3 10 29 https://localhistory.tadl.org/files/original/8ac405a801126d76d58cbbe89c7a332c.pdf b3ebdde38b3ded12c3841099340bd9b4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1908. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Northern Michigan Asylum for the biennial period ending June 30, 1908. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Wynkoop Hallenbeck Crawford Company, State Printers. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1908 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0012 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT BOARD OF TRUSTEES TRAVERSE CITY JUNE 30, 1908 BY AUTHORITY. LANSING, MICHIGAN WYNKOOP HALLENBECK CRAWFORD COMPANY, STATE PRINTERS 1908 �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM. TRUSTEES. THOS. T. BATES H. C. DAVIS W. W. MITCHELL A. F. TEMPLE M. F. QUAINTANCE W. LLOYD TRAVERSE CITY TRAVERSE CITY CADILLAC MUSKEGON PETOSKEY MANISTEE RESIDENT OFFICERS. JAMES D. .MUNSON, M. D A. S. ROWLEY, M. D W. D. MUELLER, M. D ] BEATRICE STEVENSON, M. D. }• H. D. PURDUM, M. D R. E. WELLS, M. D MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT ASST. PHYSICIANS NON-RESIDENT OFFICERS. C. L. WHITNEY '. W. P. MANTON, M. D STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN , TRAVERSE CITY TREASURER. SAMUEL GARLAND.. .TRAVERSE CITY �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM FROM ITS ORGANIZATION IN 1881. BOARD OF COMMISSIONERS APPOINTED TO SELECT SITE FOR THE MICHIGAN ASYLUM. Date of appointment. Retired. Work of board completed Sept 30 1882 1881 1881 1881 M.H.Butler BOARD OF COMMISSIONERS Detroit. APPOINTED TO ERECT THE- NORTHERN ASYLUM. Name. Date of appointment. 1881 1881 1881 1881 1885 Residence. Name. NORTHERN Residence. MICHIGAN Retired. 1885. M H Butler H. H. Rilev Thos.T. Bates St. Joseph. Traverse City Vice Perry Hannah. The work of the building commission was finished Nov. 10, 1886. MEMBERS OF THE BOARD OF TRUSTEES OF THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Term expires. President from to Traverse City Detroit Three Rivers Traverse City Elk Rapids. 1887 1887 1889 1913 1897 1885 to 1886. 1891 1893 • 1899 1897 to 1899. 1891 1895 Residence. 1885 1885 1885 1885 1885 C. M. Wells 1885 1887 1887 1889 1891 Geo. A. Fair Varnum B. Cochran C.L.Whitney Muskegon 1891... 1889 1895 1897 1897 H.C.Davis G A Hart Traverse City 1889 1901 1901 1902 H. D.Campbell W.W.Mitchell H D Birgham . . D. B. Butler Traverse City Cadillac 1901 1910 1901 1903 1901 1903 1905 1907 G. A. Hart A. F. Temple M F Quaintance William Lloyd Manistee Muskegon Petoskev Manistee 1907 1908 1911 1913 ,1 W. French Thos. T. Bates H.H. Noble Cadillac C F Backus . . . 1908 1897 1901 1901 1905 1885 to 1892. 1892 to 1897. 1899 to 1902. Remarks. Present member. Deceased. Resigned. Present member. Resigned. Resigned. Ad. interim appt. Present member. Resigned. 1902 to 1907. Present member. Present member. Present member. �Medical Superintendent : James D. Munson, M. D., 1885. Assistant Medical Superintendents: J. H. Dawson, M. D.—1885 to 1890. Resigned. C. G. Chaddock, M. D.—1890 to 1892. Resigned. A. S. Rowley, M. D.—1895 . Assistant Physicians: C. G. Chaddock, M. D.—1885 to 1890. Promoted to Assistant Superintendency. W. M. Stone, M. D.—1886 to 1891. Resigned to accept the Assistant Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendency. M. Rockwell, M. D.—1891 to 1892. G. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. E. L. Niskern, M. D.—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1899 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. W. D. Mueller, M. D.—1900. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. D—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 • . B. F. Sargeant, M. D.—1904 to 1905. H. D. Purdum, M. D.—1906 . R. E. Wells, M. D—1907 • . TITLE AND ADDRESS. THE NORTHERN MICHIGAN ASYLUM FOR THE INSANE, TRAVERSE CITY, Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is 1955,221.20. The property consists of 42 buildings, occupying a tract or land containing 728 acres. It cares for 1,337 patients. �REPOET OF THE BOAED OF TEUSTEES. To the Governor and Legislature of the State of Michigan: The trustees of the Northern Michigan Asylum have the honor to siibmit their report for the biennial period ending June 30, 1908, together with the reports of the medical superintendent, treasurer and steward. The board held twenty-three regular meetings during the period. The last year required most careful attention, owing to the high prices of supplies which prevailed and the low per diem rate which was charged for the maintenance of patients. Although the net cost of maintenance exceeded the 48 cents per day allowed for each patient, yet no deficiency appropriation will be required, since the working capital of the institution has been sufficient to take care of the loss. The increased cost in maintenance, besides the higher prices paid for supplies, was due to the greater amounts spent in repairs, or the up keep of the asylum during the period. Greater attention than ever was given to the purchase of foods and to their economic preparation, and the standard of living was not lowered. As required by law, a committee of trustees has regularly inspected the asylum each month, and a written report of its findings and recommendations is submitted to the board at each regular meeting. We have only words of commendation for the officers and employes who have so faithfully and efficiently carried out the work of the asylum. We would especially commend the newer and better clinical methods, since we believe they have made the medical treatment more comprehensive and brought about an increased number of cures. The examination of patients is thorough, is oftentimes of extreme value to the patient and always of scientific interest. A training school was established two years ago and the first class of twenty-four was graduated in June, 1908. This measure marks another step forward in the care of the insane. As in the medical care so with the nursing of insane minds, the modern spirit demands the best trained doctors and nurses to care and direct the insane. Another step forward in the interest of economy as well as the greater welfare of patients is promised in the greater attention to dietetics. This insures better preparation of food, greater economy in food supplies, a greater variety of foods, and trains or educates the nurses as well as willing workers in the art of dietetic science. The advantages of this department are manifested by greater contentment among patients and enthusiasm on the part of employes. It fosters more faithful per- �8 STATE OF MICHIGAN. vice and greater efficiency in the performance of lionseliold duties as well as in the duties of the sick-room. The period just closed will mark the transition from the asylum, with its conservatism, routinism and unscientific methods, to the hospital in the widest sense of the word, where.every patient is studied and brought in the closest observation of trained doctors and nurses. Everyone who has watched the trend of the care of the insane in Michigan knows that with the advent of the Psychopathic Ward at Ann Arbor, the study and treatment of mental diseases has rapidly advanced. A mental clinic is held nearly every morning, at which every new case is presented, and at which all forms of diseased conditions are presented and discussed. This has been of value to patients, and stimulating to greater efforts on the part of the staff and brings the doctors, nurses and patients in that relationship which is of the highest interest and value to all. We have watched the scientific growth of the work and believe that more patients are improved and cured than ever before; that mental diseases are better understood, and that the atmosphere of the institution is one of activity and interest and that all that pertains to the welfare of its people. We are glad to report that the hospital was free from epidemic diseases during the period and that no violent deaths from homicide or suicide occurred. One patient was transferred to the State Hospital at Ionia, by direction of the Governor, and one patient was transferred to the Eastern Michigan Asylum at Pontiac, and one patient was deported to his home in Europe, by authority of the United States government. The institution has been able to care for all patients within its boundaries. As a rule commitments have been prompt, and as a result the recovery rate has been greater than ever before. There were eleven less women patients in the institution on June 30, 1908, than there were June 30, 1906, and the gain in male patients during the same time was forty. We regret to report that the department for men is overcrowded; but are pleased to say that the hospital will be able to receive all patients until the new wing, which is under construction, is completed. The number of patients treated during the period was: Men, 290; women, 215; total, 505. There were thirty-six less admissions than during the preceding two years. �NORTHERN MICHIGAN ASYLUM. The several counties committed patients as follows: 7 Alpena Antrim 13 7 Arenac . 4 Alcona Beuzie . 10 0 Bay . oo Charlevoix 4 Clare 3 Crawford Clieboygau . . . . 17 21 Emmet 2 Genesee -1 Gladwin 46 Grand Traverse Gratiot . . . 35 Isabella . . . . . 12 7 Tosco 29 Ionia . . . . ... 0 •Ta ckson 3 Kalkaska 1 Kent . . . Lake .... 5 Leelanau . . . 13 No legal settlement State . Manistee Mason Mecosta . Midland • • • Missaukee Montcalm Moutmorencv Muskegon Newavgo Ottawa Oceana Ogeinaw Osceola Otsego Oscoda Presque Isle . Roscommon Shiawassee Saginaw . . . St. Glair Wexford . . Wayne .... 28 16 24 8 9 26 1 41 14 0 17 £i 16 6 0 4 1 0 o 0 2.°, 1 1 0 Of the 505 patients admitted: 25 had been confined in county-houses. 30 had been confined in jails. 10 had been treated in other asylums. 60 were said to have been destructive. 20 had attempted or threatened suicide. 15 were homicidal or had threatened homicidal assaults. 23 had been confined or restrained at home. The number of patients confined in county-houses, jails and other asylums exceeded the last biennial period by 17, the number of suicidal cases was less by 15, and the number of homicidal cases was greater by 6. Since June 30, 1892. these statistics have been regularly kept, and show out of a total of 3,211 admissions: 119 364 221 392 300 460 352 ( 3.7%) (11.3%) ( 6.8%) (12.2%) ( 9.3%) (14.2%) (10.9%) were confined in county-houses. had been confined in jails. had been treated in other asylums. were destructive. were suicidal. were homicidal. required some sort of restraint at home. These statistics may be without practical value, but are sufficiently �10 STATE OF MICHIGAN. extensive to establish the averages to be anticipated for the conditions stated in the insane of this district at least. COST OF MAINTENANCE. The daily cost of maintenance per patient for the last 23 years has been as follows: Cents. 1886 53 1887 52 1888 51 1889 50 1890 49 1891 49 1892 48 1893 48 1894 48 1895 47 1896 46 1897 44 1898 42 1899 44 1900 44 1901 , 44 1902 44 1903 (The above exclusive of officers' salaries).... 44 1904 (Inclusive of officers' salaries) 48 1905 (Inclusive of officers' salaries) 49 1906 (Inclusive of officers' salaries) 48 1907 (Inclusive of officers' salaries) 47 1908 (Inclusive of officers' salaries) 48 • INCREASE OF PATIENTS. The average yearly net increase of patients for a period of 20% years has been 45.1. The net increase of patients for the district for the period ending June 30, 1908, was 40. There were 476 patients discharged during the period, 250 men and 226 women. Of this number 95 were discharged recovered, 106 improved, 51 unimproved, and 224 died. The percentage of recoveries on the whole number under treatment was 5.2 per cent; on the number admitted 18.8 per cent. The death rate 77 per thousand 1906-07, and in 1907-08, 66 per thousand. The readmissions for the period were, men, 41; women, 28; total, 69. The readmissions from the beginning have been, men, 237; women, 211; total, 448,—hence the total number of admissions, 4,695, represents 4,247 individuals. The daily average number of patients for the period was 1,314. The number of weeks spent in the institution by patients was 136,656. This was an increase of 77 in the daily average, and an increase of 7,607 weeks' board over the preceding period. �NORTHERN MICHIGAN ASYLUM. 11 On June 30, 1908, there were 1,328 patients under treatment at State expense and 25 at private expense. There were 267 persons employed at the asylum on June 30, 1908, in the positions and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND IMPROVEMENTS. During the period many necessary and important improvements were made. The cost of repairs for the vear ending June 30, 1907, was 120,511.69, and for the year ending June 30, 1908, $30,653.03. The expenditures exceeded the preceding period by $20,632.97. The greater part of this excess was due to repairs and additions in the boiler room and heating appliances. The heating plant is antiquated and practically worn out. When the placing of the boiler, for which an appropriation was available, had to be determined it was found that to locate it in line with the other boilers would not only use up much of the room used for storage of fuel, but would also make the conveying of coal to it and to the other boilers awkward and expensive and would also necessitate the construction of a new breeching to the smoke stack; all of which would have to be done again in the near future. Before deciding upon the location of the new boiler it was decided to employ Mr. J. E. Allen, of the firm of Brush, Allen & Anderson, architects of Detroit, Mich., to look over the plant and to recommend to the board the most economical method of locating and setting the boiler and arranging the boiler room, so that additional boilers could be erected without further expense for space, etc., in the room. Mr. Allen presented plans which incorporated these ideas and which also provided for a mechanical method of handling fuel. These plans, which after most careful deliberation were adopted, necessitated the re-setting of the old boilers and changing from an unwieldy, complicated system of heating to a simple, upto-date method. The cost of the changes necessiated in carrying out these plans was considerable, but in reality the cost was not much greater than would have been incurred had the new boiler been located outside the boiler house and a new room built for it and new breeching to connect it with the smoke stack. In either case the machinery for conveying coal and ashes would have been imperative unless the cost of labor for doing this work was no object. In addition to these"improvements the farm house was enlarged sufficiently to provide accommodations for the teamsters and all help employed in carrying on the farm operations. This improvement was indispensable from the fact that the help's hall in the administration building was too small to provide room for the greatly increased number of helpers during the last few years. We can scarcely realize ourselves how rapid has been the growth of the asylum population. This provision of a separate farm house has proved economical, not only in cost of maintenance; but in the facilitation of carrying out the farm work .and team work of the institution. Formerly the men had to walk from the barns to the administration building for their meals, a distance of one-half mile, which consumed much time as well as adding much to the labors of the men. The greenhouse boiler, which had been used sixteen years, developed �12 STATE OF MICHIGAN. a leak and when an attempt was made to replace the defective part all the other sections of the boiler resented the interference and went to pieces. A new boiler became imperative as the greenhouse contents were too valuable to be allowed to waste for lack of heat. Consequently a new boiler was installed in the place of the old one, but the cost, $560.62, was not allowed in the Auditors Department, and your honorable body should pass an act enabling the institution to pay this money from its current expense fund. Owing to the toppling over of the greenhouse chimney during a wind storm a portion of the middle section of the greenhouse was destroyed and necessitated quite a large outlay to repair the damage done. We would also report that as the institution was without storage room for coal and that during the last few years the fuel was thrown in heaps about the institution at a great loss from rain and snow and from increased cost of handling, it was decided to enlarge the old coal bunker, which held about seven hundred tons, to a capacity of twenty-five hundred tons. These concrete bunkers, with the exception of the roof, were built by patient labor, and the roof which is also used for a driveway, was superintended by Mr. Knapp of the Trussed Concrete Steel Company of Detroit, Mich. We would most earnestly invite your honorable body and all persons interested to inspect these improvements, and ask approval of them. The ordinary repairs have been very numerous, chief among which has been the replacing of kitchen and toilet room wood floors, wherever decayed, by tile floors. The cost of renovation of wards, painting of woodwork both inside and out, repair of roofs, etc., has been unusually great, but not greater than is to be expected in so large a plant. , SPECIAL APPROPRIATION, 82,000.00. This appropriation was made by the legislature of 1905, to repair the reservoir. Several artesian wells have been sunk in connection with it, and its efficiency has been greatly increased thereby. There still remains in the hands of the treasurer credited to this fund $1,287.22. This balance will be used in the near future in general repair work to the reservoir and in connecting it with the fire mains. , SPECIAL APPROPRIATION, S2.500.00. The legislature of 1905 appropriated this sum to improve the fire protection, to "enlarge and extend the mains and to connect same with the water mains of Traverse City." The work has been completed with the exception of connecting the asylum and city mains. The money originally appropriated was not sufficient to complete the work and the legislature of 1907 authorized the Auditor General to transfer the special appropriation of $1,000 for a telephone system, to the fund for additional fire protection. The work will be completed within the near future. There still remains in the hands of the treasurer to the credit of this fund the sum of $1,796.95. SPECIAL APPROPRIATION, $2,500.00. This appropriation was passed by the last legislature for additions to the store. We are glad to report that the additions have been com- �NORTHERN MICHIGAN ASYLUM. 13 pleted as contemplated by the act, and within the amount appropriated for the purpose. The enlargement of the store has greatly increased its efficiency, and also has lessened the cost of caring for the large stock of groceries, clothing and general supplies that has to be carried to meet the needs of the hospital. SPECIAL APPROPRIATION, $1,200.00. This sum was appropriated by the last legislature for the removal of the piggeries to a site just south of the farm barns. The buildings have been moved and repaired, and within the amount appropriated for the purpose. SPECIAL APPROPRIATION, $2,100.00. This appropriation was granted by the last legislature for the construction of an additional section to the greenhouse. We are glad to report that the new section has been completed, and within the amount appropriated. The building is constructed of cement and iron, the only wood used in its construction being the rafters which support the glass of the roof. The walls, the supports and the benches are of concrete, and the building presents an exceedingly attractive appearance. This department is of vast service to the institution as it enables it to have a constant supply of vegetables nearly the year around. SPECIAL APPROPRIATION, $2,300.00. This appropriation was passed by the last legislature, to be added to the sum of |2,500 appropriated by the legislature of 1905, for the purchase of a water tube boiler and automatic stoker. We would respectfully report that a Stirling boiler of 400 H. P. capacity, and a Detroit stoker, were purchased at a cost of $5,300. This amount exceeded the appropriation by $500. This additional expense was not authorized until after the advice of heating experts had been secured. The board did not deem it wise to install a smaller unit than 400 H. P.. as the space to be occupied by the boiler was too valuable not to be used to its full extent. It should be stated that the stoker cost $700 more than was estimated. The boiler and stoker have been in operation about a year, and have proved so satisfactory that we are assured that the added expenditure has been more than justified. It cannot be stated at this time whether the several appropriations will be more than sufficient to meet all the improvements contemplated by the act, and that there will not be a surplus left in one or the other of them sufficient to meet the deficiency in the appropriation for the boiler and stoker. SPECIAL APPROPRIATION, $1,200.00, This appropriation was granted by the last legislature for a new dry room for the laundry. WTe are glad to say that the apparatus was purchased for the amount named in the appropriation. SPECIAL APPROPRIATION, $500.00. This appropriation was passed by the last legislature for the purchase of books and musical instruments. There has thus far been expended 3 �14 STATE OF MICHIGAN. $175 on account of musical instruments. The balance is in the hands of the treasurer and will be expended from time to time for additions to the library. SPECIAL APPROPRIATION, $6,000.00. This appropriation was authorized by the last legislature for the purchase of 60 acres of land adjoining the asylum property. The land was purchased from the Hannah & Lay Company, and the State came into possession of it in the spring of 1907. It is a valuable addition to the farm and is well adapted for fruit raising as well as other general farm purposes. SPECIAL APPROPRIATION, $90,000.00. This appropriation was made by the last legislature for an extension to the south wing, $45,000, and an extension to the north wing, f45,000. We would respectfully report that these buildings are in process of construction. They are planned to be up-to-date hospitals in every respect, including heat, light, ventilation, special diet kitchens, offices for doctors and stenographers, hydrotherapeutic rooms, mortuary rooms, electric elevators, etc. There has been spent on account of extension to the south wing $4,954.99, and on account of extension to the north wing $7,266.60. There remains in the hands of the treasurer to the credit of appropriation for extension to south wing $40,045.01, and to the credit of extension to north wing $37,733.40. NEEDS OF THE ASYLUM. There are many needed repairs and betterments for the institution which are imperative and which your honorable body is respectfully requested to provide for. We would recall to you that the institution is nearing a quarter century of continuous work and growth, and in order to keep it in condition almost constant repairs and betterments are required. ROOF FOR BOILER ROOM. The roof over the boiler room is too low, in some places not clearing the boilers, and dormer windows have been constructed in it to house the valves of the main steam pipes. The roof is a wooden one and is a constant menace by fire to the safety of the institution. This roof should be replaced with an iron one, not only to lessen the danger from fire, but to increase the usefulness of the plant. In its present condition it is difficult to get at and in case of accident serious consequences might result. We would respectfully request of your honorable body an appropriation of $2,955.00 for the purpose of replacing this roof. CARPENTER AND PAINT SHOP. Your honorable body is respectfully requested to appropriate the sum of $5,500 to be used in the construction of a carpenter and paint shop for the use of the institution. From the beginning of the asylum the blacksmith shop and the carpenter shop have been associated in small �NORTHERN MICHIGAN ASYLUM. 15 rooms connected to the engine and boiler rooms. They are too small for either purpose. There is loss in time and money and in the waste that is inseparable from lack of storage room. The carpenter shop is too small for any amount of modern machinery. There is a small planer in it, but in order to use it the lumber often has to be passed out through a window, as there is not sufficient space in the room to handle a long board. There has never been a proper place to care for lumber, for carpenter utensils, for paints, oils and glass, for lockers for workmen, for merchandise such as is used in these departments, and no place in which the blacksmith or engineering departments can store and properly care for the thousand and one fittings that have to be carried in stock. It is almost imperative in the interest of economy and of safety from fire to have a building for a carpenter and paint shop and a general storeroom for material used in-these departments, and located at a safe distance from the main building. The present blacksmith shop and carpenter shop can be converted into a blacksmith shop and store room for engineering materials. COLD STORAGE ROOM. Many years ago a small building was constructed just outside of the kitchen building for keeping meats, milk, butter, eggs and other supplies. This building was arranged with ice storage overhead and cold storage below. It has never been satisfactory and the institution has never been able to stock, during the low prices of spring and summer, with butter, eggs aiid other food supplies. Many plans have been suggested and carried out for improving this store room, but all have proved failures. We believe that the only remedy is to erect a cold storage plant, similar to the one at the State Hospital at Ionia, and other institutions, in which the temperature can be regulated and the conditions of ventilation controlled, and in which food supplies can be kept for almost an indefinite period. For this purpose you are respectfully requested to grant an appropriation of $5,500. EXTENSION TO COTTAGE THIRTY-FOUR. This cottage was built to accommodate 50 patients, but by enlarging the dining room and making a few alterations in its general arrangement, 75 patients can be comfortably cared for in it. We would respectfully request an appropriation of $500 to enlarge the dining room to accommodate 75 people. HEATING PLANT. The heating plant exclusive of the boilers is antiquated and mnchof it is beyond repair. The heating and ventilation of the building are combined, the latter being by the natural method. It has been found by experience that this is an expensive method of heating as well as a very uncertain one so far as ventilation is concerned. It probably costs twice as much to heat the building as it should,- and the ventilation is imperfect in portions of the building, depending largely on atmospheric conditions. Brush, Allen & Anderson, architects of Detroit, �16 STATE OF MICHIGAN. Mich., were employed to examine the plant and to prepare plans and furnish estimates of the cost of re-arranging the heating, ventilating and hot-water systems of the institution with the most up-to-date systems. The following is their report, which is respectfully submitted: BRUSH, ALLEN & ANDERSON ENGINEERS 1330-32 Penobscot Building DETROIT August 21, 1908. Board of Trustees, Traverse City, Michigan: Gentlemen: We beg herewith to submit our report upon the necessary immediate changes required in the mechanical equipment at your institution. The reasons for considering a change of the present heating system are as follows: 1st. The present system does not adequately heat the buildings, and provision should be made to take care of this difficulty. 2nd. The present system has exhausted itself in part, and will require constant and excessive repairing annually from now on. 3rd. The present system does not serve as a consistent ventilating system, and proper ventilation is by no means secured. 4th. The present system is extravagant in the extreme regarding the expense of operation in comparison with results given. These conditions are going to require a continual expenditure in patching up, repairing and making temporary arrangements to give more adequate results. The ultimate expense of these changes will become very great year by year. Providing it is possible to make the investment in an entire new system immediately, the total cost in the long run will be much less than the running expense of constantly patching up the old system, especially when considering the benefits of economy realized providing the system is rectified. PRESENT HEATING & VENTILATING SYSTEM IN MAIN BUILDING. The present system consists of indirect radiators located in the basement, these being connected by flues to the various halls. The system was provided with two long tunnels connecting the basement from power house at which location a large steam "driven fan was provided, the fan to deliver fresh air into basement. The use of this fan is entirely impractical and the result has been that it was never used, having been abandoned shortly after the plant was installed. Air is supposed to enter the basement through open windows or the equivalent, pass through the indirect radiators where it is heated and after being heated rises through flues into the building where it is supposed to provide ventilation and warm the building by means of its excess heat. This means that the ventilation of the rooms is dependent upon the amount of heating required, that is, on cold days an excessive �NORTHERN MICHIGAN ASYLUM. 17 amount of air would be necessary to heat the rooms, while on moderate days the same amount of air would overheat them, consequently, as less heat is demanded the ventilation must be proportionately reduced. As applied to modern practice, this principle is obviously incorrect, as the ventilation should be constant and provide fresh air irrespective of the degree of heating required. All power for circulating air for ventilating purposes must be derived from the tendency of heated air to rise in the flues after passing the radiators. This force is entirely inadequate to circulate sufficient air for ventilation. On account of the failure of the fan system and its inability to properly supply the basement, instead of drawing fresh air from the basement proper, the flues tend to draw air down the shorter flues and up the long ones; this simply passes the foul air of one room into another room which is a decidedly objectionable feature, for instance, air from the tuberculosis section may be distributed through a large part of the building. In addition, we find the radiation provided is inadequate to heat, and even meagerly ventilate the building which would account for your statement that it is necessary for the patients to resort to overcoats in cold weather. The present system has been in constant operation for twenty-four years, and through corrosion the piping is constantly leaking and giving out. This renders the system so unreliable as to put it in danger of becoming inoperative Avhen required. A large part of the system would have to be replaced immediately to make it reliable. Under these conditions the system is extravagant in its operation and a large amount of energy is being wasted in obtaining the inadequate result this system is now giving. After due consideration of these difficulties, we are satisfied that proper results can be secured only by abandoning the principle of the present system and installing apparatus capable of giving proper results. Also, in view of the extensive repairs required immediately, it would be more advisable to make this change now. PRINCIPLE OF THE PROPOSED SYSTEM. We would recommend that the heating and ventilating systems be. entirely separated so that proper heating could be supplied depending upon the demands of the weather and proper ventilation afforded at all times irrespective of the operation of the heating system. With such a system the best results would be secured with the greatest possible economy. PROPOSED HEATING SYSTEM. We would recommend a heating system consisting of radiators located so as to maintain proper temperatures in all of the various rooms and for economy these radiators should be equipped with a vacuum system and automatic temperature regulation. The cost of installing this system complete will be $36,960. PROPOSED VENTILATING SYSTEM. We would recommend a ventilating system operated by motor driven fans which would be capable of giving the guaranteed air supply to �18 STATE OF MICHIGAN. each and every room under all conditions of weather. This air supply would be at the same temperature as the rooms so that the ventilating system could be operated according to requirements for ventilation and entirely independent of the heating. The cost of installing this system would'be 126.250. HOT WATER SYSTEM. The apparatus for heating water for domestic purposes has not been increased to meet the growth of the institution and is too small to meet the present condition. The present apparatus does not remove the objectionable scale forming substances from the water, which substance accumulate in the pipes and obstruct the same and they have to be frequently replaced. A proper apparatus would precipitate these solids where they could be easily removed before entering the pipes. We would recommend the installing of a heater and purifier with circulating pumps which would cost complete f 5,200. BOILER PEED PUMPS. At present you are supplied with but one boiler feed pump. A duplicate pump should be installed in order to guarantee a continuous service, and permit the repairing of the present pump when necessary. We would recommend the installing of this pump at a cost complete of $630. Respectfully submitted, 'BRUSH, ALLEN & ANDERSON. Per Fredk. F. Brush, H. C. Anderson. We would respectfully call your attention to this report, and would request your honorable body to make an appropriation of f 69,040 to meet the expenses of the betterments specified by the architects. CARRIAGE BARN. We would renew our request for a carriage barn for the use of the institution. The barn in use is imperfectly constructed, is much out of repair and does not meet the needs of the institution. The carriage horses are stabled in this building, the horses are coming and goingall times of day and night, in all kinds of weather. The institution should provide a barn, properly warmed, to care for the coachmen, the horses, the carriages, sleighs and other utensils in a proper manner. An appropriation of $5,000 is respectfully asked for this purpose. FENCING. The fence along the west side of Elmwood avenue and on the west side of Division street and on both sides of the avenue leading from Division street to Elmwood avenue, will need to be rebuilt. The present fence was built nearly twenty years ago; the posts are rotted and many of the fence boards are worthless. We would recommend that a wire fence Avith cast posts be used to replace it, and would respectfully ask the sum of $3,000 for the construction of one mile of fence with gates, etc. �NORTHERN MICHIGAN ASYLUM. 19 / ARTESIAN WELLS. Your honorable body is respectfully requested to appropriate the sum of $1,000 to sink artesian wells to increase the domestic water supply of the institution. The institution is outgrowing its supply of water and it is of great economic importance that an additional artesian supply be secured, if possible. EE-EOOFING OF COTTAGES TWENTY-EIGHT AND THIETY-TWO. The roofs on these buildings were laid with shingles and have been in service respectively since 1887 and 1889. They are in bad condition and will have to be re-covered. It is proposed to replace them with slate, and we would respectfully ask for this purpose an appropriation of $2,100. EXTENSION TO LAUNDRY, REPAIE OF LAUNDRY EOOF AND ADDITIONAL LAUNDRY MACHINERY. Your honorable body is respectfully asked to appropriate the sum of $1,025 to build an extension to the laundry, to be vised as a general repair room, and as an enlargement to the ironing room of that department. A further sum of $1,275 is requested for the purchase of one washing machine, one extractor and one body ironer. The laundry has been in use since 1895 and much of the machinery is practically worn out. We would also request the further appropriation of $500 for repairing the roof of the laundry building. The present roof is a tin one and it has rusted through in so many places that it is practically worthless as a covering for the building. ENLARGEMENT OF SWITCH BOARD. The electric switch board is too small, and the sum of $750 is respectfully requested to install an additional panel to the board with necessary switch to accommodate circuits for new buildings, etc., etc. If this appropriation is granted the switch board will be of ample size to carry the institution a number of years. IMPROVEMENT OF ASYLUM AVENUE. Your honorable body is requested to appropriate the sum of $7,550 for paving the main driveway of the institution from the administration building to Division street. It is 1,000 feet in length and should be paved not less than 30 feet wide. The institution has an elevation of HO feet above Division street, and as the grade is quite steep it is difficult to prevent washing and cutting out of the roadway during heavy rainstorms, and also from cutting or rutting during the heavy teaming of fall and spring. A bitulithic pavement will cost $2.25 per square yard, which will make the cost of this improvement $7,550. The interest on the money at 3 per cent would amount to $226.50, and doubtless the amount of money spent every year in repairing the driveway much exceeds this sum. It is of the utmost importance to the institution to have a perfect roadway, since all its freight and supplies �20 STATE OP MICHIGAN. have to be teamed from the city, the State never having provided a railway side track for it. It is especially hard on teams during the rainy season to pull heavy loads through the mud and slush of:' the dirt roadways. This improvement should be authorized. RECAPITULATION OF APPROPRIATIONS REQUESTED. Eoof for boiler room Carpenter and paint shop Cold storage room Extension to cottage 34 Heating plant Carriage barn Fencing Artesian wells Ee-roofing of cottages 28 and 32 Laundry Enlargement of switch board Improvement of Asylum avenue Total f2,955 00 5,500 00 5,500 00 500 00 69,040 00 5,000 00 3,000 00 1,000 00 2,100 00 2,80000 750 00 7,550 00 ' • 1105,695 00 FARM,, GARDEN, STOCK AND GROU5S7DS. By the act of the last legislature provision was made authorizing the purchase and addition of 60 acres to the asylum farm, increasing the acreage of the farm to 728 acres. This addition was all cleared highland, 32 acres of which was an old apple orchard, 20 acres of which had been cut down too old to be productive, leaving 12 acres of thrifty apple trees mainly of the Duchess and Oldenburg variety, yielding each year from 300 to 800 bushels of good fruit. The orchards, vineyards and small fruit plantations now occupy about 36 acres. The gardens and fields under cultivation and in meadow cover about 422 acres, while the forest, lawns and grounds occupy 210 acres and there are about 60 acres of uncleared, undrained land, making the total 728 acres. The products from the farm during the last biennial period have exceeded those of any former period, and with the improved methods of management employed they will increase each coming period. The dairy herd of the asylum continues to meet the needs of the institution. There are now 125 head of pure-bred Holstein-Friesians upon the asylum farm. The young cattle sell readily, there being a great demand for them. During the past two years 40 head have been sold, for which |3,412.12 have been received. They have been sold in 18 different counties in the State to become the foundation of herds. Ten of these counties in their purchases have bought their first purebred stock. The milk yield of the herd in the biennial period has been 1,251,989 pounds, or 625,994 pounds per year, or over 26 tons of milk per month. During the period the quality as well as the quantity of milk has increased, and by a late test the herd is entirely free from tuberculosis. �NORTHERN MICHIGAN ASYLUM. 21 RECEIPTS AND DISBURSEMENTS. The total receipts of the asylum for the fiscal year ending Jnne 30, 1907, including cash on hand and credits on special appropriations accounts, were $245,861.74; and the total disbursements for the same period, including special appropriations, were $254,469.51. The total receipts of the asylum for the fiscal year ending June 30, 1908, including cash on hand and credits and cash on special appropriations accounts, were $314,292.15; and the total disbursements for the same period, including special appropriations, were $294,153.76. There was at the close of the biennial period ending June 30, 1908, $40,237.72 in the hands of the treasurer; $4,767.86 of which amount was to the credit of the current expense account and the balance of $34,469.86 unexpended balances to the credit of special appropriations accounts. OFFICERS. In 1907, Hon. T. T. Bates of Traverse City, Mich., was reappointed to the board. Mr. Bates has served continuously on the board since 1885. In 1907, Hon. William Lloyd of Manistee, Mich., was appointed on the board. Mr. Lloyd's business experience well qualifies him for the duties of the office. On July 26, 1907, Dr. J. F. Canavan died after a brief illness. Dr. Canavan had been a member of the medical staff for a number of years, and had made himself of great value to the institution. He was a man of fine attainments, an earnest student in liis profession, and a faithful and conscientious worker. His death was greatly regretted by the Board of Trustees, by his associates on the staff, and by all who knew him. In July, 1907, Eobert E. Wells, M. D., was appointed to the staff. He came to us highly recommended, and he has proved very efficient in his duties. The period just closed has been an important one in the history of the institution. We can only express our appreciation of the efforts of the officers and all other employes. T. T. BATES, H. C. DAVIS, M. F. QUAINTANCE, A. F. TEMPLE, W. W. MITCHELL, WILLIAM LLOYD, Traverse City, Mich., June 30, 1908. Trustees. 4 �22 STATE OF MICHIGAN. TREASURER'S REPORT. ABSTRACTS OF (THE ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS OF^THE NORTHERN MICHIGAN ASYLUM FOR THE FISCAL YEAR ENDING JUNE 30, 1907. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the'Northern Michigan Asylum, for month ending July 31, 1906. CREDITS. By balance on hand July 1, 1906 Cash from State Treasurer: Account current expense Cash from other sources '.'. $28,707 10 20,645 07 1,274 65 $50,626 82 DEBITS. To account of artesian wells Account of current expense Balance on hand to new account $91 00 16,894 53 33,641 29 $50,620 82 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending August 31, 1906. CREDITS. By balance on hand August 1, 1906 Cash from State Treasurer: Account of current expense Cash from other sources. To account of artesian wells Account of current expense Balance on hand to new account $33,641 29 20,645 07 1,271 06 : DEBITS. $283 66 20,575 39 34,698 37 $55,557 42 $55,557 42 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending September SO, 1906. CREDITS. By balance on hand September 1, 1906 Cash from State Treasurer: Account of current expense Cash from other sources $34,698 37 20,645 08 469 31 : $55,812 76 DEBITS. To account of artesian wells Account of current expense Balance on hand to new account $317 29 20,209 96 35,285 51 $55,812 76 �NORTHERN MICHIGAN ASYLUM. 23 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending October 21, 1906. CREDITS. By balance on hand October 1, 1906 Cash from State Treasurer: Account of current expense Cash from other sources $35,285 51 18,736 49 685 33 $54,707 33 DEBITS. To account of artesian wells Account of current expense Balance on hand to new account $117 23 21,215 59 33,374 51 $54,707 33 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending November SO, 1906. CREDITS. By balance on hand November 1, 1906 Cash from State Treasurer: Account of current expense Cash from other sources $33,374 51 18,736 49 534 62 $52,645 62 DEBITS. To account of current expense Balance on hand to new account $19,792 46 32,853 10 ' $52,645 62 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending December S I , 1906. CREDITS. By balance on hand December 1, 1906 Cash from State Treasurer: Account of current expense Cash from other, sources $32,853 16 18,736 48 785 13 $52,374 77 DEBITS. To account of current expense Balance on hand to new account $20,454 48 31 ,920 29 S52.374 77 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending January 31, 1907. By balance on hand January 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources CREDITS. , : • $31,920 29 21,175 22 917 18 854,012 69 DEBITS. To account of current expense Balance on hand to new account $21,125 59 32 ,887 10 $54,012 69 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending February 28, 1907. CREDITS. By balance on hand February 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources • $32 ,887 10 21,175 21 489 14 $54,551 45 �24 STATE OF MICHIGAN. DEBITS. To account of current expense Balance on hand to new account $20,308 07 34,243 38 $54,551 45 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending March S I , 1907. CREDITS. By balance on hand March 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources 134,243 38 21,175 21 612 48 $56,031 07 DEBITS. To account of current expense Balance on hand to new account $25,906 39 30,124 68 $56,031 07 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending April SO, 1907. CREDITS. By balance on hand April 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources $30,124 68 17,428 35 919 09 $49,472 12 DEBITS. To account of current expense Balance on hand to new account $20,951 11 28,521 01 $49,472 12 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending May SI, 1907. CREDITS. By balance on hand May 1, 1907 $28,521 01 Cash from State Treasurer: Account of current expense 18,428 35 Cash from other sources 470 84 J47,420 20 DEBITS. To account of current expense Balance on hand to new account '. $26,280 52 21,139 68 • $47,420 20 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending June SO, 1907. CREDITS. By balance on hand June 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources $21,139 68 18,428 34 477 55 $40,045 57 DEBITS. To account of current expense Balance on hand to new account $19,946 24 20,099 33 $40,045 57 �NORTHERN MICHIGAN ASYLUM. 25 SUMMARY. THE STATE or MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the fiscal year ending June SO, 1907. CREDITS. By balance on hand July 1, 1906 828,707 10 Cash from State Treasurer: Account of current expense 236,955 36 Cash from other sources 8,906 38 1274,568 84 DEBITS. To disbursements: Account of artesian wells Account of current expense Balance on hand to new account ...... $809 18 253,660 33 20,099 33 S274.568 84 �26 STATE OF MICHIGAN. ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS OF THE NORTHERN MICHIGAN ASYLUM FOR THE FISCAL YEAR ENDING .JUNE 30, 1908. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending July 31, 1907. CREDITS. By balance on hand July 1, 1907 Cash from State Treasurer: Account of land Account of current expense Cash from other sources To account of addition to store Account of addition to greenhouse Account of current expense Balance on hand to new account $20,099 33 6,000 00 20,343 35 825 70 ................................... .............................. .................................... ................................. $202 279 20 ,042 26 ,744 $47,268 38 09 50 14 65 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum. for the month ending August 31, 1907. CREDITS. By balance on hand August 1, 1907 ............................... Cash from State Treasurer: Account of addition to store .................................. Account of addition to greenhouse ............................ Account of extension to south wing ........................... Account of boiler and automatic stoker ........................ Account of current expense ........... . ...................... Cash from other sources ........................................ $26 ,744 65 ---- To account of addition to store ................................... Account of addition to greenhouse ......................... s ..... Account of extension to south wing ....................... .N ..... Account of land .............................................. Account of additional fire protection ............................ Account of repairs on reservoir ............................. .... Account of current expense .................................... Balance on hand to new account ................................ 2 , 500 2 , 100 45 ,000 2 ,300 20,343 620 00 00 00 00 35 34 $99,608 34 _ $846 86 1 ,268 71 1 ,472 50 6,000 00 8 23 1 05 00 1 7 , 926 00 71 ,981 04 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending September 30, 1907. CREDITS. By balance on hand September 1, 1907 ............................ Cash from State Treasurer: Account of piggeries ......................................... Account of current expense .................................. Cash from other sources. . . ...... $71 ,981 04 1 , 200 00 20 , 317 49 608 23 ------ $94,106 76 $428 551 505 84 83 22 , 105 70 , 348 ----- $94,106 76 DEBITS. To account of addition to store Account of addition to greenhouse Account of extension to south wing Account of repairs on reservoir Account of additional fire protection Account of current expense Balance on hand to new account ................................... .............................. ............................. ................................... ............................ .................................... ................................ 63 79 00 00 41 39 54 �NORTHERN MICHIGAN ASYLUM. 27 THE STATE or MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending October SI, 1907. CREDITS. By balance on hand October 1, 1907 Casli from State Treasurer: Account of dry-room for laundry Account of current expense Cash from other sources 870,348 54 v • 1,200 00 19,297 85 908 12 $91,754 51 DEBITS. To account of addition to store Account of extension to south wing Account of additional fire protection Account of piggeries Account of current expense Balance on hand to new account ... — $350 241 303 1,018 21,314 68,526 10 31 70 12 31 97 $91,754 51 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending November SO, 1907. CREDITS. By balance on hand November 1, 1907 808,526 97 Cash from State Treasurer: Account of current expense 19,297 84 Casli from other sources 934 96 $88,759 77 DEBITS. To account of addition to store Account of repairs on reservoir Account of piggeries Account of boiler and automatic stoker Account of current expense • Balance on hand to new account $414 195 181 850 22,983 64,135 - 28 00 88 00 45 16 $88,759 77 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending December 31, 1908. CREDITS. By balance on hand December 1, 1907 Cash from State Treasurer: Account of current expense Cash from other sources $64,135 16 19,297 83 472 30 $83,905 29 DEBITS. To account of boiler and automatic stocker Account of new boilers Account of current expense Balance on hand to new account $1,450 700 25,134 56,620 00 00' 70 59 $83,905 29 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending January 31, 1908. CREDITS. By balance on hand January 1, 1908 "Cash from State Treasurer: Account of current expense Cash from other sources $56,620 59 22,013 11 763 34 $79,397 04 DEBITS. To account of current expense Balance on hand to new account , §22 ,939 38 56,457 66 $79,397 04 �28 STATE OF MICHIGAN. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending February £9, 1908. CREDITS. By balance on hand February 1, 1908 Cash from State Treasurer: Account of current expense Cash from other sources $56,457 66 22,013 11 1,160 57 _$79,631 34 DEBITS. To account of addition to store Account of new boilers Account of new greenhouse boiler Account of current expense Balance on hand to new account $67 1,762 560 19,925 57,314 50 94 62 71 67 _S79,631 34 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending March SI, 1908. DEBITS. By balance on hand March 1, 1808 $57,314 57 Cash from State Treasurer: Account of current expense 22 ,013 10 Cash from other sources 1,870 26 $81,197 93 To account of addition to store Account of extension of south wing Account of new boilers Account of new telephones Account of current expense Balance on hand to new account $27 25 100 00 2880 1,000 00 2.3,496 90 56,544 98 $81,197 93 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending April 30, 1908. CREDITS. By balance on hand April 1, 1908 Cash from State Treasurer: Account of books and musical instruments Account of current expense Cash from other sources To account of extension to south wing Account of extension to north wing Account of current expense Balance on hand to new account $56,544 500 19,195 1,759 : 98 00 75 03 — $1,420 1,033 18,565 56,980 57 40 18 61 $77,999 76 $77,999 76 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum* for the month ending May 31, 1908. CREDITS. By balance on hand May 1. 1908 Cash from State Treasurer: Account of current expense Cash from other sources $56,980 61 19,195 74 549 38 $76,725 73 DEBITS. To account of addition to store Account of extension to south wing Account of repairs on reservoir Account of new boilers Account of extension to north wing Account of dry-room for laundry Account of boiler and automatic stoker Account of current expense Balance on hand to new account $163 481 92 8 2,785 1,200 374 25,853 45,767 29 69 37 26 06 00 60 22 24 $76,725 73 �NORTHERN MICHIGAN ASYLUM. 29 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending June 30, 1908. CREDITS. By balance on hand June 1, 1908 Cash from State Treasurer: Account of current expense Cash from other sources $45,767 24 19,195 74 495 66 To account of extension to south wing Account of repairs on reservoir Account of extension to north wing Account of books and musical instruments Account of current expense Balance on hand to new account $733 92 18 91 3,448 14 175 00 20,844 95 40,237 72 $65,458 64 $65,458 64 SUMMARY. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the fiscal year ending June SO, 1908. CREDITS. By balance on hand July 1, 1907 $20,099 33 Cash from State Treasurer: Account of land 6,000 00 Account of addition to store 2,500 00 Account of addition to greenhouse 2,100 00 Account of extension to south wing 45,000 00 Account of boiler and automatic stoker 2,300 00 Account of piggeries 1,200 00 Account of dry-room for laundry 1,200 00 Account of books and musical instruments 500 00 Account of current expense 242,524 26 Cash from other sources 10,967 89 $334,391 48 DEBITS. To disbursements: Account of addition to store Account of addition to greenhouse Account of extension to south wing Account of land Account of repairs on reservoir Account of additional fire protection Account of piggeries Account of boiler and automatic stoker Account of new greenhouse boiler Account of new telephones Account of extension to north wing Account of books and musical instruments Account of dry-room for laundry Account of boiler and automatic stoker (new account) Account of new boilers Account of current expense Balance on hand to new account $2 ,500 00 2,100 00 4,954 99 6,000 00 495 28 395 34 1,200 00 2 ,300 00 560 62 1,000 00 7,266 60 175 00 1,200 00 374 60 2,500 00 261,131 33 40,237 72 $334,391 48 We have carefully examined the accounts of Samuel Garland, treasurer of the Northern Michigan Asylum, for the biennial period ending June 30, 1908, and have compared the same with the books and vouchers; and verified the same by further comparison with the books of the steward and hereby certify to the entire correctness of them. T. T. BATES, WM. LLOYD, A. F. TEMPLE, Auditing Committee. 5 �30 STATE OF MICHIGAN. STEWARD'S REPORT. FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1908. ANALYSIS OF RECEIPTS AND DISBURSEMENTS FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1908. RECEIPTS. Maintenance, etc., State patients Maintenance, etc., private patients Farm Sundry accounts Special appropriations: Land Addition to store Addition to greenhouse Extension to south wing Boiler and automatic stoker Piggeries Dry room for laundry Additional fire protection Books and musical instruments $479,479 9,510 4,383 4,980 62 75 44 08 6,000 2,500 2,100 45,000 2,300 1,200 1,200 1,000 500 00 00 00 00 00 00 00 00 00 $560,153 89 DISBURSEMENTS. 1. Salaries and wages Officers' salaries J72,010 48 13,062 71 — 2. Food: Meat and Butter Flour Tea and coffee Wages Fuel Miscellaneous Sugar fish 3. Clothing: Wages of clerks Cost of clothing 4. Laundry expenses: Wages Soap making Fuel Starch Machinery Soda Electric irons Gasoline Gas Blueing Tallow 5. Heating and light: Wages Coal Electrical supplies Gas Oil '. Wicking Candles Coke $49,457 27,982 13,095 6,205 8,837 1,117 25,130 5,327 • $501 97 24,219 97 $9,023 1,746 375 327 269 203 157 34 1 25 670 ' • 79 28 66 91 06 08 57 81 90 26 00 50 82 28 19 40 40 36 23 $9,170 66 48 ,024 30 947 76 134 37 49 92 1 20 1 08 23 80 • 185,073 19 137,154 16 24,721 94 12,834 34 58,353 09 �NORTHERN MICHIGAN ASYLUM. 6. Floral greenhouse and grounds: Wages Seeds Garden hose Implements Drain pipe Flower pots Paris green Manure Seats Wheelbarrows Trees Glass SI ,771 75 101 42 82 50 88 51 30 44 29 63 60 00 22 20 14 10 924 7 86 5 28 7. Medical department: Wages Drugs, etc Medical books Expenses of pathologist Laboratory supplies • 8. Office, stationery, etc.: Wages Telephones Typewriters and supplies Postage stamps Printing Stationery Blanks Rule books Filing cases Treasurer's stationery account City Directory 9. Amusement and instruction: Music for dances Medical books Billiard table Christmas toys, candies, etc Billiard balls and chalk Games Entertainment Hymn books Express Tuning pianos Magazines 10. Furniture and household supplies: Wages Dry goods Bedding Blankets Hardware : Crockery Furniture Brooms Ranges and castings Soap Utensils Toilet paper Carpet Upholstering Sewing machines Gas range Insect powder Carpet linings Window shades Refrigerator Clothes truck Shelf paper Seating Curtains , Carpet sweeper Iron bedstead Baskets Freight Grates Leather 11. Carriage barn and vehicles: Wages Feed Harness Blacksmithing Buggy repairs Horseshoes Veterinary Telephone message 31 $46,111 4,929 50 12 3 — 82 14 66 95 80 $2,041 806 734 510 487 341 221 225 190 97 3 90 45 82 00 19 85 80 75 80 10 00 $354 146 316 124 27 30 25 23 1 22 6 50 18 53 14 22 12 00 07 75 00 00 $2,222 93 51,108 37 5,660 66 1,07651 $1,158 62 4,619 53 5,292 27 1,273 61 1,669 27 1,003 61 945 77 918 58 657 92 633 72 468 12 411 94 177 97 135 00 91 80 78 00 74 17 45 75 35 75 26 46 23 76 15 51 9 22 6 00 6 50 7 00 5 79 1 85 1 46 98 J 19,795193 : . $701 429 23 22 19 10 5 84 63 77 68 85 69 09 10 1,21.3 65 �32 12. Improvements and repairs: Wages r Pipe and Lumber Lime and cement Iron and castings Paints and oils Hardware Hoist for coal Steel beams Tiling Coal Boiler, etc Material for coal bunkers Consulting engineer account Wire screens Roofing Wall paper Brick : Sewer pipe Glass Moving paint shop Awnings Tools Blacksmith coal Felt 13. Machinery: Automatic stokers Machinery for handling coal Boilers and Machine fittings and supplies Lubricating oil Potato peeling machine Pump, etc Vertical engine Boiler insurance Wages Tools Freight Packing Steam trap Repairs to gas engine Meat cutter Belting Pump Repairs to laundry machinery Hose and packing Gauge charts Valves Steam gauge Gaskets Mud pipe 14. Farm, garden and stock: Wages Feed Steers (or beef Hay Stock, cows Implements Blacksmithing Seeds Cattle tests Oats Horses Manure Straw Veterinary Harness.." Wagon and sleighs Cattle registering Carriage Paris green, etc Trees •. Hogs Sewer pipe Advertising cattle Fence Freight on calf Milk tester Photos of cows STATE OF MICHIGAN. fittings ". fittings : fittings • .... ..... — S29.472 28 4,036 13 2,866 26 2,710 55 2,637 87 2,438 54 1,677 65 1,210 00 1,267 40 591 91 464 48 289 60 283 37 361 43 233 75 180 63 123 70 167 75 48 04 25 13 25 00 19 85 16 31 5 94 11 15 — $51,164 72 $4,568 19 1,072 00 663 32 338 17 312 76 250 00 505 00 200 04 218 00 184 90 147 17 115 58 69 51 51 97 46 75 117 90 28 98 26 78 23 25 . 31 22 12 00 11 91 10 60 20 15 3 75 — 9,029 90 $19,235 70 13,396 88 5,600 79 3,699 99 2,030 41 716 82 573 55 448 61 17148 480 04 50000 381 76 323 86 324 83 289 86 180 50 130 42 175 73 113 73 62 47 63 30 52 25 4110 26 35 19 50 12 60 7 75 49,060 28 �NORTHERN MICHIGAN ASYLUM. 33 15. Miscellaneous expenses: Tobacco Wages of watchmen Elopement expenses Undertaker's fees Refunded money Purchases for patients Steward's expenses purchasing supplies Patients' expenses home Messages, etc Money refunded tor old boiler Superintendent's expenses to Board meetings, etc Accountant's expenses to Board meetings, etc Assistant superintendent's expenses visiting hospitals, e t c . . .. Wages for housecleaning Nurses pins Chief engineer's expenses to Chicago Surveying Pipes Fruit Express Recording deed Miscellaneous $2,487 31 1,049 10 563 71 404 64 366 21 319 45 301 85 170 57 132 16 100 00 80 23 34 08 117 96 26 00 56 25 20 00 15 00 4 12 2 13 1 75 1 65 67 82 Special appropriations: Extension north wing Extension south wing Repairs to reservoir Boiler and automatic stoker Land Addition to greenhouse New boilers Addition to store Dry-room for laundry Piggeries New telephones Artesian wells 'New greenhouse boiler Books and musical instruments Additional fire protection $7,266 60 4,954 99 495 28 2,674 60 6,000 00 2,100 00 2,500 00 2,500 00 1,200 00 1,200 00 1,000 00 809 18 560 62 175 00 395 34 $6,321 99 33,831 61 $548,623 27 �34 STATE OP MICHIGAN. FARM REPORT. FOR THE BIENNIAL PEKJOD ENDING JUNE 30, 1908. Asparagus, pounds Apples, bushels Beans, bushels Bedding, tons Beef, Ibs Beets, bushels Beet greens, Ibs ' Cabbage, heads Carrots, bushels Cauliflower, heads Celery, heads Chicken, Ibs Corn, bushels Cucumbers, dozen Eggs, vegetable, dozen Fodder,, tons Feed, green, tons Grapes, bushels Hay, tons Kohlrabi, bushels Lettuce, pounds Milk, pounds Musk-melon, pounds Onions, dozen Onions, bushels Parsnips, bushels Peas Peaches Pepper, bushels Potatoes, bushels Pork, Ibs Potatoes, sweet, bushels Plums, bushels Pumpkins, tons Radishes, dozens Rhubarb, pounds Strawberries, quarts Squash, tons Sage, bunches Savory, bunches Salsify, bushels Spinach Tomatoes, ripe, bushels Tomatoes, green, bushels Turnips, bushels Veal, pounds. Watermelon, pounds Premiums on cattle Cattle sold Hides sold Wheat sold... I '. 2,160 579 378 33 75,960 769 75 27,760 7,148 679 17,605 419 1,341 1,059 5 40i 25 202i 329 J 15,025 1,214,613 5,670 11,882 144 6,001 339 526 8 9,000 36,904 88 ISO} 11 15,167 10,635 4,579 25t 350 100 205 4,720 1,292i 105 1,340 2 ,249 1,250 $77 00 3,341 12 887 84 83 48 �NORTHERN MICHIGAN ASYLUM. 35 SUMMARY OF INVENTORY, NORTHERN MICHIGAN ASYLUM, JUNE 30, 1908. Farm and grounds JS3,160 00 Buildings 770,201 00 Stock on farm 16,160 00 Administration building 7,264 15 Library and chapel 1,244 00 Pathological laboratory 1,200 00 Dispensary 1,259 45 Wards 30,493 06 Cottage 21 2 ,996 33 Cottage 23 3,187 84 Cottage 25 2,499 39 Cottages 24 and 26 4,003 07 Cottage 27 -. . 3 ,200 08 Cottage 28 1,939 23 Cottage 29 : 3,476 75 Cottage 30 3,067 01 Cottage 31 1,753 05 Cottage 32 1,858 65 Cottage 34 3,217 35 Cottage 36 3,333 35 Cottage 38 1,036 42 Engine room and shops 7,147 27 Kitchen and bakery 4,991 24 Laundry 5,909 72 Farm implements, etc 3,363 69 Store fixtures 252 85 Groceries and meat 4,319 75 Crockery 206 19 Notions 1 ,'235 25 Silver plated ware 37 55 Hardware and miscellaneous ' 916 84 Dry goods I 3,347 58 Boots and shoes 1,014 10 Clothing 5,907 51 Total $955,199 72 �STATE OF MICHIGAN. 36 EEPOET OF MEDICAL SUPEEINTENDENT. To the Board of Trustees: Gentlemen: As required by law, I have the honor to submit for jour consideration the following report of the principal events of the asylum for the biennial period ending June 30, 1908. The movement of population has been as follows: TABLE I.—For the biennial period. Males. Patients. Discharged . Discharged improved Died Females. Total. 699 290 609 215 1,308 989 250 824 226 1,813 739 598 1 ,337 39 50 35 126 56 56 16 98 95 106 51 224 505 476 From the beginning. Males. Patients. Total admitted f Discharged recovered . . Discharged improved Discharged unimproved Died ... Total discharged Remaining under treatment June 30 1908 Females. Total. 4,695 2,596 2,099 313 598 200 748 257 595 154 495 1,193 354 1,243 1 857 1 ,501 3,358 739 598 1,337 568 �NORTHERN MICHIGAN ASYLUM. 37 If these statistics are compared with the last preceding period it will be found that the admissions were 36 less, and the discharges 67 more, and that there has been a decrease in women of 11, and a gain in men of 40, or a net gain of 29 patients in the asylum district during the last two years. This increase has not more than equaled the growth of population during the same time. The new buildings under construction will meet the requirements of the district for the next three or four years. The number of patients discharged recovered was 5 per cent plus of the whole number under treatment, and IS 8-10 per cent of the number admitted. This greatly exceeds the recovery rate of any former period. It shold be stated that these percentages include the manic depressive cases, in which the recovery from attack is counted without reference to cure of the disease. The smallest number of patients under treatment on any one day was 1,294, and the largest number was 1,344. The death rate for the year ending June 30, 1907, was 7.7 per cent, and for the year ending June 30, 1908, 6.6 per cent. There were 224 deaths during the period. The following table gives the sex, age, form of disease and cause of death in each case: 6 �STATE OF MICHIGAN. 38 TABLE II. Sex. Age. Nativity. 64 63 97 Female Female Female 48 30 "57" 86 30 67 57 67 27 23 50 35 80 62 43 47 Female B II Senility B. II, Organic Apoplexy. Michigan Pennsylvania C. II, Periodical A. II, Dementia B II Senility Pulmonary tuberculosis. Bright's disease. Michigan Ohio Germany New York Ohio Germany 54 57 Michigan Ohio Michigan 58 46 61 75 54 England Ohio Finland Michigan New York 56 74 45 19 33 29 C B I Hvsteria II Senilitv Sweden New York 60 78 C. II, Periodical B II Organic New York 64 27 37 Female Cause of death. Vermont 54 69 60 46 46 50 75 Form of disease. C III Imbecility A. II, Dementia B II Senility B B B Bright's disease. II Organic .. II Senility II, Organic . C. II Periodical Pulmonary tuberculosis. C. I, Epilepsia B II Senility B II Organic New York 88 62 60 67 50 B B II Organic 80 B II Senility II Senility 22 61 50 50 Female Male . Male Male.. , Male 47 50 83 84 27 Ohio Male.... Male... Male Male ... Male 50 72 73 27 29 Sweden . . B II Organic C III Imbecility C I Epilepsia C III Imbecility . . . . . �NORTHERN MICHIGAN ASYLUM. 39 TABLE II.—Continued. Sex. Male Male Male . Male Male . Age. . 46 23 77 78 36 Nativity. Form of disease. England New York England B II Senility Organic Unknown... Unknown Bohemia Germany B. II, Organic B. II, Organic Dementia praecox B. II, Organic Male Male Male Male Male . . . . "76" 60 Male .. Male Male . . . Male Male 68 61 67 40 46 Ohio New York B. Unknown B. II, General paralysis Male Male Male Male Male 70 36 76 75 65 Canada Unknown Massachusetts Canada B. II, Organic C. I, Epilepsia Orgaaic Male Male Male Male Male . . . "is" 37 86 46 New York Michigan Male Male Male Male Male 66 89 54 52 36 Male ... Male Male Male Male 40 45 54 26 42 Male Male Male Male Male 32 35 32 Michigan 75 Male Male Male Male Male Male Male Male Male Male I, Toxic B II Senility B. II, General paralysis Cause of death. Peritonitis. Pulmonary tuberculosis. . . Arterio-s clerosis. Arterio-sclerosis. Pulmonary tuberculosis. Arterio-sclerosis. Bright's disease. Arterio-sclerosis. Arterio-sclerosis. Paretic seizure. Arteriosclerosis. Pulmonary tuberculosis. Apoplexy. Paretic seizure. Pulmonary tuberculosis. Apoplexy. Edema of lungs. Arterio-sclerosis. Arterio-sclerosis. Cardiac disease. Paretic seizure. Arterio sclerosis. Paretic seizure. Arterio-sclerosis. Paretic seizure. Arteriosclerosis. Bright's disease. Bright's disease. Pulmonary tuberculosis. Status epilepticus. Ohio Illinois Michigan C. Michigan Canada Manic depressive C. II, Periodical Bright's disease. Pernicious anemia. Bright's disease. Exhaustion. Exhaustion/ Unknown Germany C. Ill, B. II, B. II, B. II, B. II, Pyaemia. Paretic seizure. Pulmonary tuberculosis. Paretic seizure. Bright's disease. 53 Michigan C. Ill, Imbecility 62 83 52 New York Canada B. II, Senility 51 44 67 50 53 Michigan Ireland Male.... Male Male Male Male 54 35 69 74 50 Male.... Male Male Male Male.... 54 73 43 46 Male Male Male Male..., Male 32 "41" „ C. New York Unknown Imbecility General paralysis Organic General paralysis Senility I, Epilepsia Cardiac disease. Status epilepticus. Pulmonary tuberculosis. Chronic bronchitis. Cardiac disease. I, Epilepsia Edema of lungs. Status epilepticus. Cardiac disease. Gumma brain. Status epilepticus. C. I, Epilepsia C. I, Epilepsia Organic brain disease B II Organic A. II, Dementia Status epilepticus. Status epilepticus. Exhaustion. Exhaustion. Bright's disease. Organic Bright's disease. Bright's disease. Paretic seizure. Cardiac disease. Paretic seizure. B. II, Organic C. New Hampshire Wisconsin I, Neurasthenia Unknown General paralysis Canada Epilepsia Unknown General paralysis A. II, Dementia Pulmonary tuberculosis. Arterio-sclerosis. Paretic seizure. Pulmonary tuberculosis. Pulmonary tuberculosis. �STATE OF MICHIGAN. 40 TABLE II.—Continued. Male Male Male Male Male 19 45 48 47 63 .. . .. . Male Male Male Male Male . Male Male Male Male . Male 49 35 53 71 • Cardiac disease. . . Paretic seizure. Edema of lungs. Pulmonarv tuberculosis. Exhaustion. New York 63 57 69 51 64 ... . . . . 59 84 Bright's disease. Paretic seizure. Suffocation. Ohio Exhaustion. 41 75 88 .... 78 50 58 40 75 44 82 60 44 08 Male Male Male Male Male 43 31 63 54 57 Male Male Male Male Male 61 23 44 36 75 Male Male 50 74 72 39 65 49 18 (S 61 42 Female Cause of death. 65 Male Male Male Male Male Female Poland " Ohio... 50 34 22 38 45 , Male Male Male Male Male Male Male Male Male Male Form of disease. 52 25 79 47 56 Male Male Male Male Male Male Male Male. Male Male Nativity. Age. Sex. 48 41 53 68 62 Ohio Ohio Scotland Senility Arterio-sclerosis. Senility Colitis. Acute rheumatism. End o- card itis. Paretic seizure. . . Ohio Paretic seizure. Holland Imbecility Pulmonary tuberculosis. Pulmonary tuberculosis. Paretic seiaure. Pulmonary tuberculosis. Holland Paretic seizure. Alter io-sclerosis. Pulmonary tuberculosis. Cardiac disease. Exhaustion. Puknonarv tuberculosis. Carcinoma. Ohio Apoplexy. Ohio Acute delirium Exhaustion. Ohio.... Dementia nrtecox Erysipelas. Cardiac disease. Carcinoma. �NORTHERN MICHIGAN ASYLtJM. 41 TABLE II.—Concluded. Sex. Age. Nativity. Cause of death. Form of disease. Female.. Female.. Female.. Female.. Female.. 41 60 54 24 83 Michigan Michigan Canada Michigan New York Epilepsia Dementia prsecox.. Organic Dementia prsecox.. Senility Status epilepticus. Cardiac disease. Exhaustion. Pericarditis. Arterio-sclerosis. Female.. Female.. Female.. Female.. Female.. 49 49 49 26 41 Indiana Michigan Canada Canada Michigan Paranoia., Organic. Dementia prsecox.. Acute delirium Manic depressive... Pernicious anemia. Pulmonary tuberculosis. Pneumonia. Exhaustion. Exhaustion. Female.. Female.. Female.. Female.. Female.. 38 I Michigan Michigan 66 Michigan 35 Michigan 51 Germany 44 Dementia prsecox.. Imbecility Dementia prsecox. Epilepsia Pulmonary tuberculosis. Apoplexy. Pulmonary tuberculosis. Apoplexy. Pulmonary tuberculosis. Female.. Female.. Female.. Female.. Female.. 71 36 54 65 65 Canada Michigan Germany Sweden New York Manic depressive Dementia prEecox Dementia prsecox Manic depressive Epilepsia Apoplexy. Chronic meningitis. Intestinal perforation. Apoplexy. Exhaustion. Female.. Female.. Female.. Female.. Female.. 59 37 82 69 30 Ireland Michigan Scotland New York Prussia Melancholia Organic., Senility Senility Imbecility... Pulmonary tuberculosis. Exhaustion. Bright's disease. Apoplexy. Pulmonary tuberculosis. Female.. Female.. Female.. Female .. 49 48 34 52 New York Michigan Michigan Sweden Organic Epilepsia Dementia prsecox Organic Exhaustion. Status epilepticus. Endo-carditis. Diabetes. SUMMARY. Males. General paralysis Pulmonary tuberculosis Intestinal tuberculosis Cardiac disease Exhaustion Females. 24 19 8 9 > Apoplexy Pneumonia Status epilepticus Suffocation Pernicious anemia 4 '•' 2 1 Bright's disease Arteriosclerosis Peritonitis Enteritis Edema of lungs .'. * Influenza Chronic meningitis Acute rheumatism Pyaemia Erysipelas 12 22 2 1 3 2 1 1 Total. 2 24 1 11 15 26 10 3 5 14 3 14 2 2 1 43 1 19 24 10 5 22 27 2 2 3 3 1 1 1 3 1 1 1 1 1 1 3 Chronic bronchitis Brain tumor..., Aneurism Intestinal obstruction 1 1 1 1 1 1 2 1 1 126 98 224 Total... 1 1 1 1 1 4 Intestinal perforation Diabetes mellitus Gastroptosis ". Carcinoma .' . . �42 STATE OF MICHIGAN. Eighty-nine of the patients who died were over 55 years old; 14 were between 80 and 90, and one was over 90. The deaths from tuberculosis were 19.6 per cent of the deaths from all causes, about twice as great as during the former period. It cannot be stated that this increase of mortality from tuberculosis is an index of the disease among the patients, since many of the cases were of long standing, and others were infected before admission to the hospital. There has undoubtedly been a slight spread of the disease during the last two years. General paralysis, arterio-sclerosis, cardiac disease, and organic diseases of the brain and nervous system were the other principal causes of death. In all cases in which permission could be gained postmortem examinations were made. The results were often of value. Special examinations of various organs were made at the psychopathic laboratory at Ann Arbor, and many more in our own laboratory. Dr. Barrett's reports of the pathological findings in these cases are of great interest and frequently confirm the diagnosis of the disease made during life. �NORTHERN MICHIGAN ASYLUM. W <M i—' ** OO»O OO •**< GO -* -*f CO "*< CO Ol •* TH i—i •* 1>- 43 " >O T~( 0 OS Q ~U TO faD "go 28~S 3g ~< oogggo |s=s ^ ;r 8- - I 1 I2 _g £ . £ E «' "3 - 6 g^- :OT S^ Nlf= "^2^2^ 2 ^S S ^ 2 0 C'J S 1 \\\i \ Mi M M ; MM M i : : :| : : :-a j • * : :: : : 1 •;'! 