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Wasteful Public Charity
The Springfield Alms House, Hospital and Lock-up
Intelligently Criticised in a Report to the Union Relief Association

The Alms House.

On the second day of July last the alms-house in this city was visited and thoroughly examined by the undersigned, a committee appointed by the Union Relief association to ascertain the conditions and needs of that institution. Through the courteous assistance and from information clearly and fully stated in writing by Mr. Pease, the master, we are enabled to furnish the accompanying tables, giving the ages, sexes, physical conditions, nationality of and other facts in regard to the inmates at that date. The clothing, bedding and premises generally we found in reasonable order, -- better in fact than we could have expected, where so few officers have so many helpless inmates in charge and such varied duties to perform. The food appeared to be good and sufficient. No complaint was made to us by the inmates of their treatment, though we conversed freely and alone with them.

We find, however, some grave defects in the system. First, it is impossible with the small number of officers employed, that the children and the sick and infirm persons should have proper care, and that all these, particularly the children, should not suffer from neglect. A matron and assistant matron, with the help of an inmate of the alms-house as nurse, have the entire charge of the persons of 13 infirm, disabled or insane women, of 20 men of the same class, and of 32 children, five of whom are under two and all but two under 10 years of age. The cook and the laundress are both paupers, with children in the alms-house, receive small wages, and cook, bake and wash for 12 persons besides officers, with only such help as they get from able-bodied pauper women, of whom there are three at date in the home. The heavy and out-door work is done by able-bodied male paupers, of whom we found three present. Some light in-door work is done by partially disabled men. Of course the inmates should be made useful so far as possible, but more supervision is indispensable to proper cure. We found seven sick persons in the house, three of whom were hospital cases, amputation, some abscess and acute erysipelas. Such should not go to the alms-house, but to the city hospital. We shall speak of this more fully in our report on the latter institution. It is a deep disgrace to our city authorities that they do not provide better care for such paupers, but send them to the alms-house where there are no proper facilities or room for nursing acute or surgical cases.

The bad construction of the alms-house building adds much to the labor of caring for the inmates both sick and well. The central portion contains the private rooms of the master and his family. It completely intersects the wings, which have no other communication, except in the third story. Of course the family of the master cannot permit their house to be made a thoroughfare by the inmates of the alms-house for obvious reasons. Therefore, many of the latter, in going from one part of the house to the other, to the dining and sleeping rooms, are obliged to ascent to the third story and descend again to the second; 13 inmates go up 21 stairs to sleep, 63 go up 9 stairs, among them 10 old men while 13 children go up 39 stairs and down one flight again to go to bed. The plan of the building is a masterpiece of inconvenience and want of forethought. There are no elevators or modern improvements for carrying food to the sick and bedridden, some of whom are by necessary lodged in the third story. The only common day room appropriated to 32 children is but 10 by 12 1/2 feet in dimensions. They must fit in it like sardines in a box, if they are all there at once. Having no proper place to stay, they roam over and about the building at pleasure. The overworked matron, assistant and nurse, with 41 adults infirm and disabled to feed and attend, and some 70 sick persons to nurse, can have little time to care for the moral well-being, the daily wants and habits of these little ones, most of whom are very young. They lounge in the corridors and the rooms occupied by insane men and those of both sexes who are broken down by dissipation and vice, in company with women of abandoned character. We must remember that, although some excellent and worthy men and women are reduced by age or ill health to a dependence on public charity, most of our paupers arrive at their destitute condition through vice and intemperance. An alms-house is no place for children, and it would be a wise act for the Legislature to prohibit their stay there being prolonged beyond a month, excepting only infants with their mothers. No conscientious and thoughtful person can witness the condition of our alms-house children without seeing that we are training them to crime and pauperism. That the quarters assigned to them for company during the day, narrow, bare and unfinished, are less cheerful and spacious by far than the hall of our county prison for men, is bad enough, but the companionship afforded them is a greater evil. Every citizen of this town should feel guilty, in permitting these alms-house children to exist in such a condition of neglect, but no blame attaches to the master of the institution of his assistants. They see the evil, but have neither time nor proper accommodation to give them.

