evident when we consider that a hospital is necessarily an expensive place, arranged and ordered for the use of the severely sick and injured. In a large town, if properly used, it will always be full of true hospital cases, and there will not be room for these, if chronic patients are allowed. Our own hospital has room for almost 12 to 14 patients at once, a small number for a city of 30,000 inhabitants.

On consulting the hospital report in the municipal register for 1877, which gives the statistics for last year, we find that there were 29 patients One only was free. He was a man injured by a fall, with broken spine, who boarded 33 weeks, was afterward removed to and died at the alms-house. The total number of weeks paid for, 217. The greatest number of patients at any given time was for the week ending September 16, when there were 11 at once. The smallest number was for the week ending April 5, when there was only one. From January 1 to February 5, only 2 per week: to Match 18, from 1 to 8 per week: to June 24, from 1 to 5 per week; to October 28, 4 to 11 per week, to December 30, 3 to 7 per week. Average duration of stay for each patient, 8 weeks, showing the chronic character of the inmates. From the imperfect records we cannot find out the longest or shortest duration of a patient's stay, but we know that some have been over a year in the hospital, mere invalids who prefer to board there because it costs them so little, and they receive so much.

We are told that $202 more was "due from patients and considered good." Thus we find that the average amount charged each patient was $5.15, and the average amount received up to date, $4.74. The average cost of each patient was $13.39, the average amount of cost of keeping, above amount actually received from each patient, was $8.08, and the average cost above amount charged was $7.74. Of the $2365 given by the city only $442 went to a charity patient, and be a hopeless case, who would have been as comfortable at the alms-house as the many unable sufferers who go there.

The annual report of the managers is very limited and of little value. No list of cases or names of diseases is given as is customary in all complete hospital reports. Without giving names, a complete list of cases should be printed annually, stating age, sex, disease, time of treatment, and whether discharged, cured or incurable, or deceased. We find nothing of the kind. The books are loosely kept, not a single entry for this year, the records of former years imperfectly carried out, names of diseases not given always in medical terms, but patients recorded as sick with "nervousness" and similar vague and unscientific terms. The books should be regularly and accurately kept, open to proper inspection at all times, and filled up to date, always a light task for the clerk where the entries are so few and far between.

While chronic, infirm and well-to-do persons are receiving more than half their support from the tax-payers of our city with no more benefit than they could receive in any comfortable private family, it is impossible to gain admittance for our true hospital cases of urgent need if they cannot pay at least $5 per week. Last year we were refused admittance for a boy with hip disease, whom Dr. Smith wished to treat. His father is a respectable Irish artisan of Springfield, but his poor and crowded home could not afford the nursing which alone could have his life under the trying operation which be required. We were obliged to send him to Boston to the Massachusetts general hospital, from which he returned cured in five months. He was indebted to the charity of a citizen of Boston for a free bed. We have sent from the home for the friendless similar cases requiring operation, who should have been treated here. We shirk our burdens upon Boston. We deprive our patients of our pure country air. We permit many to suffer and die without treatment. We waste the money and the room which we should give them on people who never would be admitted to any well-ordered hospital. However, there are a considerable number of proper cases treated annually, acute diseases and surgical patients, and the money is not all wasted.