3 ' -tt; § t S 3 : :5 g :: | : : : : : : : : :: : : :I : : : : : : : : : : : : : : : & : : : : : : : : ' - o - ; : : : g. : : : : : : : : :: . . . .^ : . . : : •M j! I M nf M N M M ! : ::| g :: ::-=:! :: : :i : ! I if ,"|f • li i.B=li 1 ^ • I .if • ; : ;1 —ll i i :•l lll a: ;•§;"° ^ • I I ;.-§• ^ '"-^ - ' Jg^ ° fee •"•" ; c .5 • "5 "s :-Jc 1-J "S ^ ss'S . 2 s ! : : '• '-. ; c : -j^-Jg J>l-s l.t.al ^ •-£ >, -" — «3 c c! p cS "w a ^5 g*" ; : -c; c 1 l iil II §| Hill iliE Ills I-1 '• SSPM QP -f.S monpp f5WfSa tpai^a S3 ^fj^s is ^ -^^is Jif,0.^, -if,0.^ if. ; EJ ^ I 1 o - - • - SJ : :' ; ; 1 d S ^ i "S" "^ ^ . 2 | tj_, o* "o •i Oi : - "S g i ' ; i £ 3* > ' § o -^ ^ ^ ^ 1 ^ ^ *" ' 1 M § H S £ £ Q -s P-H £ -< ' C 1 '• '• '. 1; j i 1 1 1 § « ;§ 33-1 3 ~s -Sj "^ _g •1 1§ H i S -D J § > 3 ~s | S g" S 5 •? 3 H �44 STATE OF MICHIGAN. The foregoing table showing the forms of mental disease is no longer in use, but is inserted to show the classification of the cases up to June 30, 1906. Parallel with the introduction of the psychopathic ward, efforts were made to establish uniformity of classification in the various asylums of Michigan, with the result that the following modification of the well known classification of Kraepelin has been adopted in the asylums of this State. �NORTHERN MICHIGAN ASYLUM. 45 ^=0, OO OOO i-l (TOO - 1 CO - :-g : : :fl £.§.-& i I 111 o^i!•§ o o3"^ 55 s-*c c3 ; --« o*S 11*111 Sfl P^.S S^ if q) to i 1IT5- !>, H-<!E'OC SSSS5 i II CSCO-rH nit •g s ^ ^ I co i-H i1111 & ^ & & it§ 'S '"§. s g '1 i-; M ^ H 55 �46 STATE OP MICHIGAN. This table shows that nearly 50 per cent of the patients suffered from incurable mental disease, the largest portion of which was organic. Of the 138 cases falling in group C, 76 per cent were men and 26 per cent women. This great difference would indicate that the causes which bring about these lesions in the brain and nerve centers are several times more operative in men. The dementia praecox group also shows that nearly twice as many men as women are afflicted; while in the manic depressive types of insanity the opposite condition exists. It is doubtless true that all the cases classified as dementia praecox are hereditarily unstable, but I am inclined to believe that the hebephrenic and katatonic forms of this group are toxic in origin rather than hereditarily degenerative. Thjs classification has proved quite satisfactory from a clinical standpoint. It is quite possible that many modifications will need to be made in it as time passes and the toxic origin of mental and nervous diseases becomes better known and our knowledge of faulty metabolism of the proteid bodies becomes better established. It does not seem to us to be outside of the possible to regard hebephrenia and katatonia and the manic depressive insanities as being caused by a poisonous proteid, either from the protein of the tissues and inert protein introduced with the food or from poisonous proteids from microbic infection, or to a faulty splitting up of the highly proteid bodies of the internal secretions. The question of faulty metabolism opens up a vast field of investigation in the domain of neurology and psychiatry. Pathological chemistry must take a higher place in the investigation and treatment of mental diseases. It is known that the internal secretions play an important part in the economy and any modification of the amount of these secretions—increase or decrease—or faulty splitting up of these bodies in the organism, induces changes in the bodily functions. Diabetes and myxedema are diseases due to abnormal internal secretion from the pancreas on the one hand and the thyroid on the other. Recently the thyroid secretion has gained some notoriety in the causation of katatonia, but sufficient observations have not yet been made to establish a law in the matter. The removal of a portion of the thyroid gland has been tried for the cure of katatonia, and one such operation has been performed here. In this case permanent benefit did not follow, but several interesting mental states followed. Katatonia and possibly hebephrenia are toxic diseases and it is not unlikely that a poisonous proteid originating in defective metabolism of the thyroid secretion may be the essential etiological factor. The period just closed has not been marked by any brilliant innovations in the care or treatment of patients, but by progress on many lines, a development of the forces of the hospital. The care exercised in the purchase of supplies and the interest of the Governor in the matter has led to the establishment of conferences at which the superintendents and purchasing agents of all the institutions of the state take part. These conferences are of value, since the question of the cost of every supply is considered and comparisons made from actual samples of all materials purchased, and the statements of the stewards and others are discussed, which includes the quality, cost, where and �NORTHERN MICHIGAN ASYLUM. 47 from whom purchased and everything that tends to the most economic buying, quality being considered. Within the period a training school for nurses was established. The opening of the school was in October, 1906, and the first class graduated in June, 1908. The school added greatly to the work of the staff, but both the physicians and the nurses carried it on with enthusiasm and success. Trained mental nurses are an important factor in the treatment of insanity. By their training they comprehend the patients' needs much better and can get much nearer to them than can nurses without knowledge of the simplest psychic processes. A word of kindly explanation, of encouragement, of assurance, if based on accurate knowledge, frequently is of the greatest aid to the mental patient, since the conviction gradually forces itself in his mind that the nurse is giving the true explanation of all his mental distress and suffering. The professional interest of the nurses in their charges, and the ambition to succeed in their calling, is helpful and is stimulating to all associated with patients. "Ordinarily there is too much of the presumption that an insane person cannot reason rightly with regard to anything. The consequence is a -lack of discrimination in treatment which may have serious consequences in the resentment evoked by it." (Independent, page 662.) For these reasons a thorough course -in psychology should be given in connection with the training school. There can be no doubt in cases of mental disease, in which dissociations are present, that a nurse trained in psychology is of highest assistance in the restoration of patient. The most ordinary observer of mental patients notes that there are currents of mind activities, which completely dominate them and without consciousness on their part of their morbid nature; or these activities may partially dominate—a portion of the time being subconscious—but ever ready to break through the crust of consciousness and often with intense and dangerous reactions. Many such patients strive to overcome such morbid activities, and if they have the direction and sympathy of a nurse who knows practical psychology and how to explain fundamental operations, may be often able to replace these insistent activities with others which induce or are followed by normal mental reactions. • Many mental reactions which are at their beginning insane or morbid, may be continued through habit. In these cases the nurse by suggestion, direction and friendly attention may divert them into normal channels. It is a kind of re-education of the patient, and the mental nurse should be thoroughly grounded in psychology and how to apply it in the care of mental derangements. During the period there were 182 blood examinations made. Secondary anaemia was found in 28 examinations, pernicious anaemia in 5, surgical leucocytosis in 5, leucocytosis other than surgical 36, polycythaemia 1, and Widal tests 2. Blood pressure examinations were made in 118 cases. Increased blood tension was found in 11 cases. Six hundred thirty-six urinary analyses were made. Nephritis was found 41 times, glycosuria 10, pyuria 20, and the diazo reaction 2. During the past year 49 sputum examinations were made. Tuberculosis was found in 12, pneumonia in 3. There were 71 autopsies made during the period, and as before men- �48 STATE OF MICHIGAN. tioned, very many pathological examinations. It would be unprofitable to detail all the findings in these cases. The most important conditions found were: (1) Metastatic sarcoma of brain and lungs. (2) Gangrene of intestines. (3) Ulceration of intestines with peritonitis. (4) Terminal pneumonia. (5) Mitral insufficiency. (6) Syphilis of brain. (7) Pulmonary tuberculosis. (8) Metastatic sarcoma of osseous system from primary tumor in breast. (9) Pleurisy and ulceration of intestines. (10) Aneurism of aorta. (11) Hereditary syphilis. The chief value of the autopsies and laboratory examinations of tissue, etc., was found in the verification of diagnoses and in the explanation of the symptoms observed before death. I am not hopeful that pathology will ever be able to solve psychic problems. It is in the study of the living tissues, of proteid metabolism and the metabolism of the internal secretions and poisons of bacterial origin that the greatest hope of cure of the mentally sick will be discovered. Chemical pathology and chemical research are beginning to take an important part in the diagnosis, prognosis and treatment of disease, and this new science promises brilliant results for the mentally afflicted. The value of scientific research is also becoming apparent and the mental associations, mental reactions.—normal and abnormal,—the preceptive powers, the memory, the judgment, etc., are studied with as much, if not more, care than were formerly the gross symptoms of insanity— hallucinations and delusions. The following surgical operations were performed during the period: Operation. Number of cases. Tracheotomy 1 Trachelorrhophy 1 Tonsillotomy 11 Partial Thyreoidectomy 1 Oophorectomy 2 Appendectomy 8 Extirpation of Cervical Lymph Node 4 Extirpation of Sebaceous Cysts 3 Breast amputation 3 Paracentesis Abdominis 4 Paracentesis Thoracis 3 Intestinal obstruction 1 Cellulitis 3 Uterine Curettage 2 Dislocated jaw 1 Dislocated finger , 1 Dislocated elbow 1 Fractured femur 2 Fractured clavicle 3 Fractured humerus 2 Fractured metacarpal bone 1 Four children were born to patients during the period. It is apparent that during the last two years there has been very marked progress in psychiatry. The most careful methods are used in �NORTHERN MICHIGAN ASYLUM. 49 the examination of patients and much pains are taken with each individual from the day of admission to that of discharge, to promote his welfare and recovery. The institution is gradually becoming hospitalized, and every patient receives direct personal study by the physicians. The old plan of carrying on the work in the administration building in offices has largely disappeared and the physician spends his time on the ward with the patients carefully noting every symptom or working up the cases with the aid of a stenographer. "The medical work has greatly improved; here as in all other lines of human effort, progress has been slow, but to demonstrate that progress has been made, one need only to compare the written records of patients of ten years ago with those of today. With the advent of the laboratory a new era commenced in psychiatry, a great stride forward was taken for the relief and cure of mental and nervous conditions. No attempt is made to take the mental status of a patient in longhand. The mental examination requires accuracy and in order that the questions may be reported verbatim it must be taken in shorthand. Anything less than verbatim reports of these examinations render the work worthless from a scientific standpoint. Every physician to the institution, if not a shorthand writer himself, should be furnished a stenographer to assist in his work and to write out the examinations. This has been done during the last two years at this institution with great advantage to the patients; it has been stimulating to all of us to further and better efforts, and certainly tends to increase our insight into the activities of the mind whether normal or abnormal." It is our object to establish offices in connection with the hospital, on both sides of the house, in which the physicians can perform their work and in which the examinations of patients, the mental status, etc., can be taken, and in which the physician will come in constant contact with his charges and personally direct the mental cure of each and every one. The needs of the asylum have been thoroughly discussed in your report and I need not speak of them, nor of the improvements that have been made during the period, since you are thoroughly familiar with them. We append herewith the usual statistical tables: TABLE V.—Degree of heredity. From the beginning. For the biennial period. Males. Total Females. Total. Males. Females. Total. 6 18 15 20 18 4 12 6 22 10 10 30 21 42 28 36 119 87 165 99 33 129 66 217 115 69 248 153 382 214 29 9 .99 76 19 9 41 92 48 18 140 168 183 68 715 1,124 191 60 611 677 374 128 1,326 1,801 290 215 505 2,596 2,099 4,695 �STATE OF MICHIGAN. 50 TABLE VI.—Occupation of those admitted. For the biennial period. Males. Females. From the beginning. Total. Males. Females. Total. "'2 2 4 1 3 4 8 1 5 7 7 4 11 1 15 11 6 8 22 18 10 19 1 Bakers, cooks, confectioners 5 4 "i 5 5 Blacksmiths and metal workers 8 4 2 12 44 15 5 49 6 19 12 8 23 3 63 27 13 72 9 1 1 13 2 "'3' 3 1 16 1 9 99 3 3 5 4 62 2 6 13 161 5 3 1 ..... 1 4 60 2 2 20 1 1 3 6 80 2 5 7 6 869 5 9 3 355 1 1 2 Farmers, gardeners and florists 98 4 60 4 158 1 1 2 8 763 Farm laborers 28 2 10 ..„. 38 2 8 '1 1 Accountants, private secretaries 2 4 Apothecaries and chemists Carpenters and woodworkers Civil engineers and surveyors Coachmen and teamsters Housekeepers 1 Journalists 2 Laundrymen and laundresses 2 2 3 Liverymen, stablemen and jockeys Machinists, gunsmiths, locksmiths 3 Marine engineers, firemen, sailors 1 Milliners, dressmakers, seamstresses 2 "'3' 4 2 6 1 2 1 5 1 1 2 1 2 13 25 Physicians 2 4 "T Policemen, firemen, watchmen 1 Stenographers 1 Stone and marble workers Tailors 4 1 12 Veterinary 5 Total..., . ' 290 '"as 2 5 ..... 8 561 3 1 2 16 1,324 5 1 20 4 159 2 1 53 9 159 7 2 '"9 17 4 38 1 5 14 4 34 1 14 31 8 72 1 5 27 2 8 1 12 42 5 24 10 15 39 123 4 16 15 109 216 4 3 9 22 28 1 4 3 33 5 7 15 4 16 6 "'?0' 93 19 19 1 3 2 13 13 1 2 '.'••'«' 11 17 1 20 ..... 4 2 31 12 4 216 7 "'si' 19 "'2' 215 505 2 2 10 16 9 1,224 2.596 • 1 1 164 2 15 "'55' 164 2 32 1 75 9 2 213 1 25 21 6 429 1 56 2.099 4.695 �NORTHERN MICHIGAN ASYLUM. TABLE VII.—Nativity of patients admitted. For the biennial period. Males. Females. 1 Holland Italy From the beginning. Males. Total. .. . . . . 1 1 22 1 1 "9' 5 1 1 1 31 6 243 3 25 1 53 569 8 57 2 137 1 2 23 1 2 21 24 1 2 7 4 11 326 5 32 1 84 4 16 6 2 2 6 1 8 6 22 7 10 7 71 170 29 95 4 35 144 18 81 11 106 314 47 176 6 1 3 1 2 1 13 3 4 1 7 33' 17 9 1 2 50 16 4 2 9 83 33 13 3 2 8 6 1 612 10 16 12 3 1,238 4 4 42 3 4 1 '"«' 4 5 4 83 7 4 3 1 193 2 10 1 452 4 1 126 44 19 1 1 254 102 37 1 8 155 24 "'2' 128 14 2 S "'io' i 283 38 2 2 18 1 1 90 193 4 1 1 3 1 7 2 1 2 1 3 7 33 18 51 259 2 1 24 7 1 19 3 1 43 10 2 128 58 18 4 3 3 6 1 1 1 Utah 1 Total 10 4 1 1 i Wales 8 8 6 2 626 » 103 3 South Dakota Total. 1 .... Poland Females. 1 1 1 Ohio 51 1 7 "i i 1 1 4 10 4 27 3 258 145 5 50 3 403 2,596 2,099 4,695 1 1 22 18 2 1 40 290 215 505 2 12 1 23 2 1 6 22 RECAPITULATION. Unascertained Total .. 322 133 40 2,349 1,943 403 505 4,695 �STATE OF MICHIGAN. 52 TABLE VIII.—Duration of disease previous to admission. For the biennial period. . Males. Total Females. Total. From the beginning. Males. Females. Total. 58 31 14 8 19 55 17 12 7 10 113 48 26 15 29 469 248 142 45 262 389 207 127 44 169 858 455 269 89 431 42 25 23 10 60 32 20 11 20 31 74 45 34 30 91 368 212 195 132 523 314 216 205 124 304 682 428 400 256 827 290 215 505 2,596 2,099 4,695 TABLE IX.—Civil condition. From the beginning. For the biennial period. Males. Widowed Total . . . Females. Total. Males. Females. Total 118 127 30 6 9 126 47 25 15 2 244 174 55 21 11 1,020 1,212 158 59 147 1,339 457 208 72 23 2,359 1,669 366 131 170 290 215 505 2,596 2,099 4,695 TABLE X.—Age of patients. For the biennial period. Males. Females. From the beginning. Total. Males. Females. Total. 16 to 20 21 to 25 26 to 30 31 to 35 2 17 25 23 30 12 22 28 29 2 29 47 51 59 17 148 267 337 280 13 113 206 278 291 30 261 473 615 571 36 to 40 41 to 45 46 to 50 51 to 55 18 33 29 27 19 24 19 15 37 57 48 42 273 271 185 168 273 229 190 131 546 500 375 299 56 to 60 61 to 70 19 36 25 6 14 22 11 33 58 36 6 129 195 128 198 105 127 73 70 234 322 201 268 290 215 505 2,596 2,099 4,695 Total �NORTHERN MICHIGAN ASYLUM. 53 TABLE XI.—Probable exciting cause. For the biennial period. Females. Males. 11 21 4 Fright Ill-health Phthisis Total 2 17 From the beginning. Total. Males. Females. Total. 9 4 13 38 4 16 4 74 103 12 99 84 101 53 37 36 56 175 156 49 135 140 1 3 22 1 10 19 2 13 41 8 2 10 12 38 204 4 53 23 135 132 5 24 35 173 338 9 77 14 30 5 3 19 1 1 33 31 6 3 8 195 285 27 15 18 326 7 4 18 26 521 292 31 33 4 2 8 12 2 9 9 1 53 7 3 2 37 14 29 211 3 90 21 32 211 3 3 2 2 24 2 5 4 29 3 7 65 38 114 23 31 10 16 56 26 23 34 17 SI 94 140 5 26 7 87 2 1 16 2 83 1 6 42 9 170 3 31 147 65 694 155 5 9 116 11 507 21 5 40 263 76 1,201 176 290 215 505 2,596 2,099 4,695 2 �STATE OF MICHIGAN. 54 TABLE XII.—Residence of patients admitted. From the beginning. For the biennial period. Males. Bay . Clare Clinton Females. Total. Males. 6 8 4 4 1 5 3 7 13 7 4 74 60 29 15 6 4 10 1 11 33 17 5 22 61 3 2 1 1 4 3 30 17 15 2 17 90 15 13 8 21 2 2 Delta 1 Gratiot 2fi 20 . Kent Ottawa . . . 20 15 5 4 7 3 12 7 19 10 29 1 2 3 1 2 5 3 8 14 14 136 125 45 34 1 5 33 13 40 1 16 66 13 101 14 15 1 51 7 44 32 1 141 22 15 9 61 2 5 38 31 132 2 5 20 125 123 97 5 21 94 120 60 12 41 219 243 157 49 35 2 2 1 52 30 1 2 1 101 65 3 3 78 23 22 71 10 89 1 29 8 21 8 13 167 1 50 16 1 5 13 4 17 49 2 1 2 28 .44 3 1 6 45 93 5 28 11 106 87 53 1 13 87 57 60 1 24 193 144 113 88 88 52 39 70 31 66 21 1 158 119 118 60 1 ' 10 (i 10 11 13 24 4 8 4 1 8 9 10 1 27 7 16 14 7 26 1 41 14 140 11 183 57 1 119 4 158 58 259 15 341 115 1 G 3 11 2 17 5 7 4 9 2 16 6 59 20 7 58 16 68 13 6 62 16 127 33 13 120 32 . . Total. 62 65 16 19 1 1 46 35 Females. �NORTHERN MICHIGAN ASYLUM. 55 TABLE XII.—Concluded. From the beginning. For the biennial period. Females. - Males. Hales. Total. 1 11 10 2 7 2 9 25 21 7 15 5 1 23 1 1 20 1 65 8 107 51 7 2 57 2 25 54 27 3 122 10 132 105 215 505 2,590 2,099 4,695 3 1 4 1 1 1 2 14 1 9 290 State.... Total Females. 8 14 11 5 8 3 1 Ft Clair Wexford Total. ESTIMATES OF SPECIAL APPROPRIATIONS. The following are the estimates of special appropriations requested by the Board of Trustees and submitted to the State Board of Corrections and Charities for its approval: To the State Board of Corrections and Charities: Gentlemen: As required by section 2228, Compiled Laws of 1897. I submit below, estimates of special appropriations requested by the Board of Trustees of the Northern Michigan Asylum for new roof of boiler room; for carpenter and paint shop; for cold storage room; extension to cottage 34; for heating plant; for carriage barn; fencing; for artesian wells; for re-roofing cottages 28 and 32; extension to laundry and laundry machinery, enlargement of switch board, and paving of Asylum avenue. I. NEW ROOF FOR BOILER ROOM. 5 iron girders or trusses, each 80 feet long Steel beams Gravel roof Lumber Brick work, labor, etc fl,125 1(55 350 800 515 00 00 00 00 00 |2,955 00 II. CARPENTER AND PAINT SHOP. Excavation, 2,000 cubic yards, at 25 cents Stone and concrete work Gravel roof Lumber Doors and windows, door jams, window jams, complete Shafting and belting Electric motor, 30 H. P foOO 1,000 200 500 500 500 550 00 00 00 00 00 00 00 �56 STATE OF MICHIGAN. Sewer connection Electric wiring and electric light fixtures Heating and plumbing Carpenter work, labor, nails, hinges, sash and door locks... $150 00 100 00 600 00 900 00 $5,500 00 III. COLD STORAGE ROOM. Eefrigerating apparatus, etc., complete as per estimates of the Boland Machinery Company Enlargement and alterations in present ice house $4,600 00 900 00 $5,500 00 IV. EXTENSION TO COTTAGE 34. Stone and concrete work : Brick work and cut stone Window frames, glass, carpenter work, etc V. $100 00 200 00 200 00 HEATING PLANT. For vacuum system, automatic temperature regulation, radiators, etc., and installing heating system complete. . For the proposed ventilating system For hot-water system, heater and purifier, with circulating pumps, complete Boiler feed pump, one pump in duplicate of one in use $36,960 00 26,250 00 5,200 00 630 00 $69,040 00 VI. CARRIAGE BARN. . Concrete and stone work 125,000 brick, at $12 per M 4,000 feet concrete floor, at 9 cents 5,000 feet matched pine flooring 5,000 feet matched ceiling 50,000 shingles, at $3.00 per M 36,000 feet lumber 10 windows, complete, at $10.00 15 windows, complete, at $3.00 6 doors and frames, at $10.00 3 doors, at $15.00 200 yards plastering, at 20 cents 1,200 yards painting, at 20 cents Hardware, etc Labor and carpenter work Electric wiring and sewers $216 00 1,500 00 360 00 125 00 125 00 150 00 570 00 100 00 45 00 60 00 45 00 40 00 240 00 300 00 624 00 500 00 $5,000 00 �NORTHERN MICHIGAN ASYLUM. VII. 57 FENCING. 5,357 feet iron fencing, at 56 cents per foot VIII. f3,000 00 ARTESIAN WELLS. 2 wells, estimated cost of each f 500.00, including pipe, driving shoe, cap, etc IX. fl,000 00 RE-ROOFING COTTAGES 28 AND 32. 200 squares No. 1 slate laid complete 12% squares tin laid complete f 2,000 00 100 00 . X. $2,100 00 LAUNDRY EXTENSION, LAUNDRY ROOF AND MACHINERY. Concrete, brick and stone work; window frames, door frames, doors, windows, sewers, electric lighting, plumbing, carpenter work and labor Washing machine Extractor Body ironer All completely installed. 95 squares gravel roofing $1,025 685 375 215 00 00 , 00 00 500 00 $2,800 00 XI. ENLARGEMENT OF SWITCH BOARD. Enlargement of switch board XII. $750 00 PAVING OF ASYLUM AVENUE. 3,000 square yards bitulithic pavement, at $2.25 per square yard 2,000 running feet gutter, at 40 cents $6,750 00 800 00 $7,550 00 RECAPITULATION. New roof for boiler room ....... Carpenter and paint shop Cold storage room Extension to cottage 34 Heating plant Carriage barn Fencing Artesian wells Ee-roonng of cottages 28 and 32 Laundry Enlargement of switch board Paving of Asylum avenue : $2,955 00 5,500 00 5,500 00 500 00 69,040 00 5,000 00 3,000 00 1,000 00 2,100 00 2,800 00 750 00 7,550 00 Total All of which is respectfully submitted, $105,695 00 JAMES D. MUNSON, Medical Superintendent. �58 STATE OF MICHIGAN. The following is the report of the State Board of Corrections and Charities on the above requests for appropriations: BOARD OF CORRECTIONS AND CHARITIES, LANSING, OCT. 29, 1908. James D. Munson, M. D., Medical Superintendent, Northern Michigan Asylum, Traverse City, Michigan: Dear Sir: Your communication to the State Board of Corrections and Charities, submitting for its consideration and opinion the proposed appropriations for the Northern Michigan Asylum for the years 1910 and 1911, was duly received. The asylum -was visited and its conditions and needs investigated. The board has carefully considered the appropriations proposed, and agrees in the recommendations herewith submitted notwithstanding the large amount in the aggregate. The necessity of the institution arising from the outworn heating equipment can only be met by the installation of an entirely new pla'nt. New roof for boiler room f2,955 00 The present roof is worn out and a new roof seems to the Board to be a necessity. The item is approved. Carpenter and paint shop $5,500 00 The need for this shop is very apparent and the board gives it approval, but in the interest of economy approves the expenditure of but $4,000 for such purpose. Cold storage room $5,500 00 The present provision for cold storage is, in the judgment of the Board, only to be condemned, and the item is approved. Extension to cottage 34 $500 00 Approved. Heating plant 69,040 00 The board has given this item most careful consideration and has thoroughly examined the existing conditions, and regards the installation of a new plant as an imperative necessity. The present plant is a peril to the institution and by reason of frequent leakage is thoroughly unsanitary. Repairs are a constant necessity, not only entailing large expenditure, but causing great temporary discomfort. The item is approved. Carriage barn Approved. $5,000 00 �NORTHERN MICHIGAN ASYLUM. Fencing 59> |3,000 00 Approved to the amount of $1,500. He-roofing of cottages 28 and 32 2,100 00 Approved. Laundry 2,800 00 The present laundry and furnishings are entirely inadequate to meet the demands of the asylum, and the item is approved. Enlargement of switch board $750 00 Approved. Paving of Asylum avenue . 7,550 00 The Board appreciates the economic value to the asylum of a good road-bed, but believes that the necessary expenditures involved should receive the careful attention of the board of control, and we recommend that this item be given further consideration and investigation by your board. The item is, therefore, not approved. Yours respectfully, JOHN P. SANDERSON, HENRY P. MOWBY, Secretary. Chairman. CHAPEL SERVICES. Religious services have been conducted by the chaplain, Rev. D. Cochlin, assisted by Revs. Mr. Dutton, Mr. Lockhart, Mr. Canby, and Mr. Gay, all of Traverse City. ACKNOWLEDGMENTS. The institution would again renew its thanks to the editors of the following papers for donation of their journals for the use of the patients: Germania Big Rapids Herald Michigan State Democrat Grand Traverse Herald Deaf Mute Mirror Huron Tribune Native Copper Times Der Sonntagsbote, of Grand Rapids Alpena Argus Cheboygan Tribune Triumphs of Faith To Mr. and Mrs. W. O. Holden, Mrs. Elsie Hannah, Senator and Mrs. O. C. Moffat and Mr. Asa Hale, our thanks are particularly due for contribution of periodicals and papers for the use of patients. We would also extend our thanks to Dr. and Mrs. Benn of Bay City, Michigan, who so kindly sang for the patients, not only in chapel but on several of the wards. �60 STATE OF MICHIGAN. Death for the first time entered the ranks of the staff during the period. On the 26th day of July, 1907, Dr. James F. Ganavan, who had been on the staff of the institution since 1899, passed away following an attack of appendicitis. The doctor came to the institution well equipped from the University and his services on the staff were of the highest order. He became very enthusiastic from the start in the study of insanity, both from the clinical and from the laboratory standpoint. His early death, with such a promising future, was a great loss to his family and associates, and the institution has also lost a most valuable, conscientious and efficient officer. It is apparent to many of us that the period just closed has marked a change from conservative asylum methods to the newer and up-todate methods of the research laboratory. I am also pleased to state that the relations between the public and the institution and between' the asylum and the officials of the various counties of the district, have been cordial; all of which has been of mutual benefit. I am under renewed obligations to the members of the staff and to all employes of the institution for personal kindnesses. Every employe, without exception, has put forth his best effort in the work. The trustees have been especially careful in the business management of the institution and have taken a great personal interest in every movement that tends to the betterment of the hospital. I believe we all feel a personal pride and interest in the hospital. Whatever progress the asylum has achieved is very largely due to your intelligent direction. All of which is respectfully submitted, JAMES D. MUNSON, Medical Superintendent. Northern Michigan Asylum, Sept., 1908. �61 NORTHERN MICHIGAN ASYLUM. OFFICERS AND EMPLOYES OF THE NORTHERN MICHIGAN ASYLUM, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1908, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Service. Name. Medical superintendent : . . . Asst. medical superintendent. . James D. Munson A. S.Rowley W D Mueller H D Purdum R. E Wells C L Whitnev Demas Cochlin T.H. A.Tregea Chaplain Accountant C M Prall A. Newman C W Nesbitt Chief engineer A Hinsdill Addie AIcMuIlen A W Hamel S G Howard H Leutholtz Clerk Clerk E C Kent Effie Bixbv Nettie Blank ,. . L M Bigbee piovd Bliss Emil E Barth C \r E L Butler Arline N Cook. .... Attendant Edna M. Crandell Nettie Cutting. Chas. Grouse .... Attendant Rate. Period. S3, 500 2,800 1,500 1,200 1,100 00 00 00 00 00 Per Per Per Per Per 800 1,800 200 106 50 00 00 00 00 00 Per annum. Resident. 1 ,500 00 l,b'00 00 55 00 50 00 45 00 annum. Resident. annum. Resident. annum. Resident. annum. Resident. annum. Resident. Per annum. Non-resident. Per month. Non-resident. Per month. Non-resident. Per annum. Noil -resident. 35 00 70 00 1 000 00 50 00 33 00 50 65 31 18 28 00 00 00 00 00 18 40 29 16 24 00 00 00 00 00 27 24 28 28 24 00 00 00 00 00 28 24 44 17 18 00 00 00 00 00 24 31 18 42 17 00 00 00 00 00 20 40 20 24 18 00 00 00 00 00 Per month. Resident. Per month. Resident. �STATE 62 OF MICHIGAN. OFFICERS AND EMPLOYEES—Continued. Service. Name. Attendant 4lbert Coryelle F P Downer . George Dell Nellie Ellsworth Kay Elliott Geo Fate H Fletcher Rose Fletcher .1. 0. Hoppes Attendant Ethel Hanes Esther Keller IJbbie Kelley . . . \ Kennedy.. . •Ubert Howard C H Leutholtz W Laskev . Ole Miller ... Rate. Period $24 24 26 24 17 00 00 00 00 00 29 28 32 40 28 00 00 00 00 00 24 17 20 38 38 00" 75 00 00 00 20 24 18 40 37 00 00 00 00 00 33 38 26 44 17 00 00 00 00 00 26 28 35 17 36 00 00 00 00 00 23 38 26 24 20 00 00 00 00 00 38 37 17 25 24 00 00 00 00 00 18 34 24 25 23 00 00 00 00 00 18 26 27 44 17 00 00 00 00 00 24 26 17 28 14 00 00 00 00 00 18 24 18 38 23 00 00 00 00 00 17 31 24 31 28 00 00 00 00 00 Per month. Resident. Per month. Resident. �NORTHERN MICHIGAN ASYLUM. 63 OFFICERS AND EMPLOYEES.—Continued. Attendant Ella J Miller Clifford Mull R. H. McKenzie Night supervisor Gladvs McWharters Attendant .Sadie E. Nichola Domestic V. A. Patrick Attendant W Delia Pepper "Hattie H Parr F G Park F G Sutherland Sadie Scott Hose Veit Charlotte Smith Rob't Tobey Madge Tissue Attendant W.J.Wilson L <V Wright Lvllian F Walsh ... Kunice Walsh Hattie Walsh Attendant '.. Attendant Attendant Thomas Whitfield . . Helen J Whitfield William J Weiler Lu cy Wilson , Attendant Telephone operator Chef Baker Georgia Baker C J Leland 11 F Herkner W Williamson . . . . .Joseph Kutnohorsky EarlMcEvoy Assistant cook Assistant cook Arthur Thompson Assistant cook Period. Rate. Service. Name. , §18 27 17 40 46 00 50 75 00 00 Per month. Per month. Per month. Per month Per month. 17 17 21 20 20 00 00 50 00 00 Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. 38 14 33 34 23 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. 40 26 17 31 26 00 00 00 00 00 Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. 18 20 18 17 14 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. 17 18 26 17 24 00 00 00 00 00 Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. 23 17 17 IS 24 00 00 00 00 00 26 22 18 40 27 00 00 00 00 00 Per month. Resident. 24 34 29 31 31 00 00 00 00 00 Per month. Resident. 44 39 34 27 24 00 00 00 00 00 Per month. Non-resident. 20 00 1 100 00 70 00 56 00 15 00 20 30 24 32 33 00 00 00 00 00 30 24 35 24 40 00 00 00 00 00 Resident. Resident. Resident. Non-resident. • Non-resident. Resident. Resident. Non-resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Per month. Resident. Per month. Resident. Per month. Per month. Resident. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Per month. Resident. Resident. Per month. Resident. Per month. Per month. Resident. Resident. Per month. Resident. �STATE 04 OF MICHIGAN. OFFICERS AND EMPLOYEES.—Concluded. Service. Name. Rate. Matthew Sleder Robert Turek S -V Conrad . . Geo F Dell Charlotte Zitka W A Western . . . Iva Elliott Ethel White Barnrnan Alfred Annitage B S Sayre Barnman Period. S24 30 24 24 40 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Resident. Resident. Resident. Resident. Non-resident. 20 17 75 35 16 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Non-resident. Non-resident. Resident. Resident. 13 14 17 19 23 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Non-resident. Non-resident. Non-resident. 22 17 21 19 19 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident, 15 13 19 19 60 00 00 00 00 00 Per month. Resident. Per month. Resident, Per month. Non-resident. Per month. Non-resident. Per month Non-resident. 33 31 30 34 34 00 00 00 00 00 Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. 29 00 32 00 31 00 29 00 1 75 Per month. Per month. Per month. Per month. Per day. E Stanwick 2 00 50 00 1 75 50 00 40 00 Per day. Non-resident. Per month. Non-resident. Per day. Non-resident. Per month. Non-resident. Per month. Resident. ffhos Dumbrille 60 00 50 00 35 00 60 00 1 75 Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Non-resident. Per day. Non-resident. W Wildfong . . . \ Leache . . . Fred E. Davis Teamster B. P. Hawkins M Nolan . . Assistant engineer Albert Truka Peter Hkluzak H Bu trick C C Cooper ... - 3 H McMiehael T B King Y Na^el Painter Laborer Thos. Pilkington Pig pens Teamster V G Lockwood Henry Brown Teamster -. Resident. Resident. Resident. Resident. Non-resident. 1 75 1 75 2 25 1 50 1 75 Per day. Per day. Per day. Per day. Per day. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. 4 2 2 2 2 50 25 25 25 70 Per Per Per Per Per day. day. day. day. day. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. 2 70 2 25 1 75 45 00 34 00 31 00 Per Per Per Per Per Per day. Non-resident. day. Non-resident. day. Non-resident. month. Resident. month. Non-resident. month. Non-resident. 31 31 30 29 29 29 29 Per month. Per month. Per month. Per month. Per month. Per month. Per month. 00 00 00 00 00 00 00 Non-resident. Non-resident. Resident. Resident. Resident. Resident.. Resident. �APPENDIX. �APPENDIX. The asylums of Michigan are organized and governed under Organic law. an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane, and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government. appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of Asylum Trustees. (Section 8.) The counties comprising the district districts. of the Northern Michigan Asylum are: Alpena Antrim Arenac Alcona Benzie Charlevoix Clare Crawford Cheboygan Emmet Gladwin Grand Traverse Gratiot Isabella losco Ionia Kalkaska Lake Leelanau Manistee Mason Mecosta Midland Missaukee Montcalm Montmorency Muskegon Newaygo Oceana Ogemaw Osceola Otsego Oscoda Presque Isle Eoscommon Wexford Provision is made by Section 7 for the transfer of patients Transfer from from one asylum to another when conditions make such trans- Bother*"01 to fer desirable. �68 STATE OF MICHIGAN. A patient is not to be committed to an asylum of a district other than that of which he is a resident, unless the court adjudicates that there is no room in the latter, and that there is in the former. (Section 8.) Classes of Patients are divided into three classes: Public patients, patients. private patients, and voluntary patients. (Section 13.) Voluntary Voluntary patients are patients who are not insane. They patients. are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for because of lack of room. In other words, there must be room for all others seeking admission before any voluntary patients can be received. I'ublic and Both public and private patients can be received only on private an order from a probate court declaring the patient insane patients. and stating the method of support,—whether public or priOrder void after thirty vate. Such an order is void unless patient is sent to the asydays lum within thirty days after it is issued. (Section 16.) Bonds. Besides the order of commitment from the court, there must accompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumbent upon the court to see that this bond is furnished. Advance Until this bond is furnished the patient is regarded as a payment. public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. . New bonds. ISiew bonds may be called for at any time by the medical superintendent, and the law requires the court to see that such new bonds are provided. (Section 16.) Temporary P'rovision is made (Section 16) for the reception of both orders. public and private patients on temporary orders wherever conditions demand immediate attention. Transfer from Section 21 provides for the transfer of a patient from priprivate to public. vate expense to public expense where conditions warrant such a change. Non-resident. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Provisional Section 32 provides for the return to the asylum without a discharge and reaclmission of new order of patients who have been discharged on trial, patients. where the duration of the temporary absence does not exceed six months. Insane women The attention of county officers is particularly called to the to he accompanied by female provisions of Section 40 regarding the state of bodily cleanliattendant. ness and the clothing of patients brought to the asylum, and more particularly to that clause of the section providing for a female attendant for insane women. Removal of In conveying a patient to the asylum do not deceive him. patients from home. Truth should not be compromised by professing a visit to the institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it,'' under the impression that they can Insane to be committed to asylum of their district. �APPENDIX. 69 leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the asylum, by giving patients an impression that they are parties to the deception. Removal to the asylum should never be attempted- when the patient is much prostrated or laboring under severe bodily illness, and care should lie taken that the excitement attending acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what articles clothing, of clothing it is necessary to provide the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemies, 3 pairs drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, 6 handkerchiefs, 4 collars, I pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings.' When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. If such articles are left in their possession the asylum cannot l>e responsible for their safe keeping. All letters concerning patients, from individuals having correspondthe right to make inquiry, will be answered at once; and friends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at the written request of friends. Where relatives of patients desire friends who are not mem- visiting bers of the family to visit patients, they should, in every in- patientsstance, furnish these friends with a letter of introduction, authorising the interview. Application for admission should be made before the patient Application 7 T , i n i ii i «n t f . 1 - 1 , 1 for admission is brought to the asylum. A* blank will be furnished the Of patients. friends which provides for a complete history of the patient's trouble. All correspondence in reference to patients should be addressed to Dr. James D. Munson, Northern Michigan Asylum, Traverse City. �INDEX. PAGE. Accounts, classification of Accounts, current Acknowledgments Additional buildings, recommendations for Additional buildings, built Admission of private patients Admission of indigent and pauper patients Admissions and discharges Age of patients. Table Appropriations, report on Artesian wells Barns Boiler feed pumps Carpenter and paint shop Civil conditions. Table Classification. Table Correspondence Cost of maintenance * Clothing Chapel services Cold storage room Deaths, causes, etc Duration of disease. Table Estimates of special appropriations Extension to cottage 34 Extension of laundry Exciting causes. Table Farm and garden products Farm and garden Fencing Form of disease. Table Government of asylum Heredity. Table Heating plant Hot water system Improvements Improvement of Asylum avenue Increase of patients Inventory, summary of Movement of population. Table Nativity of patients. Table , Names of officers and employees, etc • 26 26-29 59 11 32 68 68 37 52 12-14 19 56 18 14 52 43 69 10 69 59 15 38-41 52 55 15 19 53 34 20 18 45 67 49 15 18 11 19 10-11 35 36 51 61-64 �72 INDEX. Needs of the asylum '. Officers Occupations. Table .• Report of trustees Report of treasurer Report of medical superintendent Report of steward Report of auditing committee Report of State Board of Corrections and Charities Removal of patients to asylum Roof for boiler room Re-roofing of cottages Receipts and disbursements Residence of patients. Table Recapitulation Special appropriations Support of patients by counties Switch board, enlargement of Ventilating system PAGE. 14 3, 5, 6, 21 50 7-21 22-25 36-60 30-33 29 58-59 68 14 19 21 54 20 12-14 9 19 17 � https://localhistory.tadl.org/files/original/42e0fe9b6659fd9d8ac2446c4b065767.pdf b1a12d706a27cca89dcdbab023b1c5ce Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1910 Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Northern Michigan Asylum for the biennial period ending June 30, 1910. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Wynkoop Hallenbeck Crawford Co., State Printers. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1910. Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0006 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT B O A R D OF TRUSTEES ii i TRAVERSE CITY J U N E 30, 1910 BY AUTHORITY. LANSING, MICHIGAN WYNKOOP HALLENBBCK CRAWFORD CO., STATE PRINTERS 1910 �NORTHERN MICHIGAN ASYLUM, 1910. �TITLE AND ADDRESSES. THE NORTHERN MICHIGAN ASYLUM FOR THE INSANE, TRAVERSE CITY, Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is $1,046,862.46. The property consists of 42 buildings, occupying a tract of land containing 728 acres. It cares for 1,384 patients. OFFICERS OF THE NORTHERN MICHIGAN ASYLUM. TBtTSTEES. THOS. T. BATES H. C. DAVIS W. W. MITCHELL M. F. QUAINTANCE W. LLOYD E. S. WAGER TRAVERSE CITY TRAVERSE CITY CADILLAC PETOSKEY MANISTEE EDMOHE RESIDENT OFFICERS. JAMES D. MUNSON, M. D A. S. ROWLEY, M. D W. D. MUELLER, M. D ] R. E. WELLS, M. D V ADAH EPPERSON, M. D....J MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT ASST. PHYSICIANS NON-RESIDENT OFFICERS. C. L. WHITNEY W. P. MANTON, M. D STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN .. TRAVERSE CITY TREASURER. SAMUEL GARLAND TRAVERSE CITY �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM FROM ITS ORGANIZATION IN 1881. BOARD OF COMMISSIONERS APPOINTED TO SELECT SITE FOR THE NORTHERN MICHIGAN ASYLUM. Date of appointment. 1881 1881 1881 Name. . Retired. Residence. E. H. Van Deusen. . . Kalamazoo. . M H Butler .... Work of board completed Sept. 30, 1882. BOARD OF COMMISSIONERS APPOINTED TO ERECT THE NORTHERN ASYLUM. Name. Date of appointment. 1881 1881 1881 1881 1885 Residence . E. H. Van Deusen. . . Kalamazoo. M H Butler H. H. Riley St. Joseph. Thos T Bates MICHIGAN Retired. 1885 The work of the building commission was finished Nov. 10, 1886. MEMBERS OF THE BOARD OF TRUSTEES OF THE NORTHERN MICHIGAN ASYLUM. Date of appointment. 1885 1885 1885 1885 1885 1885 1887 1887 1889 1891 1891 1889 1895 1897 1897 1889 1901 1901 1902 1901 1903 1905 1907 1909 . . C. M. J W Thos H H Name. Residence . Term expires. President from to Wells French T Bates Noble Traverse City . - • Detroit 1887 1885 to 1886. Elk Rapids 1897 C. L. Whitney H. C. Davis G. A. Hart W. W. Cummer C F Backus .... H. D. Campbell W. W Mitchell H D Brigham D. B. Butler G A Hart A. F. Temple E S Wager Muskegon . . . . . . Traverse City . . . Manistee Cadillac Detroit .. Traverse City . . . Frankfort Muskegon 1889 1913 1891 1893 1889 1891 1895 1908 1897 1901 1901 1905 1901 1911 1901 1903 1907 1908 1911 1913 1915 Remarks. 1886 to 1892 1907 to 1910. 1892 to 1897 1897 to 1899 1899 to 1902.. Present member. �: ,: i » :!"• • -f- • - : i ! > r ' i :; ' I • ! HI till I I Ml-llil NORTHERN MICHIGAN ASYLUM, 1885, �STATE OP MICHIGAN. MEDICAL OFFICERS. Medical Superintendent: James D. Munson, M. D., 1885. Assistant Medical Superintendents: J, H. Dawson, M. D.—1885 to 1890. Resigned. C. G. Chaddock, M. D.—1890 to 1892. Resigned. A. S. Rowley, M. D.—1895 . Assistant Physicians: C. G. Chaddock M. D.—1885 to 1890. Promoted to Assistant Superintendency. W. A. Stone, M. D.—1886 to 1891. Resigned to accept the Assistant Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendency. M. Rockwell, M. D.—1891 to 1892. C. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. E. L. Niskern, M. D.—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D.—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1889 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. W. D. Mueller, M. D.—1900. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. D.—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 to 1909. B. F. Sargeant, M. D.—1904 to 1905. H. D. Purdum, M. D.—1906 to 1910. R. E. Wells, M. D.—1907 . Guy M. Johnson, M. D.—1908 to 1910. Adah Epperson, M. D.—1910 . Stewards: J. D. Billings, 1885 to 1886. John Goode, 1886 to 1887. J. P. C. Church, 1887 to 1894. C. L. Whitney, 1894 . Chaplains: Rev. W. G. Puddefoot, 1886 to 1888. Rev. D. VanAlstin, 1888 to 1890. Rev. D. Cochlin, 1890——. �REPORT OF THE BOARD OP TRUSTEES. The trustees of the Northern Michigan Asylum have the honor to submit their report for the biennial period ending June 30, 1910,— together with the reports of the medical superintendent, treasurer and steward. With this period the hospital has completed twenty-five years of its history. A quarter of a century is possibly a brief span in its evolution, but yet it would be quite impossible to describe its physical growth to say nothing of the improved methods of care and treatment of its patients. It would be difficult to fully compare the conditions surrounding the insane twenty-five years ago with those of today. Previous to that time the insane were mostly cared for in county-houses, some—the more violent—were locked in jails, some were kept at home in various sorts of receptacles, and asylum care was minimized to save expense. Restraints, both chemical and mechanical, were largely used; trained nursing was unknown, and very little if any care was given patients at night. During these early years every effort was bent to improve the housing, feeding and nursing of this class of sick people. Gradually county care gave way to asylum care and finally state ,care for the insane was established since which time wonderful changes for the better have taken place in all these things;. County house care has been abolished, none are cared for more than temporarily in jail, restraints are rarely used, and scientific medical treatment, based upon accurate medical and laboratory examinations have replaced purely empiric methods. During the last twenty-five years many wonderful transitions have occurred in almost every department of human effort. Our knowledge of diseased mental states and their treatment, of mental hygiene, and of applied or practical psychology, have almost wholly developed within that time. The psychic laboratory; the psycho-analysis of Freude and Jung; the clinical methods of Kraepelin and his pupils—unused and unknown till a few years ago—are of immense value to the mental and nervous sufferer. Psychology is making rapid progress and applied psychology is used by the business man as well as by the teacher and physician. It is of great value in the examination of school children, of railway employes and in the examination and treatment of many morbid nervous and mental states. Surgery, especially brain surgery, has greatly advanced, and operations are now performed that would not have been attempted at the beginning of this quarter of a century. Operations for the removal of brain tumors; of the gasserian ganglion, of the pituitary gland; of blood clots, and for the drainage of abscesses, etc., are frequently successfully performed. We are hopeful that insanity and all forms of degeneracy will be greatly lessened in the next generation. We are just beginning to recognize in this state the benefit of state care. The increase of cases has been comparatively small during the last four years, and there has been �ASST. MED. SUPT'S RESIDENCE. STEWARD'S RESIDENCE, �8 STATE OF MICHIGAN. a noticeable decrease in the insane population of the hospital during the last year. If senile patients were excluded from admission to the hospital, as was the practice 25 years ago, we believe there would be a marked decrease in the average number of occurring cases per year in the state. The evolution of the hospital has been along many lines: development of its grounds, clearing and additions to its farm, and enlargement of the hospital by the construction of cottages and extensions to the main building. There has been a broadening out in the care of the insane; isolated provision is made for the treatment of tubercular patients, training school for nurses has been established and maintained, and a dietician employed to look after foods and their preparation, and skilled men placed in charge of the gardens, green houses, orchards and other farm departments. The asylum domain originally consisted of 329 acres of ground. This tract possesses an almost ideal combination of those features pertaining to an ideal site: a dry, porous soil, consequently healthy, eastern front-age for the buildings, an elevation sightly yet sheltered, an ample supply of pure, artesian water, and excellent facilities for drainage. Most of this land was covered with heavy forests. The timbered ridges and valleys between them, back of the hospital and over looking the bay and city, have been conserved for parks, and afford attractive places for the outdoor exercises of patients, and at the same time are so secluded a,s to be adapted to all classes of patients. Even one who has been familiar with the institution for the last 25 years can scarcely appreciate the changes that have been made in its buildings, its grounds, etc. The forests have been cleared, the grounds stumped, graded and drained, and ornamental trees and shrubs, orchards and meadow fields have supplanted them. The grounds immediately in front of the institution are really fine, and have many interesting and attractive features. They have been carefully planted with trees and shrubs, and with charming effect. Much attention was primarily given to the selection of the trees, and an effort was made to plant all trees that would grow in this latitude. Among them may be found the salis burea, Kentucky coffee, mulberry, box alder, pecan, walnut, butternut, chestnut, hickory, the native beeches, elms and maples, the purple leaf beech, elm, maple, and the Norway maples in many varieties. These trees have attained some size and lend much beauty and interest to the grounds. A lake was constructed in the center of the grounds in front of the institution, and makes a pretty feature of the asylum, park. It is surrounded by rare trees, shrubs and flowers, and is a favorite spot for women patients. The high and wooded grounds back of the asylum are also very beautiful, and with their hills, dales and valleys, rivulets, roadways and pathways, are almost ideal for the recreation of the nervous invalid. The land available for farming and gardening contains between four and five hundred acres, and is divided into orchards, gardens and general farming lands. Large quantities of hay and soiling crops, and roots of all kinds are raised for the stock. The gardens, including the greenhouses, produce nearly all the vegetables used by the hospital. Strawberries and raspberries, grapes, apples, peaches, plums, pears and cherries are raised in large quantities, more sometimes than can be consumed by the institution during their season, and from the, excess of these fruits there was canned last vear for winter use over 15,000 quarts. �NORTHERN MICHIGAN ASYLUM. 9 Melons, egg plant and sweet potatoes are largely grown, but have to be started in the green houses. There are now over one hundred head of pure bred Holstein Friesians on the asylum farm, which produce all the milk used by the institution. It is doubtful if the public has a true appreciation of the value of the farm to the institution, not only in dollars and cents, but from the sanitary standpoint of pure foods and pure milk which are produced on the farm. As much as $32,000 worth of products have been raised on the farm in one year. The farm affords excellent occupation for a large number of men patients. It is not unusual to see several hundred men at work about the farm and grounds. The hours of labor are short, from one to three hours in the forenoon and about the same in the afternoon. Work is not compulsory, and is not asked of patients as a rule on Saturdays or on legal holidays. The following additions have been made to the asylum domain by the legislature: In In In In In In In In In 56% acres 1887 1892 1893 1896 1896 1900 1900 1901 1907 120 29 401 40 1% 40 60 at a cost of L .... .v Total $ 3,806 225 1-0,280 2,900 1,600 2,000 66 '3,200 6,000 17 00 00 Ofl 00 ,00 66 '00 00 130,077 83 The greater portion of these lands were timbered, and the wood and posts and lumber cut from them, almost covered the original purchase price, besides furnishing the very best of work for men patients. The institution received its first patients November 30, 1885. About 300 patients were transferred from Kalamazoo and Pontiac, and many patients that had been confined in jails and county houses of the district were soon after the opening of the hospital committed, so that within a few months the hospital was crowded to its utmost extent. As established by the legislature, the asylum could only accommodate 450 patients. Additions have been made to the hospital by almost all of the succeeding legislatures, as follows: In In In In In In In In In In In In In In In 1887 1887 1889 1889 1891 1893 1893 1899 1899 1899' 1901 1901 1903 1903 1907 completion of attics for 50 patients Cottage 28 for 50 patients North and South Infirmaries for 60 patients Cottage 32 for 30 patients Cottage 25 for 50 patients Cottages 24 and 26 for 100 patients Cottage 29 for 75 patients Cottage 34 for 50 patients Cottage 21 for 50 patients Cottage 31 for 30 patients Cottage 30 for 50 patients Cottage 23 for 50 patients Cottage 36 for 60 patients Cottage 27 for 60 patients extention to north and south wings for 200 patients. Total $ 5,550 13,000 30,000 15,000 15,000 25,000 18,750 20,000 20,000 7,300 21,367 .21,367 24,000 24,000. 90,000 $350,284 �10 STATE OP MICHIGAN. These buildings as authorized by the legislature, were to care for 991 patients. They will actually care for 1,022 patients. This shows that the per capita cost of the buildings as authorized was $362.25, but basing the per capita cost on the number of patients cared for in these additions June 30, 1910, (1,022 patients) the per capita cost was |342.75. When it is stated that these buildings are all constructed of brick and stone, with brick partitions, and fitted with steam heat and special ventilation, electric lights, hot and cold water, and every necessary sanitary appliance, it is doubtful if more substantial, or buildings better adapted to the care of the insane, can be found anywhere at the same cost. The experience gained from the planning and building and the use of these cottages, has demonstrated that separate heating plants and separate dining rooms and kitchens for each building, is expensive, that the storage of coal and a heating plant under the buildings or in connection with them, is not only unsanitary on account of dust which finds its way throughout the buildings, but from the danger of fire which is very greatly increased by such an arrangement, and that the cost of heating and caring for the heating plants, and the general up-keep is higher in these cottages than in the congregate building. For these reasons the several separate heating plants were abandoned, and central heating established, which has proved much more economical and satisfactory in every way, and greatly lessens the danger from fire. What was found true of the increased cost of heating is also true for the increased cost of preparing and distributing foods. Recommendations will be made to your honorable body to supplant this system with a central dining room, at least for the male patients. When the central heating system was installed, automatic stokers were put in the boilers and a mechanical system of handling coal from the bunkers to the stokers and for the disposal of ashes, was incorporated, doing away with, the laborious and expensive method previously in use. Someone has said that the planning for any institution or for its equipment, cannot expect to forsee and include up to date appliances for more than ten years. We have seen this demonstrated during the last 25 years. The heating plant has been practically re-built twice, the laundry twice, the barns partially re-built and greatly improved several times, the bakery re-modeled, greatly enlarged, and new ovens and machinery installed. Many parts of the hospital building either became obsolete or ante-dated and had to be re-built, and replaced by modern, simpler, and better plans. We have found this to be particularly true in all the mechanical departments of the institution. One can scarcely express, and few can appreciate the great wear and tear there is in connection with an institution of this magnitude. In the care of patients the same progress may be noted. Psychiatric knowledge has made great forward strides. Applied psychology is becoming more and more valuable. Our entire knowledge of the internal secretions and their action in health and disease has developed within the last few years, and the surgical treatment of thyroid diseases,in certain brain diseased conditions, and in the cure of the diseases of the internal organs, thoracic and abdominal, have wonderfully advanced. It would seem that with the general interest in the education of the young, with greatly improved public sanitation, with the better knowl- �LAWNS. �NORTHERN MICHIGAN ASYLUM. 11 edge of personal hygiene, all future generations would be benefited, and degeneracy and disease much less serious and less frequent. The biennial period has been given very careful business oversight, in order to keep within the limit of the rate fixed for the maintenance of patients. All food supplies have been higher in price than for years, and the wages paid to employees have increased more than ever before. The net cost of maintenance for each patient during the last year was 50.64 cents per day. Although 50 cents was the rate charged a deficiency appropriation will not be required, as the working capital of the institution was able to make up the loss. During the period just closed, the matter of joint purchase of supplies for the several asylums has been carefully worked out by the stewards of the institutions, and from their investigations they find that it is practical to make joint orders for about 80 or 85 per cent of all supplies required by the hospitals. They further find that there are conditions peculiar to the locality of each institution which necessarily govern the lowest purchase price of certain commodities. Under this plan quite extensive orders have been given for foods and other supplies during the last year or more, and at a slight advantage in cost. It is now suggested to establish a board of stewards, composed of the purchasing agents of all the institutions of the state, at the sessions of which board samples of goods with prices and everything pertaining to the furnishing of supplies shall be submitted, discussed, and orders determined for one or all of the institutions for certain articles. In this way it is hoped to gain for the smaller institutions the same market price as are paid by the larger ones. It is surprising, however, how very close the several institutions have been buying to each other during these years, although entirely without consultation with each other. During the period the Board has had twenty-four regular meetings, and the usual inspection of the asylum was made by committees of trustees, once each month and sometimes oftener. The training school for nurses continues under the general direction of Miss Jennie E. Leece. The trained nurse is an important factor in the care of the insane, and while, thus far, we have not been able to retain a great many of the graduate nurses in our service, it is gratifying to state that they are much sought after by general hospitals, and by general practitioners in our part of the state. Many of our graduates hold very responsible positions in similar institutions and in general hospitals, and inquiries are frequent for competent men and women graduate nurses, to fill positions in other institutions. The influence for good of our nurses, extending as it does over many communities, greatly increases the confidence of the people in the hospital, and indirectly enhances its usefulness. Many patients are successfully treated at home by their family physician, under the personal care of a trained mental nurse. The training school last year had 62 pupil nurses with 21 graduates, and this year the attendance will be as great, if not greater. Even though many of these graduates leave our service soon after graduation, yet we believe'that the effort put forth by the state in their training is worth more than it costs, since wherever they go in the care of the mentally afflicted, they bring confidence and often restored health to their patients. We are glad to say that abuses and brutalities are very infrequent. "Careful training and education of the young man or �12 STATE OF MICHIGAN. woman in the nursing profession develops in him the consciousness of competence and efficiency, and with this, increased ability a higher sense of duty, a higher appreciation of his relations to the patient, and a constant seeking for means to soothe and to cheer, and develop all that is best in the mind diseased. The trained nurse is a professional individual, and feels the same pride in his work and in well doing as does the physician or any other trained professional man." Great attention continues to be paid to the preparation of food under the skillful direction of a dietician. Food is prepared to meet the conditions of each patient, and the patient is no longer compelled to adjust himself to the food that is sent to him, whether suited to his needs or not. During the last two years there has been some progress in almost every department of the institution. The farm has been extended, fruits, not consumed in the fresh state have been canned or preserved, the orchards have been enlarged and placed in charge of an orchardist, and the dairy herd has been increased in numbers to meet the growing demands of the hospital. From the medical standpoint the asylum has become a hospital in the fullest meaning of that word. The medical treatment, the nursing, and the general environments are all carefully supervised, looking to the best good of the patient. This requires experienced physicians, skilled nurses, pleasing surroundings, the best of hygienic conditions, and pure foods skillfully prepared, that the hig-hest good to each individual may follow. If the individual patient receives such care, then it follows that all patients receive such care. Medical offices have been established in connection with the hospital wards, where the examination of patients and consultations with them can be held. This plan has been of value. It assures the patient of the personal interest and friendship of the physician in his recovery, and enables the doctor to give special direction to the patient and to the nurse, and not infrequently excites in the patient a general interest in his own recovery and also in the welfare of his fellow patients. Psychiatric knowledge has developed very rapidly during the last few years, and while much light has been thrown on many difficult mental problems, still more difficult ones of solution seem to loom up as greater knowledge of nervous functions is gained. Great advances have been made in our knowledge of the etiology and treatment of psyehoneuroses, in the methods of psycho-analysis of Freude and Jung and Putman and Prince and others. The subjects of heredity and especially of environment, are more justly appreciated and studied than ever before, and brain surgery, and the physiology and chemistry of the internal secretions, have wonderfully advanced in practical importance. The discovery of the serodiagnosis of lues, and the widening field of organotherapy, and the vaccine treatment of certain diseases, are among the most remarkable and valuable of recent medical achievements. Pathological anatomy has also made rapid strides forward, and the causes of some diseases ending in death can now be positively demonstrated microscopically after death. In the field of prevention of mental disease and degeneracy, the influence of the public schools in teaching the evil effects, direct and remote, of the improper use, or abuse, of alcoholics, tobacco and other drugs, and of bad or imperfect personal hygiene and sanitary surround- �o O! Ed o B t> w d �NORTHERN MICHIGAN ASYLUM. 13 ings, including want and privation, malnutrition and bodily diseases which hinder normal soul development, has been of vast importance. "At no time in the history of the world has more thought been given to the problem of the child than now. The child is the central psychologic study. His are the problems of the most advanced educators, physicians, scientists and economists. More significant still is the growing conception that the child is the ward of the state. He no longer belongs solely to the home. The Spartan idea has been revived, though fortunately deprived of its harshness by broader conceptions of obligations; while the state and the medical profession now claim the substantial right to assist in regulating the child's life they violate no sacred right of home, and this is as it should be." Rose Pendleton Chiles.) August Forum 1910. The first five years of a child's life are rich in emotions and vague thoughts. These years have now been adequately chronicled, but there are good grounds for thinking that traits of character are founded or accentuated at that period, which tend strongly to remain through life." (J. J. Putnam, M. D.) Boston Medical and Surgical Journal. July 21,1910. These are all factors looking to the bettering of the oncoming generation, and unquestionably human suffering will be greatly lessened, and mental diseases much less frequent. The psychopathic hospital, which is in affiliation with the asylums of Michigan, and under the able direction of Dr. Barrett, has been of great scientific service to us. The pathologic research work which Dr. Barrett has done for us has been of great value. Many diseased organs, including the brain, have been sent to the psychopathic ward for pathologic research, and the reports of Dr. Barrett on these cases have in many instances confirmed the diagnosis made during life, and sometimes have pointed out mistakes in diagnosis during life. It is such work that is of the very greatest scientific value. It stimulates all men in our special field to closer observations and study, and forces each and every one to put forth his very greatest effort in and for his patient. Among other things a uniform classification of mental diseases has been suggested by Dr. Barrett and agreed upon by the superintendents of the institutions, as also a uniform system of making up the clinical biennial reports to the governor and the legislature. This has been done in order to secure uniformity for purposes of comparison, and that it may be possible to aggregate all of the statistical data relating to the insane in the state of Michigan. It has been agreed by all of the state institutions to present the 16 statistical tables which appear with this report. We are glad to report that the hospital was free from epidemic diseases during the period. One homicide and two suicides occurred. One patient (a homicide) was transferred to the State Hospital at Ionia, by direction of the Governor, and one patient was deported to his home in Indiana. The institution has been able to care for all patients within its district. ' The net gain in patients during the period was forty-seven. There were 585 patients admitted during the period—338 men and 247 women. �14 STATE OF MICHIGAN. The several counties committed patients as follows: Alpena Antrim Arenac Alcona Benzie Charlevoix Clare Crawford Cheboygan Emmet Gladwin Grand Traverse Gratiot Isabella losco Ionia Kalainazoo Kalkaska Kent INO legal settlement Total Of the 31 42 45 65 25 20 30 16 Lake 15 Leelanau 3 Manistee 9 Mason 21 Mecosta 33 Midland 10 Missaukee 1 Montcalm 25 Montmorency 28 Muskegon 4 Newaygo 41 Oceana 34 Ogemaw 21 Osceola 5 Oscoda 34 Otsego 1 Presque Isle 4 Koscominon 1 Wexford ; 5 8 29 20 28 14 10 39 1 34 8 19 7 24 4 3 5 1 19 1 585 585 patients admitted: had been confined in county houses. had been confined in jails. had been treated in other asylums. were said to have been destructive. had attempted or threatened suicide. were homicidal or had threatened homicidal assaults. had been confined or restrained at home. The number of patients confined in county houses, jails and other asylums exceeded the last biennial period by 53, the number of suicidal cases was greater by 5, and the number of homicidal cases was greater by 5. Since June 30, 1892, these statistics have been regularly kept, and show out of a total of 3,796 admissions: 150 406 266 457 325 480 382 ( 3.9%) (10.7%) ( 7 %) (12 %) ( 8.5%) (12.6%) (10 %) were confined in county houses. had been confined in jails. had been treated in other asylums. were destructive. were suicidal. were homicidal. required some sort of restraint at home. �FARM SCENES'—1885-1010. �NORTHERN MICHIGAN ASYLUM. 15 COST OF MAINTENANCE. The daily cost of maintenance per patient for the last 23 years has been as follows: Cents. 1886 53 1887 52 1888 51 1889 50 1890 49 1891 49 1892 48 1893 48 1894 48 1895 47 1896 46 1897 44 1898 42 1899 44 1900 44 1901 44 1902 44 1903 (The above exclusive of officers' salaries).... 44 1904 (Inclusive of officers' salaries) 48 1905 (Inclusive of officers' salaries 49 1906 (Inclusive of officers' salaries) 48 1907 (Inclusive of officers' salaries) 47 1908 (Inclusive of officers' salaries) 48 1909 (Inclusive of officers' salaries) 50 1910 (Inclusive of officers' salaries) 50 INCREASE OF PATIENTS. The average yearly net increase of patients for a period of 22.5 years has been 43.1 The net increase of patients for the district for the period ending June 30, 1910, was 47. There was 538 patients discharged during the period, 317 men and 221 women. Of this number 91 were discharged recovered, 125 improved, 46 unimproved, and 275 died. The percentage of recoveries on the whole number under treatment was 2.7 per cent; on the number admitted 15.5 per cent. The death rate 77 per thousand 1908-09, and- in 1909-10, 88 per thousand. The readmissions for the period were, men, 39; women, 50; total, 89. The readmissions from the beginning have been, men, 276; women, 261; total, 539,—hence the total number of admissions, 5,280, represents 4,741 individuals. The daily average number of patients for the period was 1,384. The number of weeks spent in the institution by patients was 144,281 4/7. This was an increase of 70 in the daily average, and an increase of 7,625 weeks' board over the preceding period. On June 30, 1910, there were 1,384 patients under treatment at State expense and 35 at private expense. �16 STATE OF MICHIGAN. There were 271 persons employed at the asylum on June 30, 1910, in the positions and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND IMPROVEMENTS. During the year ending June 30, 1909, the cost of repairs was $22,017.46, and for the year ending June 30, 1910, $24,788.60. The installation of new water heaters, and the new heating and ventilating plant necessitated many changes in the steam fitting and plumbing at no small expense to the institution, as the cost of these changes was extra to the appropriation made for their installation. A new gravel roof was put on the laundry building, and the carriage and farm barns were painted. The elevator in the administration building was repaired, a new body ironer placed in the laundry, and considerable wire fence built. The wood floors of dining rooms and toilet rooms, where decayed or worn out, were replaced with tile floors. New bathrooms and an addition to the dining room in the administration building were constructed. The clothes rooms in the terminal sections of both the north and south wings were enlarged, and the fire hose cupboards made more accessible and serviceable. About one-half mile of cement sidewalk was laid to replace board walks which were decayed. A survey of the grounds has been made with a view to conserve all water flowing from springs along the base of the hills to the west of the asylum, for greater fire protection and for general irrigation purposes. It is estimated that over 300,000 gallons a day are now running to waste. About the only cost to make this large supply of water available for practical uses, will be that for necessary pipe and fittings for its proper distribution. Small repairs are always very numerous and aggregate quite a large sum each year, but need not be enumerated here. SPECIAL APPROPRIATION, $2,000. This appropriation was made by the legislature of 1905, to repair the reservoir. There still remains in the hands of the treasurer to the credit of this fund $1,287.22. Surveys have been made and estimates prepared of the cost of building an additional dam to store several hundred thousand gallons of water which is now running to waste. The expense of this improvement will about use up the balance on hand to the credit of this fund. SPECIAL APPROPRIATION, $2,500. This fund was created to increase the fire protection of the institution. There still remains in the hands of the treasurer to the credit of this fund the sum of |1,750.75. Contracts are about to be let for iron pipe and other material necessary to connect the asylum main with the mains of Traverse City. When finished it will give very adequate fire protection to the institution. ADDITION TO LIBRARY. There still remains in the hands of the treasurer about $325 to the credit of the fund for addition to the library. Small additions will be made to the library from time to time from this money until it is consumed. �FARM SCENES. �NORTHERN MICHIGAN ASYLUM. 