Of course, we know that our costly and ill-planned alms-house cannot be rebuilt, or much money expended upon alterations. We must make it serve us for years to come, but we must make some changed in its arrangements. There are, exclusive of the portion occupied by the truant school, 33 bedrooms, about 12 by 15 feet in size on average. Single beds are used generally. Thirty rooms are occupied by 69 inmates; three rooms, from necessity, have one occupant only, 11 boys occupy a room 30 by 14 1/2 feet; seven inmates occupy the lower floor; nine truant boys also are on that floor, in their own wing. Ten persons have meals carried to their rooms, six of whom are lodged on the third floor; seven of the 10 could come to their meals if lodged on the first floor. There is but one outside entrance available for the use of 82 persons. If a sick person is brought in suddenly, there is no hospital ward or vacant room. A place is made by crowding still more. The most obvious remedy for the present inconvenience is the removal of the truant school, and taking the valuable space it now fills on the two first stories for alms-house uses. This would also give two large, airy wards for the benefit of infirm persons, who are more easily cared for thus than in separate rooms. Better ventilation and facilities for heating can be had in wards, and it seems strange they should have been left out of the original plan.

The placing out of children in families we strongly recommend. All the most enlightened modern efforts of philanthropists for the benefit of pauper children are in this direction. The payment of a small sum would procure suitable homes for every one of these children. Their average weekly cost of support now, as stated in the municipal register for 1877, is $1.98. Probably $1.50 per week for some and $1 for others would provide every one with a good home in the country. One of this committee recently advertised for a home for a child at $10 per month, and received over 50 applications, many of them from excellent families. Careful visitation, however, by women should be made a safeguard for their good treatment, and the visitor should have no payment except expenses. The great amount of unpaid work already done by state commissions and boards of private charities for the state and towns guaranteed that such workers can be found and trusted. In fact, the payment of such sums generally attracts a poor kind of workers and does not tempt the best ones. Therefore we prefer unpaid service. The children would often be adopted by the families who had become attached to them. The expense would be no greater, and the change would be an inestimable blessing to the children.

We doubt the benefit of the truant school to the boys confined there. They have no yard or systematic outdoor exercise, for want of which their young muscles must suffer, and probably their nervous energy expends itself in unwholesome or mischievous acts. They were having a summer vacation of eight weeks when we were there -- an absurd farce -- equally appropriate to the county jail. It is simply a period of idleness in jail. We believe these boys corrupt one another. All but one whom we saw were very young. That one was a big brutal-looking fellow, apparently the leader, and a bad one, of the others. We ought to have a county truant school, where boys needing discipline can be sent from all our towns. They should have a master and matron also, some industrial training, plenty of wholesome outdoor work and play with drives out satan and fevers. Agricultural labor would be best for them -- gardening and the care of domestic animals -- and they could raise most of their own food. They houses for their use need not be expensive, if the folly of building a palatial mansion of architectural pretensions and absurd inconvenience which have been so much in vogue of late, be avoided.

Another serious evil in the present crowded and ill-arranged building is the mingling of sexes in adjacent rooms, freely accessible to each other without supervision during most of the time, and wholly so at night. When we consider that the men and women so closely lodged together are many of them either demented or depraved in habits of life, it seems hardly probable that great immoralities should not occur. There is every reason to suppose that advantage is taken frequently of such opportunity. The unprotected state, too, of weak-minded women and of little girls must lead to abuses which we shudder to contemplate. The newspapers have lately been giving its shocking reports of abuses and licentiousness in the Maryland alms houses. Probably our own are by no means free from these, and such vile crimes we know have been committed under negligent supervision in some of our prisons and state institutions where the sexes are not carefully separated, and the vicious and weak-minded have opportunity to use abominable practices. This is an important matter, fully appreciated by the persons in charge of our alms-house and it makes the removal of the truant school an imperative necessity. This would permit the two wings to be used for opposite sexes, as is customary in well-ordered institutions.