17 EXTENSIONS TO NORTH AND SOUTH WINGS. At the close of the last biennial period there remained in the hands of the treasurer to the credit of the fund for the extension to the south wing f40,041.01, and to the credit of the extension to the north wing $37,733.40. These extensions are nearly finished, and one ward in the north building is occupied by patients. The furniture and furnishings are still to be purchased, but there remains in the hands of the treasurer the sum of $5,559.21 to the credit of this fund. We are pleased to say that the original appropriation of $90,000 will be sufficient to complete these buildings as authorized by the legislature. SPECIAL APPROPRIATION, $35,000. This appropriation was made by the last legislature for the improvement of the heating plant, and the hot water and ventilating systems. After most careful consideration, the Marion hot water heater, manufactured at Marion, Ohio, was selected. The contract price for this heater was $3,950, and the further sum of $675 was expended for a steam pump. An expenditure of $375 was necessitated by labor and fittings for connecting the apparatus with the old pipes, making the total of the hot water machinery $5,000. The contract for the heating and ventilating apparatus was let to the Thomas Heating Co., of Racine, Wis., in the sum of $32,529.00. The Thomas Heating Co. included in their contract the heating of the extensions to the north and south wings, for which an appropriation had already been made. The work of installing the hot water, the heating and the ventilating systems has been finished, and we believe that they will prove very efficient. The heating and ventilating systems are separate, so that each can perform its work irrespective of the other. The heating system consists of radiators located so as to maintain proper temperatures in all of the rooms and hallways, and the radiators are equipped with a vacuum system and automatic temperature regulation. The ventilation is effected by motor driven fans capable of giving a full supply of air to each and every room under all conditions of weather. The air is supplied at room temperature and independently of the heating. We are pleased to say that the work has been well done, and within the amount appropriated for the purpose. SPECIAL APPROPRIATION, $2,500. (For a roof for boiler room.) This appropriation was granted by the last legislature, but it is not available until July 1, 1910. Plans and specifications have been prepared for a steel and fire proof roof, but it is doubtful whether the appropriation is large enough to cover the cost of such construction. The lowest estimate so far- received for the work is $2,900. The estimate presented to the legislature for this improvement was $2,955. This work should be commenced as soon as possible, as the old roof is in very bad shape, and allows both rain and snow to wet the machinery underneath. 3 �18 STATE OF MICHIGAN. SPECIAL APPROPRIATION, $5,000. This appropriation was granted by the last legislature for the construction of new cold storage plant. The appropriation is not available until July 1, 1910. Plans and specifications are being prepared, but it is doubtful whether the amount granted will be sufficient to cover the cost of the plant as planned by the institution. This improvement is much needed, as the asylum is practically without a suitable place in which to care for milk, butter, eggs, meats, dried fruits, canned goods, and many other stores that need to be carried in quantity. NEEDS OF ASYLUM. We regret that we have to come to your honorable body for appropriations for improvements to the institution, but as you know, the hospital is growing, and in order to meet the demands of its district certain improvements and additions have to be made from year to year. You will recall that the institution is a quarter of a century old, and that a considerable outlay is incurred each year to keep the buildings in ordinary good condition. CARPENTER AND PAINT SHOP. Your honorable body is respectfully requested to appropriate the sum of $5,500 for the construction of a carpenter and paint shop for the use of the institution. As reported to the last legislature, the blacksmith shop and the carpenter shop have been associated in" small rooms connected to the engine and boiler rooms. These rooms are too small for either purpose. There is loss in time and money and in the waste that is inseparable from the lack of storage room. The carpenter shop is too small lor any amount of modern machinery. There is a small planer in it, but in order to use it the lumber often has to be passed out through a window, as there is not sufficient space in the room to handle a long board. The institution has never had a proper place in which to care for lumber, for carpenter utensils, for paints, oils and glass, for lockers for workmen, for merchandise such as is used in these departments, and no place in which the blacksmith or engineering departments can store and properly care for the fittings, etc., that have to be carried in stock. It is almost imperative in the interest of economy and of safety from fire to have a building for a carpenter and paint shop and a general store room for material used in these departments, and located at a safe distance from the main building. The present blacksmith shop and carpenter shop can be converted into a blacksmith shop and store room for engineering materials. HEATING PLANT. The last legislature made an appropriation of -|35,000 as above mentioned, for the installation of a heating plant, etc. The trustees requested an appropriation of |69,040 made for the purpose. The legislature appropriated ,f?>5,000, with which about half of the old heating system has been replaced. The following reasons as presented by Brush, Allen & Anderson in their report to. the Board, and which were pub- �FARM SCENES. �NORTHERN MICHIGAN ASYLUM. 19 lished in the report of this institution for 1908, still hold good for that part of the building which is heated by the old system. "1st. The present system does not adequately heat the buildings, and provision should be made to take care of this difficulty. 2nd. The present system has exhausted itself in part, and will require constant and excessive repairing annually from now on. 3rd. The present system does not serve as a consistent ventilating system, and proper ventilation is by no means secured. 4th. The present system is extravagant in the extreme regarding the expense of operation in comparison with results given. These conditions are going to require a continual expenditure in patching up, repairing and making temporary arrangements to give more adequate results. The ultimate expense of these changes will become very great year by year. Providing it is possible to complete the new system immediately, the total cost in the long run will be much less than the running expense of constantly patching up the old system, especially when considering the benefits of economy realized providing the system is rectified." Last year the cost for heating was 6.02 cents per patient per day. This was 2.13 cents per patient per day more than at the Eastern Michigan Asylum, and 2.43 cents per patient per day more than at the Michigan Asylum. This would be a difference, based upon the number of patients treated in the Northern Michigan Asylum, of about 111,00,0 a year, or 33% of what the proposed new plant will cost. For these reasons we would respectfully ask an appropriation of $35,000 to complete the heating and ventilating systems of the main building, of the kitchen building and of the hospital buildings, as was contemplated by our request to the legislature of two years ago. FENCING. Your honorable body is respectfully requested to make an appropriation of |4,500 for wire fencing with cast posts to be used in replacing the fences on Division St. on both sides of Asylum Avenue and Elmwood Ave. ARTESIAN WELLS. Your honorable body is respectfully requested to appropriate the sum of $1,000 to construct artesian wells to increase the domestic water supply of the institution. During the last year water was pumped from the deep well, and doubtless the fuel used in driving the pumps cost more than an additional well would have cost. This appropriation should be granted. RE-ROOFING OF COTTAGES 28 AND 32. The attention of the last legislature was called to the condition of the roofs of these buildings. They are in very bad shape and should be re-shingled. We would recommend that slate be used, and would respectfully ask for this purpose an appropriation of $2,100. �20 STATE OF MICHIGAN. EXTENSION TO LAUNDRY AND ADDITIONAL LAUNDRY MACHINERY. Your honorable body is respectfully asked to appropriate the sum of $1,200 to build a general repair room and to enlarge the ironing room of the laundry. A further sum of $175 is requested for the purchase of a shirt ironer, and the further sum of $675 for the purchase of a washing machine. These improvements are much needed. The laundry was built in 1895 and was supposed to be large enough for all time, but the institution has outgrown it, and it must be enlarged to meet the demands made upon it. REPAIRS AND PAINTING OF ROOFS AND GUTTERS. The roofs, gutters and galvanized iron work of the asylum buildings are sadly in need of repair and painting. It has been many years since they have been repaired, and we respectfully ask an appropriation of $3,500 for these improvements. PORCH FOR COTTAGE 32. Your honorable body is requested to appropriate $600 to construct a porch at Cottage 32. This cottage has recently been devoted to the care of tuberculous patients, but it is without necessary porch room for the out-door care of the invalids. The out-door treatment of tuberculous people is imperative, and for this reason we respectfully ask for the funds to build the porch. SEWAGE DISPOSAL. For some time the city has been agitating the question of special sewage disposal for the city, and if the city decides to' change the present system it will be imperative for the asylum to make special disposal of its sewage. The existing sewers of the institution discharge into the Boardman river, thence into the bay. There can be no doubt that this is wrong, and we would respectfully ask the legislature to give this matter very careful consideration, so that it may be known what attitude the state will assume. Without doubt sewage disposal beds could be established that would be much more sanitary to the public health than is the present system. GENERAL DINING EOOMS. The experience of the last twenty years has demonstrated that the kitchens and dining rooms associated with isolated cottages add to the cost of maintenance. Each kitchen requires a range, coal and kindling, sinks, steamers and cooking utensils, etc. These have to be duplicated in each building. Also a large amount of space in each cottage is taken up by the dining room, which adds to the cost of construction. Further, cooks and assistant cooks must be employed at each cottage, all of which adds to the cost of living. An appropriation of $18,000 is respectfully requested to build a central dining room and kitchen for the cottages for men and women. Each building should be large enough to accommodate 350 patients. The rooms at present occupied by kitchens and dining rooms could be con- �HOLSTEIN-FRIESIANS. �NORTHERN MICHIGAN ASYLUM. 21 verted into dormitories, and accommodations thus provided for 130 more patients. This would be very much cheaper than to build cottages for 130 patients, which would cost at least $50,000. Further, the central dining room would save largely in help, the cost of ranges and repairs for the same, in fuel, and besides would afford much closer attention to the details of cooking, etc., than is possible under existing conditions. For these reasons your honorable body is respectfully requested to appropriate the necessary money for the construction of these buildings. RECAPITULATION OF APPROPRIATIONS REQUESTED. Carpenter and paint shop $5,500 00 Completion of heating and ventilating system.. 35,000 00 Fencing 4,500 00 Artesian Wells 1,000 00 Re-roofing of Cottages 2,100 00 Extension to laundry and additional laundry machinery , 2,050 00 Repairs and painting of roofs and gutters 3,500 00 Central dining rooms for men and women.... 18,000 00 Porch for cottage 32 600 00 Total $72,250 00 FARM, GARDEN, STOCK AND GROUNDS. The asylum real estate comprises 728 acres. As given in the census report on June 1st this estate has 445 acres improved land under cultivation, regularly tilled and cropped, or mowed and pastured in rotation, or land in gardens, orchards, vineyards, and land occupied by buildings. The woodland of the farm was 236 acres occupied by forests for wood or parks for shelter, while the balance, 47 acres, is land in process of clearing, stumping and draining, preparatory to cropping and usefulness. The products of the farm for the past two years have been as varied in kind and as great or greater in value, as in any of the previous biennial periods; and while large crops have been taken from the farm, its productiveness has been kept as good, and in some portions made better, than before, and the acreage in orchard, garden and cultivated fields has been increased. The implements upon the farm have been kept in a good state of repair, and their number and efficiency increased. The farm buildings are in an excellent state of preservation, and meet the needs of the institution. The live stock has been maintained in number and its value increased by careful breeding. The dairy herd today numbers 113 head of all ages and has a value of almost $20,000.00, and probably more, judging from recent auction sales of herds of Hoi stein Friesians in many parts of the country. The growth in size, and the increased value of the farm, and of its products and stock, in the past quarter of a century, may well claim our attention, and we may derive pleasure from its contemplation. From the first biennial report we learn that the farm then comprised 339.9 acres mostly consisting of forests in the primeval state, undrained �22 STATE OF MICHIGAN. swamps or uncleared stump lands, without fences, roads or buildings for farm use. Today there are 728 acres in the farm that show large, finely cultivated fields yielding yearly bountiful crops, or smooth meadows or pastures giving an abundance of forage, or large orchards, gardens and vineyards growing fine fruits and choice vegetables. Twenty-five years ago the orchards, small fruit plats and vineyards were yet to be planted; now there are 2,563 apple trees nearly one-half in bearing, 1,182 peach trees, two-thirds producing fruit which, with the pear, plum and cherry trees, make a total of 4,893 trees, half of which are yielding good returns, and which will be increased for many years to come. Besides these, there are 1,352 grape vines and 10 acres of currants, raspberries and strawberries. Twenty or more acres are in the gardens, yielding an abundant supply of the choicest of vegetables for the tables. These are supplemented by greenhouses and accessories, where, under glass, many vegetables are grown, and the stock is made ready for outside culture as early as the seasons will allow. The amount of crops grown has been shown in the regular reports. The first report showed $14,205.31 in value of crops, of which nearly onehalf was forest products taken from the farm in the first two years. In the last two years the gross value of the crops grown upon the farm and the value of stock sold was $66,188.94, an average of $33,094.47 per year, all of which was consumed by the institution. With the growth of the farm and its cultivation, fences, streets, parks, shade trees and buildings have been added to make access easy and protect and shelter stock and crops. The dairy herd of Holstein Friesians has been a source of pride and profit to the asylum, furnishing a good supply of milk, excellent veal and beef, and yielding a large income in the sale of the surplus stock grown. This breed of cattle was introduced iipon the asylum farm by a single animal bought 24 years ago>, two others added two years later, and a little later 16 head were purchased, and so on until the farm was fully stocked with pure bred animals. The herd has attained a reputation for its purity of breeding, and general good qualities and excellence all over the country. Fifty-two cows and seven bulls have been purchased, the cost of which was $6,035 or an average of $102.30. The sales from the herd in the meantime, have been great, $6,830.00 in a single biennial period, or $800.00 more than all the purchases for 20 years. Sales of cattle have been made to 33 counties in this state, and G states and Ontario besides. The number of sales amounts to 228 head of various ages, of which 179 head were sold within the state and 49 outside of the state. The value from these sales has been $22,153.00, and the herd is now worth more than ever before. This herd of cattle has been kept to supply milk for the patients of the institution, furnishing the best of food, and the sales have been mostly of young bulls and a few surplus cows. The yield of milk given in the first biennial report was 251,000 pounds, or 125,500 pounds per year. This amount increased each year until in 1898, when the amount of 481,210 pounds was reached. For the last 12 years, or since the herd has become pure bred Holstein Friesian, the average has been 606,185 pounds per year, a little over 303 tons of milk in 365 days, or 1,660 pounds per day. By careful breeding, judicious selection, and wise purchase of new blood, the herd can be made to yield more and better milk, and its �NORTHERN MICHIGAN ASYLUM. 23 sales of surplus stock will be larger and for better prices than in the past. RECEIPTS AND DISBURSEMENTS. The total receipts of the asylum for the fiscal year ending June 30, 1909, including cash on hand and credits on special appropriations accounts, were $358,798.72; and the total disbursements for the same period, including special appropriations, were $324,475.44. The total receipts of the asylum for the fiscal year ending June 30, 1910, including cash on hand and credits on special appropriations accounts, were $348,319.74; and the total disbursements for the same period, including special appropriations, were f320,865.70. There was at the close of the biennial period ending June 30, 1910, 127,454.04 in the hands of the Treasurer; $9,375.97 of which amount was to the credit of the current expense account and the balance of $18,078.07, unexpended balances to the credit of special appropriations accounts. OFFICERS. In 1908, Ho>n. H. C. Davis, of Traverse City, Mich., was re-appointed to the Board. Mr. Davis has served continuously on the Board since 1891. In 1908, Hon. E. S. Wagar, of Edmore, Mich., was appointed to the Board. Mr. Wagar had had large experience in the Legislature of Michigan and also in the management of large private business affairs, and is a valuable acquisition to the Board. On the 1st of April, 1910, Dr. Guy M. Johnson, assistant physician to the staff, resigned to enter private practice in Traverse City. On the 1st of September, 1909, Dr. Beatrice Stevenson, who had been the woman physician on the staff for a number of years, resigned to enter private practice in Detroit. In June, 1910, Dr. H. T>. Purdum, who had been an assistant physician for several years, resigned to accept the superintendency of the psychopathic ward of the Bay View Hospital at Baltimore. In April, 1910, Adah Epperson, M. D., was appointed to the position of woman physician on our staff. Dr. Epperson came to us highly recommended, and thus far has proved efficient in the discharge of her duties. The period just closed has been an active one in the upbuilding of the institution, not only in the extension of the hospital proper, but in bringing more modern ideas, not only in hospital construction, but in the medical care of cases, also in the development of the farm and all departments of the institution. In closing we can only express our appreciation of the efforts of the officers and all other employees. T. T. BATES, W. W. MITCHELL, H. C. DAVIS, M. F. QUAINTANCE, WILLIAM LLOYD, E. S. WAGAE, Trustees. Traverse City, Mich., June 30, 1910. �24 STATE OF MICHIGAN. TREASURER'S REPORT. ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE NORTHERN MICHIGAN ASYLUM FOR THE FISCAL YEAR ENDING JUNE 30, 1909. THE STATE or MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending July 31, 1908. By balance on hand July 1, 1908 Cash from State Treasurer: Account of extension to north wing. Account of current expense Cash from other sources To account Account Account Account Balance of of of of on repairs on reservoir extension to south wing extension to north wing. current expense hand to new a c c o u n t . . . . $40,237 45,000 21,628 487 72 00 75 64 $217 3,914 4,192 21,303 77,725 50 84 65 57 55 THE STATE OF MICHIGAN. In account with Samuel Garland, Treasurer Michigan Asylum, for month ending August 31, 1908. By balance on hand August 1, 1908. Cash from State Treasurer: Account current expense Cash from other sources To account Account Account Balance of of of on $107,354 11 $107,354 11 of the Northern ?77,725 55 21,628 75 932 28 $3,246 656 19,007 77,375 extension to south wing. extension to north wing. current expense hand to new account.... 82 11 71 94 $100,286 58 $100,286 58 THE STATE or MICHIOAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending September 30, 1908. By balance on hand September 1, 1908. Cash from State Treasurer: Account current expense Cash from other sources $77,375 94 21,628 75 1,357 41 $100,362 10 DEBITS. To account Account Account Balance of of of on extension to south wing extension to north wing current expense hand to new account $3,477 3,870 22.872 70,141 95 28 52 35 $100,362 10 �NORTHERN MICHIGAN ASYLUM. 25 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer Michigan Asylum, for month ending October 31, 1908. By balance on hand October 1, 1908. Cash from State Treasurer: Account current expense Cash from other sources To account Account Account Balance of extension to south wing. of extension to north wing. current expense on hand to new account. .. of the Northern $70,141 35 20,569 60 1,238 07. $3,308 3,018 24,562 61,059 36 53 33 80 $91,949 02 $91,949 02 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending November 30, 1908. By balance on hand November 1, 1908. Cash from State Treasurer: Account current expense Cash from other sources To account Account Account Balance of of of on extension to south wing. extension to north wing. current expense hand to new account. .. $61,059 80 20,569 59 204 75 $1,349 1,218 23.136 56,129 70 2R 81 17 1,834 14 $81,834 14 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending December 31, 1908. By balance on hand December 1, 1908. Cash from other sources To account Account Account Balance of extension to south wing .. of extension to north wing of current expense on hand to new account $56,129 17 1,280 03 $2,066 2,034 24,654 28.653 95 30 27 68 $57,409 20 $57,409 20 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum,, for month ending January 30, 1909. Balance on hand January 1, 1909 Cash from State Treasurer: Account current expense . . . . Cash from other sources To account Account Account Balance of of of on extension to south wing. extension to north wing current expense hand to new account . .. $28,653 68 20,569 58 505 44 $735 568 22,234 26,189 90 59 75 46 $49,728 70 $49,728 70 �26 STATE OF MICHIGAN. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Michigan Asylum, for month ending February 27, 1909. Northern CBEDITS. Balance on hand February 1, 1909 Cash from State Treasurer: Account current expense Cash from other sources $26,189 46 47,820 61 1,271 57 $75,281 64 To account of To account Account of Balance on extension to south wing.... of extension to north wing. current expense hand to new account $824 465 19,671 54,319 37 81 56 90 $75,281 64 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending March 31, 1909. Balance on hand March 1, 1909 Cash from State Treasurer: Account current expense . Cash from other sources To account Account Account Balance of of of on extension to south wing. extension to north wing. current expense . . . . . . . . hand to new account ... $54,319 90 23,910 30 1,349 24 $600 554 24,769 53,655 $79,579 44 50 02 79 13 $79,579 44 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Michigan Asylum, for month ending April 30, 1909. Balance on hand April 1, 1909 Cash from State Treasurer : Account current expense . . Cash from other sources To account Account Account Balance of of of on extension to south wing.. extension to north wing current expense hand to new account $53,655 13 21,276 98 1,744 47 $1,431 1,282 27,177 46,785 28 25 75 30 THE STATE OF MICHIGAN, In account witJi Samuel Garland, Treasurer of the Michigan Asylum, for month ending May 29, 1909. Balance on hand May 1, 1909 Cash from State Treasurer: Account current expense .. Cash from other sources To account Account Account Balance of of of on extension to south wing. extension to north wing. . current expense hand to new account.... $46,785 30 21,116 34 740 49 $3,816 3,381 22,760 38,683 89 25 87 12 Northern $76,676 58 $76,676 58 Northern $68,642 13 $68,642 13 �27 NORTHERN MICHIGAN ASYLUM. THE STATE OF MICHIGAN, In account -with Samuel Garland, Treasurer of the Northern Michigan A.sylum, for month ending June 30, 1909. Balance on hand June 1, 1909. Cash from State Treasurer: Account current expense . , Cash from other sources To account Account Account Account Balance of of of of on $38,683 12 21,116 33 614 03 extension to south wing extension to north wing, additional fire protection current expense hand to new account $3,205 3,127 46 19,711 34,323 63 29 20 08 28 0,413 48 $60,413 48 SUMMARY. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for fiscal year ending June 30, 1909. Balance on hand July 1, 1908 Cash from State Treasurer : Account of extension to north wing Account of current expense Cash from other sources $40,237 45.000 261,835 11,725 72 00 58 42 To disbursements : Account of repairs to reservoir Account of extension to south wing . Account of extension to north wing. . Account of additional fire protection Account of current expense Balance on hand to new account . .. $217 27,979 24,369 46 271,863 34,323 50 39 34 20 01 28 $358,798 72 $358,798 72 �STATE OF MICHIGAN. 28 ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE NORTHERN MICHIGAN ASYLUM FOR THE FISCAL YEAR ENDING JUNE 30, 1910. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending July 31, 1909. Balance on hand July 1, 1909 Cash from other sources ... To account Account Account Balance of of of on $34,323 28 1,220 67 extension to south wing extension to north wing current expense hand to new account ... $1,840 1,S51 18,340 13,511 41 22 39 93 $35,543 95 $35,543 95 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending August 31, 1909. Balance on hand August 1, 1909 Cash from State Treasurer: Account of current e-xpense Cash from other sources To account Account Account Balance of of of on extension to south wing extension to north wing current expense hand to new account $13,511 93 45,832 96 182 53 • $1,844 2,318 22,659 32,705 08 99 10 25 $59,527 42 $59,527 42 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending September 29, 1909. Balance on hand September 1, 1909 Cash from State Treasurer : Account of current expense Cash from other sources To account of Account of Account of system Account of Balance on extension to south wing extension to north wing improvement, heating, ventilating and hot water current expense hand to new account $32,705 25 22,910 46 2fi8 06 $55,889 77 $800 21 1,287 30 2,37082 17,228 54 34,202 90 $55,889 77 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month en/ling October 30, 1909. Balance on hand October 1, 1909 Cash from other sources $34,202 90 1,619 05 $35,821 95 �NORTHERN MICHIGAN ASYLUM. 29 DEBITS. To account of Account of Account of system Account of Balance on extension to south wing extension to north wing improvement, heating, ventilating and hot water current expense hand to new account $262 48 976 12 3,230 17 22,501 08 8,852 10 $35,821 95 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending November 30, 1909. Balance on hand November 1, 1909 Cash from State Treasurer: Account current expense Cash from other sources $8,852 10 43,009 76 248 22 $52,110 08 DEBITS. To account of extension to south wing Account of extension to north wing Account of improvement, heating, ventilating and hot water system Account of books and musical instruments Account of current expense Balance on hand to new account $217 02 870 14 299 8 32,015 18,700 01 65 17 09 $52,110 08 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending December 31, 1909. Balance on hand December 1, 1909 Cash from State Treasurer: Account current expense Cash from other sources . . To account Account Account Balance of of of on extension to south wing . extension to north wing current expense hand to new account . . . $18,700 09 21,504 87 807 03 $301 854 21,776 18,079 46 49 84 20 $41,011 99 $41,011 99 THE STATE OF MICHIGAN. In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending January 31, 1910. Balance on hand January 1, 1910 Cash from other sources Balance overdrawn To account of extension to south wing Account of extension to south wing Account of improvement, heating, ventilating and hot water system Account of books and musical instruments Account of current expense $18,079 20 1,225 31 2,018 22 $21,322 73 $222 72 222 73 27 67 44 50 20,805 11 $21,322 73 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending February 28, 1910. CREDITS. Cash from State Treasurer: Account of current expense Account of improvement, heating, ventilating and hot water system Cash from other sources $47,849 02 20,000 00 919 75 8,768 77 �30 STATE OF MICHIGAN. DEBITS. To balance overdrawn February 1, 1910 Account of extension to south wing Account of improvement, heating, ventilating and hot water system Account of current expense Balance on hand to new account $2,018 22 23 10 3,918 94 22,707 90 40,100 61 $68,768 77 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending March 31, 1910. Balance on hand March 1, 1910 Cash from State Treasurer: Account of current expense Cash from other sources $40,100 61 23,924 50 711 04 $64,736 15 DEBITS. To account of Account of Account of system Account of Balance on extension to south wing extension to north wing improvement, heating, ventilating and hot water current expense hand to new account $2,229 2,305 7,327 23,290 29,582 THE STATE OP MICHIGAN, In account with Samuel Garland, Treasurer Michigan Asylum, for month ending April 30, 1910. 72 92 58 39 54 $64,736 15 of the Northern CEEDITS. Balance on hand April 1, 1910 Cash from State Treasurer: Account of current expense Account of improvement, heating, ventilating and hot water system Cash from other sources $29,582 54 21,554 93 15,000 00 931 16 $67,068 63 DEBITS. To account of Account of system Account of Balance on extension to north wing improvement, heating, ventilating and hot water current expense hand to new account $43 98 6,601 83 26,065 01 34,357 81 $67,068 63 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for month ending May 31, 1910. Balance on hand May 1, 1910 . . Cash from State Treasurer: Account of current expense Cash from other sources . . . . To account of extension to south wing Account of current expense Balance on hand to new account . .. $34,357 81 21,554 93 654 00 $185 00 24,879 87 31,501 87 $56,566 74 $56,566 74 THE STATE OP MICHIGAN, In account with Samuel. Garland, Treasurer of the Northern Michigan Asylum, for month ending June 30, 1910. Balance on hand June 1, 1910 . Cash from State Treasurer: Account of current expense Cash from other sources $31,501 87 21,554 92 507 29 $53.564 08 �31 NORTHERN MICHIGAN ASYLUM. DEBITS. To account of Account of system Account of Balance on extension to south wing improvement, heating, ventilating and hot water current expense hand to new account $79 3,149 22,881 27,454 20 12 72 04 $53,564 08 SUMMARY. THE STATE oir MICHIGAN, In account with, Samuel Garland, Treasurer of the northern Michigan Asylum, for month ending June 30, 1910. CREDITS. Balance on hand July 1, 1909 Cash from State Treasurer: Account of improvement, heating, ventilating and hot water system Account current expense Cash from other sources DEBITS. To disbursements : Account of extension to south wing Account of extension to north wing Account of improvement, heating, ventilating and hot water system Account of books and musical instruments Account of current expense Balance on hand to new account $34,323 28 35,000 00 269,702 35 9,294 11 $8,005 10,730 26,925 53 275,151 27,454 40 89 14 15 12 04 ,319 74 $348,319 74 We have carefully examined the accounts of Samuel Garland, Treas'nrer of the Northern Michigan Asylum, for the biennial period ending, June 30th, 1910, and have compared the same with the books and vouchers and verified the same by further comparison with the books of the Steward and hereby certify to the entire correctness of .them. T. T. BATES, M. F. QUAINTANCE, WM. LLOYD, Auditing Committee. �32 STATE OF MICHIGAN. STEWARD'S REPORT. FOR THE BIENNIAL PERIOD ENDING JUNEj_30, 1910. ANALYSIS OF RECEIPTS AND DISBURSEMENTS FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1910. RECEIPTS. Maintenance, etc., State patients Maintenance, etc., private patients Farm Sundry accounts Special appropriations: Extension to north wing Improvement of heating, ventilating and hot water system. $531,537 11,762 5,678 3,577 93 85 74 94 45,000 00 35,000 00 $632,557 46 DISBURSEMENTS. 1. Offlcrs' 2. Food: Wages Meat and . Butter Flour Sugar Coffee Tea Miscellaneous Coal and gas salaries $27,757 39 . fish .' $16,273 42 61,455 18 23,059 45 16,886 67 10,823 20 5,687 47 2,617 58 32,841 06 1,336 79 3. Clothing: Wages of clerks Cost of clothing $2,352 51 31,957 99 4. Laundry expenses: Wages Soap making Tallow Starch Caustic soda Machinery and Electric irons Baskets and tubs Indelible ink $9,613 89 1,894 22 538 57 379 41 238 97 1,268 50 38 32 175 50 13 10 5. 6. Heating and light: Wages Coal and freight on same Gas Electric supplies Light and gas Gas range Oil Floral, greenhouse and grounds: Wages Seeds Trees Flower pots and boxes Spraying outfit Fencing Glass Implements Drain pipe Garden hose fittings fixtures $7,334 96 44,548 20 1,545 29 922 46 260 58 274 10 3743 $3.823 244 133 54 202 324 33 65 65 75 37 57 56 07 63 96 34 37 69 05 $27,757 39 170,980 82 34,310 50 14,160 48 54,923 02 5,022 61 �NORTHERN MICHIGAN ASYLUM. 7. Medical department: Wages Drugs Surgical instruments Medical books Pins for graduate nurses 8. Office, stationery, etc.: Wages Postage stamps Telephones Stationery Printing Typewriters Ink Blank books, etc County atlas 9. Amusement and instruction: Music for patients' parties Christmas tree candies and toys Circus tickets Entertainment Books and games Music for choir Repairing and tuning pianos Basket making material Addresses to graduates Music for graduating exercises Medical books 33 $97,871 5,453 45 106 67 83 84 58 97 50 $3,989 16 660 00 859 49 466 60 596 11 180 86 735 108 07 15 00 $219 136 39 25 78 6 83 11 50 25 52 50 87 00 00 86 00 00 13 00 00 55 10. Furniture and Household supplies: Wages Dry goods Bedding Blankets Mattress hair Carpet Curtain rollers Furniture Hardware Crockery Utensils Soap Polish Insect powder and disinfectant Electric renovator and cleaner Sewing machine Brooms and brushes Toilet paper Baskets and paper sacks Leather muffs $3,028 10,920 331 563 465 131 24 421 1,906 1,648 657 1,559 39 46 303 26 1,102 510 13 18 70 39 38 16 00 40 50 41 27 30 64 19 20 50 50 40 92 77 95 25 11. Carriage oarn and vehicles: Wages Feed Hay and straw Vehicles Blacksmithing, etc Repairs to harness Implements Oil Veterinary $1,406 05 398 98 254 21 10980 64 01 44 72 2 90 120 6 50 12. Improvements and repairs: Wages Hardware Iron pipe and -fittings Iron and castings Paint and oil Lime and cement Tile and tiling Lumber Roofing Glass Wall paper Weather strips Elevator repairs Valve reseating machine Rubber hose Blacksmithing Wheelbarrow Tools and implements Valves Food cars $30,506 77 2,117 89 4,498 89 1,970 00 2,776 00 1,182 42 985 68 724 17 350 83 93 79 154 60 298 52 500 00 170 50 121 58 38 27 8 00 1992 23 43 224 95 - •. ' , $103,545 72 6,882 64 726 91 23,718 83 2,288 37 46,806 06 5 �STATE OF MICHIGAN. 34 13. 14. Machinery: Machine Valves Steam trap, etc Water Hose Lubricating oil, etc Belting Steam charts Castings Packing and gaskets Steam gauges Engine supplies Repairs to gas engine fittings filter Farm, garden and stock: Wages Feed Hay Strays' Testing and registering cattle Steers for beef Pigs Chickens Veterinary •. Implements Harness Plaster Manure Fertilizer Fencing Sewer pipe Paris green Seeds Trees Blacksmithing 15. Miscellaneous: Wages of watchmen Tobacco Messages, etc Superintendent's expenses to Board meetings, etc.. . •. Steward's expenses purchasing supplies, etc Assistant physician's expenses at University of Michigan, Ann Arbor Freight and express Repairing clocks Sacks Livery for trustees Expenses for consulting engineer for heating plant, etc. Miscellaneous Amounts charged back: Patients' expenses home Elopement expenses Express on patients' clothing Purchases for patients Undertakers' fees Refunded money Board of workman Special appropriations: Extension to north wing Extension to south wing Improvement of heating, ventilating and hot systems Repairs to reservoir Additional fire protection Books and musical instruments water $260 159 40 65 273 246 11 13 30 294 21 20 37 44 51 38 26 48 84 55 85 42 88 48 92 30 $18,345 1B.951 2,923 335 385 3,484 74 9 156 655 136 89 209 437 39 100 87 495 11 229 99 59 04 26 63 40 10 00 53 56 79 36 00 25 83 56 00 40 50 98 $3,012 3,534 191 58 218 34 55 05 60 72 $1,476 31 45,157 77 46 56 20 71 9 00 282 11 50 330 01 4 22 299 544 1 218 409 334 9 25 29 25 10 84 44 45 $35,100 23 35,984 79 26,025 217 46 • 53 14 50 20 15 98,327 01 $645,341 14 �NORTHERN MICHIGAN ASYLUM. FARM REPORT. FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1910. Asparagus, Ibs Apples, bushels Beans, bushels Beans, string, biishels Bedding, tons Beef, Ibs Beets, bushels Beet greens, Ibs Cabbage, heads Carrots, bushels Cauliflower, heads Celery, heads Cherries, quarts Currants, quarts Chicken. Ibs. Corn, bushels Cucumbers, dozen Cucumbers, bushels Eggs, vegetable, bushels Fodder, tons Feed, green, tons Grapes, btishels Hay, tons Kohlrabi, bushels Lettuce, Ibs Mangels, bushels Milk, Ibs Muskmelons, Ibs Oats, bushels Onions, dozen 1,755 1,765% Parsnips, bushels Peas, bushels Peaches, bushels Pepper, bushels Potatoes, bushels 45,741 Potatoes, sweet, bushels 1,885 * Pork, Ibs 130 Plums, bushels 16,347 Pumpkins and squash for feed, 9,365 tons 785 Pumpkins, tons 26,275 Radishes, dozen 7,860 Rutabagas, bushels 2,381 Rhubarb, Ibs 55% . Raspberries, quarts 1,182 Strawberries, quarts 808 Srniash, tons Sage, bunches 159 4 Savory, bunches 86% Salsify, bushels 58 Spinach, Ibs 415 Tomatoes, ripe, bushels 530 Tomatoes, green, bushels 10 1/3 Turnips, bushels 10,875 Turkey, Ibs 7,510 Veal, Ibs Watermelons, Ibs 1,210,800 11,550 Premiums on cattle 1,791 Cattle sold 10,215 Hides sold 335 79 43 2,896 240 1,840% 20 9,045 60 22,990 241 1/3 12 V> 191/2 12,653 866 15,665 2,485 6,416 29% 250 100 225 4,350 1,031 104 2,324 17 781 5,870 $56.00 $4,813.95 $721.88 SUMMARY OF INVENTORY, NORTHERN MICHIGAN ASYLUM, JUNE 30, 1910. Farm and grounds $53,163 00 857,701 00 Buildings Stock on farm 20,814 00 Administration building 7,328 04 Pathological laboratory 1,213 00 1,270 95 Dispensary Chapel and library 1.309 60 28,462 82 WTards 3,023 46 Cottage 21 3,025 42 Cottage 23 Cottage 24 and 26 4,140 04 2,402 22 Cottage 25 3,727 95 Cottage 27 1,920 69 Cottage 28 3,314 13 Cottage 29 3,191 04 Cottage 30 1,652 00 Cottage 31 1,867 33 Cottage 32 3,332 86 Cottage 34 3,466 60 Cottage 36 1,008 13 Cottage 38 4,970 58 Kitchen and bakery 6,432 75 Engine room and shops 6,853 30 Laundry 4,553 59 Farm implements and barn fixtures 259 84 Store fixtures 2,838 86 Groceries 482 17 Meats 879 87 Hardware and miscellaneous . . . . 1,905 24 Notions 357 88 Crockery 86 21 Silver plated ware 2,959 79 Dry goods 1,459 27 Boots and shoes 5,488 83 Clothing $1, 046,862 46 C. L. WHITNEY, Steward. �STATE OF MICHIGAN. 36 EEPORT OF MEDICAL SUPERINTENDENT. / To tJie Board of Trustees: Gentlemen—As required by law I have the honor to submit for your consideration the following report of the principal events of the asylum for the biennial period ending June 30, 1910. The movement of population has been as follows: TABLE I.—Patients admitted and discharged during the biennial period. Males . Admitted during period: On original committment: Public By transfer from State institutions: Public State Total under treatment . Discharged: Died Females. Total. 739 598 1337 307 19 2 216 18 2 523 37 4 9 1 0 11 0 0 20 1 0 1077 845 1922 38 76 32 171 0 48 44 25 104 0 86 120 57 275 0 760 624 1384 If these statistics are compared with those of the last preceding period it will be found that the admissions were 80, and the discharges 62 more. During the last year there has been a decrease of 23 patients in the population of the asylum. The number of patients discharged recovered was much the same as in former periods. The smallest number of patients under treatment in any one day was 1,339 and the largest number was 1,414. The death rate has been slightly greater. The following table shows the sex, age, form of disease and cause of death in each case. �NORTHERN MICHIGAN ASYLUM. 37 TABLE O. Sex. Female Age. 92 80 68 49 85 Female 46 79 63 37 64 Female 56 Female Female 45 51 82 66 Female Female Female . . . Female Female . . . . Female Female ... . Female Female Female . . . Female Female 54 33 43 64 34 47 63 79 53 41 64 32 80 90 73 42 78 35 71 36 73 48 Female ... . 30 72 Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female 65 36 42 77 47 66 42 49 65 55 50 88 89 39 47 52 72 33 58 50 46 64 55 50 Nativity. Form of mental disease. England. . . . England. . . . Germany. . . Paranoid state Norway . . . . Unknown.. . Organic Germany. . . Michigan . . . Paranoid state Finland . . . . Manic depressive New York . . Ohio .... C. 1. Neurasthenia New York . . A. 2 Dementia Penn Organic Michigan . . . C. 1. Neurasthenia Cause of death. Cardiac diasese. Apoplexy. Dysentery. Dysentery. Dysentery. Diabetes. Apoplexy. Cancer. Exhaustion. Apoplexy. Exhaustion. Strangulation. Tuberculosis. Apoplexy. Tuberculosis. General paralysis. General paralysis. Tuberculosis. Tuberculosis. Pneumonia. Michigan . . . Tuberculosis. Norway . . . . General paralysis. Michigan . . . Cardiac disease. Denmark . . . Organic Pneumonia. Sweden . . . . Exhaustion. Canada Status epilepticus. Germany. . . A. 2. Dementia Tuberculosis. Finland . . . . Manic depressive Tuberculosis. Cancer. New York . . Tuberculosis. Organic Exhaustion. Russia Tuberculosis. New Jersey. Wisconsin. . Exhaustion. Unknown. . . Apoplexy. Brain- tumor. New York . . Apoplexy. General paralysis. Michigan . . . Tuberculosis. Ohio Tuberculosis. New York . . Manic depressive . . . . Pernicious anemia. Indiana . . . . Dementia praecox Tuberculosis. Michigan . . . Tuberculosis. New York . . Apoplexy. Ohio .... Suicide. New York . . Manic depressive Enteritis. Ohio Sarcoma. Finland . . . . Tuberculosis. Unknown. . . General paralysis. France Tuberculosis. New York . . C. 1. Neurasthenia Erysipelas. Mich General paralysis. New York . . Arterio-sclerosis. Germany. . . Dementia praecox Tuberculosis. Michigan . . . Tuberculosis. New York . . Manic depressive Cardiac disease. Germany. . . Dementia praecox Tuberculosis. Michigan . . . Epileptic Tuberculosis. Canada Arterio-sclerosis. Michigan . . . Cancer. New York. . Psychopathic state Nephritis. Unknown. . . Epileptic Cardiac disease. Michigan . . . Organic Pneumonia. Penn Organic Arterio-selerosis. England . . . . Organic New York . . Germany . . . Organic Belgium. . . . , �STATE OF MICHIGAN. 38 TABLE O — Continued. Sex. Age. Nativity. Form cf mental disease. 85 50 79 42 Unknown. . . Unknown. . . New York . • Canada Michigan . . . Michigan . . . Organic . Dementia praecox . . . . . Organic Dementia praecox Epileptic Manic depressive . . . . . . Female Female Female Female Female 16 74 65 70 51 Michigan . . . Imbecility Female Female Female 80 33 52 29 52 Female Female 28 51 Female Female Female 66 58 34 37 46 Cause of death. Arterio-sclerosis. Tuberculosis. Cardiac disease. Pernicious anemia. Tuberculosis. Tuberculosis. Cardiac disease. Penn Ohio Manic depressive Organic Pneumonia. Erysipelas. Ohio Dementia praecox Tuberculosis. Germany . . . Manic depressive . . . . . . Michigan . - - C, 1. Neurasthenia. . . . . Tuberculosis. Pernicious anemia. Michigan . . . Manic depressive Exhaustion. Norway . . . . Organic . General paralysis. Female Female 46 49 69 55 38 New York . . Organic New York. . Organic . Dementia praecox Ohio Enteritis. Arterio-sclerosis. Septic infection. Female Female Female Female Female 38 71 78 51 51 Michigan. . - Manic depressive Tuberculosis. Poland. . . . . Dementia praecox Manic depressive Ohio Pernicious anemiaCardiac disease. Female 73 47 31 68 69 Female Female Female Female Female Female Female Female Male Pernicious anemia. New York. . Organic Erysipelas. 55 37 69 43 68 Ohio Sweden. . . . Dementia praecox Cancer. 34 70 60 Michigan . . - Imbecility Feritonitus. Sweden . . . . Imbecility Nephritis. New York. . Manic depressive Cardiac disease. Ohio . •• Unknown. . . Epileptic England. . . . Organic . Unknown. . . Organic Cardiac disease. Arteric -sclerosis. Dysentery. Sweden . . . . Organic Manic depressive Canada Michigan . . . Imbecility Exhaustion. Tuberculosis. Cardiac d'sease. Canada . . . . Dementia praecox Cardiac disease. Male Male Male Male Male 40 Male Male Male Male Male 36 83 80 . . . . 35 82 Male Male Male Male Ohio 54 68 31 82 78 61 Male Male Male Male Male . . . . 50 61 37 31 58 Male Male Male Male 64 69 55 48 Ohio Michigan . . . Organic Apoplexy. Dementia praecox Penn Michigan . . . Organic Enteritis. General paralysis. �NORTHERN MICHIGAN ASYLUM. 39 TABLE O — Continued. Sex. Age 71 Male 34 Male Male Male Male Male Enteritis. Cancer. 35 94 79 32 Michigan... . . Dementia praecox Enteritis. Unknown.. . Imbecility Nephritis. . 54 N Y N Y 67 . . . . 64 61 . . . . 53 42 Male Male Male Male Male 26 74 79 Male Male Male Male Organic Ohio 17 41 90 59 Male Male Male Cause of death. 78 66 Male Male Male . . . . . . . Male .... Male Male Form of mental disease. 69 Male Male Male Male Male Male Male Nativity. Michigan. . . . Epileptic Michigan . . . Manic depressive Organic Penn Status epilepticus. Tuberculosis. Arterio-sclerosis. 57 Arterio-sclerosis. 41 51 31 60 68 43 19 69 75 53 34 52 Male Male Male Male Male 38 . . . . 69 Male Male Male Male Male 64 39 48 60 64 Male Male Male Male Male 20 Male Male Male Male Male 85 62 55 19 61 47 76 73 55 72 52 N Y . . . Ohio Ohio Dementia praecox. . . . . Nephritis. Sweden. . . . Dementia praecox Dysentery. Tuberculosis. Arterio-sclerosis. Finand Manic depressive Tuberculosis. Cardiac disease. Arterio-sclerosis. Penn Organic Cardiac disease. Ohio Organic Arterio-sclerosis. Organic Canada Virginia. . . . Dementia praecox Poland Dementia praecox Ohio General paralysis. Pernicious anemia. Cancer. Male Male Male Male Male 78 32 73 62 65 Ohio Ohio Male Male Male Male Male 35 Epileptic Unknown.. . Dementia praecox Apoplexy. Ireland Arterio-sclerosis. 66 63 65 36 Dementia praecox Tuberculosis. Organic . Apoplexy. Organic , • �STATE OF MICHIGAN. 40 TABLE O—Continued. Sex. Male Male Male Male Male Male Male Male Male Age. 34 . . . . 74 60 26 70 46 53 52 35 Nativity. Form of mental disease. Cause of death. Michigan . . . Kpileptic Epileptic seizure. Germany. . . Dementia praecox Cardiac disease. Michigan . . . Organic General paralysis. 57 Male Male Male Male Male 82 20 25 50 36 Male Male Male Male Male 73 77 55 73 . . . . 44 Male Male Male Male Male 59 48 53 84 57 Ohio Male Male . . . 59 65 Ohio Male Male 62 28 78 Male Male Male Male Male 73 50 60 43 . . . . 70 Male Male Male Male Male 61 27 50 71 39 Male Male Male. Male Male 68 70 55 72 . . . 59 Male Male Male Male Male 32 80 75 45 . . 60 Male Male Male Male 81 87 16 69 67 Male ' Male Male Male 76 84 71 76 71 Enteritis Illinois Dementia praecox Apoplexy. / Ohio Unknown.. . Dementia praecox Cancer. Holland . . . . Rheumatism (Acute articular). New York . . Cardiac disease. Cardiac disease. Cardiac disease. �NORTHERN MICHIGAN ASYLUM. TABLE O — Concluded. Sex. Male Male Male Male Male Male Male Male Male Age. 72 81 47 39 75 62 61 64 31 83 39 Nativity. Form of mental disease. Cause of death. Canada . . . Organic Cardiac disease. Poland Arterio-sclerosis. Ohio Cardiac disease. Male Male Male Male Male 72 68 88 70 71 Indiana . . . . Organic Arterio-sclerosis. Male Male Male Male Male 31 70 25 79 69 Michigan . . . Epileptic Status epilepticus. �STATE OF MICHIGAN. 42 SUMMARY. Males. Females. 7 20 19 24 10 2 8 3 9 1 Arteriosclerosis Enteritis 38 2 9 2 1 2 1 4 6 3 8 27 10 6 8 3 5 1 9 4 1 3 1 171 10 28 46 34 16 2 16 7 12 6 1 47 2 13 1 2 1 5 1 1 6 1 1 2 1 10 1 1 8 1 1 1 1 104 275 1 1 1 Xotal Total. One hundred fifty-four of the patients who died were over 55 years old, 25 were between 80 and 90, and 4 were over 90. The deaths from tuberculosis were 16.7 per cent of the deaths from all causes, about 5 per cent less than during the former period. The greatest spread of tuberculosis occurred among male patients, as isolation of cases could not be so thoroughly carried out. Arrangements have now been made to convert Cottage 32 into a tuberculosis hospital where all men suffering from this disease will be treated. The following table showing the forms of mental disease is no longer in use, but is inserted to show the classification of the cases up to June 30, 1906, since which time a modification of the well known classification of Kraepelin has been in use in all the asylums of Michigan. �TUBERCULOSIS HOSPITAL. COTTAGE 21. COTTAGE 29. �o ftp no "^ 1 | Forms of 'insanity. CO t» w.-ico W ••* OS O CO M co i-H co i—1 e<i • C<) t~ o-* (M Ct T±I ,_i 10 T—i S ^ CM ^-H co co ,—i : : i : : : : : : !::.'-; : :: :, : OS GO i—1 O NORTHERN MICHIGAN ASYLUM. CON !>• £•- oc^ji—ioi>- *O : § : : -rt<,_i N rH Q5 co & : C<l CO M c^jr- : :•§, : i—1 to ^ . ,_( : : : : : : :g : '""' : - • • - : . . • - : : . . • : : .- -• ra • : .. . . :.g : ' (§ •' -^5 X. i c :.| '1 : • 3 g : .£l .3 •' '• :ps S3 •• g •' : : "-a : : 1 il if u ilSf 1-ali i'l-i-t ij ^ oo' . • n ° ^ T 3 ^||= 5 a -s s •§.§||'-3 ilgi, -S § g § ^.g ggpw nn ^6 JKOQRP isKWw £§£s S3 : ? ; S c o : •^aiajaj-r' : : <P£3 : : w o ' : G ^ G i S : : : J : : I J1 | . : : - :- J S *o .jj . : £>s : ; : S S ' p : | I ^o& P . S : : '" J ^ 9? c 0^ : S o £ ^ ^ o & •a ~ r^ ri ^S B £• S e _g W : >,• C OJ .3 S : "-• B ^ °3 "O "° n {2; - : 1 *". -S J - 1 t§.g 1 . 1 - 8 8 (£ ^ H S 1 •~ 3 d 1 | d il c . o 3 3 c 1 •< S I °. CO 1 43 �TABLE II.—Showing the forms of insanity of patients admitted. For the biennial period. Males. Females . 4 5 13 Organic brain disease (definite structural changes) . Paranoia . (2) Arterio-sclerotic brain disease ® Pi^hl1^ °f brai.n; v : j & lassic .V"? v (2) £ Paranoid state I (3) Mixed state Arrested mental development { ft) ^bmility . . "T From the beginning. Total. 4 6 13 Males. Females . Total. 7 14 24 1 5 ' i 7 15 24 1 6 5 1 13 2 14 18 30 9 2 65 8 37 77 127 80 1-10 66 11 56 137 67 28 17 33 3 1 3 i 4 2 2 4 27 3 15 25 67 6 2 5 13 15 33 5 20 38 82 4 1 52 6 23 59 97 25 48 5 4 7 20 10 7 3 15 1 9 24 20 3 27 39 34 6 5 7 1 34 72 25 7 34 59 44 13 8 22 2 65 78 15 7 17 44 20 9 7 19 2 15 32 51 4 39 93 47 19 10 14 1 4 4 4 4 26 18 44 45 36 81 3 4 7 5 10 15 1 1 1 2 Total 338 247 585 628 3 1 1 462 1,090 �NORTHERN MICHIGAN ASYLUM. 45 The above table shows that over 30 per cent of the number admitted were suffering from organic diseases, 22.3 per cent were suffering from dementia praecox, 7 per cent from paranoia and paranoid states, 7.5 per cent from epilepsy, 20 per cent from manic depressive insanity, and 4 per cent from alcoholic insanity. The period just closed has not been marked by any great advances in methods of care or in the use of remedies in the treatment of patients, but every effort has been made to maintain the institution at its highest efficiency as a hospital and an asylum for its mentally afflicted inmates. Perhaps the application of the so-called Wassermann's Test in the diagnosis of luetic diseases has been one of the most important medical advances of the period. This reaction is of far reaching value in our medical work, since general paralysis, with its severe effects on mentality, and its fatal termination, is unquestionably of specific origin, and it is hoped that by means of early and sure diagnosis, an arrest of the disease, if not permanent cure may be had in many of the cases. A modification of the Wassermann test, or the socalled Licithin test, has been used in many cases, and has been quite certain in its results. Another method of diagnosis that is being applied is that of lumbar puncture. This test is a very positive one, but owing to the dread that many patients have for the slightest operation, it cannot be so readily applied to all individuals. The relations of the asylum with the psychopathic ward at Ann Arbor have been more practical and have stimulated a higher scientific interest in our work. During the last two years a great deal of clinical laboratory work has been done, which includes 470 urinalyses. Of these 470 examinations, nephritis was found 86 times, glycosuria 12 times, pyur'ia 57 times, diazo 2 times, and bile 3 times. One hundred fifteen blood examinations were made, out of which pernicious anaemia was found in 5, secondary anemia 35, lymphatic leukaemia 1, splenomyelogenous leukaemia 1, surgical leukocytosis 9, other leukocytosis 25, and polycythemia 1. There were 10 Widal tests made, of which 2, were positive and 8 negative. Of the 59 sputum examinations, tubercle bacillus was found in 11, and pneumococcus in 7. There were 35 postmortems made during the period. Some of the most important conditions found in these examinations were: (1) Sarcoma. (2) Syphilis (congenital). (3) Syphilitic endarteritis. (4) Pulmonary tuberculosis. (5) Papilloma of larynx. (6) Papilloma of bladder. (7) Diphtheritic colitis. (8) Sclerosis of the bundle of His'. (9) Peritonitis. (10) Myocarditis. (11) Valvular Heart Disease. (12) Apoplexy. (13) Nephritis. (14) Septicaemia. (15) Carcinoma. (16) Pneumonia. (17) Cholelithiasis. (18) Enteritis, etc. Besides the pathological examinations connected with the autopsies, the following were made: (1) Carcinoma of gall bladder. (2) Tuberculous glands. (3) Cervical caruncle. (4) Sarcoma of lymph gland. (5) Carcinoma of breast. (6) Myoma of leg. (7) Carcinoma of uterus. (8) Appendicitis. (9) Carcinoma from the eye of a cow. (11) Lipofibroma of breast. Many bacteriological examinations other than sputum were made, of which the most important findings were: Gonococcus 5, streptococcus 1, staphylococcus 1, pneumococcus 2, anthrax bacillus 1, actinomycosis (cow) 1, diplococcus (unknown) 1, treponema pallidum 1, and tubercle bacillus 2. �46 STATE OF MICHIGAN. There were 98 tuberculin tests made, of which 16 were positive, 66 negative, and 16 were regarded as suspicious. There were 48 blood pressure tests made, in which hypertension was found in 19 and hypotension in 2. Staphylococcus vaccine and streptococcus vaccine were prepared in the laboratory, and used in several cases of acne, furunculosis and prostatitis, with excellent results. During the past two years the following surgical operations were performed : Operation: Number of cases: Appendectomy 5 Amputation of toe , 3 Amputation of finger 2 Amputation of breast , 6 Cellulitis 6 Circumcision 10 Cervical Caruncle 1 Extirpation of Cervical Lymph Node 10 Extirpation of Cartilaginous Tumors 1 Fibroma of Leg •. 1 Fibroma of Arm 1 Fracture (Colles) 4 Fracture (Clavicle) 1 Fracture (Hip) 2 Fracture (Jaw) 1 Fracture (Ribs) 2 Fracture (Ulna) 1 Hemorrhoids 2 Herniotomy 3 Laparotomy for Cancer of Pylorous 1 Laparotomy for Tuberculous Peritonitis 1 Paracentesis Abdominis 2 Paracentesis Thoracis 4 Prolapse of Rectum 1 Radical Mastoid Thyroidectomy 6 Tonsillotomy 12 Uterine Curettage Varicose Veins 2 During the period there were four obstetrical cases and fifty-one gynecological examinations. The work of the training school continues to be carried on with enthusiasm. It has grown in usefulness, and the number of applications for entrance into the school are increasing in number from year to year. As explained in your report our graduate nurses are in great demand, and we are not able to retain many of them in our service, but yet the carrying on of the school creates an "esprit" among the nursing force which is of importance to the patients. From the above it may be seen that the laboratory work has been of increasing value in the diagnosis and treatment of diseased mental �NORTHERN MICHIGAN ASYLUM. 47 states. More recently it lias been decided to make differential blood counts, and take blood pressure tests in every case. Research work along psychologic, pathologic, chemical and clinical lines, has steadily developed, and we b-elieve that the institution has progressed instead of standing still. It is a pleasure for me to say that you have, individually and as a Board, been in entire sympathy with the scientific side of the hospital work, and it has been through this appreciation of its value on your part as a Board, that much of it has been made possible. As stated in your report, the following tables were agreed upon by the superintendents of all the asylums of Michigan, for presenting the statistical data of the asylums. It is hoped that this plan will secure uniformity for purposes of comparison, and that it may be possible from this time to aggregate all of the statistical data relating to the insane in the state of Michigan. The tables, however, without elaboration, would be lacking in some special features. Therefore, it was further agreed to present a brief analysis of the forms of mental disease of the patients admitted during the period; for example: Each group of the insanities; the number'admitted, men and women; the percentage of each sex to total admissions; phases or clinical varieties of each group; number of attacks, age of attacks; etiology, etc. THE MANIC DEPRESSIVE GROUP. One hundred fifteen patients out of 585 admissions to the hospital during the period were diagnosed as cases of manic depressive insanity. Women. Men. No. Per cent. 338 37 No. Per cent. No. 31.9 585 116 247 10.9 79 Total. Per cent. 19.8 Ten and nine-tenths per cent of the men, and 31.9 per cent of the women admitted, were cases of manic depressive insanity. 19.8 per cent of all the patients admitted were cases of this disease. These statistics show that two-thirds of the cases of manic depressive insanity were women. This great preponderance of women might seem accidental if it did not agree with the observations of others, (Eitto, Pilez, BarrettPilcz, Christian-Noble). The relation of the different phases among the cases of this disease admitted, were: �48 STATE OF MICHIGAN. Men. No. Manic 20 Depressive. . . Mixed. . 10 Women. Per cent. 7 54 27 18.9 Total. No. Per cent. 39 49.3 59 50.8 34 43 44 37.9 13 11.4 7.6 6 No. Per cent. From this table it may be seen that 54 per cent of the men and 49.3 per cent of the women belonging in this group were manic; and 27 per cent of the men and 43 per cent of the women were depressive. Of the mixed cases 18.9 per cent of the men and 7.6 per cent of the women were of this form of the disease. Among both sexes 50.8 per cent were manic, 37.9 per cent depressive; and 11.4 mixed cases of this form of the disease. This table shows that the manic was twice as frequent as the depressed form in men, and more frequent than the same form in-women. Over 50 per cent of the patients of this group were manic. This seems to be at variance with some authoritative statistics which show the depressive form as being most frequent. ATTACKS. The relations of the attacks is shown in the following three tables: Women. Men. Total. More than 1 attack 26 45 71 First attack 11 34 45 The phase of the previous attack was: Men. Women. Total. Manic 16 23 Depressive 11 41 39 52 Mixed 8 12 20 Unknown 2 3 5 In all cases of manic depressive insanity admitted, the first attack was: Men. Manic Women. Total. 21 21 42 Depressive 9 41 50 Mixed. 5 12 17 Unknown 2 5 7 �COTTAGE 23. COTTAGE 25. HOSPITAL. �. I— O O O O O O t O K J ' - ' t O C O t O l - ' H-OOO.-H'WfrM^WW-aN NOoo-»-wc»*.o,-ao=<ow H-OOOOK-tC^t-l-bObOOO ~0~0-*.- CO (0 0=00*0, ~ *, = >-<= l - O O C O - J W « £ o > 0,- OOOO^COCT^^^^OO 000=000~~M00~0 00001-00.- CO* ~tO 1-0 OH-iOOCO^- W C O t O H ^ totol-*!-* ooo^w^a-^o-co-a^^ O^O^OCOffi-J-JO^CD^to O O O t O > —' C O O C O l - i O O O O O O^OMOT^O-J^-CICOMWO OO^OC.OtOCH-^^H-c.0 OOOOOtOOt-'NS'-'OOOO NVOIHOIM Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. S, o* 0 3 a 1 i? 3 o ~' >i" O- - 1 e 1 » 5' ? �50 STATE OF MICHIGAN. Of the 59 cases of the manic phase it may be found that the first attack occurred in 55 per cent before the 30th year. Of the 56 cases of the depressive phase 40 per cent occurred before the 30th year. The ages between 15 and 20, and 40 and 55 seem to be the periods of the greatest incidence of the disease. The disease is rare in children under 10 years, and in the age of 70 years and over. HEREDITY. Total. I d <A & Female. 9 Brothers and sisters. •3 7 11 18 34 52 4 4 4 3 3 26 12 3 37 20 "3 "o H S Female. s Collateral. Female. 0) 13 Atavistic. Female. Direct. Female. In 59 out of the 116 cases belonging to this group of insanity, hereditary pre-disposition was present. In 37 heredity was denied, and in 20 it was unknown. Heredity was present in 61.4 per cent of the cases in which this etiologic factor could be determined. Therefore, it becomes the most important etiologic factor. Kraepelin noted 80 per cent of heredity in the cases at the Munich-Clinic, and other observers have found from 40 to 75 per cent. Doubtless, if accurate information could have been gained in regard to this point in all of our cases, a larger percentage of heredity would have been- found. Very few patients have any knowledge of their ancestry beyond their parentage. The following table shows the nature and distribution of heredity in this group of the disease: 'S 1 | a 19 28 2 4 6 4 3 JD 3 4 a "ca | ^H 7 s 4 11 8 r«3 I Other hereditary factors were found in 6 men and 13 women. The results of tieatment. Recovered Died 21 32 1 5 5 3 2 7 10 1 10 12 4 <3 ^ ^ 12 17 5 5 4 5 13 17 3 2 4 2 11 1 •3 •£ H 3 13 £rf S Total. E-i Total. Female. 3 "o Mixed. Female. "3 | 1 4 11 .. Depressive. Female. si cS % Female. Manic. 19 6 37 56 7 13 4 11 8 24 15 32 �NORTHERN MICHIGAN ASYLUM. 51 Of the 37 men admitted during the period suffering from manic depressive insanity, 51.3 per cent were discharged recovered, 16.2 per cent improved, 10.8 per cent died, and 21.3 per cent remain in the hospital. Of the 79 women admitted during the period 47 per cent were discharged recovered, 8.8 per cent improved, 13.9 per cent died, and 30.3 per cent remain under treatment. Of the 116 cases of manic depressive insanity admitted, 48.2 per cent were discharged recovered, 11.2 per cent improved, 12.9 per cent died, and 27.5 per cent remain under treatment. Duration of treatment. Duration of treatment of those discharged. 3 12 1 5 13 1 8 3 11 2 2 Reo. Imp. Died . 5 2 6 Rec. Imp. Died. 4 4 1 2 8 3 Rec. Died. 3 years and over Rec. Died. 1 1 "rf § 4 7 3 3 2 4 1 4 4 2 3 1 2 3 1 2 1 1 OJ a ' i Total. Female. 7 to 12 months 1 "3 1 Female. 1 to 90 days . Rec. Imp. Died. Female. o> 1 Mixec Depressive. 1 ii 1 2 1 5 1 3 17 1 8 22 2 11 i 2 3 8 2 1 10 4 1 18 6 2 2 1 1 3 1 6 2 8 3 2 14 5 2 1 1 Q a^ | Female. Manic. "3 1 ®rf "rt ^ 1 1 Of the 84 patients discharged 21.1 per cent recovered within 3 months; 21.4 per cent recovered within 6 months; 16.6 per cent within 1 year, and 1.2 per cent within 2 years. Of the 84 patients ^2.3 per cent were discharged improved within 3 months; 7.1 per cent within 6 months; 6 per cent within 1 year, and 1.2 per cent within 4 years. Of the 15 patients who died, 73.3 per cent died within 3 months; 2.3 per cent within 6 months, and 2.3 per cent within 1 year. The fact that 12.9 per cent of this group of patients died plainly indicates its gravity. �52 STATE OP MICHIGAN. ETIOLOGY. Apart from heredity, no particular predisposing cause of the disease was noted. Neither does there seem to be any especial cause or causes which may be regarded as the exciting factors in the disease. In many instances a condition of ill health seemed to precede; in others there had been typhoid fever or other infections. The puerperal state was the assigned cause in some, and worry and mental depression preceeded the attack in some instances. It is quite worthy of note that there were only 3 alcoholics out of the 116 cases, and morphinism was only found in 2. It was doubtful whether these drugs had much to do with the development of the mental disease. ( PRECURSORY SYMPTOMS. The manic depressive insanity is preceded in many of the cases by a change in psychic activity, sometimes amounting to true depression, in others to an exaltation or hyper-activity of the mental reactions. In at least half of our cases the outbreak was comparatively sudden, oftentimes without any premonitory warning. Among the precursory symptoms were found: fear of insanity; gloomy, morose, irritable moods; brooding over imaginary trouble; suicidal ideas; homicidal ideas; delusions of various kinds; jealousy; tendency to drink; listlessness; suspiciousness; loss of sleep; agitated and depressed moods; belief that something was to happen; the expression of great business schemes; a feeling of incapacity to do or to act; religious feelings and emotions; various emotional states, both depressed and elated; idea that the world is coming to an end; dissatisfaction with surroundings; belief in being doped; feeling of hypocrisy; a general change in condition and demeanor; oftentimes sensations of fatigue; vague ideas of persecution and poisoning, and hypochondriacal fancies and headache were among the most frequent. After a few hours, a few days, or a few weeks, the attack of the frank disease followed. Sometimes it was noted that a sudden improvement took place in the precursory symptoms. The patient became pleasant and active again, but very soon after he would become talkative, discursive, or depressed, as the case might be, and the disease fully established. PERSONAL HISTORY. Of the 116 cases nothing was known of the period of childhood in 30. This leaves 86 patients in whom a fair knowledge of early life was gained. The mental development was rapid in 19; average in 42, and slow in 10. The bodily development was rapid in 29; slow in 10, and normal in 45. 3 men and two women were said to have practiced masturbation in youth; 3 men drank to excess; 2 women were morphine habitues; and one man indulged in sexual excesses. So far as school life was concerned there was nothing noted worthy of further elaboration. This study has been of interest from the fact of so large hereditary predisposition, and so few deviations from the normal mental standard. Exhausting diseases, such as typhoid and pneumonia, had been suffered by a few patients, while exanthema had been very common during child- �NORTHERN MICHIGAN ASYLUM. 53 hood. Injuries of any kind were rare, and the venereal diseases were not frequent. The general temperament and disposition of this group of insanities was sociable in 41; peculiar in 1; solitary in 14; even in 20; erratic in 12; nervous in 8; impulsive in 6; passionate in 9; morose in 7; ill tempered in 2; selfish in 6; despondent in 2; untruthful in 1; and irritable in 23. Sometimes two or more of these temperamental peculiarities were noted in the same person. A change in mood, hysterical and hypochondrical symptoms, and restlessness, were noted in a few instances. Many of these patients were of religious temperament. 43 were said to have been industrious, and many had been successful in business. 6 men were said to have been idle. No patient had been arrested or convicted of any crime previous to the development of mental disease. Many of them had suffered from previous attacks of mental diseases, which is shown in the table above. HISTORY OF THE DISEASE. General characteristics: There was noted in quite a number of patients, carelessness in dress, habits and appearance, and sometimes improper language and conduct had been indulged in. In some there was motor restlessness, and tendency to violent and destructive acts, especially if any attempt was made to control or correct the individual. On the other hand, uncleanliness of person was always associated with profound mental and motor disturbance. Sleep, as a rule, was insufficient, as may be seen from the following table. Sleep. Manic. - Women. Men. 2 0 4 3 4 1 0 7 hours Depressive. 5 1 8 7 4 5 2 1 2 5 4 1 Men. Mixed. Women. 1 7 3 6 4 3 1 1 5 1 1 3 3 3 0 2 Women. Men 1 1 3 2 1 2 1 1 1 The mental changes were most frequently marked by restlessness, suspiciousness, irritability, feeling of sadness or apprehension, excited and hilarious mood, great facility of expression, with exalted ideas of business ability, religious feelings and feelings of sinfulness, of loss of property, of friends, the insistent idea that the world is coming to an end, �54 STATE OF MICHIGAN. impulses to wander from place to place, loquaciousness, violent outbursts, sometimes cruelties, delusional and hallucinatory ideas, singly or combined in many ways. About one-third of the patients had hallucinations of sight, and those of hearing were almost as frequent. Hallucinations and delusions of taste, touch and smell were not so frequent, being noted in 7, 8 and 10 patients respectively. Kinaesthetic hallucinations were noted in 5 cases and hallucinations of the coenaesthetic sense in 2 patients. The bodily health was good in all but 9 of the patients, and vasomotor disturbances were observed in 20 women and 3 men. The handwriting was good in 56; poor in 24; tremulous in 14; and fantastic in 12. In 10 patients their mental condition precluded any attempt at writing. The lungs and kidneys were normal in all of the cases, and only one patient suffered from organic disease (mitral insufficiency). Disease of the arteries, sclerosis, was found in 9 cases. The veins were varicose in one case. Pulse: The pulse was not much disturbed in mild cases, but in the more severe, was greatly increased in frequency. The following table will show the pulse rate at the time of admission in 85 cases. Pulse rate. 60 . 62 64 66 68 70 71 72 74 76 78 No of cases. 1 1 1 1 16 1 2 2 6 5 Pulse rate. 79 80 82 ' 84 85 86 88 89 90 94 95 No. of cases. . . 1 14 1 4 2 3 3 2 3 1 1 Pulse rate. 96 98 100 104 108 no 114 116 124 140 171 .... No of cases. 2 1 2 1 3 2 1 1 1 2 1 A high pulse rate is always a danger signal, and every means must be employed to combat the oncoming exhaustion which it presages. Gynecology: Of the 79 women patients in the manic depressive group uterine displacement was found in 2, perineal laceration in 5, and laceration of the cervix in 2. Menstrual difficulties were frequent. Urine: No serious abnormal conditions were found in the urine. Indican was almost invariably present. The phosphates and urates were often in excess, and oxalate was found in 2 instances. The Indicanuria was not always, but quite generally, associated with chronic constipation. Nervous system: About 31 per cent of the patients expressed a feeling of being well. 32.2 per cent a feeling of exhaustion, and about 1 per cent a feeling of confusion. In many cases the feeling of health was normal, or could not be satisfactorily determined on account of the mental condition of the patients. Among the disorders of general sensation headache was most frequent. It was present in 34.4 per cent, either as a precursory symptom or a symptom of the fully developed mental derangement. Vertigo was complained of in 16.3 per cent, and other aches and pains, including tenderness of the scalp, in about 10 per cent of the persons composing this group. Eyes: The expression of the eyes was said to have been animated in �NORTHERN MICHIGAN ASYLUM. , 55 10, dull in 14, restless in 4, distressed in 6. In the depressive form, the expression of the eyes seems to have been more in harmony with the mental mood than in the manic form. Defects of vision were not discovered. Hallucinations will be referred to under that caption. Ears: No marked malformations of the ears were noted. 4 patients were partially deaf, and in one tinnitus was among the early symptoms of insanity. Delusions and hallucinations will be considered later. Taste and smell: With the tests used, taste was found to be defective in 24 per cent and smell in 34 per cent. Many of the patients 'could not be accurately tested owing to their mental state. Cutaneous sensibility: In 10 patients no derangement of cutaneous sensibility was discovered. In one, tactile sense was absent. In 3, cutaneous sensation was lessened, and in one patient there was dermographia. The reflexes: In the manic phase the reflexes were exaggerated in 6, diminished in 4, and absent in 1. Neither ankle clonus or Babinski occurred. In the depressive phase the reflexes were exaggerated in 9, or 15 per cent, and diminished in 7, or about 11 per cent. Ankle clonus and the Babinski reflex were not found. The gait: The gait was normal in all the patients but 1. The gait seemed to be weakened in several of the depressive cases, and in the delirious manics. Dreams: Dreams which related to self were observed in 3 instances, of recent events in 1, vivid in 2, exhausting in 4. One patient had been somnambulistic, and 2 men and 2 women suffered terrifying dreams. Romberg symptom: The Romberg symptom was noted in 19 cases; in each case there was a slight increase or exaggeration of swaying. Speech: Articulation was normal in every case. Consciousness: In the manic phase consciousness was clear in 53 per cent of the men and in 48 per cent of the women. It was clouded in 47 per cent of the men and 52 per cent of the women of the depressive phase. Orientation: Orientation for time, was imperfect or lost in 38 per cent, for place in 32 per cent, and for person in 31 per cent of the 116 patients in the manic depressive group. School knowledge: School knowledge was found to be imperfect in 34.5 per cent, and retained in 35 per cent. In the remainder the mental condition would not permit of accurate examination. Test problems were solved in only 161/2 per cent, partially solved in 24% per cent, and unsolved in over 59 per cent. In every case, in judging of the modifications in school knowledge, early education and social advantages had to be taken into consideration. Association of ideas: Various derangements of the association of ideas were noted from practically normal to complete incoherency in all the mental processes. Disorders of self-consciousness frequently occurred among the early symptoms. With the idea that the mind is gone, or that the body is gone or changed in form, the association with the past is lost, and the present personality appears foreign to the former, or the selfconsciousness disappears so completely that the delusion develops that nothing exists or that the person of the patient no longer exists. In 53 out of the 59 manics the association of ideas was heightened. In about 10 per cent certain ideas predominated, around which the mental associations pivoted, as is seen in true symptom conplexes. The faculty of �56 STATE OF MICHIGAN. attention was disordered in about 50 per cent, and was concentrated on delusions in 10 per cent, and on hallucinations in 3. 9 per cent of the patients. Distractibility was noted in 42 per cent, the internal associations were disturbed in 17 per cent, and the external in 22 per cent of the manics. More or less pronounced flight of ideas was observed in 20 per cent. In 44 depressive cases, retardation of the association of ideas was observed in 63 per cent. Insistent ideas dominated the associations ^n 24 per cent, (e. g. the principal feeling of judgment is often times that everything that has been said is meant for the patient), and in about 12 per cent the associations were concentrated on delusions, (e. g. revolved around the predominating idea of sin and humiliation), or on hallucinations 6 per cent, (e. g. the voice of Christ, of God, etc.). The faculty of attention was often weakened, and the ability to follow was lost or impaired. Distractibility was only observed in 2 of the depressive cases. The internal associations were impaired or lost in 8 per cent, the external associations only in about 2 per cent. Flight of ideas was not observed in the depressive cases. Emotional states: There was very frequently dulling of the finer sensibilities with diminished affect. The emotions were exalted in 60 per cent of the manic and were diminished in 93 per cent of the depressives. Increased excitability was marked as such in 3 patients, but the observation on this point was largely included in the record "depressed." There was very frequently great anxiety and apprehensiveness, while in the manics euphoria was very common, although sudden outbursts of anger were not uncommon. It need scarcely be said that the emotional reactions called depressed, referred to almost endless forms of mental associations. The will: The will impulses were increased in 30 per cent and diminished in 16 per cent. Pressure of activity was present in about 50 per cent of the manics, mannerisms were found in 3 per cent, motor excitement was a common symptom. There was often noticed increased influencibility of the will, and sometimes, but not often, there seemed to be compulsive ideas. The will impulses were found increased in 10 per cent of the depressives, diminished in 61 per cent, and absent in 1 per cent. Pressure of activity was noted in one depressive, and negativism in one. Delusions of a painful character were noted in about 20 per cent. Social relations: 13 of the manics were untidy, 22 were disturbing, 8 were aggressive, 5 were violent, and 7 were destructive. Only 2 of the depressives were untidy, and 3 disturbing. THE MIXED FORMS. The mixed form of manic depressive insanity, as the term signifies, is a peculiar combination on quite rapid alternations of the manic and depressive phases of the disease. The group will not be further considered in this report. �NORTHERN MICHIGAN ASYLUM. 57 ALCOHOLIC INSANITY. In this group 22 men and one woman were placed, representing 3.9 per cent of the cases admitted during the biennial period. Men. No. 338 22 Women. Per cent. 6.5 No. Total. Per cent. 247 1 No. Per cent. 585 .4 23 3.9 These 22 men constituted 6.5 per cent of the males admitted; the females .4 per cent of the females received. The 23 cases were placed as follows: 5 13 22.7 1 100 59.1 6 13 26.1 56.5 Age at time of admission. Women. Men. 30 to 35 to 40 to 45 to 50 to 34 39 44 49 54 55 to 59 60 to 64 65 to 69 Total. 2 2 4 8 2 3 1 1 1 4 8 3 3 1 1 1 1 �COTTAGE 32. COTTAGE 24. COTTAGE 28. �STATE OF MICHIGAN. 58 *3 O & C8 a •3 g Brothers and sisters. _OJ c3 g "3 ^c3 1 Total. 3*o -2 c3 )*3 H Female. "e3 H Collateral. Female. Atavistic. Female. JS 1 Female. Direct. Female. In only 6 cases were there positive hereditary factors. Nine cases had no hereditary taint. The remainder is classed under the heading unknown. ^ 2 2 2 'cS § 4 4 2 2 9 7 1 9 8 Results of tieatment. Female. Male. 7 Unimproved Died 1 Total. s 7 7 2 2 6 6 MORPHINISM. This group includes but four patients, three males and one female. The three males represent but two individuals. One male, a physician aged 61, who had been addicted to the drug for many years. On the two occasions when admitted he had become alarmed at his own state, and requested treatment. His collateral relations had suffered from insanity. Each time, following a few weeks' treatment he has recovered. The other male, paternal grandfather insane, became addicted to morphine during illness. After remaining about six weeks lie eloped. The female was the daughter of a physician and acquired the habit from some nurses in the father's hospital. Her mother was decidedly hysterical. After being twice under treatment, she went away much improved. INFECTION AND EXHAUSTION PSYCHOSES. There were admitted two men and two> women who1 were placed in this group:—one male, aged 48, clear heredity. After an attack of diphtheria which was treated by antitoxin, he became mildly delirious. He had chronic nephritis and died about six months after coming to the institu- �NORTHERN MICHIGAN ASYLUM. tion. The other male, aged 27, clear family history, bartender. Following typhoid fever he became very unclear mentally could not recognize relatives. He improved some in the institution but retentive memory continued much impaired. He went home on trial after three months, residence. Of the women, one, aged 20, following child birth, with much loss of blood and likewise infection, became stuporous and at times mildly delirious. She fully recovered after a residence of four months. The other woman, aged 39, mother very nervous, patient always of nervous temperament. Patient's child had pneumonia. Patient became ill with chills and fever while caring for child. Immediately afterwards developed delirium varying in degree. She came to the institution on a cot. For weeks she was in a state of dreamy confusion, with vivid changeable hallucinations, clouded consciousness, completely disoriented. Gradually recovered. ORGANIC GROUP. This group in all its forms, comprises 30 per cent of the admissions for the biennial period. Women. Men. No. Per cent. Per cent. No. 338 247 137 41 40.5 Total. No. Per cent. 585 16.6 30.4 178 These 137 men constituted 40.5- per cent of the males admitted; the 41 women 16.6 per cent of the females received. The 178 cases were placed as follows: Women. Men. Other forms related to neurological changes. Total. No. Per cent. No. Per cent. No. 27 19.7 33 2.2 6 2 14.6 3 4.9 5 15 11 5 12.2 20 25 18.1 13 31.7 38 67 49 15 36 . 6 82 Per cent. 18.5 2.8 11.4 21.3 46 �COTTAGE 34. COTTAGE 36. COTTAGE 30. �STATE OF MICHIGAN. 60 Age at time of admission. Female. Male. Total. 2 0 3 35 to 39 7 2 9 40 to 44 6 4 10 45 to 49 9 50 to 54 7 6 55 to 59 9 4 13 60 to 64 21 1 22 65 to 69 22 7 29 70 to 74 20 6 26 28 4 32 25 to 29 30 to 34 2 9 13 13 Heredity. 16 2 1 "3 g 1 1 1 3 1 4 1 5 Female. 6 10 1 Brothers and sisters. Collateral. Female. 1 Female. i Atavistic. Female. Direct. Total. 3 -3» ^5 .-aM ™ g 2 7 9 28 2 .... 2 2 2 O H 19 2 2 U) & . 3 2 2 2 1 3 54 14 68 6C 15 75 Results of treatment. jj j§ •a ^ 5 Died 1 3 e 1 6 1 1 1 8 4 12 1 14 13 3 f£ 1 1 2 Forms related to neurological. 1 i i 3. General paralysis. Total. Senility. 3 £ I 4 1 1 2 3 2 2 2 1 3 2 2 4 7 4 11 5 5 6 4 10 32 4 36 51 12 63 9 16 7 23 30 9 39 66 22 88 jj Ji " S [^ £ J S 1 3 5 4 1 *=3 S £ i g Females. Brain syphilis. Females. S3 1 1 I Arteriosclerosis. Females. Brain Tumor. 3 £ ^ �61 NORTHERN MICHIGAN ASYLUM. DEMENTIA PEAECOX. There were 131 patients placed in this group or 22.3 per cent of the admissions. Women. Men. No. Per cent. No. 338 Total. Per cent. Per cent. 585 247 23 78 No. 21 53 131 22.3 These 78 males represented 23 per cent of all men admitted; the 53 females 21 per cent of the women. The following represents the types of dementia praecox. Women. Men. Per cent. No. Per cent 9 16.9 34 25 24 45.3 72 54 37.7 25 19 No. Per cent. No. 25 62 61.5 6.4 20 48 5 Total. Age at time of admission and at beginning of disease. Age on admission. Age at beginning. Male. Female. Total. Male. Female. Total. 15 to 19 13 6 19 5 4 9 20 to 24 19 15 34 20 9 29 15 to 29 13 16 29 13 14 27 30 to 34 15 7 22 18 11 30 12 4 16 12 7 19 40 to 44 3 2 5 2 3 5 45 to 49 1 1 1 2 3 3 2 5 3 1 4 35 to 39 .... 50 to 54 55 to 59 1 1 2 1 2 3 Average age at beginning. Male. Katatonic Female. 23 4 23 2 30 3 29 26 2 27 3 �Hereditary Factors. Direct. Collateral. Atavistic. Brothers and sisters. Total Hebe. ji g 3 •^ Sp N H 4 1 5 Para. i a g jj (AH 3 2 1 2 1 Hebe. Kata, 3 H 11 I ^ S 9 -g £ & H 53 4 4 1 Para. S 13 1 iS Kata. m £ H S "3 iS ti 1 1 71 5 g 1 6 Hebe. s -S H S f£ Para. Kata. 8* 98 8! pS g 13 1S 3 iS £ S 3 6 1 3 1 ^ 1 i Si £ 1 1 1 1 1 3 Hebe. 2 g 3 <3 ^ pS Para. Kata. §3 | OS 1 _JL) S 3 I^ i 1 4 "c3 1 fa S3 o H ^ ^ 1 2 27 1 17 44 3 3 2 3 5 36 19 55 9 20 1 1 H 11 O S Q �NORTHERN MICHIGAN ASYLUM. 63 Results of treatment. 2 2 11 11 Died 12 8 21 0) 1 3 "o H 8 6 1 4 2 12 8 1 33 18 51 1 % 1 2 4 13 "o Female. "3 "o H Total. Katatonic. Female. Paranoid. Female. 0) I Female. Hebephrenic, QJ ss frH 3 1 3 3 1 3 11 3 15 2 3 19 6 1 7 3 3 38 49 •a 1 5 26 9 4 87 PARANOIA AND PARANOID STATES. In this group 11 men and 30 women were placed, representing 7 per cent of the cases admitted. Women. Men. Total. t No. Paranoia and paranoid states Per cent. No. Per cent. 3.2 247 30 12.1 338 .11 No. Per cent. 585 41 7 These 11 men constituted 3.2 per cent of the males admitted. 30 females 12.1 per cent of the women received. The 41 cases were placed as follows: - . 1^otal. Women. Men. No. Per cent. 4 36.3 7 63.7 No. 3 27 The Per cent. No. 10 90 7 34 Per cent. 17 83 �64 STATE OF MICHIGAN. Age at time of admission and beginning of disease. Ages at beginning. Male. 30 to 35 to 40 to 45 to 34 39 44 49 Female. 1 Male. Total. 2 10 9 3 13 11 4 5 1 3 3 2 1 1 2 3 2 1 50 to 54 55 to 59 Ages on admission. 2 1 2 9 5 6 3 4 1 2 1 3 3 1 3 60 to 64 65 to 69 Total. Female. 3 11 6 9 6 5 1 PARANOIA AND PARANOID STATES. Heredity. 9 3 3 "o EH 4 1 5 3 8 "3 H "3 o EH a <£ Females. 7 3 EH"o Total. Females. 2 S Females. Insanity m ^H "3 Brothers and sisters. Collateral. Males. 1 "o EH "cd Females. vi Atavistic. Females. Direct. 4 4 6 12 "3 "o EH 18 Apopelxy or paralysis. . . 3 3 None 2 9 11 Unascertained 3 6 9 �NORTHERN MICHIGAN ASYLUM. 65 Results of treatment. 1 1 0 H 1 1 2 "ca E^H 10 9 9 11 2 1 1 23 7 19 1 2 1 5 3 18 "3 "o H 2 1 1 3 Died Females. •3 Total. Males. & Males. cu "rf Females. Paranoid states. Females. Paranoia. 3 <1 26 MELANCHOLIA. There were admitted three men and five women who were placed in this group, representing 1.3 per cent of thp admissions. Men. Per cent. No. Total admissions. Women. Per cent. No. 338 Melancholia Total. 247 3 .9 No. Per cent. 585 5 2 8 1.3 Age at beginning of disease and on admission. Age at beginning. Males. 40 to 44 45 to 50 to 55 to 60 to 49 54 59 64 Females. 1 2 1 1 1 1 1 Age on admission. Total. Males. 2 1 3 1 1 Females. 1 2 Total. 1 2 2 4 1 1 1 1 �STATE OF MICHIGAN. 66 Heredity. 3 PH i £ I & 3 E2 .1 1 3 <S J 1 i 1 Total. Females. $ i g a Brothers and sisters. Collateral. Atavistic. Females. Direct. 3 tS 1 i 1 f£ 1 2 2 4 1 3 4 Apoplexy or paralysis. . . Psychopathic Unknown Results of treatment. •' Males. Died Females. Total. 1 1 2 9 4 6 DEFECTIVE DEVELOPMENT. IMBECILES AND IDIOTS. In this group 16 men and 8 women were placed, representing 4.1 per cent of the cases admitted during the biennial period. Women. Men. No. Per cent. 338 16 4.8 No. 247 8 Total. Per cent. No. 3.2 585 24 Per cent. 4.1 �NORTHERN MICHIGAN ASYLUM. 67 These 16 men constituted 4.8 per cent of the males admitted, the females 3.2 per cent of the women received. The 24 cases were placed as follows: Women. Men. No. Per cent. No. 93.8 6.2 7 15 1 Total. Per cent. No. Per cent. 22 91.6 2 8.4 87.5 13.5 1 Age at time of admission. Males. 10 to 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to Total. 1 14 19 .. 24 29 34 39 44 49 54 59 Females. ... . --. 1 g 3 9 2 2 4 2 3 1 2 1 * 1 1 1 I 1 . - • I 1 I 1 1 1 Heredity. Direct. of 03 X 3 OT g 1 E-i 1 g 4 2 g VI OJ "3 Collateral. Atavistic. g Brothers and sisters. Total. of 5 ^a •3 "o EH 1 (D OJ C6 3 s 1 2 r^ CH cc "o H "3 S 3 6 4 <| 1 10 1 1 1 1 1 2 2 2 2 1 5 4 5 5 �68 STATE OF MICHIGAN. Results of treatment. Wemen. Men. Died Women. 4 1 5 3 1 4 9 6 15 EPILEPSY. In this group 26 men and 18 women were placed, representing 7.5 per cent of the cases admitted during the period. Women. Men. Total admissions. Epileptics Total. No. Per cent. No. Per cent. No. 338 26 7.7 247 18 7.3 585 44 Per cent. 7.5 AGE AT TIME OF ADMISSION. These 26 men constituted 7.7 per cent of the males admitted. women 7.3 per cent of the females received. Males. Females. The 18 Total. 10 to 14 1 1 2 15 to 19 7 1 20 to 24 6 3 8 9 1 1 30 to 34 2 3 5 35 to 39 2 4 6 1 1 3 7 25 to 29 40 to 44 1 1 45 to 49 50 to 54 . . .. 4 3 55 to 59 3 60 to 64 65 to 69 .. 1 1 �NORTHERN MICHIGAN ASYLUM. 69 Heredity. Direct. <B OT c3 s •3 £ Atavistic. 01 • fl 2 2 1 1 3 1 Total. ro • • s 1 g Brothers. and sisters. Collateral. a 1 £ 73 DQ | 1 1 2 4 • ( W •s H ; 1 1 I 4 g g 3 4 g 22 1 1 88 1 H Apoplexy or paralysis . . l 1 7 j 2 1 14 7 7 Results of treatment. Women. Men. 4 3 2 3 4 Died Total. 3 16 7 7 5 25 9 PSYCHOPATHIC. In this group are three men and four women representing 1.2 per cent of the cases admitted during the biennial period. No. 338 3 Total. Women. Men. Per cent. No. Per cent. .9 247 4 1.6 No. Per cent. 585 7 1.2 �STATE OF MICHIGAN. 70 Ages at time of admission. Women. Men. 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 . . . . 2 Total. I 1 2 -1 1 1 1 1 Heredity. Direct. •ii •a S i Atavistic. • CO i 1 a s tn !-H ^ H Collateral. is ^ g S Brothers and sisters. Total. CO to WJ H t« C3 3 O> J£ ^ ^ § a 1 to" ,! am r£ 1 s ^_; -S H 1 2 3 1 1 2 1 1 2 Psychopathic . Alcoholism Unascertained.. , Results of treatment. Men. Women. 3 Total. 3 1 1 3 3 Died HYSTERICAL INSANITY. There were four women placed in the hysterical group. One, aged 52, married, had three children. Two paternal uncles were insane. Early life uneventful. She had been irritable and subject to passionate outbreaks for a number of years. About eight years ago both ovaries were removed. About nine years ago she had nervous prostration, was a bed four years. The hysterical characteristics were those of hyperesthesia, �NORTHERN MICHIGAN ASYLUM. 71 particularly over the abdomen, with contractures of the legs. Patient's mental condition was free from any special involvement other than some hallucinations of the temperature, muscular and coensthetic senses. After remaining with us for about six months there was considerable improvement, and she was able to be about the ward with less assistance. The second case: Married, aged'31, one child, who died at the age of 10 months. Father had epithelioma of the lip. Maternal grandmother had tuberculosis. One brother excessive drinker. Patient's early life was characterized by poor physical endurance, always of a nervous temperament, said to have had peculiar fainting spells for years. Sent to the institution because of an attempt at suicide by the use of carbolic. There was a slight scar on the lip as the result, but it was evident that she had not taken a great quantity of the drug. The physical examination did not reveal any particular areas of anaesthesia or hyperesthesia, but patient had peculiar attacks, fainting in character, which were not characterized by loss of consciousness. She apparently recovered, and left after being in the institution less than three weeks. The third case: Single, aged 20. Father died of tuberculosis. On the paternal side one cousin and one aunt were insane; maternal grandfather was a drinker of whiskey. Early life normal, at the age of 12 had a severe attack of typhoid characterized by delirium, following which she was not well much of the time. Mental trouble came on gradually, but the final outbreak was sudden; excited state, had illusions, all objects appeared distorted to her, thought people had four eyes. Patient complained of numbness in the lower extremities, peculiar sensation of cold, peculiar mottled vasomotor state. Her condition seemed to be one of befogged state of hysteria. This state lasted but a short time, after which she rapidly regained her normal condition and was discharged! about a month after coming. The fourth case: Aged 23, married, no children. Paternal grandmother died of paralysis, mother died of pneumonia, maternal grandfather for years was insane, maternal grandmother died of Bright's Disease. Early life uneventful, was healthy, unusually bright, but irritable and hysterical temperament. Was once in a hysterical state for three weeks. When she was 16 fainting spells began. At the age of 19 she was married. Peculiar fainting spells continued after marriage. Married life was not very satisfactory. She was not happy, and on two occasions she took carbolic and followed it up with alcohol. On neither occasion was there any damage done. Following one of the hysterical attacks she manifested considerable anaesthesia over the left side of the body. Patient was in the institution about three weeks. NOT INSANE. One woman was received into the institution whose mental condition did not appear to be such as to justify her remaining. She was 32 years of age, no insanity in the family, married, two children dead. She had been suffering for a couple of years with painful and cancerous condition, and was sent to the institution because of the care which she required. Before arrangements could be completed for her removal she died. �72 STATE OF MICHIGAN. TABLE III.—Showing the occurrence of hereditary factors in patients admitted. For the biennial period ending June 30, 1910. Total heredity a 3 a & £ JJ B 11 27 32 59 0 2 2 8 13 21 5 3 8 40 50 90 3 •a sS s 13 24 21 1 S 3 £ jjj 1 I 24 45 17 25 42 0 1 1 0 11 13 24 22 Total. Females. 8 •a Brothers and sisters. Collateral. Females. $ Atavistic. Females. Direct. 24 46 26 17 1 43 a & 3 £ 76 94 170 1 2 3 8 14 22 5 3 8 "3 90 113 203 155 91 146 93 43 136 338:1 247 585 Total . TABLE IV.—Showing the age of patients admitted. Biennial period ending June 30, 1910. Males . From 45 to 49 years Total Females. Total. 1 1 15 8 23 34 21 55 21 26 47 30 30 60 32 32 64 29 30 59 20 26 24 21 44 31 20 51 26 7 33 47 18 14 32 23 7 30 33 6 39 338 247 5 �NORTHERN MICHIGAN ASYLUM. 73 TABLE V.—Showing civil condition of patients admitted. Biennial period ending June 30, 1910. Civil conditions. Males. Single Total Females. 131 147 40 13 . . . Total. 287 77 28 7 53 140 37 15 2 184 338 247 585 9 TABLE VI.—Showing the degree of education of patients admitted. Biennial period ending June 30, 1910. Males. Unascertained Total . . . Females . Total. 10 2 12 15 12 27 228 166 394 40 3 43 83 9 12 29 14 43 13 1 14 338 247 585 �STATE OF MICHIGAN. 74 TABLE VII.—Showing the occupation of patients admitted. Biennial period ending June 30, 1910. Occupation. Males. Professional: Architects, cleTgymen, engineers, surveyors, journalists, lawyers, musicians, physicians, and surgeons, teachers (school), etc.. . . Clerical and official: Bookkeepers, clerks, copyists, bankers, brokers, collecters, auctioneers, agents, etc Mercantile and trading: Commercial travellers, merchants, pharmacists, peddlers, etc . . Public entertainment: Hotel and boarding-house keepers, saloon keepers, liquor dealers, Personal service, police and military: Barbers, hairdressers, janitors, sextons, policemen, watchmen, detectives, soldiers, sailors, marines (U. S.), etc Laboring and servant: Manufacturing and mechanical industry: Bakers, blacksmiths, butchers, cabinetmakers, carpenters, cigarmakers, jewelers, printers, engineers, and firemen (not locomotive), coopers, machinists, masons, millers, painters, Agriculture, transportation and other outdoor: Boatmen, draymen, hackmen, farmers, farm laborers, gardeners, florists, livery stable keepers, lumbermen, sailors, fishermen, steam railroad employees, stock raisers, e t c . . . . Total Females. Total. 20 7 27 9 4 13 9 8 17 7 2 9 4 1 5 78 101 179 34 25 59 162' 74 236 10 14 24 5 11 16 338 247 585. �NORTHERN MICHIGAN ASYLUM. 75 TABLE VIII.—Showing the nativity of patients admitted. Biennial period ending June 30, 1910. Nativity. Males . 136 86 Total United States . 45 4 3 2 16 4 5 1 2 4 1 1 4 8 0 Total Foreign born Xotal • • Males. Females . Total. 121 62 . . 3 2 Holland Females. 222 183 405 105 59 164 11 5 16 338 247 585 1 0 26 3 0 1 6 5 1 0 6 2 0 1 0 6 1 �STATE OF MICHIGAN. 76 TABLE IX.—Showing the nativity of parents. Biennial period ending June 30, 1910. Males. Native born Foreign bom Native and foreign born Unascertained Females. 114 165 Total Total. 30 29 99 35 25 202 264 65 54 338 247 585 TABLE X.—Showing the residence of patients admitted. Biennial period ending June 30, 1910. County. Males. Antrim Alcona Alpena Arenae Benzie Cheboygan Charlevoix Crawford Clare Emmet Grand Traverse. Glad win Gratiot losco Isabella Ionia Kalamazoo Kalkaska Leelanau Lake Montmorency. . . Manistee Missaukee Mason Mecosta Midland Montcalm Muskegon Newaygo Otsego Oscoda Ogemaw Osceola Oceana Presque I s l e . . . . Roscommon.... Wexford Total..'.... Females. 15 9 16 3 20 2 9 20 24 0 5 10 25 0 14 4 16 16 1 2 5 3 1 20 7 8 20 11 25 16 6 3 2 25 1 5 18 17 4 20 2 5 18 0 2 3 2 33 1 10 28 42 4 34 6 21 34 1 4 1 4 13 2 13 2 14 19 2 0 2 5 11 8 4 0 5 338 247 2 13 11 1 Total. 28 11 21 28 13 39 35 8 3 4 7 24 19 5 2 18 585 �NORTHERN MICHIGAN ASYLUM. 77 TABLE XI.—Showing the form of insanity of patients discharged, and the results of treatment. For the biennial period ending June 30, 1910. Forms of insanity. Recovered. 1 1 & 3 £ Js' S 2 3 2 0 2 1 0 0 0 0 3 3 2 0 2 0 0 1 0 0 Hebephrenic forms Katatofiic forms Melancholia, (involutional) Hysterical insanity Total 8 Total Died. ro _0> C3 ~3 |3 & S J£ I & "oi S 2 1 6 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2 0 0 0 1 1 0 0 0 0 0 0 0 0 i i 1 2 1 6 0 2 0 0 4 5 11 0 3 1 0 0 0 1 5 5 11 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 3 0 0 0 0 7 0 0 0 0 8 0 0 2 0 0 0 0 0 2 0 0 14 0 0 5 0 0 19 1 0 23 g 0 6 3 0 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 4 0 0 1 4 3 4 0 0 2 3 2 0 1 1 0 2 6 5 19 4 42 0 0 0 6 8 20 0 0 12 27 62 0 1 11 24 48 0 1 7 11 22" 0 2 18 35 70 0 0 2 0 2 0 0 0 0 2 0 0 2 0 4 0 0 14 10 0 0 0 4 6 1 1 0 14 14 6 2 0 1 7 0 1 0 0 3 4 2 0 1 10 4 3 0 2 4 0 0 0 0 0 3 0 0 2 4 3 0 0 19 21 2 2 0 0 7 15 3 0 19 28 17 5 0 12 7 3 1 0 0 25 10 5 0 0 0 37 17 8 1 0 2 5 0 2 0 0 10 6 2 0 0 12 6 6 4 0 0 0 0 0 0 0 5 1 0 0 0 0 1 1 0 0 0 0 6 2 5 1 0 1 7 2 0 8 13 7 8 0 0 1 2 2 9 4 22 8 5 2 12 11 34 23 7 1 3 15 56 31 12 3 15 0 0 0 0 0 1 0 3 0 0 0 0 0 3 0 0 0 1 0 0 4 3 0 8 0 0 6 2 0 2 0 0 10 5 0 10 0 0 5 0 0 2 0 0 3 1 0 5 0 2 0 0 8 16 1 0 0 0 7 48 2 3 0 0 25 25 1 1 3 0 0 0 33 81 59 1 3 18 4 0 40 3 3 43 7 0 99 38 48 86 76 44 120 32 25 57 171 104 275 317 221 538 1 1 1 0 0 1 a 3 & 1 8 ~3 & s 3 £ "=3 S Insanity due to infective and exhaustive in- Unimproved. Improved. 0 2 2 0 1 0 Q S 1 �78 STATE OF MICHIGAN. TABLE XII.—Showing the duration of residence in months of all cases discharged. For the biennial period ending June 30, 1910. Six to nine months One year to eighteen months Overten years Total Died. Total. 3 J £ a Females. Females. Females. Unimproved. Improved. Females. 1 Females. Recovered. 8 19 20 16 36 6 24 50 34 84 3 3 6 4 2 6 2 3 5 i 11 11 12 23 16 11 27 5 5 10 18 7 11 18 20 12 32 1 2 3 19 9 28 47 34 81 8 7 15 11 7 18 4 3 7 9 4 13 32 21 53 1 3 4 5 3 8 7 1 8 9 6 15 22 13 35 4 6 10 7 4 11 5 4 9 19 6 25 35 20 55 1 1 2 1 0 1 3 2 5 10 6 16 15 9 24 1 5 6 10 3 13 2 2 4 30 22 52 43 32 75 1 0 1 1 1 2 2 0 2 10 8 18 14 9 23 1 0 1 1 1 2 1 3 4 36 29 65 39 33 72 38 48 86 76 44 120 32 25 57 171 104 275 317 221 538 1 3 1 3 £ S g 3 sS "ES 3 H TABLE XIII.—Showing the age of patients dischaiged recoveied. Biennial period ending June 30, 1910. Males. From From From From From From From From From From From From From From 10 to 14 years. . 15 to 19 years. . 20 to 24 years 25 to 29 years. . 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years. . . 50 to 54 years. . 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 and upwards Total Females. 0 0 0 1 9 Total. 4 7 0 3 ] 10 8 ] 15 11 7 6 ]13 4 1 5 4 6 ]10 3 3 5 8 7 2 2 6 1 1 1 7 2 o o 0 0 38 48 0 0 £ �NORTHERN MICHIGAN ASYLUM. 79 TABLE XIV.—See Summary of Deaths, page 42. TABLE XV.—Showing the age of patients who died. Biennial period ending June 30, 1910. Females. Males . 1 3 14 0 2 5 11 8 8 11 . 13 16 5 6 4 6 8 From 45 to 49 years 12 • 18 16 Total 1 4 4 8 13 25 16 24 28 23 22 27 13 9 15 33 32 42 171 104 275 20 From 70 to 74 years 0 1 Total. 23 ESTIMATES OF SPECIAL APPROPRIATIONS. The following are the estimates of special appropriations requested by the Board of Trustees and submitted to the State Board of Corrections and Charities for its approval: To the State Board of Corrections and Charities: Gentlemen: As required by section 2228, Compiled laws of 1897, I submit below estimates of special-appropriations requested by the Board of Trustees of the Northern Michigan Asylum for carpenter and paint shop; for completion of heating and ventilating systems; for fencing; for artesian well; for re-roofing cottages 28 and 32; extension to laundry and additional laundry machinery; for repairs to roofs and gutters; for central dining rooms for men and women; and for porch to cottage 32. �80 -STATE OF MICHIGAN. I. CARPENTER AND PAINT SHOP. Excavation, 2,000 cubic yards, at 25 cents Stone and concrete work Gravel roof Lumber ., Doors and windows, door jams, window jams, complete. . . . Shafting and belting Electric motor, 30 H. P Sewer connection Electric wiring and electric light fixtures Heating and plumbing Carpenter work, labor, nails, hinges, sash and door locks.. $500 00 1,000 00 200 00 500 00 500 00 500 00 550 00 150 00 100 00 600 00 900 00 $5,550 00 II. HEATING PLANT. For vacuum system, automatic temperature regulation, radiators, etc., for the completion and installing of heating system, complete For the completion of ventilating system $19,000 00 16,000 00 $35,000 00 III. FENCING. 1320 feet iron fencing 500 rods fencing $1,980 00 1,520 00 3,500 00 IV. ARTESIAN WELLS. 2 wells, estimated cost of each $500.00, including pipe, driving shoe, cap, etc , V. $1,000 00 REPROOFING COTTAGES 28 AND 32. 200 squares No. 1 slate laid complete ..' 200 squares No. 1 slate laid complete $2,000 00 2,000 00 $2,100 00 VI. LAUNDRY EXTENSION AND LAUNDRY MACHINERY. Concrete, brick and stone work; window frames, door frames, doors, windows, sewers, electric lighting, plumbing, carpenter work and labor Washing machine, largest size > $1,000 00 550 00 $1,550 00 VII. REPAIRS TO ROOFS AND GUTTERS. Material, labor, scaffolding, etc., $3,500 00 �NORTHERN MICHIGAN ASYLUM. VIH. 81 DINING ROOM FOR COTTAGES FOR MEN. Excavation : Cement and concrete work 150,000 brick in wall at f 10.00 per M Steel ceilings, 50 squares 40 squares gravel roofing 4000 feet tile floor Columns and steel beams Plastering Painting Hardware and tin work Heating and plumbing Carpenter work and labor 14 windows, complete at $12.00 each 8 doors, complete, at $15.00 each Lumber Ranges, kitchen utensils, electric lighting sewer connections , $150 00 700 00 1,500 00 400 00 200 00 1,600 00 262 00 200 00 150 00 150 00 800 00 1,500 00 168 QO 120 00 400 00 700 00 |9,000 00 IX. DINING ROOM FOR COTTAGES FOR WOMEN. Duplicate of the above X. $9,000 00 PORCH FOR COTTAGE 32. Steel beams and columns Cement and concrete work Wire guards Labor" $200 00 200 00 100 00 100 00 $600 00 RECAPITULATION. Carpenter and paint shop Heating plant Fencing Artesian wells Re-roofing of cottages 28 and 32 Laundry extension and laundry machinery Repairs to roofs and gutters Dining room for cottages for men Dining room for cottages for women Porch for cottage 32 Total All of which is respectfully submitted. $5,500 00 35,000 00 3,500 00 1,000 00 2,100 00 1,550 00 3,500 00 9,000 00 9,000 00 600 00 $70,750 00 J. B. MUNSON, Medical Superintendent. The following is the report of the State Board of Corrections and charities on the above requests for appropriations: 11 �82 STATE OF MICHIGAN. BOARD OF CORRECTIONS AND CHARITIES, LANSING, November 22, 1910. Dr. James D. Munson, Medical Superintendent, Northern Michigan Asylum, Traverse City, Michigan. Dear Sir—At a meeting of the State Board of Corrections and Charities held on the 10th. inst., the estimates of appropriation for your institution for the fiscal years ending June 30, 1912, and June 30, 1913, were given final consideration. During the rec-ent visit to your institution by representatives of this Board, your needs were carefully noted, and we are of the opinion that the special appropriations requested are all actually necessary, with the exception of the one for fencing in the amount of f3,500.00, which seems to us may be withheld at this time without serious inconvenience. The other items have received the approval of the Board. Very respectfully, HENRY P. MOWRY, Chairman. BOARD OF CORRECTIONS AND CHARITIES, LANSING, December 8, 1910. Dr. James D. Munson, Medical Superintendent, Northern Michigan Asylum, Traverse City, Michigan. Dear Sir—Your letter under date of November 28th, requesting an additional appropriation of |5,000.00 to be used with the appropriation already available for the construction of a Cold Storage Plant, was presented to the members of this Board at a meeting held here j-esterday, and your request has been approved. Very respectfully, HENRY P. MOWRY, Chairman. CHAPEL SERVICES. Religious services have been conducted by chaplain, Rev. D. Cochlin, assisted by Revs. Mr. MacGregor, Mr. Atwell, Mr. Canby, Mr. Gay and Mr. Allington, all of Traverse City. ACKNOWLEDGMENTS. The institution is under renewed obligations and extends thanks to the editors of -the following papers for donation of their journals for the use of the patients: Germania. Big Rapids Herald. Michigan State Democrat. Grand Traverse Herald. Deaf Mute Mirror. Huron Tribune. Native Copper Times. Der Sonntagsbote, of Grand Rapids. Alpena Argus. Cheboygan Tribune. Triumphs of Faith. �'>• r& ' . . - . : "•' : ."': I' • •HJ GREENHOUSE. FARM SCENES. �NORTHERN MICHIGAN ASYLUM. 83 To all who have in any way contributed to the welfare and comfort of patients our thanks are extended. I am pleased to report that the relations of the institution to the counties which it serves have been pleasant, and that there has been cooperation between all county officials and the asylum authorities in the prompt and careful treatment of patients. All this is as it should be. I would again express my thanks to the members of the staff and to all employees of the institution for personal kindnesses. Everyone has put forth his best effort to further the work of the hospital. The trustees have been faithful in the performance of their duties, and have given more than usual attention to the flnancial side of the institution, and have taken a deep interest in every measure looking to improvement in the care of patients, or to increase scientific interest in the institution. All of which is respectfully submitted. J. D. MTJNSON, Medical Superintendent. Northern Michigan Asylum Sept., 1910. �STATE OF MICHIGAN. 84 OFFICERS AND EMPLOYES OF THE NORTHERN MICHIGAN ASYLUM, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1910, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Service. Name. James D. Munson Medical superintendent W D Mueller ' R.E. Wells Assistant physician C L Whitney . . . . . . .... T H A Tregea C W Nesbitt C M Prall . . . . S G Howard B.P.Burns Jennie Leece A W Hamel General supervisor General supervisor . . . . Clerk Clerk Floy Theobald Nettie Blank Albert Baughman Telephone operator Geo W Ashby Cook Effie L Bixby Hugh C Boyle Clara Billadeau E. L. Butler Marie Baxter H. Bushell George C Dell Vern R Duell .. Night nurse Attendant Period. Rate. .... $3,500 2,800 1,600 1,100 800 00 00 00 00 00 Per annum. Resident. 1,800 260 500 106 70 00 00 00 00 00 Per annum. Per annum. Per annum. Per month. Per month. 1,500 1,600 1,000 85 72 00 00 00 00 00 Per annum. Per annum. Per annum. Per month. Per month. Non-resident. Non-resident. Non-resident. Resident. Resident. 60 55 50 45 35 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Non-resident. Non- resident. Non-resident. Non-resident. 70 " 70 33 35 25 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Non-resident. Cottage. Resident. Resident. Resident. 30 31 17 18 28 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Non-resident. Resident. Resident. Resident. Resident. 30 47 33 28 38 00 00 00 00 00 Per month. Per month . Per month. Per month. Per month. Resident. Resident. Non-resident. Resident. Resident. 26 18 46 31 28 00 00 00 00 00 Per month. Per month. Per month. Per month. Resident. Resident. Non-resident. Resident. 14 18 14 17 24 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 25 24 17 18 28 18 00 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Resident. 24 24 24 42 26 30 00 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Per month. Per annum. Non-resident. Per annum. Resident. Per annum. Resident. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. Resident. Resident. Resident. Non-resident. Resident. Resident. �85 NORTHERN MICHIGAN ASYLUM. OFFICERS AND EMPLOYES.—Continued. Service. Name. Period. Rate. $26 32 18 38 00 00 00 00 29 24 60 20 00 00 00 00 24 17 17 26 45 00 00 00 00 00 37 30 24 29 34 00 00 00 00 00 28 44 23 28 40 00 00 00 00 00 28 17 38 37 24 00 00 00 00 00 38 27 30 26 38 00 00 00 00 00 Ada Hall R C Hiiner 23 20 26 38 23 00 00 00 00 00 Hazel Knight 18 17 18 18 42 00 00 00 00 00 31 20 18 18 24 00 00 00 00 00 26 17 20 25 34 00 00 00 00 00 22 40 20 24 34 - 23 00 00 00 00 00 00 30 46 16 17 18 33 00 00 00 00 00 00 H W Dickinson Win Glazier . . . A H Fisher . Attendant Bert Ghss \lvin Gilbert Eirl Griffiths H M Hannaford D. E. Hale Laura Hannaford Attendant Attendant Robt 0 Hodgman Libbie Kelley C H Leutholtz Ghas W Long Ella Miller R. H. McKcnzie Lucille Meister Domestic Mary McMahan Attendant . .' Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. �STATE OF MICHIGAN. OFFICERS AND EMPLOYES—Continued. Name. Service. Cleo V Miller Hate. Period. $29 29 20 17 00 00 00 00 18 28 21 23 00 00 00 00 38 24 18 17 18 00 00 00 00 00 18 40 26 42 23 00 00 00 00 00 20 20 16 18 31 00 00 00 00 00 42 28 18 24 18 00 00 00 00 00 Perry Tobey 20 28 17 24 30 00 00 00 00 00 Charles Zigler Cook Cook 28 28 14 34 37 00 00 00 00 00 Attendant 30 18 38 17 24 Hattie Walsh Thos Whitfield Helen J Whitfield William J. Weiler Attendant Almon Young Attendant Clara MeGivern Attendant Grace Shearer Laundress Per month. Resident. Per month. Non-resident. 00 00 00 00 00 Per month. Resident. 31 31 44 39 40 00 00 00 00 00 Per month. Resident. Baker Assistant baker 24 30 60 70 45 00 00 00 00 00 Assistant cook 25 20 16 65 28 00 00 00 00 00 30 26 33 24 26 00 00 00 00 00 C R Olson Bertha C Peterson V A Patrick . F G Park Matilda Send . . .• F G Sutherland Walter Scott V W Smith Robert Tobey L A Wright GusZeigler W Bellau S.A.Conrad Geo F Dell Robt F Herkner Earl Tuller Ray Perkett Waldo Culver Per month. Resident. Per month. Non-resident. Per month. Resident. �NORTHERN MICHIGAN ASYLUM. 87 OFFICERS AND EMPLOYES.—Continued. Service. Name. Assistant cook Tomy Thompson Maude Fate Assistant cook D E Ward Edna B Allen Ethel White . . . Mabel Stilson . - Per Per Per Per Per 35 60 32 14 21 00 00 00 00 00 Per month. Resident. Per month. Resident. Per month. Resident. 19 14 21 21 24 00 00 00 00 00 26 22 22 22 23 00 00 00 00 00 13 17 13 23 21 00 00 00 00 00 60 00 60 00 1 75 1 50 50 00 - - . W H Scott 1 75 1 50 1 75 1 75 33 00 Joe Brief Wm Meteer Wm D Fraser Len M Miller Ray L. Pennell E. J. Hammond Homer Hall C J Garnett 00 00 00 00 00 month. month. month. month. month. Resident. Resident. Resident. Resident. Resident. Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. 50 00 50 00 1 75 2 75 1 75 W Fraser H Butrick $24 24 35 24 28 50 00 1 75 40 "00 1 75 1 75 M Nolan J 0 Edwards Period. Rate. Carpenter . . S. H. McMichael J. G. Loeding Carpenter J B King A. H. Bennett Painter Painter Charles Peterson C. McNinch Painter John Trcmaine Louis Strack John Murphv S. Etigerlev ' E F . Hopkins Assistant gardener Assistant gardener Bnrnman . . . 1 2 50 45 2 75 00 00 00 70 2 2 2 2 2 70 70 70 70 70 48 2 2 2 2 00 25 25 25 25 1 75 1 75 35 00 35 00 33 00 Perr nth Non r 'i'l \ H ' N Per d "' P rl Per m 'nth Non re idp t N "H t" N m re iHont P N n H '' Per day. P H ' P j' • r 'ii i Non-resident. TvT 'H TJ >J t ," Per day. Non-resident. Pern nth Per day. Resident Non-resident. Per day. Non-resident. Per day. Non-resident. Per day. Non-resident. Per month. Non-resident. Pfr month Non resident 'H �APPENDIX �APPENDIX. The asylums of Michigan are organized and governed under organic law. an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government. appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of Asylum Trustees. (Section 8.) The counties comprising the district distncts' of the Northern Michigan Asylum are: Alpena Leelanau Antrim Manistee Arenac Mason Alcona Mecosta Benzie Midland Charlevoix Missaukee Clare Montcalm Crawford Montmorency Cheboygan Muskegon Emmet Newaygo Gladwin Oceana Grand Traverse Ogemaw Gratiot Osceola Isabella Otsego losco Oscoda Ionia Presque Isle Kalkaska Eoscommon Lake Wexford Provision is made by Section 7 for the transfer of patients Transfer from from one asvlum to another when conditions make such trans- one ^strict to . -i diioLner. ter desirable. A patient is not to be committed to an asylum of a dis- insane to be trict other than that of which he is a resident unless the as^Snfof to their district. �92 STATE OF MICHIGAN. court adjudicates that there is no room in the latter, and that there is in the former. (Section 8.) Patients are divided into three classes: Public patients, Classes of patients. private patients, and voluntary patients. (Section 13.) Voluntary Voluntary patients are patients who are not insane. They patients. are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for because of lack of room. In other words, there must be room for all others seeking admission before any voluntary patients can be received. Public and Both public and private patients can be received only on private an order from a probate court declaring the patient insane patients. Order void and stating the method of support,—whether public or priafter thirty vate. Such an order is void unless patient is sent to the asydays. lum within thirty days after it is issued. (Section 16.) Bonds. Besides the order of commitment from the court, there must acccompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumbent upon the court to see that this bond is furnished. Until this bond is furnished the patient is regarded as a Advance payment. public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. New bonds may be called for at any time by the medical New bonds. superintendent, and the law requires the court to see that such new bonds are provided. (Section 16.) Temporary Provision is made (Section 16) for the reception of both orders. public and private patients on temporary orders wherever conditions demand immediate attention. Transfer from Section 21 provides for the transfer of a patient from priprivate to vate expense to public expense where conditions warrant such public. a change. Non-resident. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Section 32 provides for the return to the asylum without a Provisional discharge and readmission of new order of patients who have been discharged on trial, patients. where the duration of the temporary absence does not exceed six months. The attention of county officers is particularly called to the Insane women to be accom- provisions of Section 40 regarding the state of bodily cleanlipanied by female atness and the clothing of patients brought to the asylum, and tendant. more particularly to that clause of the section providing for a female attendant for insane women. In conveying a patient to the asylum do not deceive him. Removal of patients from Truth should not be compromised by professing a visit to the home. institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the asylum, by giving �NORTHERN MICHIGAN ASYLUM. patients an impression that they are parties to the deception. Removal to the asylum should never be attempted when the patient is much prostrated or laboring under severe bodily illness, and care should be taken, that tlie excitement attend' ing acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what articles clothing, of clothing it is necessary to provide the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 enemies, 3 pairs drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, 6 handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. If such articles are left in their possession the asylum cannot lie responsible for their safe keeping. All letters concerning patients, from individuals having Correspondthe right to make inquiry, will be answered at once; and en friends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at the written request of friends. Where relatives of patients desire friends who are not mem- visiting bers of the family to visit patients, they should, in every in- patientsstance, furnish these friends with a letter of introduction, authorizing the interview. Application for admission should be made before the pa- Application tient is brought to the asylum, A blank will be furnished the friends which provides for a complete history of the patient's trouble. All correspondence in reference to patients should be addressed to Dr. James D. Munson, Northern Michigan Asylum, Traverse City. 93 �INDEX. Accounts, abstract of Accounts, current Accounts, current, summary of Acknowledgments Admission of indigent and pauper patients Admission of private patients Admission of voluntary patients Admissions and discharges. Table Age of patients. Table Age of patients discharged recovered. Table Age of patients who died. Table Alcoholic insanity Appendix Appointments, resignations, etc Appropriations, report of Artesian wells Carpenter and paint shop Chapel Civil condition. Table Classification of mental diseases, recommendation for Clothing Cold storage plant Cost of maintenance Daily average of patients Deaths, causes of, etc Death rate ' Dementia praecox Duration of residence of patients discharged. Table Education. Table Epilepsy Estimates of special appropriations Extension to laundry and additional laundry machinery Extension to institution, cost of Farm and garden Farm and garden products Fencing Form of disease. Table General dining rooms Heating and ventilating systems Heredity. Table Holstein-Friesian herd Hysterical insanity Imbeciles and idiots Improvements Increase of patients Infection and exhaustion psychoses Insanity of patients discharged. Table Inventory, summary of Laboratory work Lands by purchase Manic depressive disease Medical offices on wards Melancholia , Page. 24 28-31 31 82 91-92 92 92 36 72 78 79 57 91 23 16-17-18 19 18 82 73 " 13 93 18-82 la 15 37 15 61 78 73 68 79 20 9 21 35 19 44 20 18 72 22 70 66 16 15 58 77 35 45 9 47 12 65 �96 INDEX. Morphinism Movement of population. Table Names of officers and employes. Table Nativity of patients. Table Nativity of parents. Table Needs of asylum Not insane Occupation. Table Officers, names of Organic group Paranoia and paranoid states Patients treated in county houses, jails, etc Patients, suicidal, homicidal, etc Porch for cottage 32 Psychopathic Recapitulation Receipts and disbursements Removal of patients to asylum Repairs and painting of roofs and gutters Report of medical superintendent Report of State Board of Corrections and Charities Report of trustees Report of treasurer Report of steward Report of auditing committee Residence of patients committed Residence of patients. Table Results of treatment of patients discharged. Table Re-roofing of cottages 28 and 32 Roof for boiler room Sewage disposal Summary of causes of death. Table Supplementary appropriation for cold storage plant Surgical operations Title and addresses Training school for nurses Page. 58 36 84-88 75 76 18 71 74 5-6 59 63 14 14 20 69 2181 23 92 20 36 82 7-23 24 32 31 14 76 77 19 17 20 42 82 46 ' • 11 � https://localhistory.tadl.org/files/original/b45895d51e9882addd63f3f05cb64ae8.pdf 7d27c7b9b1b3376c30abf1e5cd058d59 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Traverse City State Hospital at Traverse City June 30, 1912. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Traverse City State Hospital and addressed to the Governor and Legislature of the State of Michigan for the biennial period ending June 30, 1912. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Wynkoop Hallenbeck Crawford Co., State Printers. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1912 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0005 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT BOARD OF TRUSTEES TRAVERSE CITY STATE HOSPITAL TRAVERSE CITY JUNE 30, 1912 BY AUTHORITY LANSING, MICHIGAN WYNKOOP HALLBNBECK CRAWFORD CO., STATE PRINTERS 1912 �FRONT VIEW OF MAIN BUILDING, �TITLE AND ADDRESSES. THE TRAVERSE CITY STATE HOSPITAL, TBAVEBSE CITY. Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is $1,071,803.27. The property consists of 42 buildings, occupying a tract of land containing 728 acres. It cares for 1,398 patients. Act No. 21, Public Acts of 1911, provides that the Northern Michigan Asylum shall be hereafter known as the Traverse City State Hospital. This law went into effect July, 1911. OFFICERS OF THE TRAVERSE CITY STATE HOSPITAL. TRUSTEES. THOS. T. BATES H. C. DAVIS W. W. MITCHELL M. P. QITAINTANCE W. LLOYD E. S. WAGAR TBAVEBSE CITY TBAVEBSE CITY CADILLAC PETOSKEY MANISTEE EDMOKE RESIDENT OFFICEBS. JAMES D. MUNSON, M. D A. S. ROWLEY, M. D W. D. MUELLER, M. D.. .. 1 R. E. WELLS, M. D j ADAH EPPERSON, M. D.. > J. A. J. HALL, M. D ! S. C. NILES, M. D j MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT AssT. PHYSICIANS NON-RESIDENT OFFICERS. G, B. PIKE W. P. MANTON, M. D STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN TRAVERSE CITY TREASURER. A. J. MAYNARD TRAVERSE CITY �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM FROM ITS ORGANIZATION IN 1SS1. BOARD OF COMMISSIONERS APPOINTED TO SELECT SITE FOR THE NORTHERN MICHIGAN ASYLUM. Date o! appointment. Name. Perry Hannah Traverse City. E. H. Van Deusen. . . Kalamazoo. M H Butler . . . Detroit 1SS1 . . 18S1 1881 Retired. Residence. Work of board completed Sept. 30, 1882. BOARD OF COMMISSIONERS APPOINTED TO ERECT THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Residence. Perry Hannah Traverse City. E. H. Van Densen. . . Kalamazoo. M H Butler H. H. Riley St. Joseph. Thos T Bates 1881 . . 1881 1881 1881 1885 Retired. 1885. The work of the building commission was finished Nov. 10, 1880. MEMBERS OF THE BOARD OF TRUSTEES OF THE TRAVERSE CITY STATE HOSPITAL Date of appointment. Name. Residence. Term expires. President from to 1885 . . . 1885 1885 1885 C. M. Wells Alex. Chapoton Sr. . . J. W. French Thos. T. Bates Traverse City . . . Detroit Three Rivers. . . . Trave-se City . . 1887 1885 to 1886. 1885 H. H. Noble Elk Rapids 1897 1885 1887 1887 1889 1891 Geo. A. Farr Varnum B. Cochran.. Lorin Roberts John Benjamin C L Whitney Grand Haven. . . Marquette Traverse City. . . Grand Rapids. . . 1891 189:-! 1889 1891 1895 1891. . 1889 1895 1897 1897 H. C. Davis G. A. Hart W. W. Cummer John Maywood C. F. Backus Traverse City . . . Manistee Cadillac Bad Axe Detroit 1915 1897 1901 1901 1905 H. D. Campbell W. W. Mitchell . . H D Brigham D. B. Butler Traverse City. . . Frankfort 1901 1917 1901 1903 Muskegon Petoskey Manistee Edmore . . 1907 1908 1913 1913 1915 1889 1901 1901 1902 . 1901 1903 . 1905 1907.. 1909 G A. Hart A. F. Temple M. F. Quaintance. . . . William Lloyd E. S. Wager 1889 1913 1886 to 1892. 1907 to 1910. 1892 to 1897. Remarks. Present member. 1897 to 1899. 1899 to 1902. Present member. Present member. 190° to 1907 1910 to 1912. 1912 Present member. Present member. Present member. �MEDICAL OFFICERS. Medical Superintendent: James D. Munson, M. D., 1885. Assistant Medical Superintendents: 3. H. Dawson, M. D.—1885 to 1890. Resigned. C. G. Chaddock, M. D.—1890 to 1892. Resigned. A. S. Rowley, M. D.—1895 . Assistant Physicians: C. G. Chaddock, M. D.—1885 to 1890. Promoted to Assistant Supermtendency. W. A. Stone, M. D.—1886 to 1891. Resigned to accept the Assistant Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendency. M. Rockwell, M. D.—1891 to 1892. C. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. B. L. Niskern, M. D.—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D.—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1889 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. W. D. Mueller, M. D.—1900. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. D.—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 to 1909. B. F. Sargeant, M. D.—1904 to 1905. H. D. Purdum, M. D.—1906 to 1910. R. E. Wells, M. D.—1907 . Guy M: Johnson, M. D.—1908 to 1910. Adah Epperson, M. D.—1910 . E. G. Williams, M. D.—1910. J. A. J. Hall, M. D.—1910. Steicards: J. D. Billings, 1885 to 1886. John Goode, 1886 to 1887. J. P. C. Church, 1887 to 1894. C. L. Whitney, 1894 to 1911. G. B. PIKE—1912. Chaplains: Rev. W. G. Puddefoot, 1886 to 1888. Rev. D. VanAlstin, 1888 to 1890. Rev. D. Cochlin, 1890 . �REPORT OF THE HOARD OP TRUSTEES. To the Governor and Legislature of the State of Michigan: The Trustees of the Traverse City State Hospital have the honor to submit their report for the biennial period ending June 30, 1912, together with the reports of the medical superintendent, treasurer and steward. The period included in this report lias not been marked by any great change in the methods of care and treatment of patients. It has been the endeavor of the officers to keep in touch with the advances in. psychiatry and in hospital management in general. The cost of livinghas steadily increased, which, coupled with partial failure of farm crops, and the reduction of a cent a day in the maintenance tariff of each patient, made it difficult to keep the hospital at the highest state of efficiency,—in fact, many repairs were carried forward for lack of funds to make them. The unusual cold winter of 1911 and 1912 added greatly to the fuel cost, and rendered still more difficult maintenance within the fixed tariff charges. While the per diem charge was exceeded, yet a deficiency appropriation will not be requested, since the working capital of the hospital was sufficient to care for the financial loss to the institution which followed. The rate charged last year was 49 cents per patient per day. The actual cost was 52.47 cents. The Stewards of the several state hospitals, acting jointly, constitute a Board of Stewards, which, among other duties, is empowered to purchase supplies for the institutions. This plan has worked well. Not only prices, but quality of supplies, are considered, a'nd are the dominating factors in the purchases. During the period regular monthly meetings have been held. In addition regular monthly visitations by committees from the Board have been made for the purpose of inspecting the hospital in its various departments and determining many questions looking to its improvement. TRAINING SCHOOL FOE NURSES. The training school for nurses continues to be an important factor in the hospital work. The school was organized in 190G and each year has increased its efficiency. Its graduates are much sought by the general hospitals of our large cities. We regret that more of our graduates do not remain in the service of the hospital. A sufficient number of competent nurses is absolutely essential to the fully successful care of the insane. The trained nurse is a professional individual, and feels the same pride in his or her work and in well doing as does the physician or any other trained professional man. We believe the State must recognize this fact, and in order to attract to its service suitable men and women for nurses must pay such salaries and throw about the �STATE OF MICHIGAN. 8 nursing corps of the hospitals such conditions, social and educational, as will tend to retain them. Surround any order of employes, professional or others, with conditions that show that the work in which they are engaged is of a high order of importance, and when properly prosecuted it has acquired recognition on the part of the State, and that they are socially respected because of the character of the service they are rendering, and the problem will be largely solved. DIETETICS. For many years the Superintendent of the Hospital has been interested in issuing foods to patients upon the plan of a balanced ration; at first using the United States standard ration for a basis, but more lately the Atwater standard has been followed as closely as possible. In reviewing twenty years' experience we believe that it has worked well, securing a greater variety of foods to patients and at less expense, than the old fashioned or haphazard plan of furnishing the cheapest kind of foods without reference to their physiologic value. For several years an analysis of all foods consumed in certain sections of the hospital has been made, and in 1912 the months of February, April and August were selected. The following tables will show the result of these analyses: FOOD NUTRIENTS USED IN THE TRAVERSE CITY STATE HOSPITAL. COTTAGE 21. FOR THE MONTH OF APRIL, 1912. DAYS' BOARD 1680. Protein 434383 Ibs. 1 17 Km. per patient 125 gm. 46S calories Man at moderate from 117 gm. Fat 589797 Ibs. 159 Km. per patient per day 125 gm. 1892033 Ibs. • 513 Km. per patient per day 450 gm. 3000 to 3500 calories Carbohydrate 1431 calories from 159 gm. fat. 2052 calories from 513 gm. Total of 3951 calories per diem. COTTAGE 28. FOR THE MONTH OF APRIL 1912. DAYS' BOARD 1624. Protein 594807 Ibs. 166 gm. per patient per day Atwater's standard— man at hard work 150 gm. 664 calories from 166 gin. protein. Fat 516067 Ibs. 150 gm. Carbohydrate 2300854 Ibs. 144 gm. per patient per day 642.34 gm. per patient per day 1296 calories from 144 gm. fat. 2429 calories from 642.34 gm. carbohydrate. Total 4389 cal. per diem. • 500 gm. 4000 to 5000 calories �TRAVERSE CITY STATE HOSPITAL. FOOD NUTRIENTS IN TRAVERSE CITY STATE HOSPITAL. FOR MONTH OF FEBRUARY, 1912. Entire Population Fat . Carbohydrate I 256 employees. Days' Board 46538. 9/.6S gm. Atwater's standard (or light exercise. per patient per day Men 1(10 gm. Women 80 gm. 11682 Ibs. 113.68 gm. per patient per day 100 gm. SO gm. 33787 Ibs. 319.31 gm. per patient per day 360 gm. 300 gm. 9401 Ibs. Protein ;' 1409 patients. 391.2 calories. 1023.12 calories. 1277.24 calories. 2691.56 calories per diem. 2500-2800 calories. From 97.65 gm. protein From 113.68 gm. fat From 319.31 gm. carbohydrate Total ' f Man at light work Standards \ Woman at light work 1SOO-2400 calories. FOOD NUTRIENTS USED IN THE TRAVERSE CITY STATE HOSPITAL. COTTAGE 21. FOR THE MONTH OF AUGUST, 1912. DAYS' BOARD 1674. Protein 3S7.9S Ibs. 103.78 gm. per patient per day Calories 125 gm. Man at moderate 415.1 work — Atwater Fa.'. 482.38 Ibs. 130.63 gm. per patient per day. 125 gm. Carbohydrate 1586.51 Ibs. 429.54 gm. per patient per day. 450 ?m. 3000 to 3500 •calories. Calories 1.175. Calories 1,718.18 Total of 3309 calories per diem. COTTAGE 28. FOR THE MONTH OF AUGUST 1912. DAYS' BOARD 1767. Protein 689.47 Ibs. 177.8 gm. per patient per day. 150 gm. Atwater's standard for man at hard work. Calories 611.2 Fat 516.58 Ibs. 140.16 gm. per patient per day. 150 gm. Calories 1,261.44 Carbohydrate 1 727.78 Ibs 449.18 gm. per patient per day. 500 gm. 4000 to 5000 calories. Calories 1,796.72 Total of 3,669.36 calories per diem. �STATE OF MICHIGAN. 10 POOD NUTRIENTS USED IN TRAVERSE CITY STATE HOSPITAL. FOR MONTH OF AUGUST, 1912. Entire Population Protein 7 781 Ibs. / Patients 44 051 days. I Officers and Employes 5 159 days. Total daysrboard 49 210. 71.7 gm. Atwater's standard for light exercise. per patient per day. Men 100 gm. Women 80 gm. Fat 8 571 Ibs. 70.1 gm. per patient per day. 100 gm. 80 gm. Carbohydrate 39 502 Ibs. 344.3 gm. per patient per day. 360 gm. 300 gm. From 71.7 gm. protein From 70.1 gm. fat From 344.3 gm. carbohydrate Total f Man at light work Standards ^ I Woman at light work 286.8 calories. 630.9 calories. 1377.2 calories. 2294.9 calories per diem. 2500-2800 calories. 1800-2400 calories. Governor Osborn has shown interest in this effort and has been helpful in many ways, especially in calling attention to recent authorities and in general encouragement in the work. Our experience has shown that a fixed dietary is not practical for so large a number of people as is fed in this hospital. The patients must be graded and their diet regulated. For example, people past middle life, patients suffering from organic dementia, especially if dne to arterial degenerations, which usually include organic changes in the heart, liver, kidneys, etc., a low proteid content of food is beneficial in their treatment; while other cases,—those suffering from purely nervous or functional disturbances, or those whose mental trouble is secondary to an infection, require concentrated, rich foods, of large proteid content. There is' a class of patients,—feeble minded, epileptic and others, who can better live on soft foods, and a dietary should be arranged for them from milk, soups, cooked fruits, cereals, etc., so as to balance the nutrients at a low average calorie value. For several years past the hospital has employed a dietitian, and foods are often especially prepared for feeble and sick patients, both inmates and employes. More intelligent study of our dietaries and the criticisms of those who have been interested in them have led us to believe that the calorie content of our dietary, as shown in the first of those above given, is greater in proteid value than necessary; while the second is probably over rich in carbohydrates. At any rate, we have not had sufficient experience with the calorie standards of Ohittenden, Kubner and others, to determine what the effect would be on the health of the household of a dietary of a relatively higher percentage of fats and carbohydrates, as may be found in the second table given above. The subject of dietetics is a very interesting one and we believe worthy of attention by the management of all public institutions. The strictest economy in directing the affairs of the hospital has been practiced. We believe some advance has been made in many of its �GENERAL DINING ROOM, MALE DEPARTMENT �TRAVERSE CITY STATE HOSPITAL. 11 departments. The new dining rooms have proved of value not only in the distribution of foods, and better oversight of patients during the meal hours, but have also reduced the number of employes required in supervising the dining room work. While the ordinary farm crops were poor last year, the garden and orchards yielded well. The new cold storage enabled us to carry fresh, fruits through the year, adding greatly to the health and comfort of our people. Careful attention was given to the practical development of the dairy, the gardens, and especially of the fruit orchards. It has been the aim of the board to develop a model farm. Dairying, gardening and orcharding have been carried on in a conservative, but up-to-date way, and the fruits, vegetables, farm products, and the stock, have received more than favorable mention wherever shown, either at home or abroad. "It has been our object to effect a plain, practical achievement of the very best achievement in horticulture and agriculture and in, general farming." It is a notable fact that the farm is worth several thousands a year to the State. Its development, however, has not cost the people a cent, because the necessary labor has been almost entirely furnished by able bodied men patients. We would also point out that the farm is the great natural workshop for men patients, and indeed for many women patients as well. The farm with its various departments,—dairying, orcharding, gardening, greenhouses, etc.,—forms a great industry, and not less than 100 patients and often many more, are employed in its service. One of the pressing needs of the State for this hospital is the acquirement of more land. The arable lands of the State domain consist of about 500 acres, and the hospital could very well work 1,000 or 1,500 acres. We believe it would be the part of wisdom for the State to secure adjoining farm lands at the earliest possible date. The same effort has been made to improve the methods of care and nursing of the patients. The laboratory work both clinical and scientific, is conducted by Dr. R. E. Wells, of the Medical Staff. He has prepared vaccines, and secured blood and spinal fluid for the Wassemnan and other reactions, all of which are of scientific and therapeutic importance. From the medical standpoint the institution has become thoroughly hospitalized. The medical treatment, the nursing and the sanitary conditions of the hospital, to be successful, must be carefully supervised. This requires experienced physicians, trained nurses, pleasing surroundings, the best of hygienic conditions, and pure foods scientifically prepared. A special study of alcohol as an etiologic factor has been made of patients admitted during the last year. Similar studies have been made at the other State hospitals, and it is hoped that the collective study of such a large number of individuals will help to> determine more accurately the part alcohol plays in the causation of mental disease. The heredity of patients is carefully taken, but the study of heredity will be imperfect until field workers are employed by State to trace it. Eugenics is attracting more and more attention, and the State should supply workers in this new scientific field in connection with its charita.ble institutions, prisons, etc. A review of the First International Eugenics Congress, by Mr. Raymond Pearl, in the September 12th issue of the New York Independent, says: �12 STATE OF MICHIGAN. "Fundamentally there was general agreement among all present as to certain necessities in the eugenics campaign. First of all is the great need for education. The young of all classes of society must be taught the general facts of heredity in such a way as to make it clear that they are not abstract, impersonal propositions, like the theorems of geometry, but are real, vital,.human matters which concern every one of us in the most direct and personal manner. In this way and in no other can a personal sense of duty to future generations and to the race be made an intricate part of the individual ego. This new science is a social problem and can be made practical only by the aid of the State in establishing eugenic workers whose duty it shall be to study the heredity of all our people and to determine ho\ education can be made to help the science." In connection with the study of eugenics, that of the effect of environment on human development should go hand in hand. Whether the race is degenerating is doubtful, but if preventive measures, both environmental and eugenic, could be applied, nature would have much less pruning to do. "It is essential to bear in mind Hie truth, that if the human race is to continue to progress,—indeed, if it is not to lose some of the ground so painfully won in the long ages of struggle in the past,—some other agency, checking the reprodnction of the feeble in body and mind, must be made to take the place of natural selection, the action of which we are now in so many ways endeavoring to prevent.7' (L. Darwin.) We would also report that the heating and ventilating system were completed, with the exception of the hospital for men, in the main building last year, and have proved satisfactory in operation. Although last winter was unusually cold, yet no difficulty was experienced in maintaining a temperature of from 08 to 72 degrees. The ventilation, is always under control. The cost of fuel has apparently been greater with the new than the old system, but the new has hardly been in use long enough to determine operating cost. It is true, however, that the building was never before so well heated and ventilated. Formerly there were always winter days in which it was impossible to maintain a comfortable degree of temperature. Witli the new heating system there was installed a complete outfit for determining the efficiency of the plant viz., the amount of water evaporated, the amount of steam used in each department, the caloric value of fuel used, the amount of gases present in combustion chambers, chimney temperature and draft, etc. This outfit consists of a Ventuii meter for registering the amount of feed water, steam lio\ meters for measuring pounds of steam used in each department, viz., laundry, general kitchen, north and south wings, cottages, etc., and automatically recording the same. The gas analysis apparatus enables the engineer at all times to determine whether the coal is burned in the most economical way. These appliances soon demonstrated that the boilers, with the coal in use, were only generating from 45 to 60 per cent of efficiency, instead of the normal average of TO per cent. This led to an expert investigation of the plant, and it was found, among other things, that the boiler furnaces Avere faulty in construction, and that the chimney draft was not at all times sufficient to economically burn the coal. The furnaces were rebuilt and the draft improved. The efficiency of the �AUTOMATIC STOKERS �• "W' ~~ • , ~ mg >• sSs "?\G PLANT �TRAVERSE CITY STATE HOSPITAL. 13 boilers has been increased thereby, but whether further alterations will need to be made in them to secure greater fuel economy cannot be stated until after they are put to further test. There is no doubt that the cost of these meters, gas machines, etc., has been more than repaid by the economy already effected. It may be of interest to state that coals of the same or practically the same British thermal unit value varied greatly in efficiency under our boilers, some evaporating from 20 to 25 per cent more water than others of the same thermal unit value. COLD STOEAfJE. The cold storage plant completed in 1!)11 has proved of economic value in the care of meats, eggs, butter and fruits. Apples, for example, were carried till the new crop came, and without loss. The season during which fruits can be used in the fresh state, viz., strawberries, raspberries, cherries, peaches and plums, was lengthened by this storage and their value to the hospital correspondingly increased. The advantages of cold storage can scarcely be overestimated, and the cold storage plant should be enlarged to enable it to care for all kinds of perishable fruits and vegetables, and for the storage of canned goods, dried fruits and the like. PSYCHOPATHIC HOSPITAL. Our relation with the Psychopathic Hospital continue important. Many specimens were sent for scientific determination, and the reports from the Psychopathic Laboratory were of the grestest value in the diagnosis and treatment of patients. A large number of spinal fluid and blood specimens were examined for the Wasserman reaction. E P I D E M I C DISEASES. With the exception of an outbreak of diphtheria early in June, 1912, the hospital has been free from epidemic diseases. Diphtheria was brought into the institution by a young boy patient. He died after1 a few days' illness. Quarantine Avas established and all those exposed were given prophylactic treatment with antitoxin. We are not able to state to what extent the disease will spread but do not apprehend that many cases will follow. VIOLENT DEATHS. One serious accident occurred during the period. Mr. II. K., a patient, in Hie institution for many years, died from injuries received in a struggle with an attendant. His death was reported to the coroner and prosecuting attorney, and an inquest was held. While the verdict was that the patient came to his death at the hands of the attendant, it did not hold him responsible for the death of the patient. Two suicides occurred, one by suspension and one by drowning. Both were investigated by the coroner and the coroner's inquest attached no blame to the officers or attendants of the institution for the death of these patients. Two patients, epileptics, suffocated in their pillows, and one homicide occurred, one patient killing another. �14 STATE OF MICHIGAN. TRANSFER OF PATIENTS. Two patients were transferred to the Ionia State Hospital, one was deported to Austria by order of the TJ. S. authorities, one was returned to Ohio by order of the State authorities, and two were transferred to the Kalamazoo State Hospital. The hospital has not only been able to receive all patients of its district, but has been able to receive overflow cases from the Newberry and Pontiac State Hospital districts. INCREASE OF PATIENTS. The net gain in patients during the period was 14,—there were 8 less women patients under treatment at the close of the period and 22 more men than at its beginning. While there has been a slight increase in the population of the district, the number of patients accredited to the district has decreased. If the patients, received from the other districts are deducted, there was a total of 524 received. This is a decrease of 12 in the district during the last 2 years. The average net increase of patients for the last 26 years has been 36.2. There were 550 patients admitted during the period—310 men and 240 women. The several counties committed patients as follows: Antrim Alcona Alpena Arenac Alger Benzie Bay Cheboygan Charlevoix Crawford Clare Chippewa Emmet Grand Traverse Gladwin Gratiot losco Isabella Ionia Kalamazoo Kalkaska Leelanau Lake 25 14 15 4 2 18 1 17 29 1 8 5 28 44 6 28 6 13 26 1 9 11 5 Moutmorency Manistee . .'. Missaukee Mason Mecosta. Midland Montcalm Muskegon Menominee Marquette Mackinac Newaygo Otsego Ogemaw Osceola Oceana Presque Isle Eoscommon St. Clair Schoolcraf t Sanilac Wexford Washtenaw Total Of the 550 patients admitted: 28 had been confined in county houses. 100 had been confined in jails. 46 had been treated in other asylums. 3 22 9 13 15 13 23 35 5 3 1 7 6 5 10 21 6 2 2 4 1 25 3 550 �TRAVERSE CITY STATE HOSPITAL. 15 30 were said to have been destructive. 31 had attempted or threatened suicide. 51 were homicidal or had threatened homicidal assaults. 15 had been confined or restrained at home. The number of patients confined in county houses, jails and other asylums exceeded the last biennial period by 56, the number of suicidal cases was greater by 6, and the number of homicidal cases was greater by 31. Since June 30, 1892, these statistics have been regularly kept, and show out of a total of 4.346 admissions: 178 ( 4 %) were confined in county houses. 506 (11.6%) had been confined in jails. 312 ( 7.1%) had been treated in other asylums. 487 (11.2%) were destructive. 356 ( 8.1%) were suicidal. 531 (12,2%) were homicidal. 397 ( 9.1%) required some sort of restraint at home. COST OP MAINTENANCE. The daily cost of maintenance per patient for the last 27 years has been as follows: Cents. 1886 53 1887 52 1888 51 1889 ' 50 1890 49 1891 49 1892 IS 1893 48 1894 48 1895 47 1896 46 1897 44 1898 42 1899 44 1900 44 1901 44 1902 44 1903 (The above exclusive of officers' salaries).... 