An additional matron is much needed to take charge of the infirm. We repeat that it is impossible that the present number of matrons should do their work well even if all the children, including the truant school-boys, are removed as we desire. The entire absence of appliances for extinguishing fires and the limited supply of water expose the inmates to extreme danger in case of a fire, and great destruction of property also is certain to occur in such case. The nearest signal box is one mile distant. There should be one in the house. It is not probable that all the helpless and aged persons could be got out in time to save their lives if the house were on fire. These dangers and defects are well known to the overseers of the poor, and fully stated in their last annual report, which designated the manner in which fire-escapes, hose, etc., should be provided. Nearly a year has elapsed without a remedy -- in sinful apathy. If this procrastination and indifference continue much evil will result. Children are being corrupted and living untamed, lives and valuable property are endangered, old people and invalids are needlessly worn and worried with discomfort, curable patients are becoming incurable. Perhaps we shall see, before long, one of those horrors where 30 or 40 human beings are roasted alive. God is not unmindful of sins and omissions, and will hold the guilty to strict account. Citizens of Springfield, voters and tax-payers, ye are all guilty of these things, see ye to it. We do not ask the city to increase the expense of our pauper department. Far too much is spent already: But alas! More than half is thrown away. Too much is spent on unfortunate, extravagant, idle and thriftless mendicants, too little on the really helpless and needy. Cut down outside relief to almost nothing, spend judiciously and to good purpose on alms-house and hospital, always working to promote the future usefulness of the young and the sick. There should be no long delay. One or two vigorous men in the city government ought to be able to carry on all the rest to prompt and conscientious action.

To sum up, we recommend and earnestly urge the speedy

(1.) Removal of the truant school (2.)

(3.) Placing out of all the children in families (4.)

(5.) The removing or sending all acute diseases and surgical cases to the city hospital (6.)

All of which we predict will prove to be true economy and humanity -- while the present method is pennywise, pound foolish and morally wrong.

We would suggest to the city government to consider that 70 per cent of their alms-house cases are intemperate persons. It is already well known that nearly all our crime and pauperism originates to intemperance. The granting of 100 licenses in our city seems a great encouragement to the habit of drinking, and probably if all the saloons were refused licenses, one-fifth the number now granted were allowed, and the law enforced, we should need less money for pauper relief. Dr. Howard Crosby of New York, and eminent philanthropist, advises withdrawing licenses from all grog-shops. We beg that the number of licenses in this city be greatly restricted.

Physical Condition of Alms-House Inmates July 1, 1877

Twenty-one men and 3 women came to the alms-house intemperate; 34 more persons were made paupers by intemperate habits of themselves or their parents.

Ages

Nationality

The nine boys at the truant school July 1 were all of foreign parentages.

The City Hospital.

On the 20th day of September this committee visited the city hospital. We found the house, bedding, kitchen and everything about the premises scrupulously kept and orderly, the ventilation thorough, the whole appearance of the house comfortable and fully supplied with the appliances of good nursing. The well-known and high character of the matron, Mrs. Howard, her experience and efficiency, are in themselves an assurance of the well-being of patients. Mr. Howard, also, is an excellent person in his own department. A sufficient number of employees are kept, consisting of a nurse, cook and laundress, and there is room enough and persons enough employed to take charge of twice as many patients as the average number, when we examine other hospitals and see how many persons at the hospital; all but one were old persons, two over 60, four over 50, two over 70, and one patient, 16 years old, blind from birth; the last the only one in bed. All were chronic and incurable, except, possibly, the younger one, who has a home in the city. One was hopelessly imbecile, a fit subject only for a lunatic hospital, and had been there 13 months, at present under no treatment. He came there at first with a broken leg, lapsed into dementia, and was permitted to stay for no particular reason. He could be boarded at less cost at the Northampton hospital than he now pays -- $5 per week. Not one of these patients would be received or retained in a well-managed hospital, under the care of a board of physicians. Not one receiving any particular benefit from being there. They pay an aggregate of $20 per week. They cost the city an aggregate of $66.97 per week besides the rent of the house. The salaries of the attendants in charge of them are $23 per week, and there are five attendant to five persons, only one of whom is in bed, and that one has a private attendant in addition. Compare this with the alms-house, where seven attendants take care of seven severely sick and of seven other persons, most of whom are infirm invalids or young children, and where the salaries are $26.50 per week. The average weekly cost of attendance on persons at the hospital is found to be $4.60 and at the alms-house 32 cents. Yet we found the invalids of the hospital far more well and active than at the alms-house, though costing the city taxpayers, as will be seen from estimates drawn from the municipal register, four times as much to keep as the paupers cost.