44 1904 (Inclusive of officers' salaries) 48 1905 " " '• " 49 1906 '• ", ;i " 48 1907 " " " " 47 1908 '; >< " " 48 1909 " " " " 50 1910 " " " " 50 1911 " '•' " '• 50 1912 " " " " . 49 �16 STATE OF MICHIGAN. DISCHARGE OF I ' A T I K X T S . R E A D M I S S I O X S , ETC. There were 536 patients discharged during the period, 288 men and 248 women. Of this number 75 were discharged recovered, 142 improved. 56 unimproved, and 203 died. The percentage of recoveries on the whole number under treatment was 3.8 per cent; on the number admitted 13.(5 per cent. The death rale, 78 per thousand, 1010-11, and in 1011-12 (50 per thousand. The readmissions for the period were, men, 38; women, 43; total, 81. The readmissions from the beginning have been, men, 314; women, 304; total, 618,—hence the total number of admissions, 5,830, represents 5,212 individuals. The daily average number of patients for the period was 1,301. The number of weeks spent in the institution by patients was 145,402 6-7. This was an increase of 7 in the daily average, and an increase of 1,130 2-7 weeks' board over the preceding period. On June 30, 1012, there were 1,308 patients under treatment at State expense and 26 at private expense. There were 255 persons employed at the hospital on June 30, 1912. in the positions and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND I_\ 1'ROVE.ME.XTS. During the vear ending June 30. 1011, the cost of repairs was 122,878.57, and'for the year ending June 30, 1012, $18,852.03. The continuation of the heating and ventilating systems in the building necessitated many alterations, in the steam fitting and plumbing, which were extra to the appropriation and were charged to the account of improvements and repairs. A great many minor repairs were made throughout the building and a new culvert was built over the asylum creek on Eleventh Street. This culvert was washed out by the flood of July. 1010. The work of excavation of a new reservoir has been continued but has not yet been completed for lack of funds. Some fence has been rebuilt and many minor repairs have been made. SPECIAL APPROPRIATION, $90,000. Extensions to north and south wings. At the close of the last biennial period there remained in the hands of the treasurer to the credit of this fund $6,603.39. The furnishing of these buildings has been nearly completed. There remained in the hands of the treasurer to the credit of this fund at the close of business June 30, 1012, $7(50.67. The buildings are occupied, and are satisfactory. The general dining rooms, built in connection with them for each story of the main building, are practical, require less help, and food can be served in them more quickly and neatly than in the ward dining rooms. They are also more attractive and better lighted and heated than the old dining rooms. SPECIAL APPROPRIATION, 32,500. For a roof over boiler room. This appropriation was granted by the Legislature of 1909. It was not available until July. 1910. This improvement has been completed and is satisfactory. The roof is constructed of steel and concrete and is fire proof. �KOOH JI'IP.J �TRAVERSE CITY STATE HOSPITAL. 17 SPECIAL APPROPRIATION, $5,000. The Legislature of 1909 granted $5,000, to which the Legislature of 1911 added $5,000, making an available appropriation of $10,000 for the construction of a cold storage plant. The cold storage building is a reconstruction of the former ice and meat house. The building was enlarged and an elevator built in for lifting fruits and other supplies to the second story. The contract for the machinery, insulation, etc., was awarded to the Fred AY. Wolf Mfg. Co. of Chicago, 111., in the sum of $7,950. The plant consists of a 12-ton Linde ice machine, with chloride of calcium circulating outfit, brine pumps, condensing apparatus, etc. As previously mentioned in this report, the cold storage plant has been of great value to the hospital. SPECIAL APPROPRIATION, $30,000. This appropriation was made by the last Legislature for extensions to the heating and ventilating systems. The contract was let to the Thomas Heating Co. of Racine, Wis., and the work has been completed and is satisfactory. Your honorable body will be requested to. make an appropriation to complete the heating of the hospital, and of one or more of the cottages. SPECIAL APPROPRIATION, $2,100. This appropriation was made by the last Legislature for roofing cottages 28 and 32. When it came to making contracts for the work, it was found that the appropriation was not sufficient to roof both buildings. Therefore, it was decided to roof one. The Detroit Cornice & Slate Co. were awarded the contract for roofing cottage 32, in the sum of $1,400. The roof is of the best Peach Blossom slate, and is1 a nice piece of work. There remained in the hands of the treasurer to1 the credit of this fund on June 30, 1912, $700. SPECIAL APPROPRIATION, $3,500. This appropriation was made by the last Legislature for repairs and painting roofs. Quite a number of repairs have been made, but the season has been so wet that little work could be done to the roofs. The work will be pushed forward as fast as possible. There remained in the hands of the treasurer to the credit of this fund on June 30, 1912, $2,783.35. NEEDS OF THE ASYLUM. We regret that we have to ask of your Honorable Body appropriations for improvements, betterments and extensions to the hospital, but a large institution such as this, unavoidably presents conditions which call for State aid, in the form of appropriations. You will bear in mind that the hospital is growing older as well as larger, and that the outlay requested may seem large and yet it is only a very small percentage of the actual value of the institution so far as the cost of upkeep is concerned. CARPENTER SHOP AND PAINT SHOP. Your honorable body is respectfully requested to appropriate the sum of $5,500 for the construction of a building to be used as a carpenter 3 �18 STATE OF MICHIGAN. and paint shop. As reported to previous Legislatures, the blacksmith shop and carpenter shop have been associated in small rooms connected with the engine and boiler rooms of the hospital. They are too small for either purpose. We cannot urge too strongly in the interests of economy and safety from fire the granting of this building. The present blacksmith shop and carpenter shop can be converted into a blacksmith shop and store room for engineering materials. HEATING PLANT. Your honorable body is respectfully requested to grant an appropriation of $18,000 to complete the heating and ventilation under the hospital for men and to replace the present system under cottages 24 and 26. SHED OR BARN FOR STORAGE OF FARM IMPLEMENTS. Your honorable body is requested to appropriate the sum of |2,500 for a shed or barn for the storage of wagons, sleighs and other farm utensils. This is a much needed improvement as under present conditions wagons, sleighs, farm implements, etc., are largely stored in the open. REPAIRS TO ROOFS AND GUTTERS. Your honorable body is respectfully requested to grant an appropriation of $2,500 to continue the work of the repair to roofs and gutters of the asylum building. Last winter was very severe on the roofs and will necessitate quite a large additional outlay to put them in order again. FENCING—ENTRANCE GATE. Your honorable body is respectfully requested to make an appropriation of -|3,000 for iron fencing with cast posts to replace fences on Elmwood Ave., and to build a suitable entrance gate to the hospital, in place of the wooden one which is nearly worn out. The amount of fence needed is about 120 rods of ornamental fence and about one mile of ordinary wire fence. ARTESIAN WELL. Your honorable body is respectfully requested to grant an appropriation of $500 for an additional artesian well. During the last year the existing wells have not supplied water enough. No doubt the cost of pumping the additional water has been more than another well would have cost. ROOFING OF COTTAGES 21, 25, 26 AND 28. Your honorable body is respectfully requested to grant an appropriation of $6,400 to finish the shingling of cottage 28, and to reshingle cottages 24, 25 and 26. The estimate of cottages 24 and 26 is $3,500, and was made by the Detroit Cornice & Slate Co. The reshingling of 25 is a necessity and the amount, $2,000, is a careful estimate of the cost at which the work can be done. The slate is to be of the best Peach Blossom variety, similar to the roofs on the institution. The balance, $900, of the requested appropriation, is to complete the shingling of cottage 28 and to provide for scaffolding, etc. �TRAVERSE CITY STATE HOSPITAL. 19 E X T E N S I O N TO LAUNDRY A N D ADDITIONAL L A U N D R Y .M A C I I IN 1C It V. Your Jionovable body is respectfully requested to grant an appropriation of $1,200 for the construction of a general repair room and to enlarge the ironing room of (he laundry. A further sum of }800 is requested for the purchase of washing machines. These improvements are much needed. The laundry has been in operation since 1895. Much of (he machinery is worn out. The hospital lias outgrown the laundry and it should be enlarged as requested. POUCH FOR COTTAGE 32. Your honorable body is requested io appropriate (lie sum of ,1600 for t h e construction of a porch at the tuberculosis coltage for men. This cottage is without necessary porch room for the outdoor care of invalids. Outdoor treatment of tuberculous people is everywhere recognized as of first importance, and for this reason this appropriation is respectfully requested. GENERAL DINING ROO.M FOR THE COTTAGES FOR MEN. An appropriation of flO.OOO is respectfully requested for the construction of a central dining room for the cottages for men. At present there is a kitchen and a dining room at each of these cottages, which is extravagant in help, in the use, of fuel, and also in floor space. Jf this appropriation is granted, the existing dining rooms and kitchens can be converted into dormitories for 1001 additional patients. In other words, for an outlay of $10,000 the State can secure additional room for 100 patients and also greatly lessen (lie cost of kitchen and diningroom upkeep. X-RAY APPARATUS. Your honorable body is respectfully requested to grant an appropriation of $950 for the purchase of a first-class X-ray outfit for the use of the hospital. The hospital has never hart such an appliance. The X-ray is important in diagnostic work, and in the treatment of certain forms of diseases. The hospital should be furnished with an outfit similar to what may be found in all first-class general hospitals as well as in many of the offices of general practitioners of medicine. A D D I T I O N " TO THE COLD STORAGE PLANT. Your honorable body is respectfully requested to grant an appropriation of $4,800 for building an addition to the cold storage plant and installing necessary machinery for refrigeration purposes. The amount requested is based on estimates furnished by the Fred \Y. Wolf Mfg. < V for the machinery and i n s u l a t i o n , and upon estimates of our architect for the cost of (he building. CULY15RT OR \\-.\TIi.R\V.\V. A casual inspection of the s i t e of (he hospital will show that it is located across ( h e slope of t h e ground. The only provision for the care of water coining from (he c o u n t r y wesl o! (he h o s p i l a l is a small culvert w h i c h passes u n d e r ( l i e h o s p i l a l , a n d t h r e e s m a l l sewers placed a t l o w if 1 �20 STATE OF MICHIGAN. points iu the grounds in the rear of the hospital. These provisions are adequate for the care of surface water under ordinary conditions, but during freshets and unusual downpours of rain, they are entirely inadequate and the result is that water overflows into the basements, doing more or less damage to supplies stored in them, besides soiling them greatly and rendering them unsanitary. Only recently a cloud burst of great severity occurred and the water coming from the great water shed west of the hospital and through the narrow valley which empties back of the building was so great that it completely filled the subways and the basements to a depth of nearly three feet. The water did damage to the pipe coverings, to stored goods, trunks, satchels, etc., to canned goods, to the bake shop and its machinery, to the boiler room, coal bunkers, etc., all of which were under Avater. The silt and other filth thai \vas deposited into the basement rendered them unsanitary, and it required weeks of labor to put them iu condition. Immediately after this flood a culvert was directed to be built of sufficient area to care for as much water or more, as fell during the recent storm. The estimated cost of this culvert is fl.OOO, and we most respectfully request your honorable body to reimburse the hospital in this amount. It was imperative that this culvert be constructed, that such damage to the buildings can never occur again. SIDE TRACK. An effort has been made to secure a right of way for a side track from the Pere Marquette railway to the hospital. All the options have been secured on the property traversed by this proposed road with the exception of one lot which is estimated to be Avorth $500. The right of way and the construction of the proposed side track and t h e equipment of the same will cost as follows: Grading One spur trestle bridge 4.350 ties 174 tons 60-lb. rails Joints Spikes Bolts 3 tournonts Track laying and ballasting Right of Avay as per options secured The total cost of the proposed side track, as per above estimate is ijSU.oOO 00 120 00 2,392 50 4,350 00 208 80 185 50 56 00 450 00 825 00 22,050 00 45,137 SO From this may be safely deducted $7,000 from the item labor, which labor will be furnished by the hospital, and a further deduction from the cost of the right of way can be made, as the lands crossed by the road can be sold for at least half as much as they w i l l cost. Monies accruing from sale of such lands would be returned (o (lie Slate. If your honorable body grants I h e appropriation for ( h i s greatly needed utility, it must be understood t h a t each and every r a i l w a y no\ coming into Traverse City, or thai may come i n t o Traverse C i t y in (he fillure, shall have unrestricted use of ( h i s side track under such regu- �TRAVERSE CITY STATE HOSPITAL. 21 lations as may be approved by the Railway Commissioner of the State of Michigan, or other proper authority of the State. Your honorable body is respectfully requested to grant the necessary appropriation for this road. A side track will be of the greatest economic importance to the hospital. The amount of tonnage delivered to the institution is not far from 20,000 a year, and it costs about 30 cents a ton to deliver from side tracks to the hospital. The cost to the hospital of drayage and cartage exceeds $6,000 a year, which is an interest of three per cent on over |200,000 annually. HORSES AND MOTOR TRUCKS. The horses of the hospital average over 15 years old. They will have to be replaced. Your honorable body is requested to grant an appropriation of |6,000 for the purchase of ten teams of first class heavy horses, and a further sum of $5,000 for the purchase of a five-ton motor truck. If a side track is secured only five teams will be required. The motor truck and the other teams of horses would not be needed. RECAPITULATION OF APPROPRIATIONS REQUESTED. Carpenter and paint shop Completion of heating and ventilating systems Shed for storage of wagons and implements Repairs to roofs and gutters Fencing Artesian well Roofing of Cottages 24, 25, 26 and 28 Extension to laundry and laundry machinery Porch for Cottage 32 " ". Dining room for cottages for men X-ray apparatus Addition to cold storage Canal or waterway Side track Horses and motor truck $5,500 00 18,000 00 2,500 00 2,500 00 3,000 00 500 00 6,400 00 2,000 00 600 00 10,000 00 950 00 4,800 00 1,000 00 11,000 00 FARM,, GARDEN, STOCK AND GROUNDS. The asylum real estate comprises 728 acres. As given in the census of 1910, the estate has 445 acres improved land under cultivation. The following report shows the quantity of farm and garden produce raised during the last two years, and also the value of cattle sold. �22 STATE OF MICHIGAN. FARM REPORT FOR THE BIENNIAL PERIOD ENDING JUNE 30 1912. Asparagus l':s 3,300 Peas green bushels Apples bushels 2,807 Pears bushels Beans string bushels 482 Peaches bushels BeeJ Ibs 8,968 Peppers bushels Beets bushels 935 Potatoes bushels Beet greens Ibs 105 Potatoes sweet bushels Cabbage heads 23,675 Pork Ibs Carrots bushels 6,031 Plums bushels Cauliflower heads 1,100 Pumpkins tons Celery heads 28,150 Radishes dozen Celeriac bushels 6 Rutabagas bushels Cherries quarts 841 Rhubarb Ibs Currants quarts 4,081 Raspberries quarts Chicken Ibs 577 Strawberries quarts Corn sweet bushels 1,809 Squash tons Cucumbers, dozen 387 Sage, bunches Cucumbers, bushels 406 Salsify, bushels Eggplant, bushels 11 Spinach, Ibs Fodder, tons 182 Straw, tons Grapes, bushels 214 Tallow, Ibs Hay, tons 478 Tomatoes, ripe, bushels Kohlrabi, bushels 7^ Tomatoes, green, bushels Lettuce, Ibs 11,830 Turnips, bushels Mangels, bushels 7,872 Turkey, Ibs Milk, Ibs 1,206,335 Veal, Ibs Muskmelons, Ibs 4,900 Watermelons, Ibs Oats, bushels 3,296 Premiums on cattle Onions, dozen 16,050 Cattle sold Onions, bushels 2,189 Hides sold Parsnips, bushels 810 167 14 1,446 27 9,150 49 25,879 422 16 10,525 1,899 4,025 1,905 5,036 18J 400 120 1,855 59 76 1,170 232 4,931 18 215 14,950 $37.00 S8.553.80 $285.28 =====—. Few have a comprehensive knowledge of the magnitude of the farm operations. It really comprises four distinct departments,—the farm proper, the stock, the grounds, greenhouses and gardens and the orchards. Each of these constitutes a business of considerable magnitude. All of them are under the general direction of the steward,—each in turn under the immediate control of a trained superintendent. Mr. Dennis Kelly is superintendent of the farm, Mr. J. B. Armitage of the stock, Mr. H. Tobler of the garden, greenhouses and grounds, and Mr. R. Pennell of the orchards. The farm -superintendent lias control of the horses, vehicles, farm implements and machinery, and the direction of the farm help, teamsters and other assistants, the hauling of freight, the planting, cultivation and care of all crops, and the living or boarding of many of the assistants and some of the patients who work at the barns. To perform all these duties, at the proper season, without confusion in work or loss from either misdirection or lack of direction, requires executive ability of a high order. In fact, from early spring till late fall the carrying on of the farm work requires many assistants, many patients, and is a period of constant activity. What is true of the farm is also true of the stock. Since the first, the hospital has been interested in the breeding of thoroughbred Hoistein cattle, primarily for dairy purposes. It was soon found, however, that there was a demand for all excess of thoroughbred stock raised, and as the years have passed by, more attention has been given to the development of the cattle, and much higher prices have been received for stock sold. The above report shows that over 18,000 worth of cattle were sold during the last period, Avhile the value of the milk produced by the herd exceeded $35,000. The feeding and care of the herd requires skilled oversight, and the registration of the animals, the making and record- �TRAVERSEiCTTY STATE HOSPITAL. 23 ing of pedigrees, requires much clerical work. The health of the stock, testing for tuberculosis, and the constant struggle against the invasion of tuberculosis, requires more or less scientific knowledge; the sanitary care of the milk and the proper preparation of the food rations for the slock, all require, the application of expert practical knowledge. Mr. Armitage has had the general management of the herd for a number of years, and is a very competent man in his field of effort. The gardens, grounds and greenhouses have been for years under the management of Mr. H. Tobler. Mr. Toiler's success in all these departments is known the country round, and it is doubtful if a more skilled man can be found anywhere in this special field. The report shows the vegetables, etc., produced by the gardens, but it does not show the beauty o!' the grounds, the great variety of flowers raised, and neither does it give anv notion of the vast amount of labor, effort and knowledge that is required to bring success in this great field of usefulness. The orchards are rapidly coming into value, and for the last few years have been under the care of Mr. B. Pennell, a trained orchardist. Under his direction the orchards have more than doubled in value during the last 1'ew years., and from this time on each and every year will increas<; the value of their output. Only a trained orchardist can appreciate ihe amount of effort and skill it requires to maintain general orchards and small fruit orchards in successful operation. Spraying several times a year, pruning, thinning of the fruit, search for borers and their destruction, planting of trees, gathering, sorting and care of the fruit, a l l of which must be done in a way to make it of most value to the hospital, is a vast industry, and requires constant supervision to make it successful. During the last season, frequently 60 to 70 patients besides assistants, were engaged in harvesting fruit, and during the canning season, a large number of women patients helped in canning fruit for winter use. All of these things combined to make the farm and its branches a very interesting as well as active business. It requires from I'd to 30 paid assistants all the time, and during the working months not less than 100 men patients are employed in carrying on i i s operations. There were no voluntary admissions during the period. Many patients who would avail themselves of this provision of law, are insane, and cannot be received as voluntaries. We believe that our State hospitals should be open to the treatment of all forms of nervous and mental diseases, and that the only requirement for admission should be some form of guarantee of payment of hospital charges while under treatment. The public feeling toward our State hospitals has greatly changed in ihe last few years, and more patients seek relief at them, and still more would do so if there was not so much publicity attached to it. It would seem the part of Avisdom that the State hospitals with their great equipment, should be used to the fullest extent for the care and welfare of the nervous and mentally afflicted, and that without undue publicity. \Ve believe also that your honorable body should take steps to provide for the separate care of the feeble-minded and epileptic. Quite a large number of both these classes of patients are cared for in the hospitals for the insane. It is unjust to these individuals. We would respectfully urge upon your honor-able body to devote the institution at Lapeer to the care of the feeble-minded, and to provide a separate institution for �2-1 S'I'ATK Ol"1 MICHIGAN. the care of the epileptic. There is a growing belief in the scientific world that both the epileptic and the feeble-minded should be trained and cared for in special institutions, and that these institutions should be on the colony plan, where the home life, schools, industrial training and social life, could be carried on to their best and highest advantage, it is a well known fact that the institution at Lapeer is not large enough to take care of these people, and that our asylums receive many of them. Measures should be taken for their separate housing and support. RECEIPTS AND DISBURSEMENTS. The total receipts of the hospital for the fiscal year ending June 30, 1911, including cash on hand and credits on special appropriations accounts, were f276,468.26; and the total disbursements for the same period, including special appropriations, were $297,806.54. The total receipts of the hospital for the fiscal year ending June 30, 1912, including cash on hand and credits on special appropriations accounts, were $330,489.77; and the total disbursements for the same period, including special appropriations, were $331,506.68. There was at the close of the biennial period ending June 30, 1912, $5,098.85 in the hands of the treasurer; fG9.C9 of which amount was to the debit of the current expense account and the balance of $5,168.54, unexpended balance to the credit of special appropriations accounts. OFFICERS. In 1911, Hon. M. F. Quaintance, of Petoskey, Mich., and Hon. W. W. Mitchell, of Cadillac, Mich., Avere reappointed to the Board. Mr. Quaintance had served as a member of the Board since 1905 and Mr. Mitchell since 1901. In July, 1910, J. A. J. Hall, M. IX, and in August, 1910, E, G. C. Williams, M. I)., were appointed assistant physicians. Both came highly recommended. Dr. Williams resigned his position in June, 1911, to enter private practice in Illinois. In August, 1911, Dr. S. C. Niles was appointed assistant physician. Dr. Niles came highly recommended. It is with great regret that I report the resignation of Mr. C. L. Whitney, who has been steward of the hospital for seventeen years. Mr. Whitney resigned on account of ill health, after many years of faithful and efficient service. The following memorial was presented to Mr. Whitney at the time of his resignation, and only imperfectly expresses the esteem in which he was held by the Board, the officers and all others with whom he was associated at the hospital. Inasmuch as Mr. Whitney, because of his advancing years and the inclemency of this northern climate, has found it best to sever his connection with the institution, we can surely predict his greater comfort and many years of healthfulness in the far distant west. We remember with much pleasure our association with him as trustee while he was a member of this Board from the year 1891 to 1894. His services as steward during the seventeen years of residence in Traverse City have been of very high order. While a trustee he became familiar with many needs of the institution, became impressed Avilh the advantages of a high grade herd of cattle, and �TRAVERSE CITY STATK HOSPITAL. 'J.r> largely through his efforts (he herd of Ilolsteins of this institution has become famous throughout the United States. Mr. Whitney lias also been instrumental in raising the standard of farm products, and the orchards and the greenhouse work have prospered under his directions. As a purchasing agent he has devoted his time to the advantage of the institution. He has been careful, conscientious and at all times laboring for the economical management of this large institution. We are very sorry to lose his services and companionship, but realizing that health and comfort are of supreme importance, our best wishes go with Mr. Whitney wherever he may reside. In January, Mr. Geo. It. Pike, of Manistee, Mich., was appointed steward, to succeed Mr. C. L. Whitney, who had resigned that position. Mr. Pike came to the institution thoroughly equipped by education and by training for the duties of the position. He assumed the duties of Jiis office on February 1, 1.012. He has given eminent satisfaction thus far in his work. In closing this report we can say that we believe that each officer and employe has rendered his best service to the institution. We believe that the institution has grown in usefulness, and Avould most respectfully ask your honorable body to visit it, inspect it thoroughly, and lend vour assistance to its further upbuilding. T. T. BATES, W. AV. MITCHELL, H. C. DAVIS, M. F. QUAIXTANCE, E. S. WAGAR, W. LLOYD, Traverse City, Mich., June 80, 191.2. Trustees. �Young Salisburia Young Pecan Young Coffee TREES ON GROUNDS �STATE OF MICHIGAN. TREASURER'S ABSTRACTS, OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE NORTHERN MICHIGAN ASYLUM FOR THE FISCAL YEAR E N D I N G J U N E 30, 1911, THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of tlie Northern Michigan Asylum for tlic month ending July SO, 1910. By balance on hand July I st, 1 !l 10 'Cash from State Treasurer: Account of current expense Cash from other sources $27 ,454 01 22,47S 94 765 OS $£0,695 06 DTTBIT&. Account of extension south wing Account of improvement, heating anil ventilating Account of current expense Balance on hand to new account : $67 3,087 23,913 23,627 50 31 21 04 $50,695 06 TTIE STATE OF MICHIGAN-, In account with Samuel Garland, Treasurer of lite Northern Michigan Asylum, for the month ending August ,?.', lOto. CREDITS. By balance on hand August 1, 1910 'Cash from State Treasurer: Account of current expense ('ash from other sources $23,627 04 22 ,475 94 760 40 DEBITS. Account of extension to south wing Account of extension to north wing Account of improvement, heating and ventilating Account of current expense ~ Balance on hand to new account $811 255 73 18,307 27,415 45 2:i 85 14 71 $46,803 38 THE STATE OF MICHIGAN, In Account with Samuel Garland, Treasurer of the Northern Michigan rlsylum, for the month ending September $0, 191O. CREDITS. Balance on hand September 1,1910 Cash from State Treasurer: Account of current expense Cash from other sources Account of extension to south wing.. . Account of current expense Balance on hand to new account 827 ,415 71 22,475 94 662 20 $50,553 85 $500 63 22,147 58 27,905 64 .$50,553 85 �TRAVERSE CITY STATE HOSPITAL. 27 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum for the month ending October 31, 1910. f By balance on hand October 1, 1910. Cash from State Treasurer: Account of current expense Cash from other sources 827,905 64 21,156 19 1,027 00 $50,088 83 Account of repairs to reservoir Account of additional fire protection.. Account of extension to south wing... Account of current expense Balance on hand to new account $443 40 1,750 90 25,308 22,495 75 00 85 83 $50,088 83 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending November SO, 1910. 22,495 83 By balance on hand November 1, 1910. Cash from State Treasurer: Account of current expense Cash from other sources 21,028 63 489 21 Account of repairs on reservoir Account of extension to south wing.. Account of extension to north wing.. Account of current expense Balance on hand to new account $843 258 40 21,966 20,903 82 99 70 27 89 $44,013 67 $44,013 67 THE STATE OF MICHIGAN In a'ccount 'With Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending December 31, 1910. By balance on hand December 1, 1910 Cash from State Treasurer: Account of new roof for boiler room Account of current expense Cash from other sources 20,903 89 2,500 00 21,028 63 828 37 Account of extension to south wing... . Account of extension to north wing.. .. Account of new roof for boiler room . .. Account of current expense Balance on hand to new account $526 129 1,753 24,169 18,682 15 52 66 41 15 $45,260 89 $45,260 89 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending January 31, 1911. By balance on hand January 1, 1911 Cash from State Treasurer: Account of current expense Account cash from other sources $18,682 15 Account of extension to south wing.. Account of extension to north wing.. Account of new roof for boiler room . Account of current expense Balance on hand to new account.... £60 75 23,652 64 1,072 14 71 17 22,372 20,885 50 00 54 14 $43,406 93 $43,406 93 �28 STATE OF MICHIGAN. THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending February US, 1911. By balance on hand February 1, 1911 Cash from State Treasurer: Account of current expense Cash from other sources 520,885 14 23 ,652 63 1,574 71 846,112 48 DEBITS. Account of extension to south wing Account of extension to north wing Account of improvement, heating and ventilating Account of current expense Balance on hand to new account $130 15 250 71 4,913 70 22,871 96 17,915 96 $46,112 48 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending March 31,1912, By balance on hand March 1, 1911 Cash from State Treasurer: Account of current expense Cash from other sources $17,945 96 23,078 35 257 04 841,281 35 DEBITS. Account of extension to south wing Account of extension to north wing Account of current expense Balance on hand to new account $88 13 138 57 23,771 43 17,283 22 $41,281 35 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum, for the month ending April 29, 1912. By balance on hand April 1,1911 Cash from State Treasurer: Account of current expense Cash from other sources $17,283 22 20,959 91 966 28 $39,209 41 DEBITS. Account of extension to south wing Account of extension to north wing Account of current expense Balance on hand to new account $592 592 27,905 10,119 39 39 22 41 $39,209 41 THE STATE OF MICHIGAN, In account with Samuel Garland, Treasurer of the Northern Michigan Asylum for the month ending May SI, 1911. By balance on hand May 1, 1911 Cash from State Treasurer: Account of current expense Cash from other sources Account of current expense Balance on hand to new account $10,119 41 20.959 89 817 34 • $22,508 71 9,387 93 $31,896 64 $31,896 64 �TRAVERSE CITY STATE HOSPITAL. S9.387 93 By balance on hand June 1, l u l l Cash from State Treasurer: Account of current expense Cash from other sources 20.959 89 843 91 Account of Account of Account of Balance on 2-1,382 53 6,115 76 $31,191 73 $163 25 new roof for boiler room cold storage current expense hand to new account 530 19 $31.191 73 SUMMARY. THE STATE or MICHIGAN, In account willi Samuel Garland unil A . J. Mai/nanl, Treasurers of the Northern Michigan Asylum for the fiscal year ending June 30, 1011. By balance on hand July 1, 1910 Cash from State Treasurer: Account of new roof for boiler room Account of current expense Cash from other sources Account of repairs on reservoir Account of extension to south wing Account of extension to north wing Account of improvement, heating and ventilating Account of new roof lor boiler room Account of cold storage Account of additional fire protection Account of current expense Balance on hand to new account 827,454 04 2,500 00 263,904 58 10,063 68 81,287 3,126 1,478 8.074 1,933 530 I .750 S303.922 30 22 14 62 86 91 19 75 279.624 85 0.115 76 8303,922 30 �STATE OF MICHIGAN. f ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE TRAVERSE CITY STATE HOSPITAL FOR FISCAL YEAR ENDING J U N E 30, 1912. THE STATE or MICHIGAN, In account with A. J. Maynard, Treasurer of the Northern Michigan Asylum, for the month ending July S I , 1911. By balance on hand July 1, 1911 Cash from State Treasurer: Account of cold storage Account of completion of cold storage Account of completion heating and v e n t i l a t i n g Account of current expense Cash from other sources 22,511 31 615 03 Account of extension to south wing Account of extension to north wing Account of new roof for boiler room. . . . Account of cold storage Account of current expense Balance on hand to new a c c o u n t . . . . . . . SI 38 169 393 190 19,190 29,160 $6,115 76 5.000 00 5,000 00 10,000 00 3G 10 87 25 20 32 849,242 10 $49,2J2 10 THE STATE OF MICHIGAN, In Account willi, A. .7. Mai/nanl, Treasurer of Traverse City State Hospital, {or the month ending Auyust S I , 1911. CREDITS.. By bala net on hand August 1, 1911 Cash from State Treasurer: Account of repairs! and painting roofs. . . Account of current expense Cash from other sources Account of new roof for boiler room Account of cold storage Account of completion cold storage Account of completion heating and ventilating Account of repairs and painting roofs Account of current expense Balance on hand to new account $29,160 32 3,500 00 22,511 31 597 19 $172 4,279 2 812 860 132 20.092 27,418 22 56 50 76 92 27 59 $55.768 82 $55,768 82 THE STATE OF MICHIGAN, In account with A. .1. Maynard, Treasurer of Traverse City Stale Hospital, for the month eiulinu September SO. 1911. By balance on hand September 1. 1911 Cash from State Treasurer: Account of current expense Cash from other sources Account of extension to south wing Account of extension to north wing Account of books and musical instruments. . . Account of completion of cold storage. . . . . . Account of completion heating and ventilating Account of repairs and painting roofs Account of re-roofing cottages Account of current expense Balance on hand to new account $27,418 59 22,511 30 855 22 S79 79 93 25 7,525 850,785 11 75 75 00 00 63 232 70 1,400 00 18,754 00 22,595 28 $50,785 11 �TRAVERSE CITY STATE HOSPITAL. 31 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, tor the month ending October SO, 1911. „ By balance on hand October 1, 1911 Cash from State Treasurer: Account of current expense Cash from other sources $22,595 28 21,452 32 671 66 Account of extension to south wing Account of extension to north wing Account of completion cold storage Account of completion heating and ventilating Account of repairs and painting roofs Account of current expense Balance on hand to new account $250 470 300 3 ,987 220 29,891 9,599 00 00 00 62 46 21 97 $44,719 26 $44,719 26 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for the month ending November 29,1911 \. By balance on hand November 1, 1911 Loan from Traverse City State Bank Cash from other sources $9,599 97 10,500 00 406 94 $20,506 91 DEBITS. Account of completion heating and ventilating Account of current expense Balance on hand to new account $3,210 95 16,802 52 493 44 $20,506 91 THE STATE OP MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for the month ending December SO, 1911. By balance on hand December 1, 1911 Cash from State Treasurer: Account of completion heating and ventilating Account of re-roofing cottages Account of current expense Cash from other sources $493 20,000 2,100 40,904 449 — 44 00 00 62 72 $1,712 10,500 34,156 18,578 — 50 00 56 72 $64,947 78 DEBITS. Account of completion cold storage Account of loan paid to Traverse City State Bank Account of current expense Balance on hand to new account $64,947 78 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospitali for the month ending January 31, CREDITS. By balance on hand January 1, 1912 Cash from State Treasurer: Account of current expense C sh from other sources $18,578 72 23 ,018 71 738 06 $42,335 49 DEBITS. Account of current expense Balance on hand to new account $24,940 52 17,394 97 842,335 49 �32 STATE OF MICHIGAN. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for the month ending February 29,191%. Balance on hand February 1, 1912 Cash from State Treasurer: Account of current expense Cash from other sources $17,394 97 23,018 70 628 25 $41,041 92 DEBITS. Account of completion heating and ventilating Account of current expense Balance on hand to new account $9,706 85 23,239 88 8,095 19 $41,041 92 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for the month ending March SO, 1912. CREDITS. By balance on hand March 1, 1912 Cash from State Treasurer: Account of current expense Cash from other sources $8,095 19 23,018 69 2,419 06 $33,532 94 DEBITS. Account of extension to south wing Account of completion heating and ventilating Account of current expense Balance on hand to new account $132 00 37 80 25,055 43 8,307 71 $33,532 94 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for month ending April SO, 191%. CREDITS. By balance on hand April 1, 1912 Cash from State Treasurer: Account of current expense Cash from other sources $8,307 71 20,894 40 3,034 64 $32 236 75 DEBITS. Account of completion heating and ventilating Account of current expense Balance on hand to new account $4,403 55 25,857 19 1,976 01 $32,236 75 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for month ending May S I , 1912. CREDITS. Balance on hand May 1, 1912 Cash from State Treasurer: It Account of current expense f ! Cash from other sources FH Balance overdrawn to new account IPpp, r V*9 Account of completion heating and ventilating Account of current expense $1,976 01 20,894 39 954 47 3,840 83 $27,665 70 DEBITS. $19 90 27,645 80 $27,665 70 �TRAVERSE CITY STATE HOSPITAL. 33 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital, for month ending June 29, 191&. CHEDITS. By cash from State Treasurer: Account of current expense... . Cash from other sources $20.894 38 389 41) Balance overdrawn on June 1, 1912.. . Account of repairs and painting roofs. Account of current expense Balance on hand to new account $21,283 78 $3,840 S3 130 57 12,213 53 5,098 85 $21,283 78 SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse Citi/ State Hospital, (formerly Northern Michigan Asylum) for the fiscal year ending June 29, 1912. Balance on hand July 1, 1911 Cash from State Treasurer: Account of cold storage Account of completion cold storage Account of completion heating and ventilating. Account of repairs and painting roofs Account of re-rooting cottages Account of current expense Cash loan from Traverse City State Bank Cash from other sources 5,000 5,000 30,000 3,500 2,100 262,630 10,500 11,759 00 00 00 00 00 13 00 64 Account of extension to south wing Account of extension to north wing Account of completion heating and ventilating Account of new roof for boiler room Account of books and musical instruments Account of cold storgae Account of completion cold storage Account of repairs and painting roofs Account of re-roofing cottages » Account of current expense Refund of loan, Traverse City State Bank Balance on hand to new account S600 718 29,753 566 93 4,469 4,850 716 1,400 277,839 10,500 5,098 11 85 06 09 00 81 00 65 00 11 00 85 $6,115 76 $336,605 53 8336,605 5,3 We have carefully examined the accounts of Samuel Garland and A. J. Maynard, Treasurers of Traverse City State Hospital (formerly Northern Michigan Asylum) for the biennial period ending June 30, 1912, and have compared the same with the books and vouchers and verified the same by further comparison with the books of the Steward and hereby certify to the entire correctness of them. M. F. QTJA1NTANOE, THOS. T. BATES, WILLIAM LLOYD, Auditing Committee. 5 �34 STATE OF MICHIGAN. STEWARD'S REPORT. FOR THE BIENNIAL, PERIOD ENDING JUNE 30, 1912. ANALYSIS OF RECEIPTS AND DISBURSEMENTS FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1912. Maintenance, etc.. State patients Maintenance, etc., private patients Farm Sundry accounts Special appropriations: Re-rooflng cottages Repairs and painting roofs Completion heating and ventilating system Cold storage Completion of cold storage New roof for boiler room Repairs to reservoir $526,534 10,473 8,877 12,032 71 97 07 55 2.100 3 .500 30,000 5,000 5.000 2,500 339 00 00 00 00 00 00 73 $606,958 03 DISBURSEMENTS. 1. Officers' salaries $28,580 02 2. FoodWages Meat and Butter Flour Sugar Coffee Tea Miscellaneous foods $16,489 52,215 29,764 15,616 12 ,626 7,115 2,511 30,703 fish S. Clothing: Wages of clerks Cost of clothing 4. Laundry expenses: Wages Soap making Starch Soda Machine Electric irons Tubs and baskets Indelible ink Wax 57 89 94 55 26 71 21 15 f 2,756 90 30,200 65 89,911 63 2 ,502 76 183 41 .">80 10 51701 54 42 98 10 16 90 49 fittings 5. Heating and light: Wages Coal and freight on same Gas Electric supplies Lubricating and other oil Fuel tester Rent of coal shed $7,354 67,829 2 ,126 1,252 89 77 IS 6. Floral, greenhouse and grounds: Wages Seeds Trees Flower pots and boxes Glass Hose Implements Survey of grounds 17 79 18 22 36 65 00 . $4,763 154 178 71 7 167 226 36 17 97 37 38 60 11 56 00 ~. Medical department: Wages Drugs Graduating class pins and diplomas , • $94,946 32 5 873 45 25 00 $23,580 02 167,043 28 32,957 55 13.604 82 78,747 37 5,605 16 100,844 77 �TRAVERSE CITY STATE HOSPITAL. -S. Office, stationery, etc.: Wages Postage stamps Telegrams, telephone and rent of telephones Stationery Printing Blank books Filing cases Index of Joint Board proceedings 3. Amusement and instruction: Music for entertainments . Music for patients' parties Tuning pianos Christmas candy Games Moving picture entertainment Circus tickets Medical books 10. Furniture and household supplies: Wages Dry goods Bedding Mattresses Carpet Furniture Hardware Crockery Kitchen utensils Bedsteads Polish Soap Brooms Toilet paper Baskets and paper sacks Stoves Disinfectant 11. Carriage barn and vehicles: Wages Repairs to vehicles Blacksmithing Repairs to harness Feed Hay 12. Improvements and repairs: Wages Hardware Iron pipe and Iron and castings Paint and oil Lime and cement Sewer pipe and tile Lumber Tools and implements Wall paper Glass 13. Machinery: Machine Valves Fire and steam hose Lubricating oil Belting, etc Packing and gaskets Scale dissolvent Steam charts Calorimeter Pump and boiler Boiler insurance 14. Farm, garden and stock: Wages Feed Hay Straw Cattle Pigs Veterinary Implements Harness Fertilizer Fencing Paris green Seeds Trees and plants Blacksmithing Drain tile Oats Lime — • $7,755 97 720 00 1,060 80 408 15 673 08 107 73 112 40 125 06 S98 113 11 85 87 20 108 93 : fittings 60 50 50 31 85 00 80 90 S3,099 24 9,334 09 1,310 55 471 86 108 52 73 38 2,122 32 1.423 77 433 63 12 72 39 20 1,543 93 809 83 510 59 1192 30 4S 66 00 SI ,369 20 67 23 144 164 fittings 35 53 95 94 75 52 60 S30.5S5 12 1,213 94 2 ,542 97 844 53 3 ,460 65 945 42 175 19 1,513 53 123 10 69 97 256 78 8451 556 f>07 298 82 222 277 31 10 155 ISO 98 88 15 73 05 71 87 68 75 29 00 • SIS, 186 62 13,183 43 5,739 81 601 38 857 78 116 70 196 25 929 14 147 92 92 15 76 03 14 89 773 30 22 85 75 76 57 84 248 64 4 30 $10,963 19 619 46 21,402 03 $1,791 35 41,731 20 2,875 09 �36 15. STATE OF MICHIGAN. Miscellaneous: Wages of watchmen Tobacco Steward's expenses purchasing supplies, etc Superintendent's expenses to Joint Board meetings, etc.. Expenses of pathologist Expenses of examining engineers Telegrams Amounts charged back: Patients' expenses home Elopement expenses Purchases for patients Refunded m oney Undertakers' fees (burial of patients) Treasurer's note Special appropriations: Repairs and painting roofs Completion of heating, ventilating and hot water system. Extension to north wing Extension to south wing Completion of cold storage Re-roofing cottages New roof for boiler room Additional fire protection Cold storage Repairs to reservoir Books and musical instruments $3,416 3,618 235 71 18 219 52 85 16 37 22 71 74 90 227 437 49 796 169 10,500 88 90 76 OS 31 00 $716 37,827 2,197 3,726 4,850 1,400 2,500 1,750 5,000 1,287 93 65 92 47 25 00 00 00 75 00 22 00 §19,813 88 61,349 26 629,313 22 SUMMARY OF INVENTORY, TRAVERSE CITY STATE HOSPITAL, JUNE 30, 1912. $58,240 00 Farm and grounds 868,200 00 Buildings 29,615 50 Stock on farm 6,115 63 Administration building Dispensary 1,667 46 1,254 00 Pathological laboratory 1,188 20 Library and chapel 30,750 55 Wards 2,719 05 Cottage 21 552 79 Cottage 23 3,907 27 Cottages 24 and 26 2,110 00 Cottage 25 3,219 54 Cottage 27 1,722 80 Cottage 28 2,818 53 Cottage 29 2,732 93 Cottage 30 1,527 76 Cottage 31 1,377 81 Cottage 32 2,945 20 Cottage 34 3,030 03 Cottage 36 889 18 Cottage 38 8,174 16 Engine room and shops 3,700 27 Kitchen and bakery Laundry 6.428 64 4,380 48 Farm implements and barn fixtures.. 538 25 Store fixtures 5,685 08 Stock—Clothing 1,269 59 Stock—Boots and shoes 6,962 11 Stock—Groceries and provisions 60 03 Stock—Silver plated ware 1.429 29 Stock—Notions 364 95 Stock—Crockery 812 27 Stock—Hardware and miscellaneous. 2,736 44 Stock—Dry goods • 677 48 Stock—Meats $1,071,803 27 G. B. PIKE, Steward �TRAVERSE CITY STATE HOSPITAL. 37 REPORT OP MEDICAL SUPERINTENDENT. To the Board of Trustees: Gentlemen-—I have the honor to submit for your consideration the following report of the principal events of the hospital for the biennial period ending June 30, 1912. The movement of population has been as follows: TABLE I.—Patients Admitted and Discharged During the Biennial Period, Females. Males. Remaining June 30, 1910 Admitted during period: On original commitment: Public By transfer from State institutions: Public Private State Discharged: Died Remaining under treatment June 30, 1912 Total. 760 624 291 11 1 213 1.384 22 0 504 33 1 6 0 1 0 11 0 1 1 070 864 1,934 25 78 30 155 50 64 26 108 142 56 263 782 616 1,398 0 75 If these statistics are compared with those of the last period it will be found that there were 35 less admissions and two less discharges. If the 26 patients admitted from the Pontiac State Hospital and the Newberry State Hospital districts are counted, there was a net increase of 14 patients under treatment. The percentage of patients discharged recovered of the whole number under treatment was slightly less than for the last period. The smallest number of patients under treatment in any one day was 1,349, and the largest number was 1,412. The death rate was not so great as for the previous period. The following table shows the sex, age, form of disease and cause of death in each case: �STATE OF MICHIGAN. 38 TABLE II. Sex. Female Female Age Nativity, 32 Kentucky New York 92 42 69 85 31 54 80 61 Canada Ohio 68 65 48 29 England. . 40 Female 71 68 35 47 Form of mental disease. Senility Senility Cause of death. Cancer of the uterus Pulmonary tuberculosis Arterio-sclerosis Cerebral apoplexy. Tuberculosis of arm, leg and intestine Organic heart disease, acute nephritis New York . . Senility Cardiac disease. Arterio-sclerosis Acute Nephritis. Indiana . . Sweden Manic depressive insanity 99 79 31 32 83 52 Female 54 65 SO 29 69 Germany . . . Organic brain disease., . Brain syphilis. Senility 45 Female Female Female Female Female Female 58 72 41 66 49 6° 59 64 70 52 65 68 55 56 63 36 67 74 66 71 62 60 Female Female Female Female 55 78 60 70 82 48 47 27 86 74 Cardiac disease Unknown, . . Organic brain disease.. . Gangrene of foot. Michigan . . . Korsakow Michigan , . . Dementia praecox Ohio Ohio Germany . , . Senility Ohio Indiana . . . . Melancholia Canada Paranoid Dementia praecox Maine Ohio Ohio Michigan . . . Melancholia Canada Senility Poland Penn N Brun. . Dementia praecox Melancholia Senility Organic brain disease. Pulmonary tuberculosis Apoplexy.t Cardiac disease Intestinal obstruction. Intestinal tuberculosis. Cardiac disease. General tuberculosis. Pulmonary tuberculosis. Cancer of the breast. Pulmonary tuberculosis. Pulmonary tuberculosis. Arterio-sclerosis. Arterio-sclerosis. Gastro-enteritis. Apoplexy. Acute nephritis. Acute nephritis. Strangulation, by another patient. �COURT-HOSPITAL FOE, MEN LAKE AND COTTAGES FOR WOMEN �TRAVERSE CITY STATE HOSPITAL. TABLE II.—Continued. Sex. Age. 28 43 49 73 Female Female 41 82 37 Female 82 43 75 Female Female Female Nativity. Unknown.. . Dementia praecox Michigan . . . Organic brain disease.. . Organic brain disease.. . Italy Ohio Canada Russia New York . . Organic brain disease... Apoplexy. Organic brain disease.- . Apoplexy. Ohio Gastroenteritis. Senility Acute dilatation of the heart. Norway . . . . Paranoid 71 67 84 22 68 Senility New York . . Paranoid Pernicious anemia. Cardiac disease. Wisconsin . . Manic depressive Ohio Senility Cancer of the uterus. Michigan . . . Dementia praecox Canada Senility Paresis Manic depressive Ohio Pulmonary tuberculosis. Apoplexy. Paretic seizures. Exhaustion from delirium. Sweden Ireland Michigan . . . Germany. . . Cardiac disease. Cardiac disease. Apoplexy. Intestinal obstruction. 34 74 47 34 48 Female 59 38 70 47 Art erio- sclerosis 46 Female Female . . . Female Female Female Male Male Exhaustion and delirium. Manic depressive General paresis. . . . . . . . Paretic seizures. Status Epilepticus. Epilepsy 48 58 69 51 Female . . . Female Arterio-sclerosis. Septicemia following childbirth. Pulmonary tuberculosis. Canada Canada 57 Female Female Senility Toxic Dementia praecox Pulmonary tuberculosis. Pulmonary tuberculosis. Organic brain disease. Organic brain disease. Cardiac disease. 3^ 39 38 35 fi<> Female Cause of death. Form of mental disease. 36 38 59 63 Senility Manic depressive Paranoid Dementia praecox Dementia praecox . Michigan . . Dementia praecox Unknown. . . Manic depressive Michigan . . . Dementia praecox 71 Ohio 73 40 60 39 New York. . Senility Ohio Scotland.. . . Manic depressive New York. . Paresis Apoplexy. Pernicious anemia. Organic heart disease. Acute dilatation of the^heart. Paranoid Apoplexy. Pulmonary tuberculosis. Paretic seizure 68 Michigan . . . Epilepsy New York, - Arteno-sclerosis Male Male Male Male Male 34 80 Male Male Male Male Male . - 71 58 62 53 61 Male . Male Male Male Male 85 73 54 77 73 Poland. . . . Organic brain disease.. . Organic brain disease. Arterio-sclerosis Canada Organic brain disease. Male Male Male Male Male 43 51 21 Michigan . . . Paresis 32 76 59 . . 37 69 Epileptic seizure. Senility Paresis Holland. . . Senility Canada Organic brain disease.. . Paretic seizure. �STATE OF MICHIGAN. 4.0 TABLE II.—Continued. Sex Male . Male Male Male Male Male Mal<; Male . Male Age 51 64 :. 77 23 81 Nativity. Form of mental disease. Cause of death. Michigan . . . Canada Senility Chronic bronchitis. England.. . . Senility Cardiac disease. New York . . Senility New York . . Manic depressive Bright 's disease 76 29 41 59 60 59 Male Male Male Male Male 24 66 Michigan . . . Epilepsy.. . Suffocation during convulsion. . . . 44 Male Male Male Male Male 82 50 40 78 68 Unknown.. . Arterio-sclerosis Cardiac disease. Male Mole Male 63 56 71 75 54 Male . . . 41 Male Male Male "Male Male 63 64 . . . 50 54 69 Male 51 65 Male Male Male 61 38 58 Male 72 42 47 25 26 Male Male Male Male Male 80 38 Male 72 55 74 Male Male Male 64 44 41 N. Carolina. Organic brain disease.. . Bright 's disease. Norway . . . . Organic brain disease.. . Lobar pneumonia. Wisconsin . . Organic brain disease.. . Apoplexy. Senility Suicide by banging. Sweden Dementia praecox Cardiac disease. Organic brain disease. Maine Organic brain disease.. . Organic brain disease. Paretic seizure. Canada Paresis Michigan . . . Exhaustive influences. . Cardiac disease. New York. . Organic brain disease.. . Bright 's disease. Organic brain disease. Unknown. . . Arterio-sclerosis Canada. . . . . Paranoid Intestinal obstruction. Michigan . . , General paresis Paretic seizure. Organic brain disease. Paretic seizure. Cardiac disease Arterio-sclerosis Perm New York. . Organic brain disease.. . Arterio-sclerosis. Apoplexy. Michigan . . . Manic depressive Organic brain disease.. . Apoplexy. Holland Pulmonary tuberculosis. Michigan . . . Paranoid Ohio Senility 84 56 Male Mal^ Male Male Male Male 35 69 48 49 Male Male Male Male Male 50 25 32 30 Male Male Male Male Male Michigan . . . Organic brain disease.. . Organic brain disease. Canada Arterio-sclerosis Organic brain disease. Vermont . . . . Arterio sclerosis Bright 's disease. 63 66 50 81 70 61 25 Paretic seizure. Michigan . . . Epilepsy Norway . . . . Senility Michigan . . . Paresis Exhaustive influences . . Organic brain disease. Pulmonary tuberculosis. Organic brain disease. Paretic seizure. Bright 's disease. Unknown.. . Paranoid S Dakota . . Epilepsy Michigan . . . Paresis Organic brain disease.. . Organic brain disease. Pulmonary tuberculosis. Pulmonary tuberculosis. Paretic seizure. Internal hydrocephalus^ Sweden Senility Dementia praecox Paretic seizure. Organic brain disease. Acute dilatation of heart. Dilatation of the colon. Pulmonary tuberculosis. �TRAVERSE CITY STATE HOSPITAL. 41 TABLE II.—Continued. Sex Age. Nativity. Form of mental disease. Cause of death. Male Male Male Male Male 31 76 53 76 83 Michigan . . . Imbecility Brain abscess. New York . . Senility Killed by fall when attempting to escape. Canada Organic brain disease.. . Bright's disease. Male 57 83 49 Paresis New York . . Senility Senile exhaustion. Male 68 64 Scotland.. . . Senility Senile exhaustion. Male Male Male Male Male 33 72 Michigan . . . Dementia praecox Ohio Senility . Pulmonary tuberculosis. Cardiac disease 77 49 Bohemia . . . . Senility Cardiac disease. Male . Male Male Male Male . 63 32' 55 70 85 Vermont.. . . New York . . Sweden Norway . . . . Denmark . . Cardiac disease. Exhaustion from delirium. Status Epilepticus. Pulmonary edema. Suffocation during convulsion. Male Male Male , Male Male 66 28 68 49 59 Illinois Male . Male Male Male Male 54 63 51 Denmark . . Organic brain disease.. . Norway . . . . Manic depressive . . . . . . New York . . Arterio-solerosis Organic brain disease.. Canada Male Male , Male Male Male 35 Male Male Mate Male Male Male Male Male Male Male Male Male Male Male Male MalP . . Male... Male Male Male Male Male Male Male Male Male. Male Male Male 70 69 70 40 71 56 24 New York. . Organic brain disease.. . Organic brain disease. Ohio Senility.. Manic depressive Epilepsy Dementia praecox Epilepsy Senilif v Arterio-sclerosis Acute dilatation of heart. Oangrene. Senility Senile exhaustion. Arterio-sclerosis. Lobar pneumonia. Organic brain disease. Brain syphilis. Lobar pneumonia. Ohio . . . Organic brain disease.. . Apoplexy. Manic depressive Cardiac disease. Indiana . . . . Tuberculosis, intestinal. Dementia praecox 97 Michigan . . . Epilepsy Finland Michigan . . . Arterio-sclerosis Pulmonary tuberculosis. 89 50 Holland.. .. Arterio-sclerosis Arterio-sclerosis Canada Organic brain disease. Organic brain disease. 36 Paretic seizure Holland . . . . Paresis Arterio-sclerosis Organic brain disease. Exhaustive influences. . Bright 's disease. Cardiac disease. 22 40 63 Epileptic sei/ures. Organic brain disease. 3S 60 Ohio Michigan . . . ! 75 80 48 Michigan . , . Paresis Michigan . . . Dementia praecox Paretic seizure. Pulmonary tuberculosis. 65 78 Ohio Bright 's disease 55 63 5° Senility Arterio-sclerosis 63 84 42 59 Canada 40 Unknown. , . Paresis 63 35 Organic brain disease. Denmark. . . Organic brain disease.. . Apoplexy. Michigan , . . Organic brain disease.. . Brain syphilis. Paretic seizure. Apoplexy. Pulmonary tuberculosis. �STATE OF MICHIGAN. 42 TABLE II — Concluded. Sex. Male Male Male Male Age. 63 38 35 10 Nativity. Form of mental disease. Cause of death. New York . . Paresis Paretic seizure. Wisconsin . . Dementia praecox Michigan . . . Epilepsy Cardiac disease. Diphtheria �TRAVERSE CITY STATE HOSPITAL. 43 SUMMARY.—Showing Causes of Death. Male. General Diseases: Pulmonary tuberculosis . . 37 i •i General tuberculosis.. . . Diabetes i Exophthalmic goitre Diseases of Circulatory System: Arterio-sclerosis ... r. 31 3 I 1 1 3 10 1 ... General paralysis 14 -. Diseases of Respiratory System: Lobar pneumonia Total. 3 Diseases of Nervous System: Paresis Cerebral hemorrhage Epilepsy Insanity—exhaustion from. Syphilis of brain Septo-meningitis Aphasia Post apoplectic Hydrocephalus Acute dilatation Female. 1 9 ->• 4 1 1 { 19 13 ,s 97 10 Diseases of Digestive System: Dysentery Diarrhea and enteritis Intestinal obstruction Diseases of Genito-Urinary System: Acute nephritis Chronic nephritis Cancer of uterus Special Senses: Mastoiditis... Violence: Suicide by hanging Suicide by drowning Suffocation—convulsion... Homicide—other patient... Fall from window—escape. Totals. 1US 2t;:i �44 STATE OF MICHIGAN. One hundred forty-nine patients or 56% of those who died were over 55 years old, 19 were between 80 and 90, and 1 was over 90. The deaths from tuberculosis were 14.1% of the deaths from all causes,—2.6% less than during the former two years. The fact that there were 8 less deaths from tuberculosis than during the former biennial period is encouraging to greater preventive efforts. Syphilis caused nearly as many deaths as tuberculosis, and arterial degenerations and organic disease consecutive to it (heart, kidneys, etc.) caused 33% of the deaths. Disease of the circulatory organs is the cause of much of the mental disease seen in our patients beyond the age of 50. A glance at the above summary will show that nearly 90% of all the deaths were due to organic and incurable diseases. The following table showing the forms of mental disease is no longer in use, but is inserted to show the classification of patients up to June 30, 1906, since which time a modification of the well known classification of Kraepelin has been in use in all the asylums of Michigan. �TABLE III. From the beginning to July 1, 1906. Forms of insanity. Males. insanity (dementia monomania) < ?' Delusional Dementia (terminal) 31 162 117 216 158 378 275 29 58 1 2 30 60 Syphilitic f 3> General paralysis { bc.- Dementia from gross brain lesions (apoplexy, tumors, etc.) i d. Dementia of senility [c. Delirium grave 16 212 HI 180 17 8 36 53 124 16 24 248 194 304 33 f a . Neurasthenia J b. Hysteria Hypochondria Id. Kpilepsia 161 3 13 191 233 85 6 113 394 88 19 304 ( a . Periodical insanity Reasoning insanitv < Paranoia Moral insanity 104 1 425 1 117 II. Primary forms 299' 6 221 1 724 7 III. Arrest of development j » ' Imbecility Idiocy 140 4 81 1 221 5 1 1 1,884 4,190 A Incident to the normal brain II. Secondary I. Toxic (jilcoliol opium) . B. Incident to the normal and the degenerate brain II. Symptomatic of organic disease of the brain C Incident to the degenerate brain 206 94 422 182 1 54 T P r1i m i. 1 11 ui niiir y r f a . Melancholia Mania Dementia Id! Hallucinatory delirium (primary confusions! insanitv) . . I. Developed on the neuroses / a Acute. \- Chronic c. U • -. D Not insane voluntary cases Total Total. 216 88 1 23 ' . JA^ • Females. 2,306 �TABLE IV.—Showing the forms of insanity of patients admitted. From the beginning. For the biennial period. Males. Females. 1. Alcohol Thyrogeme insanity p Manic depressive Arrested mental development Total ... Total. 9 22 31 1 8 1 10 1 72 12 41 89 128 9" 1 19 5 25 24 51 9 24 31 2 11 1 19 2 91 17 08 113 179 87 122 18 10 33 65 27 19 13 45 2 22 55 66 7 54 138 72 27 21 25 1 109 177 84 17 87 203 99 46 34 70 3 4 | (2) Arterio-sclcrotic brain disease 20 6 (4) Other forms related to neurology '. . . '. 18 30 (5) General paralysis 31 . (6) Senile insanity $ Cretinism.. .' ! . . . . 1 ! ! ! ! . ! ! ! ! ! ! ! ! ! ! f (1) Hebephrenic forms 22 44 3 [ (3) Katatonic forms 3 J (1) Classic type 16 21 (1) Manic state 7 . . . - (2) Depressed state 10 [ (3) Mixed state 6 26 {§) Idiocy0'.^' "]"[\]'.'.'.'.'.'.'.'.'.'.'.'.'.'.'. 6 3 11 6 21 26 9 29 36 52 7 23 15 3 15 45 25 8 11 11 29 67 18 6 31 06 32 18 17 37 1 1 5 5 17 16 33 62 52 114 1 1 2 6 11 17 1 2 3 7 3 1 6 Organic brain disease (definite structural changes) Males. Females. 2 9 7 1 5 1 10 \. Acute alcoholic hallucinosis 1_ c . Alcoholic paranoid conditions 2 8 7 Total. 1 1 2 2' 1 3 2 4 6 3 4 310 240 550 988 702 1,640 �TRAVERSE CITY STATE HOSPITAL. 47 Table 4 shows that 27% of the patients admitted were suffering from organic diseases, 20% from dementia praecox, 6.7%. from paranoia and paranoid states, G%. from epilepsy, 21% from manic depressive insanity, 3.5% from alcoholic insanity, and 6.4% from arrested mental development. This analysis does not show that there has been any marked increase in the various forms of insanity classified, save perhaps in the imbecile group. It is becoming increasingly evident that the segregation of the feeble minded is a matter of the utmost importance to the social welfare, and that a most definite economy would be secured by providing adequate accommodations. Your honorable body has suggested the desirability of increasing the accommodations at Lapeer and the desirability of establishing separate care for the epileptic and feeble minded, and there can be no doubt that both these classes of patients should receive care in institutions especially devoted to their education and training. During the period a great deal of clinical laboratory work has been done as well as some more important work along research lines. The Wasserman test, which was just coming into use at the close of the last period, has become a part of the routine in the examination of certain patients. It is of the utmost value in the diagnosis of paresis and other diseases of Inetic origin. During the last period there were 379 urine analyses made. Of these analyses, nephritis was found 50 times, glucosuria 14 times, pus 53 times and red blood cells 12 times. There were 93 blood examinations made, in which secondary anemia was found 14 times, pernicious anemia 3 times, surgical leukocytosis 7 times and polycythemia once. The blood pressure was taken in 206 patients. Hyper tension was found 80 and hypo tension 10 times. Of the very many sputum examinations the tubercle bacillus, pneuinococcus, influenza bacillus, were found in a number of cases, and coccidia was found in one patient. The patient in whom the coccidia was found presented many of the symptoms of tuberculosis, but upon examination was found to be suffering from this peculiar infection. He had been in the habit of caring for rabbits and it is supposed that he contracted this infection from these animals. Forty bacteriological examinations were made. In smears streptococcus pyogum were found in 6, staphylococcus 5, pneumococciis 3, colon bacillus 3, tubercle bacillus 2, diphtheria bacillus 1, gonococcus 2, unidentified 2. CULTURES. Streptococcus pyogum 5, staphylococcus 6, pneumococciis 1, colon bacillus 2, diphtheria bacillus 1, unidentified 1. There were 20 autopsies made during the period. Organs from each case were examined pathologically. Brains and spinal cords were sent to Ann Arbor for examination. The Wassermau blood examination was made 108 times. Positive reaction 37. Negative 46. Doubtful 25. Wasserman, spinal fluid, was made 32 times, positive 21, negative 12 times. Spinal fluid examinations 35, lymphocytosis was found in 22 cases, increase of albumin in 22, Nonne-apelt reaction 22. Negative 10. There were 4 stomach analyses made. Achlorhydria was found in 2, normal in 2. WidaPs test was made in 2, both negative. Vaccines were prepared from staphylococcus, streptococcus and colon bacillus. �48 STATE OF MICHIGAN. During the period the following surgical operations were performed: Xo. of cases. Appendectomy 1 Cataract ...'. 1 Cellulitis 12 Cervical abscess 1 Circumcision 2 Empyema ,. 1 Fracture (ribs) 2 Fracture (humerus) 1 Fracture (femur1') 5 Fracture (Colles) , 3 Hemorrhoids 2 Laparotomy for tuberculous peritonitis 1 Necrosis of malar bones 1 Thyroideetomy 1 Tonsillotomy 8 Varicocele 1 During the period there were two obstetrical cases and 65 gynecological examinations. The work in the training school for nurses has been carried on with increased effort. The courses of instruction have been extended and the teaching has improved with the increased experience of the staff. There were 21 graduates, from the school in 1911 and 9 in 1912. A roster of the graduates of the school is appended to this report. The work in each of the departments of the hospital has never been more carefully supervised or more strict economy practiced in their management. The medical care of patients has been thoughtful, and nothing has been left undone that was believed would promote the recovery or wellbeing of an individual. The scientific work, as before mentioned, has been pursued with interest, and we believe that as much has been done for patients as could be reasonably demanded. The following tables will present a brief analysis of the forms of mental disease of the patients admitted during the period. Each group of the insanities is shown, with the number admitted, men and women. the percentage of each sex to total admission, and other statistics that may prove of clinical interest. MANIC DEPRESSIVE INSANITY. There were admitted 38 men and 78 women who were placed in this group, representing of all cases admitted. Women. Men. No. Total admissions Manic depressive insanity Per cent. 310 38 No. Total. Per cent. 78 Per cent. 550 240 12.2 No. 32.5 116 21 �to t" >-i h-i to O . ! C3 : : : : : <] : : . . ! M Oi . O to ^ O H-t O M ~-J Cn t^ *—' GO tO 01 Total. Female. Male. Total Female. o H* Male. Oi • h-" Male. Total. Female. Male. Total. Female, Male. Oi CO • H-J 1 Total. to h- : ~ O" . . : CO M M : Ci Oi IO CO 10 71 ' . . P i-j p^ P §- : : : : H i | ii ? 3 § &U a 1 o • £ o ai* £-" 3 $ ~ % % 5 S s E » 2 £. f ct> 9 n r1* P 0 §" Sli K 2 ^ >• H i—i hH o y 1^ « | y O O O O O O O O O O = O W O o E N S M W C D S w O f r O T O O ^ O . C O O - J W M O C n O C ' O C T ' O O i O C r ' O O i ^ °f H3 3 & ^ P" 0 s S. a s a <>*• ^- '•Q O) 1-* 00 CO t-j 00 ^ IO Oi t-' O ~~J tO i-i *-! CO (O ^ ^ *^3 Oi M Oi d rfi 10 O' Oi —— *-! -— H-» CO IO h- . s?o 3 3- o 1 p 2 o % ^ o . o E. H 2 ^ & d ° S B i S o 0 ^ o CT( § ^ ( (^O P o ,S* § S Qj g- ' ffp P <J> P 5 tr ^ r+ (IS ft- JJJ d $ 2* «D ^ u_( S j-3 t> 0 tri J^ Ed 1 J 2 at a 3 S' rt " S" CL. ^ r^ CO H ^ B 5 *C! << S B' d 2 » H * f± 2_ r+ a-il w >S fD CfQ ^ ^ p PJ �STATE OF MICHIGAN. 50 Iii 65 of the 116 cases belonging to this group, hereditary predisposition was present. In 25 heredity was denied, and in 26 it was unknown. Heredity was present in 56% of the cases in which this factor could be determined. Therefore it becomes one of the more important predisposing causes of this type of insanity. The percentage corresponds closely with our records of the previous biennial period, and quite closely with the statistics of others both at home and abroad. The following table shows the result of treatment: MANIC DEPRESSIVE INSANITY. Results of treatment. OJ B ^ ^ Recovered . . . . . . . 6 5 Unimproved Died Is3 a s<5 h EH 28 11 3 2 8 2 2 8 12 21 4 | S3 a^ 2 3 6 8 2 1 1 4 4 1 12 i. 4 1 1 i aj oj _o; oj 22 1 9 o Total. Mixed. DepresrDepressive. Manic. 1 7 g C3 "5 o o3 O H B fe 4 10 24 34 2 9 9 18 E- 3 3 1 9 11 13 1.1 17 31. 48 Of the 38 men admitted suffering from manic depressive insanity 26.3% were discharged recovered, 23.6% improved, 5.2% died and 44.7% remain in the hospital. Of the 78 women admitted 30.7% were discharged recovered, 11.5% improved, 4% unimproved, 14.1% died and 3i).6% remain under treatment. Of the 116 cases, 30% were discharged recovered, 15.5% improved, 2.3% unimproved. 11.2% died, and 41.3% remain under treatment. ALCOHOLIC IN«ANITY. In this group 16 men and 1 woman were placed, comprising 3.9% of the cases admitted during the biennial period. Women. Men. No. Per cent . Per cent. 5.1 1 No. Per cent. 550 240 310 1C No. Total. .4 17 3.9 These 16 men constituted 5.1% of the males admitted; the females .4% of the women received. �TRAVERSE CITY STATE HOSPITAL. 51 The 17 cases were placed as follows: Men. No. Acute alcoholic hallucinosis Alcoholic paranoid conditions Total. Women. Per cent. 9 12 5 7 43 . 75 7 43 . 75 Per cent. No. 1 Per cent. No. 100 2 11.7 8 47.1 7 41.2 Age at time of admission. Women, Men. 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 Total. 2 2 4 4 1 1 9 9 •} 3 I 1 3 3 1 1 In only 6 cases were there positive hereditary factors. Three cases had no hereditary taint. The remainder are classed under the head unknown. *s J3 c3 Jsl 1 Apoplexy or paralysis. . . 4 "ee o H _o5 "eS S CO 1 OJ s« Female. <g c3 S Total. 1 1 4 4 1 1 ! ; .' S H Female. *e3 Brothers and sisters. Collateral. Female. Atavistic. Female. o « !§3 Female. Direct. 3 J_ i 4 1 3 1 �STATE OF MICHIGAN. 52 Results of treatment. _ Recovered Women. Men. Total. . 5 i Died Remaining 1 .. . . . 3 1 1 4 KOKSAKOW S PSYCHOSIS. One woman with the following history, appeared to be a fairly typical case of Korsakow's psychosis. She was a widow 65 years of age. Father died at the age of 55 of epilepsy. Mother died at the age of 88 from senile deterioration. The causative agent was typhoid, which occurred nine years previous to her commitment. She had evidently had neuritis. The reflexes were abolished. Mental characteristics: Marked memory disturbance for recent events. She died after a residence of a little over six months in the hospital. Autopsy was not permitted. MORPHINISM. There were received four men and two women with a history of having been addicted more or less to the use of opium. One of the men had been here several times previous. The other three were first admissions. Two of the four men were physicians. One Avas a very old man, aged 76, a farmer, who had taken opium in small quantities for a great many years. The other a young man, 26 years of age, who, as the result of ill health, had been addicted to the use of morphine and occasionally cocaine. All four men, after a short stay in the institution, were discharged apparently up to their standard. Two women, aged respectively 42 and 33, married; the former, with a history of the father having been an excessive drinker of whiskey, and strong tubercular strain in the family, had been a user of morphine more or less for a number of years. After remaining in the institution three months she left apparently without any desire for the drug. The latter, aged 33, had used opium more or less for some time. She was discharged after a year's residence very much improved. One patient, a male, had been addicted to the use of cocaine for a great many years. He had had some chronic affection of the throat and by the use of the drug his voice had been more or less rendered husky, so that he was unable to articulate clearly. On three occasions he had been discharged, and after a short time returned. He is still a patient in the institution. �O fj1 ^ "O g : : : : ~ : _ : : : ' : ; : "" Co • - • 10 Ol M • • \-i i - to W ** : : : : : > - • : : - : ' : > - : : Total. Female. Male. Total. Female. Male. Total. Female. Male. Total. Female. Male. Total. Female. Male. i f : 3 | o • B0 »; §-o, g-o a& §S-' 3 » s r— CD p" W M o o 3•" < > 3 O a . to tO • . o (-> H-. o to tO o . • o . H- K-i o to tO (_• o • • o • • o (-- (-• o s s p s p s s s g p o g § g § f e g £ § £ § r- H o e-t- £- (T Si p ^ o' 3 a* — «• 1 a_ t g £. O 00 0 O3 ^ to • 0 01 - 0 to • ^ i Oi CO 1 : 1: 5 : § i& 2. p § p- w f | o 3 a 2 o (D hd o ^H I 0 <? p i p , 1 t-< [^ '—' ™ o H .3 5° 1' sc 03 §. £4 •^ 1-15 0 ^-5? 0> d ^ o § FH bo 3 ^ H j_i >• d ^2 5< o « !xj H G 3 ^ JJ ° _ O s5 g g ^ pj s C3 ^ H ^| 8 8 M > j^ W o Q2 f> w H H ^ ^^ M ° M |"H. | » o1 CO S> 1—1 -^ *-* p0 ^ P' M ft> O '2. £• 5t , ^ 1-3 H» �54 STATE OF MICHIGAN Results of treatment. Male. Died Female. Total. i 2 3 1 1 9 4 1 5 ORGANIC GROUP. This group in all its forms, comprises 27.8 per cent of the admissions for the biennial period. Women. Men. No. Per cent. 310 106 34.2 No. Total. Per cent. 240 No. Per cent. 550 15.4 47 153 27.8 The cases were placed as follows: Women. Men. No. Per cent. 21 19.8 6 18 30 5.7 16.9 28.3 29.3 No. Total. Per cent. No. 12.8 6.4 27 9 23.4 12.8 44.6 29 36 52 Per cent. 1 Other forms related to neurological changes . . Senility . . . . 31 6 3 11 6 21 17.7 5.9 18.9 23.5 34 �TRAVERSE CITY STATE 55 HOSPITAL. Age at time of admission. Male. Total Female. 1 Up to 94 1 25 to 21 4 4 30 to 34 4 2 6 35 to 39 9 3 12 1 S 0 2 8 7 1 8 12 5 17 13 5 18 9 6 15 15 8 23 19 10 29, 40 to 44 45 to 49 50 to 54 . 55 to 59 60 to 64 65 to 69 . . 70 to 74 s Heredity. i I Direct. Brothers Atavistic. and Collateral. S a.' _J is d "3 S £ £ H a 2 Insanity 6 6 12 Apoplexy or paralysis. . . 8 2 10 9 9 9 8 6 Total. sisters. | _• ^ H a J£ s 2 6 F—j fc( 2 8 2 •ap oi £ o •4^ ^j -S ,2 o H 5 2 • £ M s £ 7 16 13 29 2 10 2 12 2 3 1 Unknown O H 6 2 61 25 86 12 4 16 Results of treatment. Arteriosclerosis. Brain tumor. A 1 i 1 cS £ i Forms related to neurological. Brain syphilis. , S i £ M £i 3 -ag H S 1 pq General paralysis. S # S 1 1 Senility. 1 S ^ Total. | 1 & 3 1 S •i • cS 1 i2 11 Recovered 1 4 1 1 i 1 1 13 2 15 2 i 1 1 s 5 2 7 1 2 3 3 Improved Unimproved. . . Died Remaining .... 2 1 4 8 I 3 11 10 1 8 7 15 16 1 4 1 5 10 2 2 2 (i 5 1 5 1 11 q 12 ! 21 I 42 19 4 20 18 6 i 24 48 21 61 69 �STATE OP MICHIGAN. 56 DEMENTIA PUAECOX. There were 114 patieids placed in this group or' 20.7'/< of the admissions. Men. Women. No. I Percent. Total admissions No. Total. Percent. 240 311) Dementia praecox No. Percent 550 45 18.7 I 114 The following represents the types of dementia praeoox: Men. IKatatonic , Women. No. Per cent. Total. No. Per cent. No. Per cent. 22 31.8 15.5 29 25.4 44 63 . 8 23 51.2 07 58.8 3 4.4 15 33 - 3 18 15.8 Age at time of admission and at beginning of disease. Age at beginning. Female. Male. 15 to 19 . . . 20 to 24 . . . 25 to 29 30to 34 . . . Total. Male. Female. 1 S 7 1 12 26 13 7 10 9 19 10 8 18 15 10 10 20 23 8 40 to 44 23 17 6 1 3 3 6 1 4 5 4 9 . 4 3 .50 te 54 2 2 4 55 to 59 1 1 2 1 2 2 1 . 6 8 20 1 45 to 49 60 to 67 Total. 14 16 35 to 39 Age on admission. 6 12 1 5 1 �s s 3 i OS 5 M I W rt CO CO CO o t-H IO I c; Tt< TRAVERSE CITY STATE HOSPITAL. wx •aprasji I $ 4 1" 1 57 �STATE OF MICHIGAN. Average age at beginning. Male. Female. 25 6 29 31 4 34 1 94 28 8 Results of treatment. '. Paranoid. £ H I Female. Hebephrenie . 3 9 15 12 _oj Katatonic. 13 9 o H Recovered Improved Unimproved . . Died 6 ... 2 Total. 'tf "o H ^ s 2 2 19 42 19 o 2 4 6 23 H 4 1 5 7 5 12 1 2 12 7 2 1 3 3 1 4 3 3 5 5 10 12 19 5 24 5 5 29 12 41 10 1 2 PARANOIA AND PARANOID STATES. In this group 20 men and 18 women were placed, representing 6.9% of all cases admitted. Men. No. Women. Per cent. Total. Per cent. No. 240 310 20 6.4 No. Per cent. 550 18 7.5 6.9 38 The 20 men constituted 6.4% of the males admitted, the 18 women 7.5% of the females received during the biennial period. The 38 cases were classified as follows: Men. No. VCornell. Per cent. Fetal. No. Per cent. No. 16J 83i 6 16 32 84 3 15 3 17 85 15 Per cent. �TRAVERSE CITY STATE HOSPITAL. 59 Age at time of admission. Male. 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 Female. Total. 1 ; . 1 1 1 4 50 to 54 55 to 59 60 to 64 3 7 2 6 2 5 7 4 2 6 4 7 1 1 3 65 to 69 1 1 1 1 Heredity. 2 1 2 6 4 6 1 5 3 30 EH s "03 "o H 4 2 6 1 "3 g 3 1 4 _0 "3 1 S Female. 3 3 o5 srt Total, Female. Insanity Apoplexy or paralysis. . . Psychopathic 13 1 Brothers and sisters. Collateral. Female. I*H Female. d 3 Female. Atavistic. Direct. 10 5 _OJ 13 "5 "o H 15 3 2 8 10 ] 3 1 1 2 2 4 6 8 10 Recovered. Improved Unimproved Died .. .. ... *c3 "o H Paranoid states. Total. 1 1 g Female. <D 1 Female. Paranoia. Female. Results of treatment. 5 1 5 10 2 3 2 12 11 23 OJ 1 •3 13 1 1 ^ , .. . . . i i 2 1 4 1 4 2 2 i 2 3 11 9 8 2 2 20 �STATE OF MICHIGAN. 60 MELANCHOLIA. There were admitted 2 men and 12 women who were placed in this group, representing' 2.5% of the whole admissions. Men. No Women. No. Per cent. 310 Per cent. No. 240 2 Melancholia Total. 550 12 .6 Per cent . 14 5 2.5 Age on admission. Male. Female. 1 1 1 3 5 5 5 1 1 1 I 1 40 to 44 45 to 49 . . . Total. . 50 to 54 2 . 55 to 59 60 to 64 65 to 69 , Heredity. Brothers <U ~ "rf 7s 1 Insanity 1 1 Apoplexy or paralysis. . . 1 1 Unknown jU r*t T5 1 JH 1 1 Total. sisters. 3 <3 H 1 ci Is § Female. "3 and Collateral. Female. jg "as H Female. Atavistic. Direct, 2 "3 ^o5 Ta 1 2 1 1 0) c8 C3 £ J_ 4 4 1 1 4 5 3 4 �TRAVERSE CITY STATE HOSPITAL. Results of treatment. Female. Male. Recovered Improved Unimproved Died Remaining 1 . 1 Total. 1 1 4 5 2 2 2 3 3 3 DEFECTIVE DEVELOPMENT. Imbeciles and Idiots. In this group were placed 26 men and 11 women, representing 6.7% of the cases admitted. Women. Men. No. Per cent. 310 26 S.4 No. Total. Per cent. 240 11 No. Per cent. 550 4.5 6.7 Age on admission. Male. 10 to 14 15 to 19 ">0 to 24 ?5 to °9 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 Fern ale. 1 1 6 6 2 9 1 3 2 2 3 3 Total. 3 2 1 4 2 3 1 4 1 1 1 1 �62 STATE OF MICHIGAN. Heredity. Atavistic. Direct. 0 r& i « a is i •3 o o> 3 S3 6 Brothers and sisters. Collateral. •3 <p 9 "3 <D cs P H En H « N 1 1 2 0) 2 H a 1 1j H 1 6 6 6 1 3 1 6 G 6 16 10 6 7f o i 6 10 P fe a 2 1 None •3 o J 1 Total. I 2 6 C 16 Results of treatment. Female. Male. Total. NO 8 Died 1 9 10 26 2 9 16 EPILEPSY. In this group are 17 men and 16 women, representing 6% of the cases admitted during the biennial period. No. Per cent. 17 No. Per cent. 5.4 16 No. Per cent. 550 240 310 Epileptics Total. Women. Men. 6.6 33 6 �TRAVERSE CITY STATE Age at time of 63 HOSPITAL. admission. Male. - Female. Total. 10 to 14. . 2 2 15 to 19 2 2 20 to 24 ^ 2 25 to 29. 4 7 2 4 30 to 34 3 35 to 39 2 40 to 44 1 45 to 49 5 . . 1 2 2 4 50 to 54 2 2 55 to 59 1 1 60 to 64 . . 65 to 69 1 1 Heredity. Apoplexy or paralysis. . . l 2 1 1 3 1 <j> ^ 3 | 3 2 1 Collateral. "03 I JH "rf § Female. Female. JP "cs g Female. Atavistic. Direct. 'rt Brothers and sisters. Total. o5 4) 1 .§ cu1 3 53 o1 s3 o ~' "rf fc 1 1 1 E-i § 1 4 1 tt H ] 1 f ] 1 4 3 4 2 1 1 4 9 6 13 Results of treatment. Female. Male. Total. Recovered . . Improved. 1 3 4 13 27 Unimproved . Died Remaining 2 2 ' 14 | �64 j STATE OF MICHIGAN. PSYCHOPATHIC STATES. In this group are 3 men and 1 woman, representing .7% of the cases admitted during the biennial period. Women. Men. No. Per cent. No. 310 Psychopathic 3 .9 Total. Per cent. No. .4 550 4 240 1 Per cent. .7 Age at time of admission. Female. Male. 1 30 to 34 35 to 39 50 to 54 1 9 Total. 1 1 2 HEREDITY. In only one of these 4 cases was there given any history of hereditary taint. One male, aged 52, had a half brother who was demented. This same patient has a daughter now a patient in the hospital. RESULTS OF TREATMENT. All four patients were discharged more or less improved. The woman went back to be tried for a crime and was convicted and sent to Detroit. HYSTERICAL INSANITY. Only one case was thus diagnosed during the period, a girl 21 years of age, with a history of insanity on the father's side, and a brother and sister temporarily insane, but recovered. Early life rather uneventful. The beginning of trouble illness; characterized by sudden outbreaks of excitement and destructiveness. The diagnosis was made on the basis of anaesthetic areas. She was a great care because of periodical and stormy attacks of excitement. Remained in the institution but a short time and was taken home on trial. UNCLASSIFIED GROUP. Two men and three women were placed in the unclassified list. The first: Male. Maternal aunt insane, maternal grandparents cousins. Was admitted to the institution in a condition of great weakness as a result of chronic interstitial nephritis. He died 7 days after his admission. The second: Male. Aged 58. No insane history. Remained in the institution but 28 days, was taken home on trial. Mental condition not clear. Phvsicallv very feeble and anemic. �TRAVERSE CITY STATE HOSPITAL. 65 The third: Female. Aged 35. No hereditary taint. Very feeble in body as the result of intestinal tuberculosis. Hallucinated. Remained in the institution about 6 weeks and was taken home to> die. The fourth: Aged 56. Female. Xo insane history. For a time at State Psychopathic. Case not clear there. Afterwards transferred to this institution. There has been no particular improvement but her mental peculiarities are not characteristic of any particular type. The fifth: Female. Aged 54. Mother died of extreme old age. Father's history unknown. Patient had led a rather irregular life. Used morphine and had had one or two peculiar attacks of fainting, not strictly epileptic in character. Mental characteristics approached nearer to Korsakow's than am 7 thing. She is still in the institution. TABLE V.—Snowing the occurrence of heredity in patients admitted. 29 Apoplexy and paralysis.. 19 Psychopathic 10 41 6 12 0 70 25 22 Alcoholism 18 15 Total heredity 76 74 150 Negative ' Total. 1 2, ^S 1 22 36 2 63 80 143 2 24 6 30 2 2 13 13 26 21 15 36 40 121 114 235 74 52 126 115 74 189 0 __; O H Brothers and sisters. Collateral. Atavistic. Female. 1 Female. Direct. W | •3 o S 5 < £ 4 7 2 2 1 33 9 I 3 16 *& £ 1 I 14 30 14 1 1 1 1 1 2 1 12 IS 1 15 33 18 22 310 240 550 �66 STATE OF MICHIGAN. TABLE VI.—Showing the age of patients admitted. Biennial period ending June 30, 1912. Female. Male. From 20 to 24 years . . Total 4 4 15 3 18 25 30 55 From 25 to 99 years 25 19 44 From 30 to 31 years 22 31 53 From .35 to 39 years 40 28 68 38 23 15 From 45 to 49 years 26 28 54 From 50 to 54 years 31 IS 49 From 60 to 6i years From 65 to 69 years 22 17 39 25 15 40 17 . . Total 17 34 15 9 24 20 10 30 310 240 550 TABLE VII.—Showing civil condition of patients admitted. Biennial period ending June 30, 1912. Civil conditions. Male. Single Fem ale. 123 55 178 114 145 259 39 32 71 16 8 24 18 18 Total Total. 310 240 550 �TRAVERSE CITY STATE HOSPITAL. 67 TABLE VIII.—Showing the degree of education of patients admitted. Biennial period ending June 30, 1912. Degree of education. Male. Read and write. Total Female. Total. 9 6 13 193 24 14 30 30 3 14 164 34 1 19 5 27 357 58 15 49 35 310 240 550 TABLE IX.—Showing the occupation of patients admitted. Biennial period ending June 30, 1912. Male. Professional: Architects, clergyman, engineers, surveyors, journalists, lawyers, musicians, physicians and surgeons, teachers (school), etc. . . . Clerical and official: Bookkeepers, clerks, copyists, bankers, brokers, collectors, auctioneers, agents, etc . Mercantile and trading: Commercial travellers, merchants, pharmacists, peddlers, etc. . . Public entertainment: Hotel and boarding house keepers, saloon keepers, liquor dealers, bartenders, restaurant keepers Personal service, police and military: Barbers, hairdressers, janitors, sextons, policemen, watchmen, detectives, soldiers, sailors, marines (XT. S ), etc Laboring and servantLaborers (not agricultural), servants Manufacturing and mechanical industry: Bakers, blacksmiths, butchers, cabinetmakers, carpenters, cigarmakers, jewelers, printers, engineers and firemen (not locomotive), coopers, machinists, ma.sons, millers, painters, plasterers, plumbers, tailors, tinners, etc Agriculture, transportation and other outdoor: Boatmen, draymen, hackmen, farmers, farm laborers, gardeners, florists, livery stable keepers, lumbermen, sailors, fishermen, steam railroad employees stock raisers etc None Unascertained. . . . Total Female. Total 18 13 31 10 5 15 9 8 17 2 2 4 6 7 13 83 54 137 28 12 40 120 9 99 219 40 25 31 9 310 240 550 34 �68 STATE OF MICHIGAN. TABLE X.—Showing the nativity of patients admitted. Biennial period ending June 30, 1912. Female. Male. Michigan Other states 136 80 Male. ! Female. Total. 110 58 Total United States.. 216 j 168 :!S4 78 61 139 IB 11 27 310 240 550 1 1 1 36 1 22 4 1 2 1 2 1 9 7 1 1 3 7 3 1 2 4 1 Italy Poland 1 1 1 3 2 1 8 3 5 2 Unascertained Total * �TRAVERSE CITY STATE HOSPITAL. TABLE XI.—Showing the nativity of parents. Biennial period ending June 30, 1912. Male. Foreign born Native and foreign born . Unascertained Total K 3 .... Female. Total. 105 119 27 59 92 100 22 26 49 85 310 240 550 197 219 �70 STATE OF MICHIGAN. TABLE XII.—Showing the residence of patients admitted. Biennial period ending June 30, 1912. County. Male. Bay Female. 13 11 6 3 2 12 3 9 1 10 g 1 15 17 1 19 Total. 14 20 1 4 Clare 5 1G 25 2 12 1() 17 3 11 16 1 10 4 3 Q 4 3 4 3 14 6 4 9 9 13 19 5 3 1 1 3 9 6 4 10 16 5 9 11 5 9 13 15 13 23 35 5 3 1 4 2 6 2 1 3 9 5 10 6 15 2 21 6 2 2 .... g 13 26 1 g 2 4 St Clair Schoolcraft s 44 (3 4 T> 2 Wexford Washtenaw 12 1 13 3 4 1 25 3 Total 310 240 550 �TRAVERSE CITY STATE HOSPITAL. 71 TABLE XIII.—Showing the form of insanity of patients discharged and the. results of treatment. Recovered. Unimproved. Improved. Died. Total. Forms of insanity. © "e3 £ "i I EH i i 5 2 Insanity due to infective and exhaustive in- 3 oj 1 i 6 1 1 3 2 2 4 1 1 1 2 2 6 1 1 1 3 6 1 1 2 3 9 12 27 4 7 1 3 4 7 1 1 1 5 6 2 3 3 2 1 "i' 2 2 Total 25 50 75 78 3 £ 3 1 2 "2' 7 2 1 4 64 142 8^ 2 i i "i' i i "3 I fe 2 6 9 "3' "i' 2 1 & 2 6 9 1 5 5 1 20 2 6 1 22 8 4 1 "4" 24 12 1 28 3 16 31 29 2 5 2 24 5 21 33 53 6 18 36 34 2 5 2 29 8 23 38 63 1 5 5 12 1 2 2 3 1 1 3 3 4 3 12 25 4 2 5 18 10 1 17 43 14 3 2 2 2 2 2 2 3 3 7 2 1 1 7 2 5 1 "5" 1 6 3 7 3 8 14 5 7 1 8 4 6 9 15 13 47 23 3 13 6 20 61 28 11 17 21 "3' "a" i i i 2 2 "s 10 15 6 12 5 7 2 5 5 8 3 5 "?' "a" .2 03 1 £ 1 1 7 32 39 1 11 12 4 1 5 &H 6 4 6 15 3 2 "03 1 1 2 2 1 "cS 3 1 3 5 2 £ i i 5 2 2 5 PH 1 i "i' 3 "5 30 26 2 4 13 14 27 '19' 17 1 1 1 37 36 4 1 3 58 56 155 108 263 288 248 536 1 8 1 1 16 '30 3 1 1 "2 46 21 �72 STATE OF MICHIGAN. Improved. Female. Unimproved. Died. Total. Female. R covered. Female. TABjLE XIV.—snowing the duration of residence in months of all cases discharged. 3 £ 6 8 14 8 3 11 3 2 5 17 13 30 34 26 60 6 12 18 12 15 27 6 6 12 19 10 29 43 43 86 5 15 20 18 9 27 6 2 8 11 11 22 40 37 77 3 4 7 11 8 19 2 5 7 2 9 24 16 40 2 3 5 7 8 15 2 2 4 13 3 16 24 16 40 1 4 5 6 10 16 1 1 17 2 19 25 16 41 2 2 6 6 2 1 3 9 3 12 11 12 23 1 3 9 5 14 5 3 8 29 13 42 45 22 67 1 1 4 4 2 3 5 14 19 33 20 23 43 3 •i 5 5 19 32 51 22 37 59 78 64 142 56 155 108 263 288 248 536 13 S 5 £ "Sa a •a "ca 1 I EH QJ £ °ca g ^ 1 & 3 2 25 Total 50 75 30 26 3 iS TABLE XV.—Snowing the age of patients discharged recovered. For the biennial period ending June 30, 1912. Male. Fern ale. 1 From 25 to 29 years Total Total. 3 4 9 9 4 8 5 12 2 4 6 1 6 4 2 5 4 5 9 2 2 4 4 1 5 2 1 3 1 1 46 75 29 7 �TRAVERSE CITY STATE HOSPITAL. 73 • TABLE XVI.—See Summary of Deaths page —. TABLE XVII.—Shouting the age of patients who died. Biennial period ending June 30, 1912. Female. Male. Total. 1 1 From 20 f o 24 years 5 1 6 From 25 to 29 years 7 4 11 6 10 16 12 8 20 13 6 19 6 12 18 17 5 22 26 From 30 to 34 years From 60 to 64 years From 65 to 69 years Total . . . . . . . . . . . . .... 14 12 20 10 30 13 13 26 13 15 28 28 12 40 155 108 263 ESTIMATES OF SPECIAL APPROPRIATIONS. The following are the_e»timafes^of special appropriations requested by the Board of Trustees and submitted to the-State Board of Corrections and Charities for its approval: To the State Board of Corrections and Charities: Gentlemen: As required by Section 2228, Compiled laws of 1897, I submit below estimates of special appropriations requested by the Board of Trustees of the Traverse City State Hospital for carpenter and paint shop; for completion of heating and ventilating systems; for shed for storage of wagons and implements; for repairs to roofs and gutters; for fencing; for artesian well; for roofing of cottages 24, 25, 26 and 28; for extension to laundry and additional laundry machinery; for porch to cottage 32; for dining room to cottages for men; for X-ray apparatus; for addition to cold storage plant; for canal or water-way; for sidetrack ; for horses and motor truck. �74 STATE OF MICHIGAN. I. CARPENTER AND PAINT SHOP. Excavation, 2,000 cubic yards, at 25 cents Stone and concrete work Gravel roof Lumber Doors and windows, door j'ams, window jams, complete.... Shafting and belting Electric motor, 30 H. P Sewer connection Electric wiring and electric light fixtures Heating and plumbing Carpenter work, labor nails, hinges, sash and door locks.. $500 00 1,000 00 200 00 500 00 500 00 500 00 550 00 150 00 100 00 600 00 900 00 $5,550 00 II. HEATING PLANT. For vacuum system, automatic temperature regulation, radiators, etc., for the hospital for men and cottages 24 and 6, installation of heating system complete For ventilating system, hospital for men and cottages 24 and 6 ". $10,000 00 8,000 00 $18,000 00 III. SHED FOR STORAGE OF WAGONS AND IMPLEMENTS. Concrete foundation and floor, 125 cu. yds. at $5.00 Lumber, 15,000 ft ". Painting Roofing 33 sqs. at $5.00 Eave trough and drainage Grading 1,000 cu. yds. at 25c Hardware and trai'eling crane Carpenter work $625 00 500 00 150 00 185 00 150 00 250 00 290 00 350 00 -_$2,500 00 IV. REPAIRS TO ROOFS AND GUTTERS. Material, labor, scaffolding, etc $2,500 00 V. FENCING. Ornamental gate for entrance to grounds 1,320 ft. of iron fencing in front of grounds 500 rods wire fencing $500 00 1,500 00 1,000 00 $3,000 00 VI. ARTESIAN WELL. Estimated cost of pipe, driving shoe, cap, pipe connections, etc $500 00 �TRAVERSE CITY STATE HOSPITAL. VII. 75 ROOFING COTTAGES 21, 25, 26 AND 28. Completion of cottage 28 Hoofing cottages 24 and 26, 300 sqs. of slate Roofing cottage 25, 160 sqs. slate laid complete Scaffolding, material and labor $800 00 3,500 00 1,800 00 300 00 |6,400 00 VIII. LAUNDRY EXTENSION AND LAUNDRY MACHINERY. Concrete, brick and stone work; window frames, door frames, doors, windows, sewers, sewer connections, electric lighting, plumbing, carpenter work and labor Washing machines, largest size $1,200 00 800 00 $2,000 00 IX. PORCH FOR COTTAGE 32. Steel beams and columns Cement and concrete work Wire guards Labor $200 200 100 100 00 00 00 00 |600 00 X. DINING ROOM FOR COTrAGBS FOR MEN. Excavation Cement and concrete work 152,000 brick in walls at $10 per M Steel ceilings, 60 squares 6,000 ft. tile floor 60 sqs. gravel roofing Columns and steel beams Plastering Painting Hardware and tin work Heating and plumbing Carpenter work and labor 14 windows, complete at $12 each 8 doors, complete, at $15 each Lumber Ranges, kitchen utensils, electric lighting, sewer connections , ., . / . . . . / ,,,.,, $150 00 700 00 1,520 00 480 00 2,400 00 300 00 262 00 200 00 150 00 150 00 800 00 1,500 00 168 00 120 00 400 00 700 00 $10,000 00 �76 STATE OF MICHIGAN. XI. X-RAY APPARATUS. X Kay apparatus f 950 00 XII. ADDITION TO COLD STORAGE. Excavation Concrete foundation 40,000 brick in wall at f 10 per M 10 sqs. slate roof at $12 3,000 ft. lumber at $16 per M 6,000 ft. lumber at $25 per M 2,500 Ibs. steel beams at 2c per Ib Painting, carpenter work and labor Nails and hardware Sewer, sewer connections and electric lighting 90 ft. cornice complete Pipe and piping for brine circulating system, Nonpareil insulation, labor and everything complete, as per estimate of the P. W. Wolf Mfg. Co $100 00 25 00 400 00 120 00 48 00 150 00 50 00 150 00 60 00 100 00 97 00 3,500 00 $4,800 00 XIII. CULVERT OR WATERWAY. Cement, labor, lumber, etc XIV. $1,000 00 HORSES AND MOTOR TRUCK. 10 span of first class heavy work horses at $600 One 5-ton motor gasoline truck $6,000 00 5,000 00 $11,000 00 XV. SIDE TRACK. RECAPITULATION. Carpenter and Paint Shop Heating plant Shed for storage of wagons and implements Repairs to roofs and gutters Fencing Artesian well Eoofing cottages 24, 25, 26 and 28 Laundrv extension and laundry machinery Porch for cottage 32 Dining room for cottages for men X-Ray apparatus Addition to cold storage Culvert or waterway Horses and motor truck Side track $5,500 00 18,000 00 2,500 00 2,500 00 3,000 00 500 00 6,400 00 2,000 00 600 00 10,000 00 950 00 4,800 00 1,000 00 11,000 00 45,137 SO All of which is respectfullv submitted. J. D. HUNSON, Medical Superintendent. �TRAVERSE1 CITY STATE HOSPITAL. 77 The following is the report of the State Board of Corrections and Charities on the above requests for appropriations: MICHIGAN BOARD OF CORRECTIONS AND CHARITIES, LANSING. October 31, 1912. Dr. J. I). Munson, Medical Superintendent. Traverse City State Hospital, Traverse City, Michigan: Dear Sir—At a, meeting of the State Board of Corrections and Charities held on the 24th instant, your estimates for appropriations for the biennial period ending June 30, 1913, were given final consideration. The several items as submitted by you under date of October 15, 1912, were approved with the exception of item No. 11. Your estimate of $11.000.00 for "Horses and Motor Truck" was approved in the sum of $3,000.00, providing appropriation for "Side Track" is made; otherwise the item is approved in full. Very respectfullv, DAYTON PARKER, Chairman. CHAPEL SERVICES. Religious services have been conducted by chaplain, Rev. D. Cochlin, assisted by Revs. Mr. Curran, Mr. Chapin, Mr. Erwin, Mr. Lay and Mr. Allington, all of Traverse City. ACKNOWLEDGMENTS. To all those who have in any way contributed to. the welfare or comfort of our patients our best thanks, are extended. CONCLUSION. It is gratifying to be able to report that the relations of the hospital to the State and to the counties which it serves, have been harmonious, and that there has been cordial cooperation between State and County officials and the hospital in everything relating to the best interests of the institution and its patients. The summation of all branches of industry of the hospital forms a vast business, and requires direction by men and women constantly on the ground and in intimate association with its aims and purposes. You have given more than usual attention to its management, and have fostered every effort having for its object better care and treatment of patients, improved and more economical business methods, and betterments of all kinds. I am sensible of my obligations to you, to my associates on the staff, and to all employes, for many personal kindnesses. I believe that every one has tried to do his full duty and that there have been very feAV occurrences during the last two years that have required special attention at your hands. It has been my best endeavor to maintain the hospital at a high standard of usefulness. All of which is respectfully submitted. J. D. MUNSON, Medical Superintendent. Traverse City State Hospital, Sept. 1912. �STATE OF MICHIGAN. 78 OFFICERS AND EMPLOYES OF THE TRAVERSE CITY STATE HOSPITAL, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1912, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Service. Name. James D. Munson A. S. Rowley W.D.Mueller R. E. Wells , Medical superintendent Asst. medical superintendent.. Assistant physician James A. J. Hall S. C. Niles. . . . G B Pike T. H. A. Tregea C. W. Nesbitt. . . C.M. Frail A. Newman S. G. Howard... B.P.Burns Chief carpenter Chief engineer Storekeeper General supervisor Period. Rate. S3, 500 2,800 1,700 1,500 900 00 00 00 00 00 Per annum. Resident. Per annum. Non-resident. Per annum. Resident. 1,000 00 1,000 00 1 800 00 260 00 106 00 Per annum. Resident. 75 00 1,500 00 1,600 00 1 200 00 85 00 Per Per Per Per Per month. annum. annum. annum. month. Non-resident. Non-resident. Non-resident. Non-resident. Resident. 72 60 65 45 35 00 00 00 00 00 Clerk . . . Clerk 40 36 35 25 30 00 00 00 00 00 Per month. Resident. HansTobler.... Win. J. Wetter Gardener Dav watchman Attendant 70 75 45 24 14 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Non-resident. Non-resident. Non-resident. Resident. Resident. John Aniskonski Attendant 26 25 17 35 17 00 00 00 00 00 Per Per Per Per month. month. month. month, Resident. Resident. Resident. Resident. 37 28 24 40 28 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Non-rent. Resident. Resident. Resident. Resident. 22 24 24 24 28 00 00 00 00 00 Per month. Resident. Per month. Resident. 14 15 14 14 38 00 00 00 00 00 Per Per Per Per Per month, month. month. month. month. Resident. Resident. Resident. Resident. Resident. 17 17 28 18 17 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Resident. Resident. Resident. Resident. Resident. *- ' Nettie Blank Effa Baatz Cook Effie L Bixby Homer Brown Attendant Leslie Brown Attendant Attendant John Bryan Ethel Russell Helen G. Callahan Arthur J Clark Gertrude Coddington Attendant Domestic Attendant Attendant Per month. Resident. Per month. Per month. Non-resident. Non-resident. Per month. Non-resident. Per month. Resident. �TRAVERSE CITY STATE HOSPITAL. 79 OFFICERS AND EMPLOYES.—Continued. Service. Name. Rate. Period. $26 46 18 24 42 00 00 00 00 00 28 37 38 42 40 00 50 00 00 00 Per month. Per month. Resident. Non-resident. Per month. Non-resident. Nellie Edwards 24 17 28 65 17 00 00 00 00 00 Per Per Per Per Per Minnie Flint Night nurse. 18 28 20 50 37 00 Per month. Resident. 00 00 hPcr month. Resident. 00 00 Per month. Non-resident. ' Minnie Greilick Bert Glass Marvin Gillis Attendant 18 34 24 18 32 00 00 00 00 00 Per month. Resident. 46 38 24 40 29 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. IS 24 26 17 36 00 00 00 00 00 Per month. Resident. Per month. Resident. 26 42 38 18 25 00 00 00 00 00 18 24 32 40 17 00 00 00 00 00 23 24 30 26 24 00 00 00 00 00 35 18 18 20 26 00 00 00 00 00 31 18 29 23 24 00 00 00 00 00 40 26 34 20 17 00 00 00 00 00 George C. Dell Night nurse Wm. L. Bernard Robert Dell Attendant H. W.Dickinson D S Dean Gill Drost Ray Elliott Night nurse. Attendant Alvin Gilbert . . . C. R. Griffith . Willard Getchel Hildur Hedenskog ... Night nurse Tillie Henschell Edw. Guilfoy L. J. Hicr Night nurse Daisy L. Graves. . . . Ada Hall Attendant Margaret E. Heator. . . . " Harrv Hibbard R. G. Johnson Attendant W. H. Keyes Fred Krone. . G. L. Kirby Ed. Krausc . . . Attendant Attendant Caroline Kcyes. . . . Anna Kropp Clare Krone Alma Leggett Julia Leo W. H. Lyons . R. L. Lyons OtisLeland Esther Lardie. Attendant Attendant Per month. Non-resident. Per month. Resident. month. Resident. month. Resident. month. Resident. month. Non-resident. month. Resident. Per month. Residen . Per month. Resident. Per month. Resident. Non-resident. Resident. Resident. Non-resident. Non-resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. �so STATE OF MICHIGAN. OFFICERS AND EMPLOYES.—Continued. Name. Night supervisor R. H. McKenzie Franc O'Dell. Attendant Bertha C. Peterson V. A. Patrick Anna Patrick F. G. Park Attendant Attendant .... Glen Parks. . Attendant John Scaton. Fred Sawdy . Lee S. Swan . Attendant Anna Smith . E. Strickler. Pearl E. Tyler Perry Tobey. Mabel Willard Elsie Wilson Stanley Tobin Fannie Soss.. Philip Tobin Robt. Tobey J W Stevens D. E. Ward.. L. A. Wright . .. Attendant Attendant Cook. . . . Alildred Ziglcr Eunice Walsh. Hattie Walsh Thos. Whitfield Helen J. Whitfield W. Bellaw Chef .. Baker S. A. Conrad. Geo J Dell Robt F Herkner Robert Shalda Fred Willsey Butcher C W Scott William Heimforth Walter Beckwith Elmer Bagnel Rate. Service. Assistant cook Period. $17 46 23 17 23 00 00 00 00 00 18 27 40 20 23 00 00 00 00 00 18 25 40 26 44 00 00 00 00 00 28 26 17 25 33 00 00 00 00 00 28 24 32 23 18 00 00 00 00 00 Per m 24 28 20 18 36 00 00 00 00 00 Per m Resident. no nt h. Resident. Per m Resident. Resident. Per m( Resident. 18 18 24 29 24 00 00 00 00 00 Per m< Resident. Per ni(.onth. Resident. Resident. Per m< Non-resident. Resident. 28 34 24 34 45 00 00 00 00 00 31 18 31 31 44 00 00 00 00 00 Per m Per m nonth. nonth. Per m iionth. 39 18 17 70 70 00 00 00 00 00 Per me nonth. Non-resident. Resident, Per me Resident. Resident. Per m( Non-resident. 55 34 18 17 17 00 00 00 00 00 Per m( 65 24 26 32 24 00 00 00 00 00 Per me Per me Per me 24 28 24 26 28 00 00 00 00 00 Per me Per me Per m Per m Per m Per m Per m Resident. Non-resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Non-resident. Resident. Resident. Resident. Resident. Resident. Per m nonth. Resident. Resident. Resident. Resident. Per m Resident. Per me Per m( Per me Per m( Per me Per me Per me Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Non-resident. Non-resident. Non-resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Resident. �TRAVERSE CITY STATE HOSPITAL. 81. OFFICERS AND EMPLOYES.—Continued. Name. Service. Cook Claude W Nelson A[mon Covey Laundryman John Alston Assistant laundryman Period. Rate. §35 24 24 40 66 00 00 00 00 00 37 00 14 00 Celia White Violet Irish 22 00 Edna Meteor. Helen McCalium. . . Ethel White 23 21 14 28 21 00 00 50 00 00 13 24 25 22 23 00 00 00 00 00 50 2 40 50 50 00 00 00 00 00 1 2 2 65 50 75 75 00 00 00 Per month. President. Per month. Resident. Per month. Resident. Per month. Resident. 20 00 13 00 Ethel Edwards May Stricklin Flora White Ina Crandall Laundress E. Stamvick J. Lotharius Fireman Jim Lutes W Frascr Emil Nelson Laborer H. Butrick Pipeman R. Blazek Fireman Pipeman J 0 Edwards J. B. King . 50 00 1 75 1 75 1 75 50 00 2 2 2 2 2 A. H. Bennett J. G. Loeding R. W. Loeding 25 25 25 70 50 Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Resident. Per month. Non-resident. Per day. Non-resident. Per day. Non-resident. Per month. Non-resident. Per month. Non-resident. Per day. Non-resident. Per day Non-resident. 2 70 2 70 2 70 70 00 1 75 S. W. McMichael John Trcmaine T P Reddin°S. Edgerley - U. Bruce C Gabriel Win. Shane John MeGill G. W. Burrctt L. A. Cunningham D. W. Kelley J. M. Murphy M. ITarig Barnman Barnman 11 2 37 31 31 33 00 00 00 00 00 60 29 32 29 29 00 00 00 00 00 70 29 32 31 29 00 00 00 00 00 31 50 33 29 29 00 00 00 00 00 Per month. Resident. Per Per Per Per month. Resident. month. Resident. month. Resident. month. Resident. �STATE OF MICHIGAN. 82 OFFICERS AND EMPLOYES.—ConclbCed. Service. Name. M?*j Frank Steele Glenn Hobbs Teamste . .... .... Rate. $29 00 29 00 29 00 1 50 29 00 29 00 Period. �GBADU> rr'T~ OF THE TRAVERSE CITY STATE HOSPITAL CHAINING SCHOOL FOR NURSES. 1908. Harry Baker. Laura M. Bigbee. Bennett P. Burns. Lena Aldrich Covey. Sadie L. Docherty. Anna Carre'" Evans. Mary Louise Jink. Wesler H. Herriman. John O. Hoppes. Raymond G. Johnson. Esther V. Keller. Louise Kitscher. Dora P 11 Lewis. Maria Margaret McDonald. Louise E. McGivern. Catherine MeKinnon. Amy Orcutt. victor A. Patrick. Hattie Holmes Parr. Florence Helen Roest. Lurene Shryer. Lyllian Faith Walsh. Anna M. Warner. Lucinda. Hazel Wilson. 1909. Margaret Clark. Edna Crandall. Gertrude Eamon. Anna Hanson. Thea Hanson. Flora Hollister. Cora Laisy. Howard Lewis. Ruth Merrifield. ; 1910. Ray H. Buttars. Loura Lela Cronkwright. Leonard A. Cluley. John F. Donovan. Nellie Taube Ellsworth. Anna Maude Grissinger. Ethel Beatrice Hanes. Albert James Howard. Ethel Lillian Johnson. 1910. Jesse Angie Keating. Gertrude A. Kerry. Juliana Mary Leo. Gail Langworthy. C. Harold Leutholtz. Tressie A. Miller. Cleo Von Miller. Ella Orvis Miller. Archie Miller. Anna Thoreson Newman. Idylia Reynolds. Mina Odolla Shearer. 1911. Martha Clara Kitscher. Nora Belle Eamon. Lena Amelia Rude. Matilda Delvena Send. Alice Julia Thoreson. Berina Cornelia Peterson. Hazel Erveilia Edgerley. Marie Esther Orvis. Gertrude Margaret Orvis. Ada Julia Hall Rosetta Aiston. Essie Marie Johnson. Grace Belle Alexander. Effie Florence Grissinger. George Oliver Zeigler. Lee S. Swan. George W. Ashby. Leo. S. Chamberlain. Perry A. Tobey. Stephen PL Young. 1912. Judith Evans Kidder. Frances Edith Soss. Wilhelmina L, Oldenburg. Daisy M. Lahr. Alice A. Smith. Mabel Cowles Willard. Alma E. Leggett. Emma Thura. Otis H. Leland. �APPENDIX. �APPENDIX. The asylums of Michigan are organized and governed under Organic law. an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government, appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of Asylum Trustees. (Sections.) The counties comprising the district of the Traverse City State Hospital are: Alpeua Arenac Antrim Alcona Benzae Charlevoix Clare Crawford Cheboygan Emmet Gladwin Grand Traverse Gratiot Isabella losco Ionia Ka 1 kaska Lake Leelanau Manistee Mason Mecosta Midland Missaukee Montcalm Montmorency Muskegon Newaygo Oceana Ogemaw Osceola Otsego Oscoda 1'resque Isle Roseommon Wexford Provision is made by Section 7 for the transfer of patients Transfer from from one asylum to another when conditions make such another1™0' *° transfer desirable. A patient is not to be committed to an asylum of a dis- insane to be trict other than that of which he is a resident unless the as^™m"0e{d to court adjudicates that there is no room in the latter, and tfceir district. that there is in the former. (Section 8.) �86 Classes of patients. Voluntary patients. Public and private patients. Order void after thirty days. Bonds. Advance payment. New bonds. Temporary orders. Transfer from private to public. Non-resident. Provisional discharge and readmission of patients. Insane women to be accompanied by female attendant. Removal of patients from home. STATE OF MICHIGAN. Patients are divided into three classes: Public patients, private patients, and voluntary patients. (Section 13.) Voluntary patients are patients who are not insane. They are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for because of lack of room. In other words, there must be room for all others seeeking admission before any voluntary patients can be received. Sec. 14 as amended by Act 155, Laws 1911, "Provided that such persons as may have been or may hereafter be adjudged to be so addicted to the excessive use of intoxicating liquors, or narcotic or noxious drugs, as to be in need of medical and sanitary treatment and care, for whose person a guardian has or may be appointed with power to restrain his said ward in some suitable hospital or asylum for treatment." Both public and private patients can be received only on an order from a probate court declaring the patient insane and stating the method of support,—whether public or private. Such an order is void unless patient is sent to the asylum within thirty days after it is issued. (Section 16.) Besides the order of commitment from the court, there must accompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumbent upon the court to see that this bond is furnished. Until this bond is furnished the patient is regarded as a public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. Xew bonds may be called for at any time by the medical superintendent, and the law requires the court to see that such new bonds are provided. (Section 10.) Provision is made (Section l(i) for the reception of both public and private patients on temporary orders wherever conditions demand immediate attention. Section 21 provides for the transfer of a patient from private expense to public expense 'where conditions warrant sucli a change. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Section 32 provides for the return to the asylum without a new order of patients who have been discharged on trial, where the duration of the temporary absence does not exceed six months. The attention of county officers is particularly called to the provisions of Section 40 regarding the state of bodily cleanliness and the clothing of patients brought to the asylum, and more particularly to that clause of the section providing for a female attendant for insane women. In conveying a patient to the asylum do not deceive him. Truth should not be compromised by professing a visit to the �TRAVERSE CITY STATE HOSPITAL. institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the asylum, by giving patients an impression that they are parties to the deception. Removal to the asylum should never be attempted when the patient is much prostrated or laboring under severe bodily illness, and care should be taken that the excitement attending acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what articles Clothing. of clothing it is necessary to provide the following suggestions are made: Male patients require 3 new shirts. 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemies, 3 pairs drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, C handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable thorn to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. If such articles are left in their possession the asylum cannot be responsible fo;r their safe keeping, All letters concerning patients, from individuals having corre the right to make inquiry, will be answered at once; and cncefriends are promptly advised of any severe illness, accident, or event of moment or interest. The postofflce and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at the written request of friends. Where relatives of patients desire friends who are not mem- visiting bers of the family to visit patients, they should, in every in- patients stance, furnish these friends with a letter of introduction, authorizing the interview. 87 �88 Application of patients.0 STATE OP MICHIGAN. Application for admission should be. made before the putient -is brought to the asylum. A blank will be furnished the friends which provides for a complete history of the patient's trouble. All correspondence in reference to patients should be addressed to Dr. -Tames D. Mnnson. Northern Michigan Asylum. Traverse City. �INDEX �INDEX. Accounts, abstract of Accounts, current Accounts current, summary of Acknowledgments Admission of public patients Admission of private patients Admission of voluntary patients Admissions and discharges. Table Age of patients. Table Age of patients discharged recovered. Table Age of patients who died. Table Alcoholic insanity Appendix Appointments, resignations, etc Appropriations, report of Artesian well Carpenter and paint shop Chapel Civil condition. Table ' Clothing Cold storage plant, addition to Cost of maintenance Culvert Daily average of patients Deaths, causes of, etc Death rate Dementia praecox Duration of residence of patients discharged. Table Dietetics and food analysis Education. Table Epilepsy Estimates of special appropriations Extension to laundry and additional laundry machinery Farm and garden Fencing Form of disease. Table General dining room for cottages for men Heating plant Heredity. Table Holstein-Friesian herd Hysterical insanity Horses and motor truck Imbeciles and idiots Improvements Increase of patients Infection and exhaustion psychoses Insanity of patients discharged. Table Inventory, summary of Korsakow's Disease ' laboratory work Manic depressive insanity Melancholia Morphinism Page 26 30 33 77 86 86 86 37 66 72 73 50 83 24 , 16 18 17 77 66 87 19 15 19 16 38 16 56 72 8 67 62 73 19 21 18 46 19 18 65 22 64 21 61 16 14 53 71 33 52 47 48 60 52 �92 INDEX. Page Movement of population. Table Names of officers and employes. Table Nativity of patients. Table Nativity of parents. Table Needs of hospital Occupation. Table Officers, names of Organic group Paranoia and paranoid states Patients treated in county houses, jails, etc Patients, suicidal, homicidal, etc Porch for cottage 32 Psychopathic states Recapitulation , Receipts and disbursements Removal of patients to hospital Repairs to roofs and gutters Report of medical superintendent Report of State Board of Corrections and Charities Report of trustees Report of treasurer Report of steward Report of auditing committee Residence of patients committed Residence of patients. Table Results of treatment ol patients discharged. Table Re-roofing cottages 21, 25, 26, 28 Shed for storage of wagons and implements Sidetrack Summary of causes of death. Table Surgical operations Title and addresses Training school for nurses Unclassified group X-Ray apparatus >...' * , , 37 78 68 69 17 67 5-6 54 58 15 15 19 64 21-76 24 86 IS 37 77 7-25 26 34 32 14 70 71 18 18 20 43 48 3 7 64 19 � https://localhistory.tadl.org/files/original/1ba3469be7275b89b785a655af873acc.pdf 9b70d678681be46d1f8073c5d7de8abf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Traverse City State Hospital at Traverse City June 30, 1914 Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Traverse City State Hospital for the biennial period ending June 30, 1914. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Wynkoop Hallenbeck Crawford Co., State Printers. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1914 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0009 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text MICHIGAN STATE L1BRAHY OFFICIAL COLLECTION REPORT MICHIGAN DOCUMENTS BOARD OF TRUSTEES TRAVERSE CITY STATE HOSPITAL TRAVERSE CITY JUNE 30, 1914 BY AUTHORITY LANSING, MICHIGAN WYNKOOP HALLENBECK CRAWFORD CO., STATE PRINTERS 1911 �TRAVERSE CITY STATE HOSPITAL �TITLE AND ADDRESSES. THE TRAVERSE CITY STATE HOSPITAL, TRAVERSE CITY. Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is $1,104,925.73. The property consists of 42 buildings, occupying a tract of land containing 723 acres. It cares for 1,517 patients. Act No. 21, Public Acts of 1911, provides that the Northern Michigan Asylum shall be hereafter known as the Traverse City State Hospital. This law went into effect July, 1911. OFFICERS OF THE TRAVERSE CITY STATE HOSPITAL. TEUSTEES. W. LLOYD H. C. DAVIS W. W. MITCHELL M. F. QUAINTANCE E. S. WAGAR C. D. ALWAY MANISTEE TRAVERSE CITY CADILLAC PETOSKEY EDMOBE TSAVEBSE CITY RESIDENT OFFICERS. JAMES D. MUNSON, M. D A. S. ROWLEY, M. D W. D. MUELLER, M. D ADAH EPPERSON M. D MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT } J. A. J. HALL, M. D f R. F. WAFER, M. D j ASST. PHYSICIANS NON-RESIDENT OFFICERS. G. B. PIKE W. P. MANTON, M. D STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN .TBAVEBSE CITY TREASURES. A. J. MAYNARD TRAVERSE CITY �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM FROM ITS ORGANIZATION IN 1881. BOARD OF COMMISSIONERS APPOINTED TO SELECT SITE FOR THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Retired. Residence. Traverse City . Work of board completed Sept. 30, 1882. Perry Hannah E. H. Van Deusen. . . Kalamazoo. Detroit. M. H. Butler 1881 1881 1881 BOARD OF COMMISSIONERS APPOINTED TO ERECT THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Perry Hannah E H. Van Deusen . . M. H. Butler H. H. Riley Thos. T. Bates 1881 1881 1881 '1881 1885 Residence. Retired. Traverse City . 1885. Kalamazoo. Detroit. St. Joseph. Traverse City . Vice Perry Hannah. The work of the building commission was finished Nov. 10, 1886. MEMBERS OF THE BOARD OF TRUSTEES OF THE TRAVERSE CITY STATE HOSPITAL. Date of appointment. 1885 1885 1885 1885 1885 1885 1887 1887 1889 1891 1891 1889 1895 1897 1897 1889 1901 1901 1902 1901.. 1903 1905. . 1907 1909 1913 . . Name. Residence. Term expires. President from to C. M. Wells Alex. Chapoton, Sr. J. W. French Thos. T. Bates H. H. Noble Geo. A. Farr Varnum B. Cochran Lorin Roberts C. L. Whitney H. C. Davis G. A. Hart W. W. Cummer C. F. Backus H D Campbell W. W. Mitchell . H D Brigham D. B. Butler Traverse City ... Detroit Three Rivers .... Traverse City... Elk Rapids Grand Haven . . . 1887 1887 1889 1913 1897 1891 1893 1889 1891 1895 1915 1897 1901 1901 1905 1901 1917 1901 1903 1907 1908 1917 1919 1915 1919 1885 to 1886. G. A. Hart A F Temple M. F. Quaintance William Lloyd E. S Wager C. D. Alway Traverse City . . Muskegon Traverse City. . . Cadillac Bad Axe Detroit Cadillac Frankfort Traverse City Remarks. 1886 to 1892. 1907 to 1910. 1892 to 1897. 1897 to 1899 1899 to 1902. 1902 to 1907 1910 to 1912 1912 Present member . �MEDICAL OFFICERS. Medical Superintendent: James D. Munson, M. D., 1885. Assistant Medical Superintendents: J.-H. Dawson, M. D.—1885 to 1890. Resigned. C. G. Chaddock, M. D.—1890 to 1892. Resigned. A. S. Rowley, M. D.—1895 . Assistant Physicians: C. G. Chaddock, M. D.—1885 to 1890. Promoted to Assistant Superintendency. W. A. Stone, M. D.—1886 to 1891. Resigned to accept the Assistant Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendencv M. Rockwell, M. D.—1891 to 1892. C. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. E. L. Niskern, M. D—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D.—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1889 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. "W. D. Mueller, M. D.—1900. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. -D.—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 to 1909. B. F. Sargeant, M. D.—1904 to 1905. H. D. Purdum, M. D.—1906 to 1910. R. E. Wells, M. D.—1907 to 1912. Guy M. Johnson, M. D.—1908 to 1910. Adah Epperson, M. D.—1910 . E. G. Williams, M. D.—1910 to 1911. J. A. J. Hall, M. D.—1910. S. C. Niles, M. D—1911 to 1913. G. V. Sigler, M. D.—1913-1913. R. F. Wafer, M. D.—1913Stewards: J. D. Billings, 1885 to 1886. John Goode, 1886 to 1887. J. P. C. Church, 1887 to 1894. C. L. Whitney, 1894 to 1911. G. B. Pike—1912. CJiaplains : Rev; W. G. Puddefoot. 1886 to 1888. Rev. D. VanAlstin, 1888 to 1890. Rev. D. Cochlin, 1890 . �REPORT OF THE BOARD OF TRUSTEES. To the Governor and Legislature of the State of Michigan: The Trustees of the Traverse City State Hospital have the honor to submit their report for the biennial period ending June 30, 1914, together with the reports of the Medical Superintendent, Treasurer and Steward. The period has been an interesting one, not only because of discoveries in the treatment of certain conditions, but of increased efficiency in the general management of the hospital. The general application of the Wasserman method,—a positive means of clinical diagnosis of luetic diseases,—and of recently discovered means for the curative treatment of these disorders, mark, perhaps, the most important advance in the field of neurological medicine. Helpful advance has been made in the diagnosis of dementia praecox by the use of the FauserAbderhalden defensive ferment test, and in its treatment by the nucleinate of sodium,—the so-called Lundvall treatment. The Abderhalden test opens a wide field, and will become a part of the clinical routine in. the investigation of cases. In the Medical Superintendent's report brief mention is made regarding the treatment of luetic diseases and of dementia praecox by recent methods. Although the cost of living continued high, yet the maintenance rate was not increased. Notwithstanding that the hospital had to pay its pro rata (f5,193.93) to the State for insurance on its property, etc., in accordance with the provisions of Act 388, Laws of 1913, yet the actual cost of maintenance was within 50 cents per patient per day. The 1914-15 rate has been fixed at 50 cents per patient per day, including fire insurance and workingmen's liability insurance, as provided by law. We would respectfully suggest to your Honorable Body that the cost of fire insurance for State institutions and for workingmen's compensation under the Liability Law, should be charged against the general fund of the State and not assessed pro rata among the institutions of the State. This method would be more business like, more direct, and would afford a saving in overhead charges. Every effort has been made to increase the efficiency of the hospital in all its departments. The orchards, dairy, farm and gardens have grown greatly in usefulness, and a handsome profit has been derived from them. The fruits grown supplied the hospital with all its fresh fruits and with much of its preserved fruits. Their value amounts to a considerable sum. The health value of fruits grown to maturity, and consumed in fresh state, is greater than that of fruits imported from a distance. Imported fruits are usually gathered green, and ripen under artificial conditions, and are not as healthful as fruits matured at home. In their possibilities these departments are only at the threshold. �8 STATE OF MICHIGAN. The "Board of Stewards" has made many joint purchases for the institutions of the State. This plan has thus far worked well, and will continue to work well so long as quality of supplies is regarded of first importance. Inferior or "old stock" provisions may cost less, but their use is ever at the expense of the health of the hospital. A few more cases of illness in the hospital, traceable to inferior foods, would cost vastly more than the difference between inferior and first class supplies would amount to. Expert inspection of foods and the proper cooking of foods are of great importance to the health of the household. The cooking is supervised by the dietitian, and foods are prepared not only more scientifically, but in a more attractive and palatable manner. Quite recently the patients have been arranged in groups, and foods prepared and served according to the needs of each group. The first group includes all those who are physically able to eat in dining rooms and without special supervision. The second group includes those who were formerly fed from trays because of untidiness or violence; and the third group includes those confined to bed. The second group cases require very special supervision, not only in reference to the kind of foods they eat, but to have them eat in a proper manner. Eggs, soups, -cereals, vegetables and fruits enter largely into the dietary of this group. The menus are varied from day to day and their nutritive value carefully estimated, so that there is a just balance maintained in the proteid, carbohydrate and fat contents. For the third group the dietary is prescribed by the physicians to meet the needs of each case. Women patients are instructed by the dietitian in the preparation and service of foods, and assist in many ways in the preparation and preservation •of fruits, etc. This is one of the most useful diversional occupations for women patients. So far this period, women patients have largely assisted in the preparation of fruits for canning, in cake and special bread making, etc. Instruction in bread, cake and pastry making will be extended as fast as suitable room for the purpose can be provided. DIETETICS. Each year for several years an analysis of food used in certain portions of the hospital for a given length of time has been made, and the following tables will show the result of these analyses for several of the cottages. They are informative of the approximate calorie value of the food materials furnished,—whether too much or too little proteid, carbohydrate, or fat, etc., etc. These analyses furnish a base on which food requisitions are made, and in the treatment of many patients are of as much value as is the determination of calorie content of foods used in the typhoid, diabetic or nephritic patient. If, for example, the analysis shows too much fat or too much proteid or too much carbohydrate, it is comparatively easy to correct any deficiency or excess that may exist in these elements. The dietetic treatment of mental cases is of just as much value as it is in general diseases. The body metabolism is impaired in the majority of cases, and the patients are, by reason of their mental state, unable to cooperate with the physicians in properly eating. We know in many cases without the utmost care in this direction patients go on to fatal exhaustion. Body metabolism is an extremely ^complicated matter in both health and disease. The value of dietetic �TRAVERSE CITY STATE HOSPITAL. treatment of the insane can hardly be over-estimated. In conclusion we may say that in arranging dietaries, the first consideration has been to give the patients a diet suited to their health needs and at the lowest possible cost. The following analyses were made by Miss N. B. Clark, dietitian of the hospital. FOOD NUTRIENTS USED IN THE TRAVERSE CITY STATE HOSPITAL. COTTAGE 21. DAYS' BOARD 1708. Protein 2654.4 gms. • per patient per month Fat 3004.4 gms. 'Carbohydrate 12796 gms. 94.8 gms. per patient per day 107.3 gms. per patient per day 453 . 4 gms. per patient per day Total 110 gms. Woman at moderate work. —Atwater 379 . 2 calories 95 gms. 966 calories 450 gms. 1813.9 calories 3000-3500 calories 3158.1 calories per day COTTAGE 25. DAYS' BOARD 1708. Protein 2500.4 gms. Fat 2570.4 gms. 'Carbohydrate 12213. 6 gms. 89.3 gms. per patient per day 91.8 gms. per patient per day 436.2 gms. per patient per day Total 110 gms. Woman at moderate work. —Atwai er 357 . 1 calories 95 gms. 826.6 calories 450 gms. 1746 calories 3000-3500 calories 3029 7 calories per day COTTAGE 27. DAYS' BOARD 1932. Protein 3214. 4 gms. Fat 3780 gms. Carbohydrate 10584 gms. Total 114.8 gms. per patient per day 135 gms. per patient per day 378 gms. per patient per day 110 gms. Woman at moderate work. —Atwater 459 . 5 calories 95 gms. 1214.3 calories 450 gms. 1512 .5 calories 3000-3500 calories 3186 3 calories �10 STATE OP MICHIGAN. COTTAGE 32. DAYS' BOARD 1204. Protein Fat 3365. 6 gm. per patient per month 5152 gm. Carbohydrate 11732 gm. 120.2 gm. per patient per month 184 gm. 41S.2 gm. Tola!.. . Men. 120-125 gm. per patient per day 1.50 gm. 500 gm. 3500-4000 4808 calories 1657 1677 caloiies calories 3814 8 calories per day COTTAGE 34. DAYS' BOARD 2072. Protein 4732 gm. per patient per month Fat 10220 gm. Carbohydrate 14840 gm. 169 gm. per patient per day 365.7 gm. 530.5 gm. Total Men. 120-125 gm. per patient per day 150 gm. 500 gm. 3500-4000 676 calories 1463 calories 2122 calories per day COTTAGE 36. DAYS' BOARD 2024, Protein 2240 gm. per patient per month Fat 2744 gm. 80 gm. per patient per day 298.57 gm. Carbohydrate Total 6608 gm. 236 gm. Men. 100-110 gm. per patient per day 150 gm. 400 gm. 320 calories 887 calories 947 calories per day COTTAGE 30. DAYS' BOARD 2268. Protein 2924 gm. per patient per month , Fat 3682 gm. 11578 gm. Carbohydrate Total 108 gm. per patient per day 131.5 gm. 413. 5 gm. Men. 100 gm. Standard for light exercise 100 gm. 360 gm. 432 calories 1186 calories 1653 calories 3271 calories per day COTTAGE 31. DAYS' BOARD 896. Protein 3791.2 gm. per patient per month Fat 3262 gm. Carbohydrate Total 8680 gm. 135. 4 gm. per patient per day 116.5 gm. per patient per day 310 gm. Women . 100 gm. Standard for light exercise 531.3 calories 100 gm. 104S.3 calories 360 gm. 1240.3 calories 2S19.9 calories per day �TRAVERSE CITY STATE HOSPITAL. 11 COTTAGE 24 AND 26. DAYS' BOARD 3276. Protein 4182. 5 gm. per patient per month 146.5 gm. per patient per day 125 to 150 gm. Man at hard work per patient per day. —Atwater Fat 3530 gm. 12922 gm. 126.1 gm. 461.5 gm. 150 gm. 500 gm. 4000-4500 c. Carbohydrate Total . 586.2 calories 1135 calories 1846 calories 3567.2 calories per day COTTAGE 28. DAYS' BOARD 1680. Protein 5644.8 gm. per patient per month Fat 5546.8 gm. 16066.4 gm. Carbohydrate 201.6 gm. per patient per day 198.1 gm. 573.8 gm. Total 150 gm. Ma,n at hard work per patient per day. — Atwater 150 gm. 500 gm. 4000-4500 806.6 calories 1793.2 calories 2294.4 calories 4894 2 calories per day COTTAGE 29. DAYS' BOARD 2212. Protein Fat Carbohydrate 4107.6 gm. per patient per month 3203.2 gm. 10052 gm. 146.7 gm. per patient per day 114.4 gm. 100-110 gm. Woman at light work. —Atwater 95 gm. 359 gm. 450 gm. Total 586 . 9 calories 1050.2 calories 1536.3 calories 3173 4 calories per day Added experience confirms the great value of dietetics in nervous and physical condition of ill health. It opens tip a field for better foods, better cooking and for the education and employment, especially of women patients. DOMESTIC ARTS AXD SCIENCES. A department of domestic science and arts was established during the period, not only to increase the efficiency of the working force, but to introduce as fast as practical, the so-called diversional occupations. All of the dress-making, repair of clothing, etc., falls in this department. An effort is made to employ, not so much the willing worker, as the depressed, the indifferent, inhibited praecox cases; all those, in fact, who require urging if they accomplish any useful thing. It is believed that every patient who is bodily able, will, under proper supervision, perform some useful work, and in praecox cases, particularly, the march to dementia arrested, or even the mental condition of the patient improved. The work of patients is frequently interrupted by luncheons, music, and games, and diversified by the teaching of fancy work. This field should be extended, so that every woman patient will be able to add, by her own industry, to her own well being and to that of others. The room devoted to this department, in the basement, is not only too small, but in every way inadequate for the purpose. As will later appear, we shall ask your �12 STATE OF MICHIGAN. Honorable Body for an appropriation to construct a suitable building in which to carry on this important work. OCCUPATION FOR MEN. To provide occupations for men is not difficult, as the work of the farm, gardens and grounds are especially suited for all classes of patients. Many men patients work with absorbing interest under the direction of the orchardist, of the horticulturist, of the herdsman, etc., from which they gain not only health and strength, but knowledge which they can apply in the conduct of their affairs at home. About one-half of the men are usefully employed every day. Epileptics, imbeciles, seniles, tuberculous and organic patients, are able to do little, if any, work. With trained nurses and vocational instructors, nearly every patient save these can be enlisted in work, to their benefit. TRAINING SCHOOL FOR NURSES. The training school has been conducted with care, to fit the pupil for the highest usefulness in mental nursing. Mental nursing is widening on many lines,—the education of patients, vocational instruction, diversional occupations, various forms of amusements,—all require the highest intelligence and scientific training for their successful attainment. Because of these demands, more men and women are seeking this special form of training,—even graduates of general hospital schools are seeking entrance into our school, hoping to gain wider knowledge and to make a life work of the care of the insane. During the period just closed there were twenty-eight graduates from the training school. Many of these nurses, as during former years, severed their connection with the hospital soon after graduation to enter the training schools and hospitals of the large cities. As just mentioned, however, graduates of metropolitan schools are seeking post work in our mental schools, and in this way our service may gain in trained nurses what it loses. CLINICAL AND RESEARCH WORK. This work has been under the general direction of Dr. J. A. Hall. The following is a brief report of the examinations and other work done. The Wasserman work has been done in collaboration with the Psychopathic Hospital at Ann Arbor, and it is interesting to note that of the luetic cases treated, two were discharged cured. These patients were apparently in normal mental health, and the blood and spinal fluid no longer gave the Wasserman reaction. It is also interesting to note that of the total number of cases tested, 15.2% of the men and 7% of the women gave positive Wasserman reactions. This demonstrates how vast a place specific disease takes in the etiology of mental disease. �CARS OVER COAL BUNKERS, END OF SIDE TRACK �TRAVERSE CITY STATE HOSPITAL. 13 LABORATORY. Examinations: Urine Blood Bacterial culture Sputum Pleural fluid Stomach contents Faeces Spinal fluid Blood pressures Widal reactions Diazo reactions Necropsies Lumbar punctures Wasserman work: Total bloods sent Bloods sent Sept. 1, 1913 to July 1, 1914 Positive reaction % Positive reaction Treated (Salvarsan) Cured Improved Not improved Pieces of apparatus added to laboratory 5S6 C3 64 26 2 4 1 37 74 4 17 8 55 299 257 31 12 7 2 4 1 2 Males' 158 Males 24 Males 15.2 Males 7 Females 99 Females 7 Females 7 Females 0 Sterilizer and Water bath. In addition to the Wasserman work the study of alcohol as an etiologic factor in insanity was carried on. Also the heredity of each and every patient admitted during the last year was carefully studied, in collaboration with the Michigan Eugenics Commission. EPIDEMIC DISEASES. During the months of September, October and November, 1913, there was a small outbreak of typhoid fever in the hospital. As soon as the diagnosis of typhoid was established, suitable rooms for the care and nursing of the patients were prepared, which were sufficiently isolated to prevent the spread of the disease. The most interesting question to consider was its source. How did the germs find their way into the hospital? Samples of the water used for domestic purposes, and samples of the milk used in the hospital, were immediately sent to the State Board of Health. Examination proved these specimens negative. The State Board of Health was requested to send a representative to investigate the disease and locate its source, if possible. The Board very kindly sent Dr. C. C. Slemons, Health Officer of Grand Eapids, to make the necessary investigations. In view of the negative report on water and milk, and of the localization of the cases in the hospital, Dr. Slemons first investigated if a carrier had been admitted. He also inquired into the nursing of the patients previous to their sickness. It was found that one nurse had cared for all of them, and that this �14 STATE OF MICHIGAN. nurse never had had typhoid or been in contact with the disease. Bacteriological examinations showed that she was free from typhoid germs, —that she was not a carrier. It was thought that there might be a patient who was a carrier and who might have distributed the germs to the patients attacked. One patient who had been bed-ridden for gome months from chronic intestinal trouble was strongly suspected. All tests of this patient proved negative. The Widal test was made of all patients admitted to the wards where patients were ill during a period three weeks previous to September 8th. All examinations proved negative. We may say that every effort made to trace the source of the disease was without avail. It still remains a mystery. Within a few days 10 patients were attacked. All recovered but one. This patient, who was an epileptic, had a very severe convulsion in the midst of her sickness, and if it was not directly the cause of her death, it probably hastened it. Prophylactic vaccination with typhoid bactuins of all patients was authorized. About 1,500 of these vaccinations were made, two for each person. The "first dose was of 5 million bacterins, and the second of 1,000 million bacteria. No serious illness or reaction followed these vaccinations. Whether without them the disease would have limited itself to the 10 cases cannot be said. At any rate, no further cases occurred. . Diphtheria made its appearance in the hospital just previous to the beginning of the period. The disease was controlled by the use of antitoxins. VIOLENT DEATHS. One homicide occurred. C. B. died of strangulation produced by a fellow patient. There were no suicides. One patient, an epileptic, suffocated in his pillow during a convulsion. TRANSFER OF PATIENTS. Three patients were transferred to the Ionia State Hospital; one was deported to Europe; one was transferred to the Kalamazoo State Hospital; and one was returned to Illinois. The hospital has been able to care for all patients within its district, and many from the dewberry and Pontiac State Hospital Districts. INCREASE OF PATIENTS. The net gain in patients during the period was, men, 79, women, 40, total, 119. If the patients received from outside the hospital district, 94 men and 53 women, total 147,—are deducted from the total admissions, the net loss in the district during the period was 29. The average increase of patients for the last twenty-eight years has been 21.7 per year. Of the 700 patients admitted: 23 had been confined in county houses. 124 had been confined in jails. 109 had been treated in other asylums. 22 were said to have been destructive. 34 had attempted or threatened suicide. �F APPROACH OF SIDE TRACK TO HOSPITAL �TRAVERSE CITY STATE HOSPITAL. 15 59 were homicidal or had threatened homicidal assaults. 6 had been confined or restrained at home. The number of patients confined in county houses, jails and other asylums exceeded the last biennial period by 82, the number of suicidal cases was greater by 3, and the number of homicidal cases was greater by 8. Since June 30, 1892, these statistics have been regularly kept, and show out of a total of 5,040 admissions: 206 630 421 509 390 590 403 (4%) were confined in county houses. (12%) had been confined in jails. (8.3%) had been treated in other asylums. (10%) were destructive. (7%) were suicidal. (11%%) were homicidal. (8%) required some sort of restraint at home. COST OF MAINTENANCE. The daily cost of maintenance per patient for the last 28 years has been as follows: Cents. 1880 53 . 188T 52 1888 51 1889 50 1890 49 1891 49 1892 48 1893 48 1894 48 1895 47 1896 46 1897 44 1898 42 1899 44 1900 44 1901 44 1902 44 1903 (The above exclusive of officers' salaries).... 44 1904 (Inclusive of officers' salaries) 48 1905 '• •' " 49 1906 " " " " 48 1907 " " " « 47 1908 " " '• " 48 1909 " " " '• 50 1910 " " "- : « 50 1911 •' " '• . « 50 1912 " " « « 49 1913 " " " '• 50 1914 " " '•' " (Including pro rata of State insurance fund $5,193.93) 51 �16 STATE OF MICHIGAN. DISCHARGE OP PATIENTS,, READMISSIONS,, ETC. There were 581 patients discharged during the period,—337 men and 244 women. Of this number 83 were discharged recovered, 150 improved, 49 unimproved and 299 died. The percentage of recoveries on the whole number under treatment was 4%; on the number admitted 11.8%. The death rate was 88 per thousand, 1912-13, and 80 per thousand, 1913-14. The readmissions for the period, were, men, 55; women, 52; total, 107. The readmissions from the beginning have been, men, 369; women, 356; total, 725. The total number of admissions, 6,530, represents 5,805 individuals. The daily average of patients for the period was 1,492. The number of weeks spent in the institution by patients was 155,599 1/71. This was an increase of 101 in daily average, and an increase of 10,196 2/7 weeks' board over the preceding period. On June 30, 1914, there were 1,486 patients under treatment at State expense, and 31 at private expense. There were 271 persons employed at the hospital on June 30, 1914, in the positions and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND IMPROVEMENTS. During the year ending June 30, 1913, the cost of repairs was $18,329.53, and for the year ending June 30, 1914, $17,435.33. A number of minor repairs and improvements were made during the period. Among the more important was the purchase of a flag staff, construction of a small garage for Steward's use, purchase of new hose and increased fire protection, electric lighting of main avenue, replacing floors and general repairs in Administration Building, replacing of stalls and mangers in cow stables, repairs to Steward's residence, and replacing of floors and closets in laboratory, fitting up room in basement for domestic science department, repairs and enlargement of gardener's cottage, spraying utensils for orchards and gardens, and other little repairs too numerous to mention. Beds and bedding, chairs and other furniture were required to meet the increase of patients in the hospital. SPECIAL APPROPRIATION, $38,137.80. This appropriation was granted by the last Legislature for the construction of a side track from the Peve Marquette main line to the institution. The right of way was purchased by the State at a cost of $22,738.46, and the cost of construction to June 30th, 1914, was $9,580.86. There still remained in the hands of the treasurer to the credit of this fund at the close of June 30th, 1914, $5,818.48. The road is nearly completed and well within the appropriation. There will be a large number of city lots crossed by the track, for sale. Their total market value is not less than $10,000" Your Honorable Body is respectfully requested to pass an act enabling the hospital to sell these lots, and to return the money accruing from such sales either to the State treasury or to the institution. This road is the most important improvement made at the institution in years. At this writing, (Sept. 13, 1914), freight is being delivered at the hospital. �TRAVERSE CITY STATE HOSPITAL. 17 SPECIAL APPROPRIATION, $1500. This appropriation was provided by the last Legislature for the purchase of track scales. It has not been drawn, and it is not yet fully determined whether it will be necessary to use it. SPECIAL APPROPRIATION, $6000. This appropriation was authorized by the last Legislature for the completion of the heating plant in the "main building. The contract for this work was awarded to the Thomas Heating Company of Eacine, Wisconsin, in the sum of $5,535.00. This work was completed within the amount appropriated, and in a most satisfactory manner. There remained in the hands of the treasurer to the credit of this fund on June 30th, 1914, $160.44. SPECIAL APPROPRIATION, $2500. This appropriation was granted by the last Legislature for a shed for storage of wagons and implements. Work has been commenced on this building, but it will not be finished till September of this year. There remained in the hands of the treasurer to the credit of this fund, at the close of the biennial period, $2,370.70. SPECIAL APPROPRIATION, $2500. This appropriation was granted by the last Legislature for repairs to roofs and gutters of the hospital. A part of the work has been completed. There remained in the hands of the treasurer to the credit of this fund, on June 30, 1914, $1,741.43. SPECIAL APPROPRIATION, $500. This appropriation was granted by the Legislature for sinking an artesian well. This work is about completed. An excellent flow of water has been obtained which- will be of the greatest service to the hospital. There remained in the hands of the treasurer at the close of the biennial period to the credit of this fund, $53.70. SPECIAL APPROPRIATION, $6400. This appropriation was granted by the last Legislature for roofing cottages 24, 25, 26 and 28. The work of re-roofing these buildings was done on contract, and in a highly satisfactory manner. The roofs are of the best Peach Bottom Pennsylvania slate. The work was finished in November, 1913. There remained in the hands of the treasurer to the credit of this fund on June 30, 1914, $494.53. SPECIAL APPROPRIATION, $2000. This appropriation was made for laundry extension and for laundry dry room. No part of this money was used during the period, but a contract has been made for a drying machine, and further additions will be made to the laundry as fast as possible. SPECIAL APPROPRIATION, $600. This appropriation was granted by the last Legislature for the construction of a porch at Cottage 32 for tuberculous patients. This porch 3 �18 STATE OF MICHIGAN. was partially completed and at the close of business on June 30th, 1914; $329.25 remained to its credit in the hands of the treasurer. The porch will be finished within a few weeks. SPECIAL APPROPRIATION, $10,000. This appropriation was granted by the last Legislature for a dining room for cottages for men. An architect was employed, and it was found that a building of necessary size to meet the present needs of the hospital, to say nothing of future needs, was entirely inadequate, and therefore the appropriation has not been drawn. This is a very much needed improvement, and we respectfully request your Honorable Body for an additional appropriation of $14,125.40, to build a dining room for 500 men patients. SPECIAL APPROPRIATION, $1,000. This appropriation was granted by the last Legislature to reimburse the hospital for culvert built in the rear of the hospital to divert storm water or flood water around the institution to the north. This money has been placed to the credit of the hospital to replace money expended in the purchase of material used in the construction of the culvert. NEEDS OF THE HOSPITAL. The hospital is very greatly in need of a building for a chapel and amusement hall, of additional farm lands, and of a home for women nurses. We would respectfully call your attention to these needs without requesting appropriations for them. The following requests for appropriations are to meet the absolute needs of the hospital. The hospital is growing in numbers, and conditions of care and treatment are changing, all of which necessitates improvements. CARPENTER AND PAINT SHOP. Your Honorable Body is respectfully requested to appropriate the sum of $8,452.00 for the construction of a building to be used as a carpenter and paint shop. The present room occupied as a carpenter shop is entirely inadequate for the purpose. We cannot too strongly urge in the interests of economy, and safety from fire, the granting of this appropriation. As reported to previous Legislatures, the present blacksmith shop and carpenter shop can be converted into a blacksmith shop and store room for engineering materials. GENERAL DINING-ROOM FOR COTTAGES FOR MEN. An appropriation of $10,000 was passed by the last Legislature for the construction of a central dining-room for men. Subsequently the preparing of plans for the building was placed in the hands of Mr. Wm. T. Cooper, of Saginaw, Mich. After his plans were drawn and estimates made, it was found that a dining room such as would meet the needs of the hospital, would cost $24,125.40. This would necessitate an additional appropriation of $14,125.40 to complete the building. If this diningroom is authorized, the old dining-rooms and kitchens, store rooms, etc., �PROTECTIVE CANAL �COTTAGES FOR MEN �TRAVERSE CITY STATE HOSPITAL. 