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.

The most striking and central error in our hospital management is the need of a board of managing physicians. There is absolutely no medical man in authority, no one to pronounce upon the patient's fitness to be admitted or discharged. Each patient employs and pays his own doctor. There is no safeguard against any quackery or any interference with personal fancies. This is an unheard of thing in a well-ordered hospital, which should have its own board, visiting in turn by the month or quarter, supreme in authority as to sanitary matters, admissions and discharges. A board of four physicians to serve quarterly would meet the requirements of our hospital. They should be men of reputation, especially in surgery, and so chosen as to work harmoniously together and to command the confidence of the public. All charlatanism should be excluded, and when we are taxed to pay for the care of the sick we should be insured that their recovery is as speedy as is possible. It is customary for hospital physicians to treat five patients without pay. It is the rule in all public hospitals to require all patients to be attended by the hospital doctors, who are usually the most eminent men in their own town. An examination into the rules and regulations of our leading city hospitals will prove this. We therefore urge the appointment of a board of four prominent and skillful physicians, and the commitments to them of the responsibility of admitting and discharging patients, the exclusion of all chronic, infirm, incurable, insane, idiotic persons, and all persons who have or can have a domicile in the city, only excepting among the latter such few and rare cases as the house surgeons may desire to admit the admission of all true hospital cases, viz.: Acute diseases and surgical cases and chronic patients who require hospital care, or who cannot procure for themselves the necessary nursing elsewhere; the exclusion of lying-in cases which can be cared for invariably elsewhere and at less expense. And this last fact your committee know to be true. A sick hospital is not a suitable place, but an unwholesome one, for lying-in cases.

The annual appropriation of $6000 is not large for our city to make for hospital use. For a population of 31,000 it is rather small, but it will so almost all we need under proper management. The average number of patients at a given time we find to be only 48. It would cost comparatively little now to have the house generally full. About 12 persons at a time, on a pinch 14 or 16, could be cared for with the help only of one more nurse, or if the sickness was severe of two more. This we base upon the number employed elsewhere. The large general expenses, salaries, heat, etc., would be the same and the increase not very large in provisions. We recommend the uniforms treatment of patients so far as is necessary to cure. No free wards, but rooms appropriated as is convenient to sick and poor. But a patient who can pay should pay according to his or her ability; $4.50 to $5 per week is the charge in the Massachusetts general hospital. We actually know that the city has been giving more than half the cost of their keeping to many people who need no help, while refusing all expense and care to dozens of poor sick, or sending cases to the alms-house which must suffer for wants of hospital care. As this mismanagement is owing to having no home surgeons, and to imperfect knowledge of the regulations of well-ordered hospitals; partly, also, to a spirit of indifference and easy-going wastefulness too common in irresponsible hands.