19 in connection with each cottage, can be converted into dormitories, and additional room made for 140 men patients. If new accommodations were built for this number of patients, the cost would be about $70,000.00. It may be seen from a purely economic standpoint, that the construction of the new dining room would be greatly to the advantage of the State. This dining room, if authorized, would also enable the institution to abandon the old central kitchen and change it into a special department for cold storage and domestic science work. The domestic science work includes the instruction of patients in cooking, also in the preparation of fruits and vegetables for canning, bread and cake making, pastry making, etc. Further, the dining room, if authorized, would concentrate the work that is now carried on in a number of dining rooms, and at less cost for labor, skilled cooks and oversight, etc. HEATING AND VENTILATING SYSTEMS FOR COTTAGES 24 AND 26. Your Honorable Body is respectfully requested to grant an appropriaation of f 12,000 for the installation of a new heating and ventilating system in these buildings. The cost of this work is estimated on bids that were made for its installation by the Thomas Heating Co., of Racine, Wis., two years ago. ADDITIONS TO DINING ROOMS NORTH AND SOUTH. Your Honorable Body is respectfully requested to grant an appropriation of $2,394.75, for an addition to the south dining room, and the same amount for an addition to the north dining room of the main building. These dining rooms were built from the appropriations made for the extensions to the north and south wings, and were only intended to provide dining room space for two wards on each floor of the main building. After they came into operation they were found so useful that all the patients of the wing were crowded in them. The object of these additions is to make sufficient serving room space for them. This will require a room about 15x25 feet, and the construction of a new elevator shaft for each. This is a much needed improvement. We doubt if there is any more desirable system for the serving of food to a large hospital population that the one to be found here. INDUSTRIAL BUILDING. During the past few years industrial and diversional occupations have become a very important part in the treatment of patients as well as in the economy of the hospital. We have been obliged to use for this department basement rooms. They are much too small and are not as sanitary as they should be to accommodate large numbers of patients. The domestic science work is so very important that we feel it imperative to request of your Honorable Body an appropriation of $9,000 to build a small building in which this work may be properly conducted. DAIRY BARN. Your Honorable Body is respectfully requested to grant an appropriation of $5,000 for the construction of a dairy barn. The present barns are fully occupied. The dairy must be increased if it is to produce all of �20 STATE OF MICHIGAN. the milk used by the hospital. The number of patients has increased quite rapidly, and the hospital has been buying milk for some time. We would strongly recommend this appropriation as an economic proposition. FENCING. Your Honorable Body is respectfully requested to grant an appropriation of f 1,500 to construct 1,320 feet of iron fence in front of the hospital grounds. The present fence is built of wood. It has been in use 28 years, and is practically decayed. It must be replaced. The cost of an iron fence would be only slightly greater than that of a wooden one, and would be very much more durable. LAUNDRY MACHINERY. Your Honorable Body is requested to grant an appropriation of $2,500 for the purchase of five washing machines and for the installation of the same. The machines we now have have been steadily in use since 1895. They have been repaired and re-built until they can no longer be made serviceable. They will have to be replaced. GRATE FOR BOILER NO. 3. Your Honorable Body is respectfully requested to make an appropriation of $2,500 for the re-setting of Boiler No. 3, and the installation of an automatic chain grate under same. The present grate is worn out. Chain grates are in use under the other boilers, are economic and highly efficient as stokers. ADDITION TO COLD STORAGE PLANT. In case your Honorable Body grants the appropriation for a new dining room for male patients, we would respectfully request an appropriation of $5,500 to re-fit part of the rooms in the old central kitchen into cold storage rooms. Our cold storage plant is too small. There is not a proper room at present in which the hospital can store fresh fruits and vegetables or canned goods which are put up from its gardens and orchards. At the present writing there are about 10,000 quarts of canned fruits which have been put up from the farm, and which are stored in the basement. Additional cold storage is an imperative necessity for the hospital. FIRE PROTECTION FOR FARM BARNS. Your Honorable Body is respectfully requested to grant an appropriation of |8,000.00 for the purchase and installation of fire protection for the farm barns. The farm buildings and the stock have a value of not less than $75,000, and are practically without fire protection. The Board especially recommends this appropriation for the installation of an automatic fire sprinkling apparatus, and for the construction of a reservoir and purchase of necessary pumps, etc. �TRAVERSE PRINCESS WEG No. 106215. Age 5 years, 4 months, 9 days �TRAVERSE CITY STATE HOSPITAL. 21 RECAPITULATION OF APPROPRIATIONS REQUESTED. Carpenter and Paint Shop General Dining Eoom for Cottages for Men Heating and Ventilating Systems for Cottages 24 and 26. Additions to Dining Booms, north and south Industrial Building Dairy Barn Fencing Laundry Machinery Grate for Boiler No. 3 Addition to Cold Storage Plant Fire Protection for Farm Barns |8,452 14,125 12,000 4,789 9,000 5,000 1,500 2,500 2,500 8,000 8,000 00 40 00 50 00 00 00 00 00 00 00 FARM, GARDEN, STOCK AND GROUNDS. The following report shows the quantity of farm and garden produce raised during the last two years, and also the value of stock sold. FARM REPORT FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1914. Apples, bushels 4.243J Onions, dozen Asparagus, pounds 2,775 Onions, bushels Beets, sugar, bushels 679 Potatoes, bushels Beets, bushels 1,289 Peppers, bushels Beans, string, bushels 552 Pork, pounds 6,567 Parsnips, bushels Beef, pounds Currants, quarts 6,268 Pumpkins, food, t o n s . . . . Cherries, quarts 10,140 Pumpkins, stock, tons.... Cucumbers, dozen 250 Pears, bushels Cucumbers, bushels 707 Peas, bushels Cabbage, heeds 25,705 Peaches, bushels Carrots, bushels 10,629 Plums, bushels Celeriac, bushels 2 Rye, bushels Celery, head 27,850 Raspberries, quarts Cauliflower, heads 415 Rhubarb, pounds Chicken, pounds 927i Rutabagas, bushels Corn, green, bushels 1,153 Radishes, dozen Ducks, pounds 65 J Silage, tons Egg plant, bushels 5 Strawberries, quarts Grapes, bushels 475} Straw, tons Greens, pounds 166 Spinach, pounds Hay, tons 215 Salsify, bushels Liver, heart and tongue, pounds. 22 Sage, bunches Lettuce, pounds 12,925 Squash, tons Kohlrabi, bushels 1 Sweet potatoes, bushels. . Milk, pounds ,203,306 Tomatoes, pounds Mangel, bushels 3,502 Tomatoes, bushels Melons, water, pounds 5,295 Tomatoes, green, bushels. Melons, musk, pounds 8,295 Turnips, bushels Oats, bushels 2,854 Turkeys, pounds Tallow, pounds 9,950 5506,940 18 26,957 4,679 II 5 199 198J 393 i 174 2,170 7,270 1,002 9,653 930 5,727 53 2,600 147 550 19 8 130 1,038 94 980 268 80 �22 STATE OP MICHIGAN. CASH RECEIPTS FROM FARM FOR THE BIENNIAL PERIOD ENDING JUNE 30, Cattle sold Premiums on cattle: Dairy show Holstein-Friesian Association (cows) Pigs sold Hides sold Gravel sold . Keep of bull sold Hog Serum sold Carrots sold Eefunded freight charges Refunded wagon repairs charges Rent of house on right-of-way 1914. $7,725 30 191 00 115 50 5 00 173 89 1 30 25 00 3 45 3 00 7 97 4 70 4 00 |8,260 11 The general management of the farm is under the direction of Mr. G. B. Pike, the Steward, and under him, Mr. Kelley has the management of the general farming operations, Mr. Tobler of the horticultural department, gardens and grounds, Mr. Pennell of the orchards, and Mr. Hatch of the dairy and dairy barns. A goodly amount of food supplies has been raised on the farm. The above report shows that $7,725.30 worth of cattle were sold during the period. The value of milk produced exceeded $35,000.00. The orchards have come into bearing rapidly, and practically produce all of the fruits used by the hospital population. We mention as a matter of pride that during the period the hospital received a silver medal from the exhibition of the International Apple Shippers' Association at Cleveland for the best individual display of fruits; gained 11 prizes for its cattle from the Chicago cattle show in 1913; and also a blue ribbon from the Boston exhibition of the International Apple Shippers' Association, 1914. As previously mentioned in this report, the farm, orchards, etc., form a vast workshop for men patients, and with their growth, still larger numbers of patients will find employment in connection with them. During the last season a large number of men patients were engaged in gathering the fruit, and quite a number of women patients assisted in the preparation and canning of fruits. We regret to report that during the period a thorough test of the herd for tuberculosis showed that about 20 head of the cattle were infected. These cattle were turned over to the State Live Stock Commission, and through them were slaughtered under the supervision of the United States Sanitary Inspectors of Detroit. This was a great loss to the dairy. Every effort is made to prevent the invasion of the disease among the cattle, and tuberculin tests are made once or twice a year of the entire herd. During the last season two sections of the dairy barns have been refitted with modern sanitary stalls. This includes a complete outfit for caring for calves. The stalls are of iron and concrete, the floors are of �TWIN HEIFER CALVES AT FOUR MONTHS OF AGE Their dam's A. R. 0. record at 2 years and 9 days old was 20.45 Ibs. of butter from 328.8 Ibs. of milk in 7 days. �TRAVERSE CITY STATE HOSPITAL,. 23 concrete covered with cork brick where the cattle stand. These stables are perfect in their appointments and sanitation. There were several voluntary admissions during the period, and we believe if the law providing for such admissions were more generally known, that a large number of patients would take advantage of it. We believe that the hospital should be open to the treatment of all forms of nervous and mental diseases, and we would especially urge the Legislature to consider the feasibility of establishing a general hospital department in connection with the hospital, where patients suffering from any form of disease, or in need of care and treatment, would find a suitable place. It seems a pity that the hospital, with its magnificent equipment, should be restricted to the care and treatment of one class of our afflicted citizens. RECEIPTS AND DISBURSEMENTS. The total receipts of the hospital for the fiscal year ending June 30, 1913, including cash on hand and credits on special appropriations accounts, were f311,954.68; and the total disbursements for the same period, including special appropriations, were $305,771.12. The total receipts of the hospital for the fiscal year ending June 30, 1914, including cash on hand and credits on special appropriations accounts, were $371,113.70; and the total disbursements for the same period, including special appropriations, were $340,826.82. There was at the close of the biennial period ending June 30, 1914, $30,286.88 in the hands of the treasurer; $17,258.06 of which amount was to the credit of the current expense account, and the balance of $13,028.82, unexpended balance to the credit of special appropriations accounts. OFFICERS. In 1913, Hon. Wm. Lloyd, of Manistee, Mich., was reappointed to the Board. Mr. Lloyd had served as member of the Board since 1907, and was at the time of his reappointment, and is at the present time, President of the Board. In 1913, Hon. C. D. Alway, of Traverse City, Mich., was appointed to the Board. Mr. Alway is a lawyer by profession, and brings with him much experience in his profession. In July, 1913, Dr. R. F. Wafer was appointed assistant physician. He came highly recommended. Dr. S. C. Mies resigned July 1st, 1913. We regret to state that the services of Dr. G. V. Sigler, who was appointed to the staff in February, 1913, were dispensed with in June, 1913. We regret to report the death of Mr. T. T. Bates, who was a member of the Board for many years. Mr. Bates became a member of the Board of Building Commissioners of the hospital in 1885, and after the work of the Building Commission was finished, he was continued as Trustee. During all those years he was a faithful officer of the State. His general knowledge, together with his information concerning the hospital, was a source of inspiration to those associated with him, and to the officers of the hospital. Mr. Bates felt a deep interest in all that pertained to the institution. He was a true and loyal friend to all those in trouble; he always favored every movement that looked to the better- �24 STATE OF MICHIGAN. ment of the hospital in every direction. By his death the State and the institution lost a valued servant. In closing this report, we can only say that we believe that each and every Trustee, and each and every officer and employee of the institution, has appreciated the necessity for giving his best to the institution. We are conscious that steady progress is being made in hospital management, and in the care and treatment of the insane, and we further believe it is the duty of every employee of the State, from Trustee down, to direct, as far as possible everything that pertains to the welfare and improvement of patients. W. LLOYD, W. W. MITCHELL, H. C. DAVIS, M. F. QUAINTANCE, E. S. WAGAK, C. D. ALWAY. Traverse City, Mich., June 30, 1914. �TRAVERSE CITY STATE HOSPITAL. 25 TREASURER'S REPORT. ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE . TRAVERSE CITY STATE HOSPITAL FOR THE FISCAL YEAR ENDING JUNE 30, 1913. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending July SI, 1912. CREDITS. By balance on hand July 1st, 1912 Cash from State Treasurer: Account of current expenses Cash from other sources $5,098 85 46,204 57 974 17 $52,277 59 DEBITS. Account of repairs and painting roofs Account of current expenses Balance on hand to new account $56 25 29,896 16 22,325 18 $52,277 59 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending August 31, 1912. CREDITS. By balance on hand August 1st, 1912 Cash from State Treasurer: Account current expenses Cash from other sources $22,325 18 23,102 17 343 15 $45,770 50 DEBITS. Account of extensions to north wing Account of completion of heating and ventilating Account of repairs and painting roofs Account of current expenses Balance on hand to new account $268 246 60 28,738 16,455 24 94 75 80 77 $45,770 50 THE STATE OF MICHIGAN, In account viith A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending September 30, 1912. CREDITS. By balance on hand September 1st, 1912 Cash from other sources $16,455 77 497 51 $16,953 28 DEBITS. Account of repairs and painting roofs Account of current expenses Balance on hand to new account $52 87 15,650 79 1,249 62 $16,953 28 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending October 31, 1912. CREDITS. By balance on hand October 1st, 1912 Cash from State Treasurer: Account of current expenses Loan from Traverse City State Bank Cash from other sources By balance overdrawn to new account $1,249 62 21,986 3,000 1,291 5,227 35 00 75 67 $32,755 39 �THE NEW EQUIPMENT IN THE CALF BARN �26 STATE OF MICHIGAN. DEBITS. Account Account Account Account of extension to south wing of extension to noith wing of repairs and painting roofs current expenses $333 97 167 46 56 32 32,197 64 832,755 39 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Trailerse City Stale Hospital, for the month ending November SO, 1912. Cash from State Treasurer: Account current expenses Loan from Traverse City State Bank Cash from other sources CREDITS. $21,986 35 4,000 00 404 00 $26,390 35 DEBITS. Account balance overdrawn November 1st, 1912 Account current expenses Balance on hand to new account $5,227 67 20,612 43 550 25 $26,390 35 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending December 31, 191S. CREDITS. By balance on hand December 1st, 1912 Cash from State Treasurer: Account current expenses Loan from Traverse City State Bank Cash from other sources $550 25 21,986 34 10,000 00 614 74 S33.151 33 DEBITS. Account of current expenses Loan paid to Traverse City State Bank Balance on hand to new account $27,717 76 4,000 00 1,433 57 f $33,151 33 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending January 31, 1913. CREDITS. Balance on hand January 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $1,433 57 32,539 72 1,746 51 $35,719 80 DEBITS. Account current expenses Balance on hand to new account $32,341 42 3,378 38 $35,719 80 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending February 2&, 1913. * CHEDITS. Balance on hand February 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $3,378 38 22,044 89 691 86 $26,115 13 DEBITS. Account current expenses Balance on hand to new account $21,815 76 4,299 37 $26,115 13 �TRAVERSE CITY STATE HOSPITAL. 27 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City Slate Hospita for the month ending March 31, 1913. Balance on hand March 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $4,299 37 22,106 83 634 67 DEBITS. Account current expenses Balance on hand to new account 820,153 78 6,887 09 I"HE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending April SO, 191S. CKEDITS. Balance on hand April 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $6,887 09 22,277 61 1,291 66 $30,436 36 DEBITS. Account current expenses Balance on hand to new account $26,170 59 4,285 77 $30,456 36 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending May 31, 191S. CREDITS. Balance on hand May 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $4,285 77 22,277 59 562 92 $27,126 28 DEBITS. Account repairs and painting roofs Account culvert Account current expenses Balance on hand to new account $311 95 260 75 21,275 34 5,278 24 $27,126 28 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City Slate Hospital, for the month ending June SO, 1913. CREDITS. Balance on hand June 1st, 1913 Cash from State Treasurer: Account current expenses Cash from other sources $5,278 24 22,277 59 2,012 88 $29,568 71 DEBITS. Account repairs and painting roofs Account re-roofing cottages Account culvert Account current expenses Balance on hand to new account .... $770 72 13 30 11125 22,489 88 6,183 56 $29,568 71 �28 STATE OF MICHIGAN. SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the fiscal year ending June SO, 191S. Balance on hand July 1st, 1912 Cash from State Treasurer: Account of current expenses Cash from other sources Loan from Traverse City State Bank $5, 098 85 278,790 01 11,065 82 17,000 00 Account of repairs and painting roofs Account of extension south wing Account of extension north wing Account of heating and ventilating Account of loan Traverse City State Bank Account of culvert Account of re-roofing cottages Account of current expenses Balance on hand to new account .- SI,308 86 333 97 435 70 24G 94 4,000 00 372 00 13 30 299,060 35 6,183 56 $311,954 68 $311,954 68 ABSTRACTS OF ACCOUNTS CURRENT OP THE RECEIPTS AND DISBURSEMENTS AT THE TRAVERSE CITY STATE HOSPITAL FOR THE FISCAL YEAR ENDING JUNE 30, 1914. THE STATE or MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending July S I , I B I S . CREDITS. Balance on hand July 1st, 1913 Cash from State Treasurer: Account of current expenses Account of culvert Account of rooflng cottages Nos. 24, 25, 26 and 28 Account of side track Account of extension to heating p] ant Account of repairs roofs and gutters Account of artesian wells Cash from other sources Account of repairs and painting roofs Account of repairs on reservoir Account of completion of cold storage Account of current expenses Balance on hand to new account $6,183 56 24,845 40 1,000 00 6,400 00 22,050 00 6,000 00 2,500 00 500 00 1,207 52 • $649 30 150 21,101 48,755 95 00 00 43 10 $70,686 48 $70,686 48 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending August 31, 191? Balance on hand August 1st, 1913 Cash from State Treasurer: Account of side track Account of current expenses Cash from other sources: Account of side track Account of current expenses $48,755 10 -. '16,087 80 24,739 40 300 00 499 87 $90,382 17 �SHOWING CONCRETE MANGERS IN THE NEWLY EQUIPT COW BARN �TRAVERSE CITY STATE HOSPITAL. Account of repairs on reservoir Account of books and musical instruments Account of roofing cottages Nos. 24, 25, 26, 28 Account of side track Account of extension to heating plant Account of repairs and painting roofs Account of current expenses Balance on hand to new account ', 29 $85 36 1,647 23,468 1,812 396 21,980 40,955 00 00 72 78 20 50 74 23 $90,382 17 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending September SO, 1913. Balance on hand September 1st, 1914 Cash from State Treasurer: Account of current expenses Account of track scales Cash from other sources 840,955 23 24,739 40 1,500 00 574 06 DEBITS. Account of repairs on reservoir Account of side track Account of extension to heating plant Account of repairs, roofs and gutters Account of artesian well Account of roofing cottages Nos. 24, 25, 26, 28 Account of repairs and painting roofs Account of current expense Balance en hand to new account $10 612 117 263 209 2,627 428 21,801 41,699 00 40 12 02 10 85 04 23 93 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending October S I , 1913. Balance on hand October 1st, 1913 Cash from State Treasurer: Account of current expenses Cash from other sources $41,699 93 23,174 61 1,762 36 . Account of side track Account of extension to heating plant Account of repairs roofs and gutters Account of artesian wells Account of re-roofing cottages Account of roofing cottages Nos. 24, 25, 26 and 28 Account of current expenses Balance on hand to new account $409 74 2,82599 282 25 100 00 192 17 667 55 28,244 86 33,914 34 : $66,636 90 $66,636 90 THE STATE OF MICHIGAN, In account with A. J, Maynard, Treasurer of the Traverse City State Hospital, for the month ending November 30, 1913. CREDITS. Balance on hand November 1st, 1913 Cash from State Treasurer: Account of current expenses Cash from other sources Account of books and musical instruments Account of side track Account of extension to heating plant Account of roofing cottages Nos. 24, 25, 26 and 28 Account of current expenses Balance on hand to new account $33.914 34 :. 23,174 60 970 32 $94 943 249 1,456 26,502 28,812 00 65 32 88 99 42 $58,059 26 $58,059 26 �30 . STATE OF MICHIGAN. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending December S I , 1913. Balance on hand December 1st, 1913 Cash from State Treasurer: Account of current expenses Cash from other sources $28,812 42 23,174 59 1,606 66 $53,593 67 DEBITS. Account of side track Account of extension to heating plant Account of current expenses Balance on hand to new account $2,501 834 26,809 23,447 95 93 22 57 $53,593 67 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending January 31, 1914CREDITS. Balance on hand to January 1st, 1914 Cash from State Treasurer: Account of current expenses Cash from other sources: Account of current expenses Account of side track. $23,447 57 26,333 78 1,649 57 1 40 $51,432 32 DEBITS. Account of side track Account of repairs roofs and gutters Account of current expenses Balance on hand to new account $2,771 72 24,643 23,944 32 90 71 39 $51,432 32 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending February 218, 1914CREDITS. Balance on hand February 1st, 1914 Cash from State Treasurer: Account of current expenses Cash from other sources $23,944 39 26,333 78 505 29 DEBITS. Account of side track Account of current expenses Balance on hand to new account $1,014 44 30,294 26 19,474 76 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending March 31, 1914CREDITS. Balance on hand March 1st, 1914 Cash from State Treasurer: Account of current expenses Cash from other sources $19,474 76 26,333 76 1.420 45 DEBITS. Account of books and musical instruments Account of current expenses Balance on hand to new account $22 50 23,399 40 23,807 07 �SHOWING STALLS AND STANCHIONS IN THE NEWLY EQUIPT COW BARN �TRAVERSE CITY STATE HOSPITAL. 31 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending April SO, 1914- Balance on hand April 1st, 1914 Cash from State Treasurer: Account of current expenses Account of porch cottage, No. 32 Cash from other sources $23,807 07 23,219 71 600 00 1,535 18 $49,161 96 DEBITS. Account of side track Account of artesian wells Account of current expenses Balance on hand to new account $397 98 22,045 26,619 77 90 62 67 $49,161 96 THE STATE OF MICHIGAN. In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending May 31, 1914CREDITS. Balance on hand May 1st, 1914 Cash from State Treasurer: Account of current expenses Account of wagon and implement shed Cash from other sources $26,619 67 23,219 71 2,500 00 496 69 $52,836 07 DEBITS. Account of culvert Account of side track Account of roofs and gutters Account of artesian wells Account of current expenses Balance on hand to new account $280 162 67 38 21,545 30,742 00 37 50 30 29 61 '$52,83607 THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the month ending June SO, 1B14CBEDITS. Balance on hand June 1st, 1914 Cash from State Treasurer: Account of current expenses Cash from other sources $30,742 61 23,219 75 754 48 DEBITS. Account of repairs on reservoir Account of side track Account of repairs on roofs and gutters Account of porch cottage No. 32 Account of wagon and implement shed Account of current expenses Balance on hand to new account $8 338 72 290 129 23,589 30,286 59 30 90 75 50 92 88 $54,716 84 �32 STATE OF MICHIGAN, SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the fiscal year ending June SO, 1&14CREDITS. Balance on hand July 1st, 1913 Cash from State Treasurer: Account of track scales Account of culvert Account of re-roofing cottages Nos. 24, 25, 26, 28 Account of roofs and gutters Account of extension heating plant Account of side track Account of artesian well Account of porch, cottage No. 32 Account of wagon and implement shed Account of current expenses Cash from other sources $6,183 56 1,500 1,000 6,400 2,500 6,000 38,439 500 600 2,500 292,508 12,982 00 00 00 00 00 20 00 00 00 49 45 $1,474 133 150 152 192 280 446 758 5,839 32,620 6,400 290 129 291,958 30,286 49 59 00 50 17 00 30 57 56 72 00 75 50 67 88 8371,113 70 DEBITS. Account of repairs and painting roofs Account of repairs on reservoir Account of completion cold storage Account of books and musical instruments Account of re-roofing cottages Account of culvert Account of artesian well Account of repairs, roofs and gutters Account of extension heating plant Account of side track Account of roofing cottages Account of porch, cottage No. 32 Account of wagon and implement shed Account of current expenses Balance on hand to new account..' $371,113 70' We have carefully examined the accounts of A. J. Maynard, Treasurer of Traverse City State Hospital for the biennial period ending June 30, 1914, and have compared the same with the books and vouchers and verified the same by further comparison 'with the books of the SteAvard and hereby certify to the entire correctness of them. M. F. QUAINTANCE, C. D. ALWAY, WILLIAM LLOYD, Auditing Committee. �TRAVERSE CITY STATE HOSPITAL. 33 STEWARD'S REPORT. FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1914. ANALYSIS OF RECEIPTS AND DISBURSEMENTS. RECEIPTS. Maintenance, etc., State patients Maintenance, etc., private patients $571,298 50 12,836 57 • Farm: Cattle sold Premiums on cattle Pigs sold Hides sold Gravel sold Keep of bull sold Hog serum sold Carrots sold Refunded freight charges Refunded wagon repairs charges Rent of house on right of way Sundry accounts $7,725 30 219 65 5 00 173 89 1 30 25 00 3 45 3 00 797 4 70 4 00 Special appropriations: Porch, cottage No. 32 Track scales Roofing cottages Side track Culvert Extension heating plant Repairs roofs and gutters Artesian well Wagon and implement shed 8,173 26 20,038 44 600 1,500 6,400 38,439 1,000 6,000 2,500 500 2,500 00 00 00 20 00 00 00 00 00 $671,785 97 DISBURSEMENTS. 1. Officers' 2. Food: salaries Wages Meat and Butter Flour Coffee Tea Sugar. . Fuel Miscellaneous foods 3. Clothing: 4. Laundry: Wages Clothing Wages Machinery Starch Soap making tallow Soda Lime Soap Pins Blueing and ammonia Baskets Wagon Acetic acid Felt for mangle $27,884 14 fish .... $17,197 43 58,480 82 31,389 59 16,864 92 7,001 28 1,467 70 11,960 71 48 58 34,426 05 $3,574 61 31,657 99 $9.880 35 168 06 274 35 2,034 88 628 21 20 64 36 48 11 12 72 09 119 68 24 00 29 01 5 31 $27,884 14 178,837 08 35,232 60 13,280 18 �STATE OF MICHIGAN. 34 5. Heating and Light: Wages Coal and freight Gas Electrical supplies Examining engr. expense Rent coal shed Kerosene oil Advertising for coal bids $8,023 52,490 2,339 1,534 548 18 12 126 6. Floral, greenhouse and grounds: Wages Implements Seeds and bulbs Hose Spraying outfit and solution Fence wire Plants and trees Flower pots Flag staff: Snow plow $6,314 32 101 54 109 38 138 60 353 95 2775 225 15 38 03 120 00 9 63 7. Medical department: Wages Drugs, etc Pins for graduate nurses' class Medical books 8. Office, stationery, etc.: Wages Blank books Postage Telegrams and telephones Printing, etc Stationery Filing cases Typewriters and desk Adding machines Recording clock t). 10. 11. ; Amusement and instruction: Games Circus tickets Books Flag Tuning piano Fair tickets Music for patients' parties Christmas entertainments Moving picture entertainments Theatrical entertainments Hymn books Address and pins for graduate nurses Furniture and household supplies: Wages Soap Dry goods Utensils Carpets Hardware Toilet paper Furniture Brooms Crockery Gas ranges Bedding, mattresses, etc Fire extinguishers Sewing machines Stoves and fit! ings Bedsteads Polish Brushes Chambers Garbage cans and barrels Mops and dusting oil Oil cloth, linoleum and curtains Carriage barn and vehicles: Wages Repairs harness Repairs express wagon Blacksmithing 87 71 50 04 50 00 95 13 $101,910 6,823 22 113 29 72 50 50 $6,966 148 697 1,173 830 394 159 232 582 172 • 93 17 00 34 39 15 57 05 25 31 $102 37 75 50 71 23 9 70 14 00 18 00 147 50 157 43 45 00 25 00 9 02 142 50 fittings $3,745 41 1,724 52 7,043 54 1,002 69 903 36 1,341 36 534 46 658 17 975 77 1,626 34 43 75 7,056 97 75 00 51 20 139 34 922 71 191 68 192 54 259 46 223 34 155 19 324 43 $1,226 7 27 13 50 95 95 90 $65,093 70 7,438 35 108,870 01 11,356 16 817 25 29,191 23 1,276 30 �TRAVERSE CITY STATE HOSPITAL. 12. 13. 14. 15. Improvements and repairs: Wages Oils and paints Lumber Lime and cement Hardware Glass Iron pipe, etc Iron Fire hole track Brick Moving small building Sewer pipe, tile, etc Brushes, tools, etc Sawing logs Calsomine Polish Glue Alcohol Plastico Soda ash Wall finish and blocks Roofing fittings Machinery: Packing, gaskets and valves Lubricating oil Machine Stoker repairs Gas apparatus Gasoline Belting Soda ash for Motors, etc Steam charts Thermometers, etc Dry cells Fire ladders and hose Chain hoist Baler for rags, etc Sewing machines Boiler insurance fittings filter. Farm, Harden and stock: Wages Fee'd Registry stock, etc Spraying Implements Harness, blankets Fertilizer Drain tile, etc Seed Veterinary, etc Freight on stock, etc Blacksmithing Plant boxes Straw Hay Threshing Horses Silo and ensilage cutter Oats Binder twine Dairy show exhibit Cow stalls Miscellaneous: .- Wages. Watchmen Amounts charged back: Patients travelling expenses Patients expenses home Undertakers' fees Expenses elopements Purchases for patients Collection of delinquent accounts Storekeeper's travelling expenses Steward's travelling expenses Herdman's travelling expenses Matches Tobacco Refunded money Medical superintendent's travelling expenses Treasurers' bank loans Hauling fire engine Freight on empties Bus transfer of patients 35 $24,564 28 2,525 15 1,204 10 843 41 710 43 274 69 2,586 46 1,104 23 252 02 721 58 125 00 257 55 101 23 98 42 . 21 95 1 00 1 60 20 24 14 70 67 80 354 78 39 24 $597 40 315 37 463 65 855 87 21 00 279 38 197 28 173 04 137 21 21 01 37 44 3 40 491 80 32 03 94 63 185 76 167 40 $17,569 06 10,210 66 4,043 87 321 15 841 32 208 75 422 50 1112 756 25 188 85 220 50 108 40 11 86 1,988 58 7,006 55 86 85 434 00 1,115 00 2,665 81 36 75 232 32 1,071 14 $3,653 55 75 87 262 10 10 00 366 26 2275 23 49 26 44 176 28 7 55 18 00 3,018 95 649 73 91 96 17,000 00 2 00 1 98 7 50 $35,764 86 4,073 67 49,£51 29 �36 STATE OF MICHIGAN. Miscellaneous—Continued— Dentistry for patients.... Telegrams, miscellaneous. Tobacco pipes Pathologist's salary Accident insurance Special appropriations: Repairs and painting roofs Completion heating and ventilating.. Extension north wing Extension south wing Culvert Re-roofing cottages Nog. 28, 32 Cold storage Repairs reservoir Side track Roofing cottages Nos. 24, 25, 26, 28. Books and musical instruments Extension heating plant Repairs roofs and gutters Artesian well Poich, cottage No. 32 Wagon and i mplement shed $15 10 47 80 00 34 23 00 $2,783 246 435 333 652 205 150 133 32,620 6,400 152 5,839 758 446 290 129 35 94 70 97 00 47 00 59 72 00 50 56 57 30 75 50 785 22 $26,352 20' 51,578 QN $646,597 94 SUMMARY OF INVENTORY OF THE TRAVERSE CITY STATE HOSPITAL TAKEN AT THE CLOSE OF THE FISCAL YEAR ENDING JUNE 30, 1914. Land Buildings Stock on farm Administration building, furniture and fixtures Dispensary Pathological laboratory Library and chapel Wards: Furniture and fixtures Cottage 21, furniture and fixtures Cottage 23, furniture and fixtures Cottages 24 and 26, furniture and fixtures Cottage 25, furniture and fixtures Cottage 27, furniture and fixtures Cottage 28, furniture and fixtures Cottage 29, furniture and fixtures Cottage 30, furniture and fixtures Cottage 31, furniture and fixtures Cottage 32, furniture and fixtures Cottage 34, furniture and fixtures Cottage 36, furniture and fixtures Cottage 38, furniture and fixtures Engine room and shops Kitchen and bakery Laundry Farm and barns Sewing room Store fixtures Stock: Dry goods, clothing, boots and shoes Stock: Groceries and meats Stock: Notions Stock: Hardware Stock: Crockery Stock: Silver plated ware $58 ,240 00 883 ,100 44 ,631 6,662 1 ,946 1 ,293 1 ,188 32 ,551 2 ,641 243 3,618 1 ,970 3 ,142 1 ,549 2 ,881 2 ,926 1 ,439 1,378 2 ,835 2 ,814 824 ,403 ,270 ,908 ,648 464 611 ,492 ,787 ,167 830 408 50 00 50 50 83 50 60 91 74 91 15 68 81 05 80 87 71 69 06 50 51 48 95 97 30 02 43 62 15 35 48 04 62 $1,104,925 73: �TRAVERSE CITY STATE HOSPITAL. 37 EEPORT OP MEDICAL SUPEBINTENDENT. To the Board of Trustees: Gentlemen—I have the honor to submit for your consideration the following report of the principal events of the hospital for the biennial period ending June 30, 1914. The movement of population has been as follows: TABLE I.—Patients Admitted, and Discharged During the Biennial Period. Males. Remaining June 30, 1912 . Admitted during period: On original commitment : Public Private By transfer from State institutions: Public Private State Discharged : Died Remaining under treatment June 30, 1914 Females. Total. 782 616 1,398 353 241 11 594 32 2 21 2 10 6 1 30 25 16 1 55 1 ,198 • 900 2 098 38 91 31 177 52 52 18 122 90 143 49 299 861 656 1,517 If these statistics are compared with those of the last period it will be found that there were 150 more admissions and 46 more discharges. If the patients admitted from the Pontiac and the Newberry State Hospital districts are counted, there was a net gain of 119 patients under treatment in the hospital. The percentage of patients discharged recovered on the whole number under treatment was slightly greater than for the last period. The smallest number of patients under treatment in any one day was 1,398, and the largest number was 1,535. The death rate was slightly greater than for the previous period. �38 STATE OF MICHIGAN. The following table is an attempt to classify the causes of death: ' TABLE II.—SUMMARY.—Showing Causes of Death. Male. General Diseases: 15 1 Tubercular peritonitis i Diabetes . . . . 2 Pyemia 1 Diseases of Nervous System: Cerebral hemorrhage. . . . Insanity— exhaustion from . . . . Syphilis o f brain. . . . Transverse Myelitis. . . Diseases of the Respiratory Lobar pneumonia System: Diseases of Circulatory System: Organic heart disease Acute dilatation Diseases of Digestive System: Dysentery Appendicitis Diseases of Genit o- Urinary System: Violence: Totals Female. . . 31 3 2 4 3 Total. 4& 4 7 1 6 8 1 30 13 2 15 1 1 12 1 1 13 10 6 6 1 1 4 5 1 35 13 3 3 3 7 38 20 10 3 4 2 2 4 1 8 3 1 1 3 1 1 177 1 2 1 2 43 23 8 21 1 1 17 1 1 1 4 1 3 3 3 4 6 1 1 1 1 122 299 One hundred fifty-three patients or 51% of those who died, were over 55 years old; 21 of the number were over 80 years old. The deaths from tuberculosis were 19% of the deaths from all causes, an increase of 4.9% during the last two years. We are unable to account for this increase. It is possible that more patients were admitted suffering from the disease during the period, and it may be due to causes entirely acci- �TRAVERSE CITY STATE HOSPITAL. 39 dental. We do not believe that there has been appreciable increase in the occurring cases in the institution. As during many years past every effort is taken to prevent the development or spread of the disease in the hospital. Separate departments for each sex are maintained for the care and treatment of tuberculous cases. Syphilis caused 14.6% of deaths, nearly as many as tuberculosis. Arterial degenerations and consecutive organic disease caused 51% of the deaths. Diseases of the circulatory organs are the cause of a large percentage of mental disease. An analysis of the above summary would show that nearly 90% of all the deaths were due to organic and incurable diseases. The following table showing the forms of mental disease is no longer in use, but is inserted to show the classification of patients up to June 30, 1906, since which time a modification of the well known classification of Kraepelin has been used in all the asylums of Michigan. �TABLE Hi. From the beginning to July 1, 1906. Forms of insanity. Males. 206 94 a. I. Primary c' d'. Hallucinatory delirium (primary confusional insanity) . . . . II. Secondary j g; Acute Chronic B. Incident to the normal and the degen- C. Incident to the degenerate brain fa. b. II. Symptomat c of organic disease of the brain . . . . { c. Dementia from gross brain lesions (apoplexy, tumors, etc.) d. [e. fa. Hysteria Hypochondria Id. II. Primary forms fa. ' d. Imbecility Idiocy Total. 31 216 88 1 23 422 182 1 54 162 117 29 58 216 158 1 2 378 275 30 60 16 212 141 180 17 161 3 13 191 8 36 53 124 16 233 85 6 113 24 248 194 304 33 394 88 19 304 104 1 425 1 117 299' 6 221 1 724 7 140 4 81 1 1 221 5 1 2,30fi 1,884 4,190 D Not insane voluntary cases Total Females. �TABLE IV.—'Showing the forms of insanity of patients admitted. From the beginning. For the biennial period. Males. Females c. Alcoholic paranoid conditions Organic f definite HumbuiiuiimiiBtt,/ structural changes) vsigium brain .J.C.U1 disease I.LMIWK lueiiuiu: Thvroeemc insanity inyrogemc insanity Paranoia. . (2) Arterio-sclerotic brain disease S °^ ^airi ; neurology -. ^ &P^¥ Other forms relatedv to (5) General paralysis '^(2° ) Myxpedoma Cretinism 1 (1) Hebephrenic .forms . ( (3) Katatonic forms <J> Classic type Manic depressive v (2) Denressed state [ (3) Mixed state Arrested mental development < [Jj Jjbeclllty Total 9 20 3' Total. 9 23 Males. Females . 9 31 51 1 12 1 20 1 99 • 19 58 125 184 11 1 21 7 40 33 75 9 33 54 2 18 1 31 2 120 26 98 158 259 89 15 2 10 32 81 80 8 84 186 115 36 21 42 1 5 71 11 2 5 150 225 109 23 154 275 158 69 35 117 4 5 160 26 4 15 1,354 986 2,340 4 3 7 10 2 12 27 7 17 30 56 2 2 15 8 25 29 9 32 44 81 31 23 5 6 35 24 16 14 1 30 1 10 30 20 1 26 48 43 9 41 52 25 7 61 72 59 23 1 '47 1 "•"ii& 27 9 1 7 19 46 9 1 8 416 284 700 17' i' Total. 144 23 15 70 89 43 33 14 75 3 2' 3 1 0 �42 STATE OF MICHIGAN. Table IV shows that 27.8% of the patients admitted were suffering from organic diseases, 17% from dementia praecox, 9.7% from paranoia and paranoid states, 6.5% from epilepsy, 22% from manic depressive insanity, 5.5% from alcoholic and drug insanity, and 11% from arrested mental development. This table does not show that there has been any marked increase in the various forms of insanity other than that in the imbecile group. During the previous two years 6.4% of the patients admitted were classified as mentally defective. This shows an increase of nearly 5% in the admissions of the imbecile class. As mentioned in our last report, it is becoming increasingly evident that the segregation of the feeble-minded is a matter of the utmost importance to the social welfare, and that a most definite economy would be secured by providing adequate accommodations. Undoubtedly, the opening of the colony for epileptics at Wahjamega will relieve the stress at Lapeer and that institution will be able to receive a much larger number of feeble-minded than has heretofore been possible. It should be the duty of the State to see that adequate provisions are made for the care and safeguarding of this class. "Poverty and crime grow in direct proportion to the freedom the State gives to feeble-minded, subnormals and morons." The State should attend that these individuals are not only properly cared for but that they should be heldin suitable institutions. We also hope that the colony at Wahjamega will soon be able to relieve the hospital of many of its epileptic patients. A great deal of clinical work has been performed during the last two years, and arrangement is being made to introduce the Abderhalden method of diagnosis of dementia praecox and other nervous statesOther research work is being carried out in collaboration with the Eugenics Commission of the State, and with the Psychopathic Hospi'tal at Ann Arbor, Mich. You have incorporated in your report an outlineor summary of the work accomplished in the laboratory during theperiod; therefore, it will not be necessary to repeat it. About the usual number of surgical operations was performed during the period, and there was one obstetrical case. The work in the training school for nurses was carried on with enthusiasm, and successfully. The field of instruction has been enlarged,, and the teaching has improved with the increased experience of thestaff. There were 14 graduates from the school in both 1913 and 1914. A list of the graduates is appended to this report. The medical work is carried on as carefully as possible, and effort is made to keep pace with the most modern methods of treatment. The detailed reports presented herewith will demonstrate that the strictest economy has been practiced in all departments, and that the aim has been to maintain the highest efficiency in the hospital. The following tables will give a brief analysis of the clinical forms of mental diseases admitted during the period. These statistics have been presented in this form for several years, and are of increasing value for comparative purposes. We are enabled from these statistics, accumulated from each of the hospitals of Michigan, to determine with considerable accuracy the percentage of each of these types of mental disease to the total population of the State. The principal lesson learned: from the past two years is that luetic diseases and alcoholic derangements are two of the principal causative factors of insanity and degen- �TRAVERSE CITY STATE HOSPITAL. 43 eracy. The constantly increasing numbers in the imbecile group all show the great necessity for supervision of marriage, and the necessity for careful eugenic statistics. All these matters require the most careful thought from our Legislators, teachers, social workers and professional men, and from all those interested in the upbuilding of the race. From the Wasserman tests made on patients in the State of Michigan during the last year, the astonishing fact is revealed that about 15% of all patients admitted to the institutions are infected with luetic disease. ALCOHOLIC INSANITY. In this group are 29 men and 3 Avomen, comprising 4.5% of the cases admitted during the biennial period. Women. Men. Alcoholics No. Per cent. 416 29 6.97 Total. Per cent. No. 284 No. Per cent. 700 3 1.05 32 j 4.57 The 29 men constitute 6.9% of the males admitted; the females a little over 1% of the women received. The 32 cases were placed as follows: Women. Men. Alcoholic paranoid conditions No. Per cent. 9 20 31.0 69.0 No. Total. Per cent. 100 3 No. 9 23 Per cent. 28.1 71.9 Age at time of admission. Men. Women. Total. 20 to 24 2 2 25 to 29 2 3 30 to 34 1 ; 1 35 to 39 .... 40 to 44 ... 6 45 to 49 2 50 to 54 4 6 1 3 4 6 55 to 59 4 60 to 64 .. 2 2 65 to 69 .. - 1 1 2 �STATE OF MICHIGAN. 44 Heredity. Direct. Atavistic. . . 1 1 o 1 1 2 2 2 2 5 1 1 £ Brothers and sisters. Collateral. Total. OJ o H i '<K I I H =3 O 1 H 1 1 i I 2 2 2 2 2 5 6 5 13 OJ Ba 2 1 6 2 15 5 2 15 13 5 Results of treatment. Women. Men. Recovered Improved Unimproved Died Total. „ 1 8 10 2 12 1 1 11 11 Act 84, Public Acts of 1912, made provision for the reception in the State Hospitals of cases of inebriety and of drug addiction. We have had sent to us a few patients under this Act. There is no special form in the classification for their reception, and they have been placed in the alcoholic group under alcoholic paranoid conditions. There were 11 men committed by the various counties, principally Grand Traverse, and 2 women. A few of the cases of chronic alcoholism were committed on regular insane orders. MORPHINISM. There were received into the hospital during the past biennial period 4 men committed because of addiction to the vise of opium. Of these four, two had been with us on one or more previous occasions; the other two were committed for the first time. One after a short residence was discharged, and has remained well up to date. The fourth patient is still with us and shows other mental involvement than that due to the use of opium. There were three women entered because of the use of opium in one form or another. One of the three had been a patient here on two previous occasions, and after a residence of about 6 months was discharged. Thus far she has remained well as far as we have been able to learn. One of the other two has been away from the institution for over a vear �TRAVERSE CITY STATE HOSPITAL. 45 and is perfectly free from any indications of the return of the habit. The third woman remained with us but a short time, less than a week, and was taken home improved. She has not been heard of since. INSANITY DUE TO INFECTIVE AND EXHAUSTIVE INFLUENCES. This group comprises 10 men and 2 women, or 1.7% of the admissions for the biennial period. Total. Women. Men. No. Per cent. No. Per cent. 416 10 2.4 284 2 .7 Per cent. No. 700 12 1.7 Age at time of admission. Male. 24 to 30 to 35 to 40 to 1 29 34 39 44 45 to 49 .... 50 to 54 55 to 59 60 to 64 Total. Female. 1 2 2 1 1 1 1 1 2 2 2 2 2 2 ' 65 to 69 Heredity. £3 g Insanity Apoplexy or paralysis Psychopathic . . . Alcoholism Unknown 2 CD -3 § w Total. o> oi 0> "c8 % o> •3 "ce o EH 0 •- 43 •a a 'cS a 8 fq "cS O H 2 1 1 Brothers and sisters. Collateral. Atavistic. Total. Direct. 1 1 .... \D 1 1 oi 'rf s IS a<B fe . "(8 o [-1 «i « s "s "cS fe "o EH 2 2' 2 2 1 .... 1 1 1 4 2 �STATE OP MICHIGAN. 46 Results of treatment. Male. Recovered Female. Total. 1 ........ 1 1 1 7 Died 7 1 2 3 ORGANIC GROUP. This group in all its forms, comprises 27.8 per cent of the admissions for the biennial period. Women. Men. No. Total admissions . . Total. Per cent. No. Per cent. No. 34.3 284 52 18.3 700 195 416 143 Per cent. 27.8 The cases were placed as follows: Women. Men. No. 1 27 Syphilis of brain and cord ... ... Other forms related to neurological changes. . General paralysis Senility 7 16 36 56 Per cent. 00.7 18.9 4.9 11.2 25.2 39.1 Total. No. Per cent. No. 2 3.8 3.8 28.9 15.4 48.1 29 9 1 2 15 8 25 31 44 81 Per cent. 00.5 14.9 4.6 15.9 22.6 41.5 �47 TRAVERSE CITY STATE HOSPITAL. Age at time of admission. Male. Total. Female. Up to 24 25 to 29 30 to 34 35 to 39 40 to 44 3 1 8 . 5 4 9 ..........: 12 6 ]8 9 2 11 13 45 to 49 50 to 54 •55 to 59 <60 to 64 65 to 69 70 to 74 3 7 ... 75 and upwards. . 8 5 10 4 14 15 6 21 12 8 20 30 9 39 32 7 39 .. Heredity. Brothers Direct. and Collateral. Atavistic. Total. sisters. 3 9 3 3 1 4 2 4 3 a o EH 16 5 4 o C3 20 30 17 33 12 29 64 5 12 12 8 8 3 None. . i Female. 10 Q •3 g Female. Psychopathic . . . Alcoholism . . . . 8 13 13 12 "o H Female. 3 '3 10 1 10 Insanity £ 0 t-i '. '. Female. 7 Apoplexy or paralysis . . •3 Female. Male. . "o H 37 20 37 15 38 93 7 3 4 3 9 29 "1 s 15 Arteriosclerosis. 3 1£ •* S p£ 1 Forms related to neurological. Brain syphilis. « •3 "^ 1 N Senility. fe af 2 3 4 1 2 16 10 11 14 "3 1 General Paralysis. Female. Biain tumor. Female. Results of treatment. 1 S 1 "ea Total. JD j s c - £ "« 2 Recovered 2 1 • 1 2 Died Remaining 1 1 Unimproved. . 21 1 . ... 1 4 2 23 8 4 4 1 3 9 5 5 7 1 5 . 6 2 5 4 20 17 3 17 23 1 5 18 68 20 86 56 27 83 7 13 5 8 7 24 17 45 8 �STATE OF MICHIGAN. 48 In explanation it may be said that 12 cases were treated with neosal= varsan from January 1, 1914. Cases include general syphilis, cerebrospinal syphilis, and general paresis. These cases received intensive treatment of neosalvarsan. Method of treatment consisted of the intravenous administration of neosalvarsan, given weekly, from 6 to 12 doses being given. In addition, 3 cases of general paresis received intradural injections of autoserosalvarsan, bi-weekly, according to method of Swift-Ellis, in all 8 injections being given in each case. Three cases of general paresis received intradural injections of from 8 to 12 milligrams of neosalvarsan, according to the method of Bavaut, two injections being given in each case, systemic treatment being carried out in all cases, as mentioned above. In the cases of general syphilis and cerebro spinal syphilis, all showed subsidence of specific symptoms and improvement in general health. In the cases of general paresis treated by the Swift-Ellis method, two cases showed marked improvement, complete restoration of mental faculties, with, however, a persistence of the physical signs of lesser degree. Onecase, late in the disease, showed pronounced remission for several months with later a return of the symptoms. One case of general paresis treated by Eavaut method has shown improvement mentally. Two cases have shown no especial change. In two of the cases of general syphilis the patients at time of discharge did not react to the Wasserman test. DEMENTIA PRAECOX. There were 119 patients placed in this group, or 17% of the admissions. Men. Women. Total. • No. Per cent. 416 Dementia Praecox Per cent. No. 700 284 59 14.1 60 1 No. | Per cent. 21.1 | 119 | i 17 The following represents the type of dementia praecox: Women. Men. • Hebephrenic Katatonic No. Per cent. No. Total. Per cent. No. Per cent. 31 52.5 10 16.7 41 34.5 23 38.9 30 47.5 53 44. £ 5 8.4 20 33.8 25 21.0 �TRAVERSE CITY STATE HOSPITAL. 49 Age at time of admission and beginning of disease. Age at beginning. Female. Male. 15 to 19 20 to 24 25 to 29 30 to 35 to 40 to 45 to 50 to 55 to 34 39 44 49 54 59 . 14 19 42 3 3 2 1 6 1 Age on admission. Total. 5 1 15 34 68 13 8 7 2 9 15 15 26 10 5 Male. 5 13 33 7 11 3 3 1 Total. Female. 1 6 5 15 9 11 9 3 2 2 18 48 16 22 12 6 3 2 �Ol Hereditary Factors. Direct. o Atavistic. Collateral. Brothers and sisters. Total. Hebe. 1 1 le§ JJ Apoplexy or paralysis Alcoholism Unascertained 0 2 1 1 4 1 Kata. Para. 4 5 "o H 6 10 3 3 3 3 <5 1 Hebe. •3 •3 "o EH a Para. Kata. j 15 1 1 E~< 1 1 2 2 2 1 1 1 1 2 2 1 I _?. — 1 Female. 2 Para. Hebe. a "S 1 -i !1 5 7 2 d s | 1 4 4 Hebe. Kata. 2 Para. Kata. -S .2 I 3 1 3 6 a i -3 &i o B I 1 2 3 5 7 H 5 4 9 % H 21 18 42 7 13 20 50 7 ... 1 1 ... ... 13 tl 1 1 Ho S Ol O O a o t> i—i : | Female. �TRAVERSE CITY STATE HOSPITAL. 51 Average age at beginning. Male. Female. 25 30 23 29 19 28 Results of treatment. Died 3 2 1 3 2 2 24 9 4 33 § "=3 o H 7 3 6 3 3 1 2 1 15 23 38 <D •3 s 4 I 3 3 7 3 17 5 3 44 3 5 12 £ 1 Female. £ "3 Total. Katatonic. Female. 3 "oi "o H Paranoid. Female. 1 s Female, Hebephrenic. 6 4 6 44 •a 3 H 13 9 9 88 During the last few months the treatment of dementia praecox by the so-called Lundvall remedy has been used. Treatment consists of the use of sodium nucleinate for the production of hyperleucocytosis. In all, five cases of dementia praecox (hebephrenic form) are receiving treatment. Subcutaneous injections of the following solution are given: Sodium nucleinate 10.000; arsenous acid 0.005; sodium cinnamate 1.000; distilled water 40.000. From 2 to 15 c. c. of the solution are given at intervals of 4 days. A moderate rise in temperature from 2 to 4 degrees of from 2 to 3 days' duration, is usually noted. In one case, on several occasions temperature reached 105 degrees, with nausea and vomiting. In three cases no notable change in leucocyte count; in one case moderate leucocytosis up to 12,000. In one case leucocyte count reached 18,000. All cases have been under treatment for several months. All show some loss in appetite and weight. No noticeable improvement in mental condition. It goes without saying that this experience is not wide enough to justify any conclusions in regard to the value of the Lundvall remedy. As before mentioned, the Abderhalden tests are being applied and further treatment of cases will be continued with the nucleins as well as with the hormones. We anticipate that there are many cases that will be benefitted by these newer methods of treatment of dementia praecox. �STATE OF MICHIGAN. 52 PARANOIA AND PARANOID STATES. In this group 41 men and 27 women were placed, representing 9.7% of all cases admitted. Men. No. Total admissions Paranoia and paranoid states Women. Per cent. 416 41 9.8' Total. No. Per cent. No. 284 27 9.5 700 68 Per cent. 9.7 The 68 cases were classified as follows: Women. Men. Paranoia Paranoid states No. Per cent. 6 35 14.6 85.4 No. Total. Per cent. No. 3.7 96.3 61 1 26 7 Per cent. 10.2 89.8 Age at time of. admission. Female. Male. 25 to 30 to 35 to 40 to 45 to Total. 29 34 39 44 49 2 2 4 4 1 9 7 2 9 3 11 14 50 to 54 55 to 59 60 to 64 8 5 13 3 3 6 3 2 5 65 to 69 1 3 4 2 2 �TRAVERSE CITY STATE HOSPITAL. 53 Heredity. "o H 1 & 2 ] 1 1 1 2 3 3"o r-i o5 'cS § 1 Is O E-l 1 % 4 4 3 1 2 2 1 2 3 Total: c3 *c3 O H I 3 5 2 5 5 15 11 1 3 1 Female. 'cS £ 03 a i Female. JD "3 Brothers and sisters. Collateral. Female. dj Atavistic. Female. Direct. 3o El 5 1 10 1 5 6 21 25 1 6 14 Paranoid states. 1 g Improved Unimproved Died , 4 1 1 B 8 4 12 10 4 1 1 2 1 4 ]8 |'S%d5 2 2 5 Total. Female. Paranoia. Female. Results of treatment. o5 £rf "eg s fe 1 4 5 i i 25 17 42 29 "o H 14 2 5 47 MANIC DEPRESSIVE INSANITY. There were admitted 54 men and 100 women who were placed in this group, representing 22 per cent of all cases admitted. Men. No. Per cent. 416 Manic degressive insanity. .. . . 54 Total. Women. 13.0 i No. i Per cent. | 284 i 100 1 No. Per cent. 700 35.2 154 22.0 �54 STATE OF MICHIGAN. The group was further divided into the following forms: Men. Mixed Women. Total. No. Per cent. No. Per cent. No. 24 16 14 44.4 29.6 48 43 9 48 43 9 59 23 26.0 Per cent. 72 46.8 38.3 14.9 Age at time of admission. Male. 15 to 20 to 25 to 30 to 19 24 29 34 35 to 40 to 45 to 50 to 39 44 49 54 55 to 59 60 to 64 65 to 69 70 to 74 Female. Total. 2 3 5 6 11 17 6 13 19 3 14 17 9 9 18 6 16 22 4 9 13 7 11 18 3 7 3 6 10 9 3 1 4 2 2 Heredity. Apoplexy and paralysis. 3 None 12 1 4 10 21 3 5 d5 'S S 2 3 1 3 "=5 o H 5 3 1 « sa 5 0) .*» o EH •a 3 5 4 'cS Total. "3 o H o5 •a § 11 16 15 5 2 2 2 13 15 14 B'emale. ID EH Female. *o3 Brothers and sisters. Collateral. Female. 9 2 1 Atavistic. Female. s1 Female. Direct. 31 1 6 10 20 32 3 1 46 6 8 13 35 46 �TRAVERSE CITY STATE HOSPITAL. 55 Results of treatment. Died EH 7 10 17 7 22 29 2 1 3 4 3 7 4 12 16 _o5 ^ s 3 8 1 4 1 "a 1 4 5 18 26 6 6 7 13 Female. 3o Mixed. Male. Female. a! 3 § Female. Depressive. Manic. 3 Total. 6 •3 d> "3 +a s £• I 7e o EH 5 15 11 26 9 21 43 64 3 7 10 5 1 1 2 5 9 14 17 2 5 7 10 30 40 MELANCHOLIA. One male patient was diagnosed as a case of melancholia, the first attack of insanity occurring late in life, about 50, characterized by the usual ideas of personal unworthiness and many visceral delusions. This patient, according to the latest ideas, might have been placed in the manic depressive group. DEFECTIVE DEVELOPMENT. Imbeciles and Idiots. In this group were placed 31 men and 17 women, representing 6.8% of the cases admitted. Women. Men. No. Total admissions Per cent. Per cent. 284 416 31 No. Total. 7.4 17 No. Per cent. 700 6.0 48 6.8 �56 STATE OF MICHIGAN. Age on admission. Male. 15 to 19 20 to 24 25 to 30 to 35 to 40 to Female. 10 6 29 34 39 44 4 Total. 3 3 13 2 7 1 5 1 4 3 3 3 3 1 2 9 1 1 3 45 to 49 50 to 54 55 to 59 60 to 64 1 65 to 69 1 ] Heredity. ' Direct. Brothers and sisters. Collateral. Total. 1 2 1 3 3 6 3 5 9 3 1 8 4 4 •3 o .En a Female. 1 i •i ^o5 a 1 Insanity Atavistic. «j •3 a 1 i 2 8 2 1 1 o H 1 2 3 •aoi a 10 2 3 3 2 ! 1 3"o H 14 2 2 6 6 17 Results of treatment. Male. Improved . . . . Unimproved . . Died. . . Remaining Female. Total. 1 1 1 5 1 26 14 40 4 2 1 �TRAVERSE CITY STATE HOSPITAL. 57 EPILEPSY. In this group are 27 men and 19 women, representing 6.5% of the cases admitted during the biennial period. Men. Total. Women. No. Per cent. 416 27 6.5 No. Per cent. No. 6.7 700 46 284 19 Per cent. 6.5 Age at time of admission. Male. 10 to 14 15 to 19 20 to 24 . 25 to 29. 30 to 34 Female. 1 1 7 7 2 1 1 1 2 3 2 3 5 3 7 6 2 1 3 2 1 5 ..... 2 35 to 39. 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 . Total. 3 8 3 3 3 i i 1 65 to 69 1 - Heredity. . ...".. 3 1 1 1 3 "" 3 4 3o H £ S 1 3 1 1 3 6 •' j Female. 3 s Female. 3 Total. s <u "3 Total. Female. Unknown 3 2 oi « 'eS O H Brothers and sisters. Collateral. co 2 Apoplexy or paralysis . . Psychopathic Alcoholism None. . . Female. 1 $ Female. Atavistic. Direct. •a 1 5 4 3 3 7 5 1 1 10 5 4 2 5 7 6 9 12 '4dS <D •3 I § 1 1 �STATE OF MICHIGAN. 58 Results of treatment. Male. Recovered • Improved Unimproved Died Remaining Female. 4 2 3 18 Total. 1 2 2 14 5 4 32 PSYCHOPATHIC STATES. In this group are 9 men and no women, representing 1.28% of the cases admitted during the biennial period. Men. No. Women. Per cent. No. Total. Per cent. No. ! Total admissions Psychopathic Per cent. !_ 416 9 284 700 | 0 2.16 1.28 i Age at time of admission. Male. 20 to 24 25 to 29 35 to 39 55 to 59 60 to 64 .,. Female. Total. 1 2 1 2 3 2 | 1 3 2 1 HEREDITY. The hereditary factors in this gronp consist of one maternal immediate insane, one whose mother was nervous, maternal grandmother senile dementia, one whose mother was alcoholic. The remainder either negative or unknown. Results of treatment. Male. Improved Remaining Female. 4 5 Total. 4 5 �TRAVERSE CITY STATE HOSPITAL. 59 UNCLASSIFIED GROUP. Seven men and one woman were not classified during the biennial period. Two men were with us but a short time, were defective criminals, and escaped. One' man was a foreigner, and was deported by order of the United States authorities. One man was a syphilitic case and came before the officials of a neighboring county for repeated thefts, undoubtedly a case of kleptomania. He improved very much under specific treatment and was finally discharged. The other cases were not sufficiently clear to be placed in any of the groups of our classification. NOT INSANE. One patient, a Pinlauder, committed from the Upper Peninsula following a state of illness or debauch, not clear, who did not appear to be mentally involved while in the institution. He was therefore classified as not insane and discharged about one month after he came. TABLE V.—Showing the occurrence o/ heredity in patients admitted. Psychopathic 7 34 Total heredity 108 £ 1 72 27 22 57 10 70 178 1 (0 2 4 2 4 2 16 1 17 14 4 0 "e§ 3 73 | | p£ 11 8 13 13 Total. s Female. 8 15 23 _oj 1 90 27 11 18 1 34 59 8 19 24, 149 35 37 58 57 169 110 84 44 163 130 279 128 293 416 284 700 Female. 24 Insanity "a Brothers and sisters. Collateral. Total. 48 Apoplexy and paralysis. 19 o5 « Atavistic. Female. a Female. Direct. 3 •ac5 | I 21 4 24 21 2 7 4 1 27 31 26 45 'I �STATE OF MICHIGAN. 60 TABLE VI.—'Showing the age of patients admitted. Biennial period ending June 30, 1914. Male. From 10 to 14 years From 15 to 19 years 25 From 20 to 24 years 35 From 25 to 29 years 37 From 30 to 34 ye^rs 32 From 35 lo 39 years | From 40 to 44 years 46 43 From 45 to 49 years 23 From 50 to 54 years 35 From 55 to 59 years 29 From 60 to 64 years 26 From 65 to 69 years 20 From 70 to 74 years 32 From 75 and upwards 33 I | Total 416 Female. Total. 1 10 17 29 1 35 52 66 31 29 39 34 29 18 63 75 82 57 64 47 18 12 9 44 32 41 41 284 700 TABLE VII.—Showing civil condition of patients admitted. Biennial period ending June 30, 1914. Civil condition. Male. Female. Total. Single 169 Married 173 172 345 Widowed 42 36 78 Divorced 18 10 28 Unascertained. 14 Total. . 416 235 14 284 700 �TRAVERSE CITY STATE HOSPITAL,. 61 TABLE VIII.—Showing the degree of education of patients admitted. Biennial period ending June 30, 1914. Degree of education. Male. Female. Collegia! e 10 Academic 24 Common school. 249 Read and write. 39 7 Read only Unascertained... 32 55 Total. . . . 416 No education. . . Total. 13 39 15 215 20 3 24 464 59 10 4 56 59 284 700 TABLE IX.—Shoiving the occupation of patients admitted. Biennial period ending June 30, 1914. Male. Professional: Architects, clergymen, engineers, surveyors, journalists, lawyers, musicians, physicians and surgeons, teachers (school), etc.. . . Clerical and official: Bookkeepers, clerks, copyists, bankers, brokers, collectors, auctioneers, agents, etc Mercantile and trading: Commercial travellers, merchants,^pharmacists, peddlers, etc... Female. Total. 11 18 14 9 23 13 10 23 Public entertainment: Hotel and boarding house keepers, saloon keepers, liquor dealers, bartenders, restaurant keepers 10 Personal service, police and military: Barbers, hairdressers, janitors, sextons, policemen, watchmen, detectives, soldiers, sailors, marines (U. S.), etc 11 19 30 Laboring and servant: Laborers (not agricultural), servants 93 55 148 63 19 82 164 13 34 113 277 15 28 27 61 416 284 700 ; Manufacturing and mechanical industry: Bakers, blacksmiths, butchers, cabinetmakers, carpenters, cigarmakers, jewelers, printers, engineers and firemen (not locomotive), coopers, machinists, masons, millers, painters, plasterers, plumbers, tailors^ tinners, etc Agriculture, transportation and other outdoor: Boatmen, draymen, hackmen, farmers, farm laborers, gardeners, florists, livery stable keepers, lumbermen, sailors, fishermen, steam railroad employees, stock raisers, etc None Unascertained Total �62 STATE OF MICHIGAN. TABLE X.—Showng tine nativity of patients admitted. Biennial period ending June 30, 1914. Nativity. Male. Female. 175 107 Finland 3 2 5 3 1 Norway Poland Switzerland Sweden. . . . 8 1 Unascertained Total , Total. 126 76 Total United States 3 46 5 10 3 14 1 4 Female. Male. 282 202 484 109 75 184 25 7 32 416 284 700 5 28 1 1 18 6 2 5 4 1 3 1 TABLE XI.—Showing the nativity of parents. Biennial period ending June 30, 1914. Male. 124 169 51 72 Total . . . 416 Female. 86 141 Total. 28 29 210 310 79 101 284 700 �TRAVERSE CITY STATE HOSPITAL. 63 TABLE XII.—Showing the residence of patients admitted. Biennial period ending June 30, 1914. County. Male. Alcona . . . Alpena. . . Arenac. . . Benzie Bay. . . . . . Cheboygan . . . Charlevoix Crawford . Clare Chippewa Delta Emmet ... ' . . Grand Traverse . . Glad win.. Gratiot ... losco Isabella . . . Ionia .... Kalamazoo . . Kalkaska ... Kent Leelanau . . Lake M ontmorency Monroe . . . Manistee ... ... Missaukee Mason. . . Midland.. Menominee Otsego . . . Oscoda Ogemaw Osceola . . Oceana Presque Isle . . . . Roscommon Saginaw St. Clair. Shiawassee Wexford Washtenaw Wayne Total . ... ... Female. 13 2 9 6 1 3 66 14 13 3 4 2 1 8 37 1 13 6 13 28 2 4 10 2 4 1 14 7 4 11 16 20 11 2 4 2 4 10 11 3 Total. 11 2 6 4 24 4 15 10 1 5 43 4 9 3 2 8 109 18 22 6 6 3 •1 22 54 4 21 10 20 44 2 1 8 1 1 14 17 3 8 4 7 16 1 4 1 6 1 2 19 3 5 8 9 6 17 2 4 1 4 8 2 2 4 1 2 1 14 3 3 1 13 1 416 284 i 16 3 6 1 33 10 9 15 20 22 37 13 6 5 2 8 18 13 5 4 1 3 2 27 4 3 700 �STATE OF MICHIGAN. 64 TABLE XIII.- -.Showng the form of insanity of patients discharged and the results of treatment. Recovered. Unimproved. Improved. Total. Died. Forms of insanity. "e3 •1 S Insanity due to infective and exhaustive in- la "rt "S EH la s I tS ^ "cs 1 5 1 6 12 2 1 14 1 3 1 4 1 2 3 1 1 1 1 4 12 5 7 30 17 3 1 42 22 10 1 1 3 1 1 1 3 4 7 5 10 "\2 5 22 5 2 2 4 19 14 11 4 3 ""•>' 1 14 7 4 2 5 5 7 7 2 1 1 3 5 i' "i i 1 2 89 "3 1 27 1 2 3 6 2 14 31 31 91 3 i£ £ 19 5 3 1 22 6 4 3 7 1 6 7 1 8 31 31 5 36 12 13 2 25 43 44 3 15 37 42 1 15 13 15 4 30 50 57 4 'ii 2 3 3 5 3 11 1 5 8 14 1 10 17 3 4 4 18 19 14 35 22 4 1 5 3 4 1 1 "4' 8 i 3 2 4 7 13 6 3 5 12 20 30 9 11 2 13 12 42 34 7 3 9 32 72 43 18 5 22 2 1 11 "i' 2 3 8 5 2 1 2 2 4 1 1 i 54 145 32 16 1 52 •a 3 5 3 1 7 9 37 1 2 5 6 "i' 1 5 1 Total £ i i 3 4 7 1 "c3 2 5 1 3 6 1 "3 _o 1 1 4 1 & 6 5 6 2 3 8 'is' 6 14 4 24 1 23 1 1 32 6 1 5 47 43 177 122 299 337 244 ?81 1 1 1 11 22 1 1 2 1 21 '2i' 42 1 1 i �TRAVERSE CITY STATE HOSPITAL. 65 TABLE XIV.—Showing tne duration of residence in months of all cases discharged. Recovered. 4 _oj £ £, .2 a 1 5 iS s fe ® Died. •3 •3 1 Total. .8 Jjeg 1 "3 £ I S fe 1 3 6 9 3 7 10 7 2 9 14 9 23 27 24 51 14 20 34 21 19 40 5 4 9 22 14 36 62 57 119 13 11 24 32 6 38 4 3 7 16 8 24 65 28 93 7 6 13 12 10 22 J 4 7 14 4 18 36 24 60 1 2 3 2 3 5 2 2 14 1 15 19 6 25 2 2 8 4 12 4 4 15 9 24 27 15 42 1 1 1 1 12 8 20 13 10 23 4 4 9 1 3 2 5 23 22 45 35 30 65 3 2 2 4 8 19 27 13 21 34 1 1 1 39 28 67 40 29 69 52 143 31 49 177 122 299 337 244 58t 1 38 52 90 91 1 11 2 3 Totals Unimproved. Improved. 18 TABLE XV.—Showing the age of patients discharged recovered. For the biennial period ending June 30, 1914. Male. From 20 to 24 years . . . From 35 to 39 years From 40 to 44 years Frcm From From From From From 50 to 54 years 55 to 59 years €0 to 64 years 65 to 69 years 70 to 74 years 75 and upwards. . Total . . . . ... . . . Female. Total. 1 2 3 6 5 11 1 8 9 4 9 13 6 3 9 4 7 11 3 5 8 3 3 6 4 7 11 3 1 4 1 1 2 2 1 3 38 80 �66 STATE OF MICHIGAN. TABLE XVI.—See Summary of Deaths, page 38. TABLE XVII.—Showing the age of patients who died. Biennial period ending June 30, 1914. Male. Female. Total. 1 9 11 5 16 11 1 3 4 20 21 17 26 14 34 24 35 10 12 8 13 27 30 30 48 177 122 299 3 2 11 11 2 9 From 30 to 34 years . . . .... 10 8 15 9 18 From 60 to 64 years . . 13 17 18 22 ... Total . ESTIMATES OF SPECIAL APPROPRIATIONS. The following are the estimates of special appropriations requested by the Board of Trustees and submitted to the State Board of Corrections and Charities for its approval: To the State Board of Corrections and Charities: As required by Section 28, Compiled Laws of 1897, I submit herewith approximate estimates of special appropriations requested by the Board of Trustees of the Traverse City State Hospital, for an additional appropriation for completion of dining room to be erected on the hospital grounds; for heating and ventilating systems in Cottages 24 and 26; for addition to dining rooms, north and south, for carpenter and paint shop; for an industrial building; for farm barn; for fencing; for additional laundry machinery; for new grate under boiler ~No. 3; for addition to cold storage plant; and for the installation of fire protection for farm barns. I. DINING ROOM. 37,000 cu. ft. of excavating @ $0 02 4,700 cu. ft. concrete for basement walls 20 35,000 common brick laid 15 00 68,000 pressed brick laid for exterior face work.... 35 00 Hollow "Jumbo" tile as per estimate of Trussed $74 940 525 2,380 00 00 00 00 �TRAVERSE CITY STATE HOSPITAL. 67 Concrete Co. f. o. b. Traverse City Mortar and laying for the above "Jumbos" 8,294 sq. ft. 3x12x18" Book tile for roof f. o. b. Traverse City Mortar and labor setting Book tile 2,710 sq. ft. 7-Rib Hy Eib 28 guage Suspended ceiling f. o. b. Traverse City per estimate Trussed Concrete Co 8,800 sq. ft. 7-Rib Hy Rib 24 guage, for floor First Floor Labor setting Hy Rib 176 pcs. 1,4x3/8 steel plates 2,011ft 60 8" I-Beams coped and riveted.... 18,766ft 76 Castiron bearing plates 3,912ft 265 6x4 and 4x4 connecting angles riveted 4 to 6" long 1,500ft 16 8" channels copped and riveted 2,300ft 300ft 3/3" rivets, driven in angles 300ft 29 10" I-Beams 8,702ft 14 4" I-Beams 874ft 6 7" I-Beams l,92ffi 30 5" I-Beams and 5" channels 4,840ft 696 %" connecting bolts for angles 187 21/4x2% Tees fitted for wire 23,635ft 120 6" I-beams and 6" channels, coped 22,940ft 2 12" I-beams 1,340ft 7 28" special 28" Both. I-Beams 36,750ft 1 Built-up 6" H I Beam Col 1,200ft f 1,419 00 1,175 00 f0 07 580 58 290 29 341 28 02y2 02y2 02y2 497 21 437 00 50 28 469 15 97 80 04 02y2 05 02% 02i/2 02% 02y4 04 023^ 02y2 02y4 02i/2 03 6000 5750 15 00 19580 2185 2682 108 90 27 84 650 00 573 50 30 15 918 75 36 00 130,262ft Annealed wire for fastening Tee ceiling 3,000 yds. plastering 30 260 ft. lin. Concrete Stone grade course 50 295 ft. lin. Concrete Stone window sills 40 22 ft. lin. Concrete Stone door sills 1 00 325 ft. lin. Concrete Stone coping 70 260 ft. lin. Concrete Stone water-table 40 190 ft. lin. Vitrified Wall coping, set 25 8,100 sq. ft. Concrete floor in Basement 07 8,100 sq. ft. Terrazzo floor Main floor 30 81 sqs. 4-ply Gravel Composition Roofing 4 00 29 windows finished complete main dining room... 23 00 3 windows finished complete women's dining room. 23 00 2 windows finished Store Room and Pantry 20 00 10 windows finished com. Kitchen 12 00 1 window finished com. Basement entrance 38 windows finished com. Basement 9 00 2 Front entrance doors and frames with hoods over 1 Outside door and frame com. Kitchen 1 Outside door and frame com. Women's Dining room 1 Outside door and frame com. Basement entrance 1 pair outside steps with rail complete Kitchen entrance.... 6 00 900 00 130 00 118 00 22 00 227 50 104 00 4750 567 00 2,430 00 324 00 681 50 70 50 40 00 120 00 12 00 342 00 100 00 18 00 18 00 1200 75 00 �68 STATE OF MICHIGAN. 1 Porch and Steps Women's dining room 3 Metal Sky-lights complete 3 doors and frames complete first floor 7 doors and frames complete basement 319 ft. lin. Cal. Iron cornice @ $1 50 Electric wiring Heating Plaster finish for one column in dining room 2 Iron stairways dining room to basement 2 Front basement entrance stairs 1 set of concrete steps, steamer room to basement 1 balcony railing and steps 8,100 sq. ft. concrete slab work for first floor @ fO 05 Erecting 65 tons of steel 12 00 Plumbing and sewer work, etc., sinks, closets, tea and coffee urns, ranges, tables, steamers, sewer connections, e t c . . . . |250 00 210 00 120 00 105 00 478 50 350 00 862 50 30 00 400 00 80 00 65 00 125 00 405 00 780 00 1,500 00 $24,125 40 II. HEATING AND VENTILATING SYSTEMS COTTAGES 24 AND 26. Heating and ventilating systems, Cottages 24 and 26 .... $12,000 00 III. ADDITIONS TO DINING BOOMS 48 M Brick in wall 600 ft. concrete wall 600 ft. tile 9 windows 12 doors 1,000 Ibs. steel 800 ft. concrete 325 ft. roof 2,000 ft. lumber Labor Elevator NORTH AND SOUTH. floor @ |0 15 $720 00 20 120 00 50 300 00 15 135 00 15 180 00 02i/2 25 00 80 00 15 4875 18 36 00 150 00 600 00 $2,394 75 Addition to South Dining room IV. $2,394 75 CARPENTER AND PAINT SHOP. 105 M Brick in wall 2,800 ft. concrete in basement 3,840 ft. concrete floor in basement 3,800 gravel roof Excavating and grading Windows and doors 46 M hemlock lumber 5,000 ft. maple floor 6 M matched pine floor 1 M matched pine floor @ $0 .15 $1,575 00 560 00 10 384 00 190 00 400 00 500 00 18 82800 40 200 00 30 180 00 40 40 00 �TRAVERSE CITY STATE HOSPITAL. Carpenter work labor, nails and hardware Machine belting and shafting 1 motor 30 H. P Sewer connection Wiring, electric lights Heating and plumbing 69 $995 00 1,200 00 500 00 150 00 150 00 600 00 $8,452 00 V. INDUSTRIAL BUILDING. 135 M brick in wall 2,770 ft. concrete wall 1,400 yds. plastering 2,400 ft. gravel roof 34 windows 16 windows 12 doors and frames 2,200 ft. cement Excavating and grading 6 M ft. maple flooring 3 M ft. matched pine 21 M ft. hemlock lumber Painting Carpenter work and labor 3 M finishing lumber Sewer connections Heating and plumbing Hardware and incidentals Wiring, electric lights, floor v fixtures @ $0 15 $2,025 00 20 554 00 35 490 00 120 00 15 520 00 05 80 00 15 170 00 08 176 00 125 00 45 270 00 30 90 00 20 420 00 200 00 1,200 00 50 15000 150 00 1,700 00 260 00 300 00 |9,000 00 VI. FARM BARN. 46 M Brick in wall 4,400 ft. 6" tile surface 2,736 ft. cement floor 3,500 ft. matched flooring 26,000 ft. hemlock lumber 1,000 ft. lumber 40 Sqs. slate roof 1,500 ft. concrete wall Painting Cement plastering on walls Hardware and incidentals Carpenter work Windows and' doors Steel stalls, cork floor, mangers, etc Ventilation Electric lighting Piping and drainage @ $0 15 10 10 30 20 40 12 00 20 00 $690 00 440-00 273 00 105 00 520 00 40 00 480 00 300 00 125 00 100 00 150 00 500 00 125 00 850 00 200 00 50 00 52 00 $5,000 00 �70 STATE OF MICHIGAN. VII. FENCING. 1,320 ft. iron fence in front of grounds VIII. f 1,500 00 LAUNDRY MACHINERY. 5 Washing Machines Shafting, belting, installation, etc $2,000 00 500 00 $2,500 00 IX. GRATE FOR BOILER NO. 3. 1 chain grate for Boiler No. 3 $1,800 00 Ee-setting of Boiler and installation of grate, piping, labor, etc. . . . . . . . . . . . . . . . . . . . . . . 700 00 $2,500 00 X. ADDITION TO COLD STORAGE PLANT (ESTIMATES FRED W. WOLF CO.) "One No. 2y2 brass fitted brine circulating pump, 3^" suction, 2%" discharge, complete with base and directly connected to a 5 H. P., 120-volt 1,100 R. P. H., D. C. motor. We will include all brine mains between the three new rooms and the new brine pump, also between new rooms and the present brine tank. The old connections between pump and tank to be increased to suit the new pump. A 3%" brine strainer will be furnished on pump suction. Insulation for the three rooms as follows: Watts: Against all outside brick or tile walls, except the front wall of Boom "C" and on the partition walls, separating Rooms "A" and "B," and "C", we will erect two course of 2" pure cork board in Portland Cement mortar. On the front wall of Room "C", we will furnish and erect two course of 3" cork board, both courses erected in Portland cement mortar. Floors: The floors of the three rooms will be insulated with two course of 2" pure cork board, laid in hot asphalt. All joints in the second course will be broken with respect to all joints in the first course. The upper surface will be flooded with hot asphalt, about %" thick and a wearing concrete floor laid down directly on top. The floor will consist of 2" of rough concrete and V of Portland cement finish, laid directly on the top of the cork board. Ceilings: The ceilings of the three rooms will be insulated with two layers of water-proof insulating paper applied on the sheated ceiling, all edges lapped at least 3", against which will be securely nailed one course of 2" cork board, all transverse joints being broken. A second course of 2" cork board will then be erected against the first in hot asphalt cement and additionally secured to the first with galvanized wire nails. All joints in the second course shall be broken with respect to all joints in the first course. A Portland cement plaster finish will be applied, approximately %" thick. Plastering: All exposed surfaces of the cork board on the walls, partitions and ceiling, will be plastered with Portland cement mortar, about V2" thick. �TRAVERSE CITY STATE HOSPITAL. 