We earnestly entreat our city fathers never to think for an instant of giving up the city hospital; rather to appropriate a little more, say $5000, to its maintenance, and to reform its outside management. Inside there appears to be no fault on the part of the persons in charge. Free beds should be established by some of our rich and benevolent citizens. No expenditure of money would be more useful. The owner of a free hospital bed in the Massachusetts general hospital can place any occupant in it that he designates, subject always to the choice of the board of surgeons, who allow no incurable or unsuitable case to come in, or to remain if there The cost of a free patient in the Massachusetts general hospital, we learn from the treasurer, is $500. The contribution of $100 gives the donor the right to nominate the occupant of a bed, under the rules, which exclude chronic and incurable patients. The rate of board at the Carney hospital, Old Harbor street, South Boston, under the charge of Catholic Sisters of Charity, is $5 to $6 per week. This hospitals largely supported by charity and endowments. The character of the Pittsfield house of Mercy states that it is for the benefit of sick persons, "Whether in indigent circumstances or not." On this humane plan the poor are nurses in charity, the rich pay according to their ability. All are equally well cared for, and the good done is inestimable. It is managed wholly by women, with great economy and efficiency; the funds supplied by private charity.

We strongly recommend to our city government to appoint one-half of the hospital board for the coming year from among the women of our city, selecting those of mature experience and financial ability. A comparison of the methods and expenses of the homes for friendless women and children for the past 12 years with those of the alms-house and hospital will make a powerful showing in favor of the superior economy and management of the weaker sex. Household duties train and it women of judgment and discretion especially for this work, and they know far better than men how to get the worth of their money in the dwelling place or institution. The co-operation of the sexes we behave to be necessary. Furthermore, women will give more time to detail, and work more freely without pay.

The Lock-up.

The lock-up was also visited by this committee September 20. So much has been said about this place that we have nothing new to offer. Truants also are confined here, children of tender age in companionship with the abandoned, profane and most infamous persons of both sexes, their tender minds acquiring ideas in one short period of confinement which may poison their whole future. Though the sexes may be sometimes placed in separate cells, they are in close contiguity, can see and hear each other, and often must be too numerous for the cells and mixed together in the open room. Common decency prescribes a separate apartment for women, and no child should ever go there. No bedding is provided, not even a blanket, no seat or support but an iron bedstead so knobby with bars that a plank would be more comfortable. The reason assigned for giving no bedding is that it would be soiled. A little discrimination would place the more filthy where they would do no harm, and soap and water would soon remedy accidents. Of course, drunken persons are able to be filthy, but why should other criminals such as we saw, neat in appearance and sober, be compelled to sit and lie on iron bars while awaiting trial. The law presumes them innocent until proved guilty; yet they are punished far more severely while awaiting trial than the tried and convicted criminal. When we consider the character of the men who govern our city, their piety, respectability, their amiable social relations and their charities, we wonder in amazement that their consciences permit them to suffer these things. Their sins toward the truant children alone should keep them awake at night. A small sum would put everything at the lock-up on a right footing. There expense need not be appreciable. A little coarse, cheap bedding, and blankets, easily washed, ought to be provided. The truant children could be retained for trial at the truant school, or elsewhere. They do not need a very strong prison, and the contamination of the lock-up is a more serious evil than the trouble of transporting them to and from the alms-house.

We also protest against the custom of placing women in the sole charge of men in the lock-up, as well as in many penal institutions. This has been strongly objected to of late years by our best citizens in the commonwealth, and the new prison at Sherborn was built for the purpose of placing women in the custody of women and apart from men, We see no reason why women awaiting trial should not stay at the jail as they do at all the small shire towns.

Conclusion.

We have thus endeavored to state without reserve what we have found to be the faults of our city institutions, not omitting the praise due to their management. The general result is that we find a well-meaning, easy-going, unmethodical way of providing for the poor and sick, not one-half the good done with the public money that could be, and often unnecessary suffering to the recipients of charity; this applies to the alms-house and hospital. For the lock-up we have only condemnation. It has no merit except tolerable cleanliness.

Emily A. Bill
Adelaide A. Calkins
Clara T. Leonard

Springfield, Mass., September 26, 1877