71 Dbors: We will furnish and set six cold storage doors 3' wide x 6'6" high, Jones or equal, you to furnish the necessary door supports in the tile walls. All exposed brine mains will be insulated with approved cork covering. Our price for the above material, delivered and installed, is four thousand seven hundred and seventy-five ($4,775.00) dollars." In addition we estimate that brick work, electric lighting, sewer connections, water supply, labor, etc., will be about $725.00, making the total cost for proposed cold storage |5,500.00. XI. INSTALLATION OF FIRE PROTECTION FOR FARM BARNS. $8,000 00 RECAPITULATION. Dining room $14,125 40 Heating and Ventilating systems Cot. 24 and Cot. 26 12,000 00 Addition to dining room, north 2,394 75 Addition to dining room, south 2,394 75 Carpenter and paint shop 8,452 00 Industrial building 9,000 00 Farm barn 5,000 00 Fencing 1,500 00 Additional laundry machinery 2,500 00 New grate under Boiler No. 3 2,500 00 Addition to Cold Storage Plant 5,500 00 Fire protection for farm barns 8,000 00 All of which is respectfully submitted. J. D. MUNSON, Medical Superintendent. The following is the report of the State Board of Corrections and Charities on the above requests for appropriations: STATE BOARD OP CORRECTIONS AND CHARITIES,, LANSING, MICHIGAN, November 6, 1914. Dr. James D. Munson, Medical Superintendent, Traverse City State Hospital, Traverse City, Michigan: Dear Sir—The estimates of appropriations for the Traverse City State Hospital for the biennial period ending June 30, 1917, as presented to the members of this board at the time of the inspection of your Hospital on September 10, 1914, have been approved with the exception of item No. 7, the same being a request for an appropriationi of $1,500 for 1,320 feet of iron fencing for front of grounds. By order of the board. Verv respectfully, " JNO. N. McCORMIOK, . Chairman. �72 STATE OF MICHIGAN. CHAPEL SERVICES. Religious services have been conducted regularly by the Chaplain, Kev. D. Cochlin, assisted by Eevs. Mr. Slade, Mr. Irving, Mr. Lay and Mr. Coates, all of Traverse City. ACKNOWLEDGMENTS. To all those who have in any way contributed to the welfare and comfort of our patients our best thanks are extended. CONCLUSION. In conclusion we may say that our relations with the State, with other hospitals, with the county officials, etc., have been harmonious, and there has been cordial cooperation between the institution and the county and state officials in everything that pertains to the best interest of the hospital. As a Board, you have given unusual attention to the hospital and its management, and it was due to your efforts largely that the right of way for the side track was secured and railway connection accomplished between the hospital and the railroads entering Traverse City. I am not unmindful of my obligations to you and to my associates on the staff and to all the employes of the hospital. It is a matter of great gratification to me to be able to state that there have been few occurrences during the last two years that have required special attention at your hands. The hospital was never at a higher standard of efficiency than it is at this time. All of which is respectfully submitted. J. D. MTJNSON, Medical Superintendent. Traverse City State Hospital, October, 1914. �TRAVERSE CITY STATE HOSPITAL. 73 OFFICERS AND EMPLOYES OF THE TRAVERSE CITY STATE HOSPITAL, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1914, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Service. Name. A S Rowley W D Mueller G B. Pike T. H. A. Tregea Carl W. Nesbitt C B 0 S. M Prall P Burns S Woodruff G. Howard Blanche Clark Period. Rate. Medical superintendent Asst medical superintendent Assistant physician Assistant physician Assistant physician S3 600 00 2,800 00 1 700 00 1 200 00 1 200 00 A=sistant physician Steward Chaplain . . . Accountant Assistant accountant 1 200 00 2,000 00 260 00 10G 00 85 00 Per month. Chief engineer Chief carpenter 1 600 00 1 200 00 90 00 70 00 1,200 00 Per annum. Non-resident. Suoerin ten dent of nurses Storekeeper Edna Skinner Dietitian Druggist Stenographer Stenograph er Stenographer 60 80 65 40 50 00 00 00 00 00 George Howarth Clothing clerk Clothing clerk Isabel Vincent Telephone operator Telephone operator 40 40 36 18 18 00 00 00 00 00 Jennie E. Beals Supt. of domestic art Sewing room assistant 50 35 25 H H 00 00 00 00 00 14 25 34 30 40 00 00 00 00 00 A Attendant . ,, , , Attendant 28 19 32 34 50 00 00 00 00 00 AtfaL™t 30 38 28 18 19 00 00 00 00 00 30 45 18 35 35 00 00 00 00 00 28 35 28 20 19 00 00 00 00 00 Carrie Fuller Stella Swan Rhea Hinsdill Domestic . Housekeeper Hattie Allen L. E. Burt Attendant Attendant Ilah Brittain E. Gertrude Cook Arthur J. Clark Roy Carns Nettie Cutting. Essie M. Covev Attendant Aft rl t Attendant Attendant Attendant Attendant Attendant Attendant Attendant ' ' Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. �STATE OF MICHIGAN. OFFICERS AND EMPLOYES.—Continued. Service. Name. Geo C Dell Robt Dell D S. Dean G J Droat Cook Ray Elliott Ethel Edwards Clint Fox Geo. Fate . Bert Glass Alvin Gilbert . . . . Glen Ginther Helen Glazer ... W. J. Getchell Edw. Guilfov Gladys Hilton Margai et E. Heator Earl Hudson . Libbie Howe Attendant Mrs. G. B. Howe R. J. Hamilton Birden Hubel J. D. Hamlin L.J.Hier... . . fifin. Hrrniriftfi Katbryn Huff Geo. R. Hockin Clarence Horton Lena Knight Judith Kidder Clara Krone Ed. Krause Hilda Moran Blossom Morse Attendant Howard Lewis Otis Leland Cook Period. Rate. Per month. Resid $20 56 26 51 20 00 00 00 00 00 45 46 30 35 18 00 00 00 00 00 65 50 20 26 50 00 00 00 00 00 46 22 32 38 26 00 00 00 00 00 36 61 50 20 46 00 00 00 00 00 32 32 20 32 19 00 00 00 00 00 Per month. Resid 19 24 32 20 20 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resid Resid Resid Reside Resid 18 30 28 18 42 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resid Reside Resid Reside Reside 40 28 20 46 18 00 00 00 00 00 Per month. Resid Per month. Reside 18 28 50 46 18 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Reside Reside Reside Reside Reside ' 28 50 30 24 26 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Reside Reside Reside Reside Reside 40 30 18 18 19 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Reside Reside Reside Reside Reside 20 50 26 36 26 00 Per month. Reside 00 •Per month. Reside 00 Per month. Reside 00 Per month. Reside 00 Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Reside Per month. Resid Per month. Resid Per month. Reside �TRAVEiRSE CITY STATE HOSPITAL. 75 OFFICERS AND EMPLOYES.—Continued. Service. Name. P^ate. Period. $24 00 18 34 26 19 00 00 00 00 26 18 20 19 26 00 00 00 00 00 26 55 26 19 20 00 00 00 00 00 32 24 18 26 33 00 00 00 00 00 Glen Parks 30 55 26 32 42 00 00 00 00 00 Charlie P Randall 18 22 30 32 26 00 00 00 00 00 26 26 35 45 36 00 00 00 00 00 32 24 28 18 20 00 00 00 00 00 18 20 20 45 18 00 00 00 00 00 24 20 18 26 24 00 00 00 00 00 26 50 18 40 36 00 00 00 00 00 32 28 18 20 18 00 00 00 00 00 70 70 55 24 19 00 00 00 00 00 Mary McGill . . Edwin T Peterson Daisy E. Slater Mabel Miller Eva O'Rorke Mable Weiss W E Vezina Bertha C Peterson V. A. Patrick Cook Will R. Steiglitz . . Frank H Snyder Robert Shalda Earl Sanford Lvla Stieo-Htz Inez Strickler Lena M. Smith C. P. Tobey Charles E. Wilson William J Weiler Gladys Wing Hattie Walsh . . D. E. Ward . . Cook Alfred Walker Winifred Westbrook W. Bellau Chef Baker �STATE OF MICHIGAN. 76 OFFICERS AND EMPLOYES—Continued. Name. Robt F Herkner Service. Rate. Butcher Emery G Smith Wayne Steele Cook Claude W Nelson Cook . . . Celia White Mabel Schlei Ethel Rinehart Hazel White Ida Richie Hazel Wilbur G E Ball Pipefitter Pipefitter W Eraser Plumber Pipefitter H Butrick Pipefitter . .... Period. $19 65 26 26 34 00 00 00 00 00 26 26 26 26 26 00 00 00 00 00 26 35 26 26 45 00 00 00 00 00 70 40 22 23 22 00 00 00 00 00 24 22 28 22 15 00 00 00 00 00 21 25 21 23 22 00 00 00 00 00 13 20 50 2 45 00 00 00 00 00 40 50 50 2 2 00 00 00 75 25 65 00 50 00 1 75 2 70 30 00 C C Cooper Libbie Kelley J 0 Edwards J B King R L Pennell 2 64 75 2 2 S H McMichael Hans W Tobler Hans Tobler 2 70 1 00 80 00 2 70 1 75 Albert Clous C D Lyon C Gabriel Teamster Teamster John McGill G W Burrett . 00 90 00 70 70 29 60 29 46 41 00 00 00 00 00 Per month Non-resident Per month Resident Per month. Non-resident. Per month Non-resident. 32 29 29 29 31 00 00 00 00 00 Per Per Per Per Per month month. month month. month Resident Resident. Resident Resident. Resident • �TRAVERSE CITY STATE HOSPITAL. 77 OFFICERS AND EMPLOYES.—Concluded. Service. Name. T. P. Redding S. Edgerley D. W. Kelley 0. E. Hatch Frank Steele B. R. Mallory ... .... J. W. Rinehart R. W. Loeding Homer Hall Harland Beck Carpenter Period. Rate. $38 31 38 33 50 00 00 00 00 00 Per month. Per month. Per month Per month. Per month. Non-resident, Resident. Non-resident. Resident. Resident. 29 60 29 29 29 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 29 33 29 29 2 00 00 00 00 70 Per month. Per month. Per month. Per month. Per day. Resident. Resident. Resident. Resident. Non-resident. 1 75 2 70 2 70 1 75 1 75 60 00 Per day Per day. Per day Per day. Per day Per month. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. �STATE OP MICHIGAN. 78 GEADUATES OF THE TEAVERSE CITY STATE HOSPITAL TRAINING SCHOOL FOE NURSES. 1908. Harry Baker. Laura M. Bigbee. Bennett P. Burns. Lena Aldrich Covey. Sadie L. Dockerty. Anna Carrow Evans. Mary Louise Fink. Wesler H. Herriman. John O. Hoppes. Raymond G. Johnson. Esther V. Keller. Louise Kitscher. Dora Bell Lewis. Maria Margaret McDonald. Louise E. McGivern. Catherine McKinnon. Amy Orcutt. Victor A. Patrick. Hattie Holmes Parr. Florence Helen Eoest. Lurene Shryer. Lillian Faith Walsh. Anna M. Warner. Lucinda Hazel Wilson. 1909. Margaret Clark. Edna Crandall. Gertrude Eamon. Anna Hanson. Thea Hanson. Flora Hollister. Cora Laisy. Howard Lewis. Euth Merrifleld. 1910. Ray H. Buttars. Loura Lela Cronkwright. Leonard A. Cluley. John F. Donovan. Nellie Taube Ellsworth. Anna Maude Grissinger. Ethel Beatrice Hanes. Albert James Howard. Ethel Lillian Johnson. 1910. Jessie Angie Keating. Gertrude A. Kerry. Juliana Mary Leo. Gail Langworthy. C. Harold Leutholtz. Tressie A. Miller. Cleo Von Miller. Ella Orvis Miller. Archie Miller. Anna Thoreson Newman. Idylia Eeynolds. Mina Odolla Shearer. 1911. Martha Clara Kitscher. Nora Belle Eamon. Lena Amelia Eude. Matilda Delvena Send. Alice Julia Thoreson. Bertha Cornelia Peterson. Hazel Erveilia Edgerley. Marie Esther Orvis. Gertrude Margaret Orvis. Ada Julia Hall. Eosetta Alston. Essie Marie Johnson. Grace Belle Alexander. Effle Florence Grissinger. George Oliver Zeigler. Lee S. Swan. George W. Ashby. Leo. S. Chamberlain. Perry A. Tobey. Stephen H. Young. �TRAVERSE CITY STATE HOSPITAL. 1912. _ T. , „ „., , Judith Evans Kidder. Frances Edith SOBS. Wilhelmma L. Oldenburg. Daisy M. Lahr. Alice A. Smith. Mabel Cowles Willard. Alma E. Leggett. Emma Thum. Otis H. Leland. Pearl LaFern Emory. Pearl Emily Tyler. Laura M. Rude. Julia Belle Carsten. E. Margaret Mortenson. Stephen A. Covey. Anna Paulina Smith. Nettie Beulah Nickerson. Leonard A. Wright. Emma E. Davis. Effie Leona Bixby. Glen L Ginther/ Hi]dur Hedenskog. MatMa R Henschell. 1914. Florence L. Vivian. Ethel M. Edwards. Lena N. Smith. Kathryn B. Huflf. Lyla Stieglitz. Maggie E. Heator. Matie Estelle Vincent. Catherine Paffhausen. Alice E. Hanes. Euby Dale MacLean. Grace L. Stieglitz. Libbie Howe. Flora Dorthy Goynon. Dora Gordon Seaton. 79 �APPENDIX. 11 �ADMIRAL WALKER COLANTHA, No. 84481 Senior Herd Sire of the Traverse Herd His weight at 3 years, 10 months, 2300 Ibs. The record cf his four nearest dams average: Butter, 7 days, 32.83 Ibs. Butter, 30 days, 131.85 Ibs. �APPENDIX. The asylums of Michigan are organized and governed under organic law. an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government. appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of j Trustees. (Section 8.) The counties comprising the district of the Traverse City State Hospital are: Alpena Arenac Antrim Alcona Benzie Charlevoix Clare Crawford Cheboygan Emmet Gladwin Grand Traverse Gratiot Isabella losco Ionia Kalkaska Lake Leelanau Manistee Mason Mecosta Midland Missaukee Montcalm Montmorency Muskegon Newaygo Oceana Ogemaw Osceola Otsego Oscoda Presque Isle Roscoinmon Wexford Provision is made by Section 7 for the transfer of patients Transfer from' „ -i i ji , TJ_. i i one district to from one asylum to another when conditions make such another. transfer desirable. 12 �84 Insane to be committed to asylum of their district. Classes of patients. Voluntary patients. Public and private patients. Order void after thirty days. Bonds. Advance payment. New bonds. Temporary orders. Transfer from private to public. Non-resident. Provisional discharge and readmission of patients. STATE OF MICHIGAN. A patient is not to be committeed to an asylum of a district other than that of which he is a resident unless the court adjudicates that there is no room in the latter, and that there is in the former. (Section 8.) Patients are divided into three classes: Public'patients, private patients, and voluntary patients. (Section 13.) Voluntary patients are patients who are not insane. They are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for because of lack of room. In other words, there must be room for all others seeking admission before any voluntary patients can be received. Sec. 14, Act 155, Laws 1911, as amended by Act 94, Laws 1913, "Provides that such persons as may have been or may hereafter be adjudged to be so addicted to the excessive use of intoxicating liquors, or narcotic or noxious drugs, as to be in need of medical and sanitary treatment and care, for whose person a guardian has or may be appointed with power to restrain his said ward in some suitable hospital or asylum for treatment." Both public and private patients can be received only on an order from a probate court declaring the patient insane and stating the method of support,—whether public or private. Such an order is void unless patient is sent to the asylum within thirty days after it is issued. (Section 16.) Besides the order of commitment from the court, there must accompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumbent upon the court to see that this bond is furnished. Until this bond is furnished the patient is regarded as a public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. New bonds may be called for at any time by the medical superintendent, and the law requires the court to see that such new bonds are provided. (Section 16). Provision is made (Section 16) for the reception of both public and private patients on temporary orders wherever conditions demand immediate attention. Section 21 provides for the transfer of a patient from private expense to public expense where conditions warrant such a change. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Section 32 provides for the return to the asylum without a new order of patients who have been discharged on trial, where the duration of the temporary absence does not exceed six months. �TRAVERSE CITY STATE HOSPITAL. 85 The attention of county officers is particularly called to the insane women provisions of Section 40 regarding the state of bodily cleanli' ness and the clothing of patients brought to the asylum, and more particularly to that clause of the section providing for a female attendant for insane women. In conveying a patient to the asylum do not deceive him. Removal of Truth should not be compromised by professing a visit to the gome"ts 'rom institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This.course not only destroys confidence in friends, but also in the officers of the asylum, by giving patients an impression that they are parties to the deception. Removal to the asylum should never be attempted when the patient is much prostrated or laboring under severe bodily illness., and care should be taken that the excitement attending acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what arti- clothing, cles of clothing it is necessary to provide the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemise, 3 pairs drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, 6 handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. // such articles are left in their possession the asylum cannot be responsible for their safe keeping. All letters concerning patients, from individuals having con-espondthe right to make inquiry, will be answered at once; and encefriends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case .are reforded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information �86 Visiting patients. Application for admission of patients. STATE OF MICHIGAN. concerning inmates will not be given to casual visitors, except at the written request of friends. Where relatives of patients desire friends who are not members of the family to visit patients, they should, in every instance, furnish these friends with a letter of introduction, authorising the interview. Application for admission should ~be made before the patient is brought to the asylum. A blank will be furnished the friends which provides for a complete history of the patients trouble. All correspondence in reference to patients should be addressed to Dr. James D. Munson, Northern Michigan Asylum, Traverse City. �TRAVERSE PRINCE INKA LAD, No. 124590 Junior Herd Sire of the Traverse Herd At 18 months of age, weight 1350 Ibs His dam's 7 day record is 29.03 Ibs. of butter from 615.5 Ibs. of milk. Her semi-official yearly record is 940.8 Ibs. butter from 19,412.8 Ibs. of milk �INDEX. �THE NINE MISSES WALKER First daughters of Admiral Walker Colantha, No. 84481 Their ages at time of photo ranged from 12 to 15 months �INDEX. Accounts, abstract of Accounts, current Accounts, current, summary of Acknowledgments Additions to dining room Admission of public patients Admission of private patients Admission of voluntary patients Admissions and discharges. Table Age of patients. Table Age of patients discharged recovered. Table Age of patients who died. Table Alcoholic insanity Appendix Appointments, resignations, etc Appropriations, report of Carpenter and paint shop Chapel Civil condition. Table Clinical and research work Clothing Cold storage plant, addition to Cost of maintenance Daily average of patients Dairy barn Deaths, causes of, etc ' Death rate Dementia praecox Dietetics and food analysis Domestic arts and sciences Duration of residence of patients discharged. Table Discharge of patients, readmissions, etc Education. Table Epidemic diseases Epilepsy Estimates of special appropriations Farm and garden P^encing Fire protection for farm barns Form of disease. Table General dining room for cottages for men Grate for boiler Graduates of Training School Heating and ventilating systems for cottages 24 and 26 Heredity. Table Imbeciles and idiots Improvements Increase of patients Industrial building Infection and exhaustion psychoses Insanity of patients discharged. Table Inventory, summary of '. Page 25 28 32 74 19 84 84 84 37 60 65 66 43 83 23 21 18 71 60 12-13 85 20 15 16 19 38 16 48 8-9 11 65 16 61 13 57 66 21 20 20 41 18 20 78 19 59 42-55 16 14 19 45 64 36 �90 INDEX. Laboratory work Laundry machinery Lundvall treatment Manic depressive insanity Melancholia Morphinism Movement of population. Table Names of officers and employes. Table Nativity of patients. Table Nativity of parents. Table Needs of hospital Neosalvarsan Not insane Occupation for men Occupation. Table Officers, names of Organic group Paranoia and paranoid states Patients treated in county houses, jails, etc Patients, suicidal, homicidal, etc Psychopathic states Recapitulation Receipts and disbursements Removal of patients to hospital Repairs to roofs and gutters Report of medical superintendent Report of State Board of Corrections and Charities Report of board of trustees Report of treasurer Report of steward Report of auditing committee Residence of patients. Table Results of treatment of patients discharged. Table Silver medal Summary of causes of death. Table Title and addresses Training school for nurses Transfer of patients Tuberculosis in cattle.... : : Unclassified group .- Page 13 20 51 ,. 53 55 44 37 73 62 62 18 48 59 12 61 5-6 46 52 14-15 14-15 58 21-71 . 25 85 17 37 71 7-24 25 33 32 63 64 22 38 3 12 14 22 59 � https://localhistory.tadl.org/files/original/79375dbb18dc4539055b0f7c9389a0ed.pdf f0678ac41fc5e0f5a2fda06f6bfb36d1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Traverse City State Hospital at Traverse City June 30, 1916. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Traverse City State Hospital for the biennial period ending June 30, 1916. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Wynkoop Hallenbeck Crawford Co., State Printers. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1916 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0008 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT BOARD OF TRUSTEES TRAVERSE CITY STATE HOSPITAL TRAVERSE CITY JUNE 30, 1916 BY AUTHORITY LANSING, MICHIGAN WYNKOOP HALLENBBCK CRAWFORD CO., STATE PRINTERS 1916. �TRAVERSE CITY STATE HOSPITAL. �TITLE AND ADDRESSES. THE TRAVERSE CITY STATE HOSPITAL, TRAVERSE CITY. Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is $1,104,925.73. The property consists of 45 buildings, occupying a tract of land containing 723 acres. It cares for 1,693 patients. Act No. 21, Public Acts of 1911, provides that the Northern Michigan Asylum shall be hereafter known as the Traverse City State Hospital. This law went into effect July, 1911. OFFICERS OF THE TRAVERSE CITY STATE HOSPITAL. TRUSTEES. WILLIAM LLOYD H. C. DAVIS M. F. QUAINTANCE C. D. ALWAY S. E. NEIHARDT, M. D C. E. MILLER, M. D MANISTEE TRAVERSE CITY PETOSKEY TRAVERSE CITY SOUTH BOAHDMAN CADILLAC RESIDENT OFFICERS. JAMES D. MUNSON, M. D A. S. ROWLEY, M. D W. D. MUELLER, M. D ADAH EPPERSON, M. D H. V. HENDRICKS, M. D F. C. MAYNE, M. D MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT N / > \T OFFICERS. G. B. PIKE W. P. MANTON, M. D ASST. PHYSICIANS STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN .TRAVERSE CITY TREASURER. A. J. MAYNARD TRAVERSE CITY �OFFICERS OF THE NORTHERN MICHIGAN ASYLUM FROM ITS ORGANIZATION IN 1881. BOARD OF COMMISSIONERS APPOINTED TO SELECT SITE FOR THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Residence. Retired. Traverse City. Work of board completed Sept. 30, 1882. Perry Hannah E. H. Van Deusen. . . Kalamazoo. M. H. Butler Detroit. 1881 1881 1881 . . ; BOARD OF COMMISSIONERS APPOINTED TO ERECT THE NORTHERN MICHIGAN ASYLUM. Date of appointment. Name. Residence. Traverse City E. H. Van Deusen. . . Kalamazoo. M. H. Butler Detroit. St. Joseph. H. H. Riley Thos T Bates 1881 1881 1881 1881 1885 Retired. 1885 Vice Perry Hannah. The work of the building commission was finished Nov. 10, 1886. MEMBERS OF THE BOARD OF TRUSTEES OF THE TRAVERSE CITY STATE HOSPITAL. Date of appointment. 1885 1885 1885 1885 1885 1885 1887 1887 1889 1891 1891 1889 1895 1897 1897 1889 1901 1901 1902 1901 1903 1905 1907 1909 1913 1915 1917 Name. C. M. Wells Alex. Chapoton, Sr . . J W French Thos. T. Bates H. H. Noble G«o A. Farr. . . Lorin Roberts John Benjamin . . . C. L. Whitney H. C. Davis. . . G. A. Hart W. W Cummer .... Residence. Traverse City . . . 1887 Detroit 1887 Three Rivers 1889 Traverse City . . 1913 Elk Rapids . 1897 Grand Haven 1891 M arquette 1893 Traverse City. . 1889 Grand Rapids. . . 1891 Muskegon 1895 Traverse City. . . 1921 Manistee 1897 Cadillac. . 1901 1901 Detroit 1905 C F Backus . . . H. D. Campbell Traverse City.. . W. W. Mitchell. . . . Cadillac H. D. Brigham Grand Rapids. . . D. B. Butler. Frankfort G. A. Hart Manistee A. F Temple. . M. F. Quaintance . . Petoskey E. S. Wager. . . C D Alway S E Neihardt. C E Miller Term expires. Edniore. . . S Boardman . Cadillac 1901 1917 1901 1903 1907 1908 1917 1919 1915 1919 1921 1917 President from to Remarks. 1885 to 1886. 1886 to 1892. 1907 to 1910. 1892 to 1897. 1897 to 1899. 1899 to 1902. Present member. -Died. 1902 to 1907. 1910 to 1912. 1912.. . Present member. Present member. Present member �MEDICAL OFFICERS. Medical Superintendent: James D. Munson, M. D., 1885. Assistant 3. H. C. G. A. S. Medical Superintendents: Dawson, M. D.—1885 to 1890. Resigned. Chaddock, M. D.—1890 to 1892. Resigned. Rowley, M. D.—1895 . Assistant Physicians: G. G. Chaddock, M. D.—1885 to 1890. Promoted to Assistant Superintendency. W. A. Stone, M. D.—1886 to 1891. Resigned to accept the Assistant "Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendency. M. Rockwell, M. D.—1891 to 1892. C. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. E. L. Niskern, M. D.—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D.—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1889 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. W. D. Mueller, M. D.—1900. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. D.—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 to 1909. B. F. Sargeant, M. D.—1904 to 1905. H. D. Purduin, M. D.—1906 to 1910. R. E. Wells, M. D.—1907 to 1912. Guy M. Johnson, M. D.—1908 to 1910. Adah Epperson, M. D.—1910 . E. G. Williams, M. D.—1910 to 1911. J. A. J. Hall, M. D.—1910 to 1916. S. C. Niles, M. D.—1911 to 1913. G. V. Sigler, M. D.—1913 to 1913. R. F. Wafer, M. D.—1913 to 1915. H. V.. Hendricks, M. D., 1915 . F. C. Mayne, M. D.—1916 . Stewards: J. D. Billings, 1885 to 1886. John Goode, 1886 to 1887. J. P. C. Church, 1887 to 1894. C. L. Whitney, 1894 to 1911. G. B. Pike—1912. Chaplains: Rev. W. G. Puddefoot, 1886 to 1888. Rev. D. VanAlstin, 1888 to 1890. Rev. D. Cochlin, 1890 �GROUNDS—EAST FROM ADMINISTRATION BUILDING. �REPORT OF THE BOABD OF TRUSTEES. To the Governor and Legislature of the State of Michigan: The Trustees of the Traverse City State Hospital have the honor to submit their report for the biennial period ending June 30, 1916, together with the reports of the Medical Superintendent, Treasurer and Steward. Regular meetings of the Board have been held each month. The period just closed has been an important one in the history of the institution. The Hospital in all of its departments has been maintained at a high state of efficiency and it has been enlarged and improved. A general hospital department has been established and new dining rooms have been constructed. Some of the problems of public health, such as community health surveys, after care of mental patients, care of delinquent and backward and feeble-minded children, the establishment of community clinics, district and school nursing, etc., which are thrusting themselves into public consciousness insisting upon practical solution have been considered. It is thus briefly shown that the activities of the hospital are ever widening and that it is taking an increasing part in the preservation of the public health. "Preventable diseases and accidents continue to take their huge toll of human life among us besides imposing prolonged suffering upon millions of our people, and depleting the wealth of the nation." We believe that it should be the duty of institutions of this character1 to disseminate the knowledge of healthful living among the people. Perhaps one of the greatest economic improvements during the period, if not since the opening of the institution, was the construction of a railway side-track from the Pere Marquette Railway to the hospital. Every effort has been made to promote the recovery and welfare of patients. We have not been inattentive to the care and best welfore of the infirm, the noisy and destructive patient, but in every way have attempted to render their life more comfortable by more skillful nursing, kindly attentions, by medical supervision, and by useful occupations and as many pleasing diversions as possible. The period just closed will mark a greater departure than ever'from the conservative methods of the closed hospital. Until very recently the hospital activities were limited to the physical care and a routine treatment of its patients, but now each patient is looked upon as a psychic problem deserving the most careful study to which is added the wider activities which aim at the scientific oversight of the mentally ill and mentally defective and of the general public health. The cost of maintenance for each year of the period was 50c per patient per day, plus clothing. It is stated by some that the cost of caring for the insane has greatly increased during the last few years, but it may be seen by consulting in this report, the record of cost of mainte- �8 STATE OF MICHIGAN. nance since 1885, that the cost for each patient per day is less in 1915-16 than it was in 1885. Further, the cost of maintenance during the last few years includes officers' salaries and the cost of fire insurance and workingmen's compensation insurance which amounts to nearly four cents per patient per day. Such statements, however, are erroneous and misleading since they gain wide publicity through the press. Every effort has been made to lower the overhead charges in every department of the hospital. The year 1915 was particularly unfavorable to the agricultural interests of this region. It was marked by frosts, and fruits and garden and farm products were practically destroyed. This year promises better results but a severe drouth will greatly shorten all crops. The failure of crops was a source of much loss and added just that much to the cost of maintenance. The joint purchases by the Board of Stewards have increased during the period and have been quite uniformly satisfactory. It should not be overlooked, however, that the expenses of this Board—a considerable sum—must be added to purchase prices before net profits from such purchases can be determined. We know of the extravagant claims made for the so-called budget system, but do not fully comprehend what reforms are intended to be accomplished by it and what the machinery is to be. No one has more than generalized upon it, and we feel that specific instances should be enumerated of extravagance before existing methods in our institutions are condemned. We favor any system that will increase efficiency, but we respectfully ask for facts and figures demonstrating present imperfections before condemning the system in use and establishing in its stead an untried one. We are familiar with joint purchase and find it as a whole satisfactory in connection with individual institution purchases. An individual institution often purchases at a lower price than the Board of Stewards. Prices of commodities depend upon conditions of market, upon the day, and even on the hour, at which a contract is made. DIETETICS. Foods and their preparation continue to be supervised by the dietitian. Both the food materials and the preparation of foods have been maintained at a high standard and at a low per capita cost. The serving of food to patients in groups has proved not only practical but of economic value. The foods are served upon a ration basis and their values are determined from time to time. The physical health of the patients has been well maintained and this is largely ascribed to the care that is given to the dietaries. Dietetics is a mighty factor for good, and nothing adds more to the health and comfort of patients than good foods. Many patients assist in the kitchens, in the canning of fruits and in the preparation of cake, bread, etc. A large number of women patients have been engaged in this work, and also quite a large number of men have been instructed in serving table and in assisting about the kitchens. A class in home economics has been established and many patients will return to their homes better fitted than ever to carry on the daily work of their households because of the training received in the hospital. �TRAVERSE CITY STATE HOSPITAL. 9 DOMESTIC ARTS AND SCIENCE. The domestic arts and science department continues to be of value, although during the year several changes have occurred by reason of ill health, resignations, etc. An effort is made to interest every patient in some useful occupation. Instruction is given in fancy work and other diversional occupations. Much attention is given to exercise, to amusements and the like. This field offers many possibilities, and undoubtedly will- grow in usefulness with each succeeding year. . . OCCUPATION FOR MEN. About 50% of the men are engaged in work. The institution has about 600 acres of land under cultivation. The garden, orchard, and farm, furnish most of the work, although some patients assist in the wards, help on the lawns and grounds and in the laundry, etc. During the summer, Elmwood Avenue was graded and made a most beautiful street and driveway by the labor of patients,—by men long resident in the hospital, and who had never before performed outdoor work. They became greatly interested and found pleasure in it and all were improved in health. We may say that all patients physically able are engaged in some useful work for a few hours every day. TRAINING SCHOOL FOR NURSES. The training school for nurses is becoming more valuable with each succeeding year. It has received much attention from its officers and is doing good work. More care has been taken in the selection of the pupils and in their training. There has been a great change in our attitude toward the nursing of mental cases. The old idea of repression, punishment, seclusion, etc. of patients has given way to the care of the sympathetic, enlightened, and unselfish nurse. ,A vast field in civics is opening for the trained mental nurse. Not only will the hospital cases come more than ever under her care and require of her the most varied accomplishments and great resourcefulness, but she perforce must become the leader in social work, mental hygiene work, child welfare work, eugenic work, school and district nursing, and in the great field of preventive medicine. During the last year the hospital has supplied nurses about the surrounding country and often as many as four or five are out at a time. A constant effort is made to better the teaching, to widen the scope of instruction, and to graduate competent nurses. It is hoped that the general hospital department may have a children's and maternity ward added to it. If so, the training school will be complete in practical training material and will not have to seek affiliation with other schools before its pupils can receive the "R. 1ST." degree. The hospital training school has a large pupil class and one of the greatest purposes of the school is to prepare thoroughly trained nurses to care for patients throughout the institution. It is also hoped that the institution will be enabled to supply social and mental hygiene workers, etc., to all the people. We cannot refrain from saying that your Honorable Body must not be inattentive to the importance of this branch of civics and by proper legislation you should make it legal for this work to become a part of the hospital service. �10 STATE OF MICHIGAN. CLINICAL WORK. This has been under the general direction of Dr. J. A. Hall and Dr. F. C. Mayne. The following is a brie! report of the examinations and other work done in the laboratory: Examinations: Urine Blood Throat cultures Culture from hand infection Ascitic fluid Pleuritic fluid Smear from eye Smear from urethra Sputum Stomach contents Faeces Widal reaction Necropsies Pathological specimen Bloods for Wasserman: 447 men; 285 women; Positive reaction: 84 men; 26 women; Doubtful: 14 men; 21 women; Spinal Fluids: Boss-Jones Cell counts Lange's gold test Tuberculosis Wasserman; C. S. F.: 26 men; 2 women; Positive: 19 men; 1 woman 857 S3 55 1 2 7 1 2 44 2 3 9 13 9 732 110 35 9 10 4 1 28 20 The Wasserman test was given to practically every patient. Positive reactions were found in 19% of the men and in 9% of the women; and doubtful reactions in 3.6% of all the cases. About 10% of the admissions were alcoholic and drug habituates. To these factors, i. e., syphilis, alcohol, and drugs, is due one-fourth of the admissions. It is evident that the removal of these causes would effect a vast saving to the state to say nothing of improved health conditions. In the preface to an article taken from the Boston Medical and Surgical Journal of April, 1915, published by the Massachusetts Society for Mental Hygiene, by J. Harper Blaisdell, M. D., of Boston, entitled, "The Menace of Syphilis to the Clean Living Public," it is said, "Not all persons who are infected with syphilis become insane but the number who do is sufficiently great to rank syphilis as one of the most immediate factors of the production of mental disease. The most of these persons suffer from a form of mental disease that is not curable. They have therefore been lost to the com- �TRAVERSE CITY STATE HOSPITAL. 11 munity and at a time—middle life—when their services to their families and to society was at its highest value." "The control of syphilis is essential to the control of mental disease." The Boston Medical and Surgical Journal of April, 1915, made the following comments on Dr. Blaisdell's paper: "There is no doubt that many persons contract syphilis innocently and that many more are exposed to this danger. It has been pointed out that even those who lead the most sheltered lives are not free from this menace." Must the innocent always be thus endangered, and how great is the risk? It is not known how many syphilitics there are in our community, how many of them will endanger their associates, or how many persons with lesions on their hands are engaged in the preparation of food. These things cannot be known until all cases of syphilis are reported promptly to the local health authorities. We believe that your Honorable Body should take this great question under most careful consideration and make specific diseases reportable to health officers. As Dr. Blaisdell clearly points out, "The course of every infectious disease may be diagrainatically represented by three links of a chain. The patient at hand corresponds to the middle link with the source of his infection being the first link, and those to whom he passes the disease being the third. The stamping out of the disease depends as much upon the control of its source and the prevention of possible exposure of others, as upon the proper medical care of the patient himself. Generally speaking, either in the hospital or private practice, little effort is being made along this line." As Dr. Blaisdell further points out, "this is a vast field of preventive medicine which is still practically untouched." THE HARBISON LAW. Under the operation of the Harrison Law, a large number of drug habituates have been admitted. The most of these patients are not insane and cannot well be detained in the hospital long enough to effect a cure. Some special provision should be made for their residence other than in the ordinary mental ward. The legal control of these individuals should be clearly defined and if segregated it should be, if possible, separate from the mentally ill. This is a matter of importance not only to the narcomaniac patients but to the welfare of the institution as well. As a matter of fact, there is no specific teratment for narcomania. In many there is not only mental, but physical, unbalance. The treatment must be varied to suit the case, but elimination should be accomplished as rapidly as safety to the patient permits. After a comparatively short time these patients become quite normal mentally and should not be kept under severe restraint or associated too closely with mental cases. "Experience has proved conclusively that there are scarcely any other diseased conditions which demand a greater range, or even so great a range, of therapy as does the treatment of narcomania."—Benton. Interstate Medical Journal. THE GENERAL HOSPITAL. The legislature of 1915, Act No. 33, provided for the establishment of a general hospital department, for the reception and treatment of all emergency cases, and others seeking medical and surgical relief, other �12 STATE OF MICHIGAN. than regularly admitted insane patients. Cottage 22 was set apart and fitted for a general hospital. Under the rules and regulations established for the government of the general hospital department, every physician in good standing in the State may send patients and treat them in it, and shall have equal rights in the use of operating rooms, laboratory facilities, or of any and all medical and surgical equipment. The general hospital department was opened June 26th, 1913. Its success has exceeded expectations. The total admission for the year ending June 30th, 1916, were men 103, women 128, total 231. Of this number 14 died, or a little over 6%. The death rate was perhaps lower than that of the best metropolitan hospitals. The following tabulation of the medical and surgical cases will afford a most comprehensive review of the work which has been accomplished: �TRAVERSE CITY STATE HOSPITAL. 13 6 2 3 1 1 1 Amputation of breast . . . Amputation of hand . . . . Amputation of leg 93 1 2 1 Arthrotomy Caesarian operation Cauterization of gun shot wounds . . . ... Drainage of abscess, appendix. . . Drainage of abscess, breast . . .... Drainage of abscess, tonsils Ectopic gestation Exploratory laporotomy . . i i 1 Lighation of artery left broad ligament . . Mastoid operation 1 1 5 2 1 1 1 1 1 6 2 1 1 1 6 2 1 Ovariotomy Plastic operation on lip Rectal Fistula Release of intestinal obstruction Removal of bunions . . . . 1 2 16 1 1 1 1 1 2 10 1 4 2 3 1 3 1 1 1 45 12 1 1 2 1 1 1 3 1 2 '. . 2 93 2 2 1 3 24 1 1 3 1 1 45 12 1 . . . 6 3 3 1 1 3 24 1 1 3 4 2 3 1 2 Hysterectomy Trachelorrhaphy Tonsillectbmy . . . . "o H 14 2 1 1 1 10 . . . Removal of cervical polyps Removal of omental tumor . . Removal of pelvic adhesions . . Removal of tuberculous glands of neck Resection of bowel Resection of rib "3 1 14 1 14 2 14 Dilation of cervix if 3 1 1 5 2 1 Cholecystotomy Cystocele . . Crushed foot Fractured skull . . Fractured temporal bone . Improved. Cured. Diagnosis. Unimproved. SURGICAL. 1 1 4 16 1 1 1 1 3 1 2 2 1 1 2 31 4 1 9 31 4 1 9 1 1 �STATE OF MICHIGAN. 14 Alcoholism Appendicitis . Births Improved. Cured. Diagnosis. 1 .... Bronchitis, pulmonary . . 1 1 1 Bruises — epigastric Bruises, lungs. Unimproved. MEDICAL. •q0) "c3 0 'S B 1 1 1 1 1 1 1 2 1 1 1 1 2 Carcinoma, uterus. . Colic, renal Dysentery, amaebic. . . . Empyema Erysipelas Gastritis .... ... Hypochondriasis . . Iritis . . . Locomotor ataxia Neuresthenia . . . . Obstruction of gall bladder Orchitis . Pelvic hemorrhage i 1 2 1 1 .... i . . . 1 . Puerperal infection . . . 1 2 Tonsilitis ... . . 4 1 i 2 1 2 6 I i 2 2 Peritonitis Pleurisy Tubercular hip . 1 1 2 1 1 1 2 1 1 1 2 1 1 1 1 1 2 2 1 4 1 1 1 1 1 1 2 4 2 2 1 1 1 1 1 1 2 6 1 The opening of the general hospital has marked another distinct advance in State Hospitals. Its patients are mentally normal and while they do not come directly in contact with the mental patients, in a way they become acquainted with the efforts of the institution, learn of its good work, and in their home surroundings become interested workers for the welfare of all patients in the hospital and in their home communities. The general hospital has been of special advantage to nurses in training. It has afforded much experience to them in the care of acute diseases and surgical cases. It has added strength to the training school. We earnestly hope that a maternity and a children's ward may be added to it and our training school for nurses may be complete in itself. The following table will show the receipts and disbursements 011 account of the general hospital and it may be observed that there is a handsome Balance to its credit at the end of the first year: Total receipts for year ending June 30, 1916 $T,936 52 Total disbursements for same period 4,803 42 Leaving a balance of $3,133 10 �TRAVERSE CITY STATE HOSPITAL. 15 We believe we echo the wishes of the citizens of this great region when we say that it will be to the interest of the State to foster this general hospital and make it possible to enlarge it to the extent above suggested. The problems confronting the State in reference to the mentally ill and to the public health in general does not so much reside in the care and treatment of the patients within the hospital as it does in the prevention of causes which lead to mental ill health and various forms of mind degeneracy. It we cite as examples two etiologic factors,—syphilis and the drug habit, (including the excessive use of alcoholic drinks)—to which are due about 25% of the mental diseases in our institutions, should it not become the urgent duty of the State to locate these cases in the vicinity and afford them timely treatment? The use of alcoholic liquors is the direct cause of much insanity and the indirect cause of much more. It aggravates nearly, if not all, the diseases that cause insanity. A larger proportion of children of the excessive users of alcoholic, liquors are mentally unbalanced and feeble-minded than are children of temperate parents. When considering the prevention of causes of insanity and mental degeneracy it should be remembered that anything that decreases the excessive use of intoxicants will decrease the number of insane and mentally deficient. Every such decrease of this class of people decreases the expense of maintenance of state institutions where such people are cared for. "The distinctive activities arising out of the needs created by mental disease and mental defect are best correlated in the comprehensive term, 'mental hygiene.' Although the true alignment of mental disease and mental defect brings them within the sphere of health and medical interests, their magnitude is so great, and their requirement so specialized, as to necessitate separate organizations and autonomy of action. Close cooperative relations must exist with boards of health, organized charity, reformatory and penal agencies, educational commissions and societies for protection of child life, social uplift and betterment of living and working conditions of the masses, but initiative and independence should be maintained."—Owen Copp. American Journal of Insanity, July, 1916. Would it not be wise for the direction of mental hygiene work to reside in the hospital? Discharged patients should not from inattention be allowed to drift back into old ways or into insanitary conditions of living. By timely help, recurrent attacks of mental disease may be prevented. If this work were made possible through legislative action, boards of insanity, as Dr. Copp suggests, might become boards of mental hygiene, expressive of constructive purpose, instead of simply dealing with mental disease within the restricted confines of the hospital. A vast new field is opening up in civics to which Davenport has given the name of "applied psychiatry." "This applied science has an end of its own and methods of its own which differentiates it from others. It requires the securing of a description of the personal history of each important individual; it requires an account of environment,—the stimulus offered to each individual in order that one may interpret the constitutional idiocyncracies lying back of the reaction; it requires an adequate picture of the reactions of all who have passed the years of childhood." —Davenport. It should be the duty of the hospital to train and supply mental hy- �16 STATE OP MICHIGAN. gieue workers and to establish out-patient clinics, "especially just now when we are realizing, almost for the first time, that the care of patients inside the hospital is one, if not, indeed, a very small part of the duty of the modern hospital, and that the welfare of the community outside the walls of the institution is the big obligation that must be met." As Dr. Copp points out, among the purposes of mental hygiene are, "interpretation and diffusion of such knowledge for information of the public and the medical profession itself, as to the magnitude and import of the problems of the mentally affected, in order that they may be aroused to consciousness of their obligation and self-interest in promoting with energy the aims of mental hygiene." The State must not be inattentive to this important work. A neglect of it on the part of our legislators will mean blocking of scientific progress, and injury to untold numbers yet unborn. We believe the state should provide authority for the taking of community health surveys by trained workers, health officers, or officers of a commission, or by those who have legal supervision of the mentally ill, the criminal and delinquent, the alcoholics, and particularly the feeble-minded. The hospital training school should be widened in scope and the most practical instruction given in this domain of civics. The state hospital, we believe, should become a co-ordinating center from which preventive work should be directed. With proper provision of law, field workers should be sent into communities to visit all discharged patients, look after their continued welfare, and determine what course is best for them. They should visit the homes of patients and from personal observation determine whether other members of the family may not be in need of advice. Social workers, child welfare workers, and school nurses snould also report the results of their observations to the local health officers or recommend the patient to expert physicians of the out clinic for examination with the end in view that an intelligent course of treatment may be planned for every needful case. Mental clinics should be established in convenient centers in charge of an experienced physician where any one could go for consultation. The patient might be referred from such clinic to their home physician for treatment, at least some line of care could be recommended for their best welfare. With such supervision, many patients now confined in the hospitals would become self-sustaining.and happy members of the community. A hospital with a training school able to equip workers for this field, workers able to mediate between it and the public health service, is of double value to the community. In this field which is opening up before us, all that is needed is clear sighted control to make it a most important tool for the control of public health. Within the term "prevention may be found most of the problems which are confronting all legislators. That this new science may be successful you must identify yourselves with its progressive spirit. Wherever mental clinics have been established they have proved successful. People have voluntarily availed themselves of their help. Many patients by the advice received at these clinics have been able to live at home. The out-patient clinics of Massachusetts, New York, and Michigan have proved themselves of great usefulness. The clinic through field workers and the cooperation of physicians will bring many patients to it for re- �TRAVERSE CITY STATE HOSPITAL. 17 lief who have spent weeks, months, and even years, under various forms of treatment, who have not been recognized as psychic cases, and "without any attempt on the part of their physician to even recognize this aspect of the case in order to prevent an impending insanity." The mental clinic will give to the general practitioner a ready means of becoming familiar with psychiatric conditions and their treatment. The problem of the feeble-minded is of great importance and its solution has had a splendid beginning in our State. Dr. W. E. Pernald of Boston, Mass., says, "The cumulative evidence furnished by surveys, community studies and intensive group inquiries have now definitely proved that feeble-mindedness is an important factor as a cause of juvenile vice and delinquency, adult crime, sex immorality, the spread of venereal disease, prostitution, illegitimacy, vagrancy, pauperism, and other forms of social evil and social disease." Mr. Lewis E. Bisch, in the New Republic of August 19, 1916, in an article entitled, "The feeble-minded as criminals," says, of prisoners selected for examination at the psychopathic laboratory in the police headquarters of New York City: "It was found that about one-half of the persons examined showed marked symptoms indicative of enfeebled mentality, of a diseased mind, and in addition, there were many whose judgment, reasoning, memory, and the other higher faculties that make for good citizenship were affected by such a decay by the use of habit forming drugs, alcohol, or the result of venereal disease, that efforts at reform would usually be fruitless unless the subjects were placed in separate institutions and given special care and medical attention. It must be remembered that this 50% does not represent the proportion of mentally irresponsible persons who pass through the hands of the police each day, for only those persons were examined who showed either suspicious symtoms or whose offense was of an unusual nature." He further says, "There is absolutely no doubt that a certain proportion of all criminals are definitely feeble-minded or irrational, and placing these individuals in prisons neither protects society nor benefits the offender. A- feebleminded individual can never be normal, and especially if he displays abnormal tendencies should be placed for life in an institution where he can be given work suitable to his capacity and where he can be made as happy and as useful as possible. It is not known how many feeble-minded people there are in the State but the number of border line cases is large. It has been estimated that there are at least three million individuals in the United States that are on the border line between mental normality and mental abnormality. It is from these border line cases that so much crime and delinquency and human degeneracy is recruited. Dr. Fern aid further states: "Many feeble-minded persons eventually become permanent public charges. Many run the gauntlet of the police, the courts, the penal institutions, the alms houses, the tramp shelters, the lying-in hospitals, and often many private societies and agencies perhaps, eventually to turn up in the institutions for the feeble-minded. At any given time, it is a matter of chance as to what state or local or private organization or institution is being perplexed by the problems they present. They are shifted from one organization or institution to another as soon as possible." If community clinics were established with social and mental workers 3 �18 STATE OF MICHIGAN. trained for the service, these individuals would be gradually picked out and in connection with health officers, mental expert physicians, etc., means would be devised for their best care. In this way, practical means would be established for the prevention of further spread of human decay. X-RAY DEPARTMENT. The board established a laboratory of Roentgenology in June, 1916. This laboratory was established because we believe every hospital should be equipped to give its patients the benefit of all means proved useful by medical science. Koentgenology has proved itself not a medical fad but a useful asset in the diagnosis and treatment of disease and no hospital is complete unless it is equipped to make use of it. The mentally sick are as prone as the mentally normal to fractures, bone diseases, gastro-intestinal diseases, accidental swallowing of foreign bodies, and many other conditions in which the Roentgen Bay has been proven invaluable as a diagnostic agent. Aside from treatment, every institution of this kind should contribute all within its power to medical knowledge. With so vast an amount of material at hand there are opportunities to make observations which might prove valuable. At the present time we are making a roentgenographic study of the sella turcica of the epileptic. We have already studied fifty consecutive cases and shall report our observations within the near future provided we believe any of them worthy contributions. And we would remark incidentally, that it is not always the positive findings only that are valuable. Sometimes negative findings are of equal diagnostic value. The laboratory is fully equipped with the most modern apparatus. We have a powerful Wappler transformer, a combination radiographic table and trochoscope, diagraphoscope, a tube stand for stereroentgenography. Wheatsone stereoscopic viewing box, Ooolidge tubes, and other small apparatus. The laboratory rooms are arranged and furnished to facilitate examinations and offer comfort to the patient. The transformer room is large enough to accommodate the different appliances but has no waste space. The reception room is also used for viewing and filing plates. The dark room is well equipped with tanks and other paraphernalia assisting in turning out work with the least delay. There is a dressing room and lavatory combined. There are two other rooms which will be used for photography and storage. During the first two months, besides establishing a working technique, we have made over seventy-five different examinations embracing a variety of diseased conditions. To illustrate the value of roentgenographic examination in our work, we will illustrate by one instance out of several in our short experience. Case 45, T. A., age 38, came to us with a diagnosis of gastric ulcer. Extracts from our roentgenological report reads as follows: Examination of stomach after a barium meal shows no pathology. Six hours after meal the stomach and small intestines were completely emptied, and the colon is filled throughout the whole length. The colon appears anatomically normal. There are adhesions about the cecum and the appendix can- �TRAVERSE CITY STATE HOSPITAL. 19 not be visualized from any position. The colon had not emptied itself at the end of 48 hours. Diagnosis: pathological appendix, probably obliterative appendicitis. The diagnosis was confirmed upon laporatomy and an appendectomy performed. The patient made a rapid recovery. Fluroscopic examinations are very valuable in the diagnosis of tuberculous conditions. Even before the patient himself may be aware of approaching lung disease, the fluroscope will show the peculiar changes in the lung tissue which is so characteristic in tubercular disease. We might enumerate many other conditions and several very interesting diagnoses which have been made by means of the X-Eay in the short time it has been in use. VIOLENT DEATHS. Two deaths occurred from suicide and one from cold and exhaustion in trying to cross a field deeply covered with snow. It was evident that the last patient became confused and mistook a road leading into a field for the highway and exhausted herself in trying to find her way out. TRANSFER OF PATIENTS. Eight patients were transferred to the Ionia State Hospital. Ninetysix patients were received from the Pontiac State Hospital and two from other State Hospitals. INCREASE IN PATIENTS. The gain in patients during the period was, men 149, women 27, total 176. If the patients received from other hospital districts, one man and 95 women, total 96, are deducted from the total admissions, the net gain in the district for the last 28 years has been 22.9 per year. Of. the 897 patients admitted, 38 had been confined in county houses, 112 had been confined in jails, 264 had been treated in other hospitals, 21 were said to have been destructive, 40 had attempted or threatened suicide, 53 were homicidal or had attempted homicidal assault, and 12 had been confined or restrained at home. The number of patients confined in county houses, jails, and other hospitals, exceeded the last biennial period by 158. The number of suicidal cases was greater by 6, and the number of homicidal cases was less by 6. Since June 30, 1892, these statistics have been regularly kept and show out of a total of 7,007 admissions that 244 (3.5%) were confined in county houses; 742 (14% + ) have been confined in jails; 685 (9.7%) have been treated in other hospitals; 530 (7.5%) were destructive; 430 (6%) were suicidal; 643 (9.1%) were homicidal; 415 (5.5%) required some sort of restraint at home. COST OF MAINTENANCE. The daily cost of maintenance per patient for the last 30 years has been as follows: �20 STATE OF MICHIGAN. Cents. 53 52 51 50 49 49 48 48 : 48 47 46 44 42 44 44 44 44 (The above exclusive of officers' salaries).... 44 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 49 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 47 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 49 (Inclusive of officers' salaries) 50 (Including officers' salaries and pro rata of Ins. fund f5193.93) 51 1915 (Incl. officers' salaries and pro rata of Ins. fund, $5143.93 and working men's Ins. 1341.37) 50 1916 (Includ. officers' salaries and pro rata of Ins. fund, |5143.93 and working men's Ins. 1341.37) 50 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 DISCHARGE OF PATIENTS, EEADMISSIONS, ETC. There were 721 patients discharged during the period; 411 men and 310 women. Of this number 146 were discharged recovered, 181 improved, 56 unimproved and 334 died. The percentage of recoveries on the whole number under treatment was 6%; on the number admitted, 16%. The death rate was 73 per thousand in 1914-15, and 89 per thousand in 1915-16. The readmission for the period were, men 65, women 63, total 128. The readmissions from the beginning have been, men 434, women 419, total 853. The total number of patients admitted 7,007, represent 6,154 individuals. The daily average of patients for the period was 1630. The number of weeks spent in the institution by patients was 172,330 3-7. This was an �TRAVERSE CITY STATE HOSPITAL. 21 increase of 158 in daily average, and an increase of 16,731 2-7 weeks' board over the preceding period. On June 30, 1916, there were 1657 patients under treatmennt at state expense and 36 as private expense. There were 312 persons employed at the hospital on June 30, 1916, in the positions and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND IMPROVEMENTS. During the year ending June 30, 1915, the cost of repairs was $30,285.16 and for the year ending June 30, 1916, $31,124.25. Among the more important improvements of the period was the reorganization of the cow stables. New concrete floors and mangers and stanchions with individual water supply for each animal were installed, and several of the barns were repainted and reshingled. These improvements were absolutely necessary in order to prevent further decay of the buildings. The dairy barns are extensive and have a money value of not less than $70,000. In the granary building a small room had been constructed for milk testing, etc. This room contained a furnace with which warm water was supplied to the various barns as required in preparing steam foods, etc., for the cattle. The chimney from this furnace reached out through the roof of the granery building. The barns caught fire from this chimney in the early part of April last and it was by rare good fortune that it was discovered and the loss of the barns and stock was prevented by timely action. These buildings were practically without fire protection and at the first succeeding meeting of the Board it was directed that a building be constructed away from the barns for the housing of the furnace, milk testing appliances, milk cooling devices, etc., and thus remove a great source of danger by fire. This building has been completed and not only greatly insures against danger from fire, but is very complete in its appointments, for the care and testing of milk and in waiting rooms for help. Considerable outlay was incurred by the renovation of toilet rooms in the main building and in the replacing of many wood floors with terrazzo floors. The fixtures in these toilet rooms were worn out and unfit for service and the floors of these had become insanitary and endangered the health of the institution. Many other minor improvements were made. After the new dining room for men was ready, the old dining rooms and kitchens had to be renovated and made ready for the reception of patients. This also involved a considerable outlay. Experience has demonstrated that it costs between 2 and 2y2% of the value of buildings per year to keep them in condition. SPECIAL APPROPRIATION, $38,137.80. This appropriation was made by the Legislature of 1913 for the construction of a side-track to the hospital. It was finished in 1915 and during the first year of its operation over 400 cars of freight were delivered to the institution. On June 30, 1916, there remained in the hands of the treasurer to the credit of this fund, f703.80. We would resr»ectfully request authority to transfer this balance to the credit of the fund �22 STATE OF MICHIGAN. for the construction of "carpenter and paint shop." This right of way cost $22,738.46. It crosses a number of city lots and we would respectfully request of your Honorable Body an enabling act to sell portions of these lots and to apply the funds accruing from any such sales to the construction of a new general hospital building. SPECIAL APPROPRIATION, $1,500. The Legislature of 1913 passed this appropriation for the purchase of track scales. Only a few dollars have been drawn from this fund and the scales are not required. On June 30, 1916, there remained in the hands of the treasurer to the credit of this special fund $1,459.95. We would respectfully request your Honorable Body to authorize the transfer of this balance to the appropriation for "carpenter and paint shop." SPECIAL APPROPRIATION, $2,500. This appropriation was made by the Legislature of 1913, for repairs to roofs and gutters of the hospital. Many of these repairs have been made. There remained in the hands of the treasurer to the credit of this fund on June 30, 1916, $412.66. SPECIAL APPROPRIATION, $10,000. The Legislature of 1913 made an appropriation of $10,000 for a dining room for men. After revised plans of this building were perfected it was found that this sum was not adequate and the Legislature of 1915 made a further appropriation of |14,125.40. We would respectfully report that the building has been finished and occupied and is one of the most complete congregate dining rooms in the country. A dish washing machine was added to its equipment at a cost of $615.17, which, strictly speaking, should not have been charged to the appropriation. We would respectfully ask your Honorable Body to authorize the hospital to transfer to this account from its general fund a sufficient amount to meet any overdraft that may be charged to this appropriation. This dining room has been in operation since March 1st, 1916, and from this brief experience we feel warranted in stating that a saving of at least $2500 a year will be effected. Patients no longer serve themselves at the table but are helped by attendants which insures proper distribution of food. In connection with the dining room a moving picture machine has been installed (a gift to the State) and is a source of enjoyment to all. The dining room can be readily converted into an assembly hall, and it comfortably seats from 600 to 800 people. The building is fire-proof and is a credit to the State. The completion of the new dining room for men was followed by converting various cottage dining rooms and kitchens into dormitories furnishing additional accommodations for upwards of 120 patients. The average cost of a cottage building is about $500 per bed. Therefore, the expenditure of a little over $25,000 for this new dining room was secured to the State additional accommodations for patients that would cost at least $60,000. �MEN'S GENERAL DINING ROOM. �r^ •» • mm "mm — ~. :„ : GENERAL DINING ROOM FOR MEN. fe , fel mm ar?' — ••«• �TRAVERSE CITY STATE HOSPITAL. . 23 SPECIAL APPROPRIATION, $2,034.75. This appropriation was made by the last Legislature for an addition to the dining rooms of the south wing of the main building. It has been finished and adds greatly to the usefulness of the rooms. We believe that there is no system of dining rooms and kitchens that is more practical or better suited to the needs of a hospital population than may be found here. The dining rooms are commodious, well ventilated, fire proof, arid foods are transferred to them directly from the kitchen by power elevators. It only requires a little time to transfer foods from the kitchens to the various dining rooms. Coffee, tea, and hot foods, reach the tables in much more palatable condition than was ever before possible. This dining room addition made some alterations in the connecting parts of the building necessary, viz: new floors in corridors, toilet rooms, and new toilet room fixtures. All new floors in these corridors and toilet rooms were laid in terrazzo. The elevator installed, owing to advanced prices, cost more than the original estimate. We are sorry to state that this addition exceeded the appropriation. This was partly due to increased values of building materials as well as of labor and partly by the alterations in the connecting parts of the building that were required in order to make the dining room extension practical. SPECIAL APPROPRIATION, $8,000. This appropriation was made by the Legislature of 1915 for an industrial building. The money has not been used. In reviewing the estimates of cost of the building, it was found that it could not be built for the amount appropriated. The cost of the building based upon present prices will be at least $12,000. We would respectfully ask of your Honorable Body an additional appropriation of $4,000. An industrial building is greatly needed. At present the industrial work is carried on in basement rooms which are too small for the purpose. You must not be inattentive to the fact that modern methods of treatment look upon useful and diversional occupations as of the highest therapeutic value. We believe it would be a matter of true economy to construct this industrial building at the earliest possible date. SPECIAL APPROPRIATION, $2,500. This appropriation was granted by the Legislature of 1915 for the construction of a dairy barn. The barn has been completed. It is a modern, handsome, sanitary structure, and well fitted to the needs of the great dairy of the institution. SPECIAL APPROPRIATION, $2,500. This appropriation was made by the Legislature of 1915 for the purchase of washing machines. We would respectfully report that the machines have been installed and within the amount appropriated. �24 . STATE OF MICHIGAN. SPECIAL APPROPRIATION, $2,500. This appropriation was made by the Legislature of 1915 for the purchase of an automatic chain grate. A Continental Chain Grate has been installed. This grate is giving the best of satisfaction. We are pleased to say that the appropriation was sufficient to install it. SPECIAL APPROPRIATION, $5,000. This appropriation was made by the Legislature of 1915 for pumps and other appliances for fire protection of the farm barns. Preliminary surveys and other work preceding the installation of the plant have been made. There remained in the hands of the treasurer to the credit of this special fund on June 30, 1916, .$4,113.31. SPECIAL APPROPRIATION, $8,452.00. This appropriation was made by the last Legislature for the construction of a building to be used as a carpenter and paint shop. The building was begun under plans and specifications made nearly two years ago and is now nearing completion. Owing to the increased cost of material and labor and of machinery, the building will cost at least $4,000 more than the appropriation. On June 30, 1916, there was an overdraft against this appropriation of $1468.94. Your Honorable Body is respectfully requested to grant an appropriation of $4,000 to finish the building and equip it with proper machinery. The new building is well planned and is a much needed improvement. The institution had entirely outgrown its old shops and no doubt the new building will render this department of the hospital much more efficient. NEEDS OF THE HOSPITAL. The following requests for appropriations are for buildings and equipment for the hospital. We would call your attention to the fact that the hospital is constantly growing, that conditions of care and treatment are changing, and that the appropriations requested are to meet absolute requirements. These requests were decided upon after careful consideration. Several other additions to the hospital should have been presented for your consideration, e. g., a chapel building, an amusement hall, but owing to the increased cost of building material, it was thought an unfavorable time to build and therefore action was deferred relative to appropriations for them. ADDITION TO STORE, $7,000. Your Honorable Body is respectfully requested to appropriate the sum of $7,000 for enlarging the store building. The institution is lacking in store room space for flour and other supplies if purchased in large quantities. We cannot too strongly urge the necessity for this building. �GENERAL DINING ROOM FOR MEN—KITCHEN. �TRAVERSE CITY STATE HOSPITAL. 25 ADDITION TO COLD STORAGE PLANT, $7,215. Your Honorable Body is respectfully requested to appropriate the sum of $7,215 to enlarge the cold storage plant. The value of cold storage can hardly be overestimated since the period of fresh fruits and vegetables can be nearly doubled if cold storage is afforded for their care. Eggs, and butter, cheese, meats, etc., can be kept almost indefinitely and if storage is adequate much money can be saved by the purchase of such supplies when the market is low. Fruits and garden products, peas, tomatoes, etc., not consumed in fresh state, are conserved by canning, but the canned goods if they are to be kept indefinitely require cold storage, Excess of fresh fruits and garden vegetables will exceed 30,000 quarts this year alone and a dead loss if allowed to waste. The plans and specifications of these buildings were prepared by the L. Wolfe people two years ago. The same specifications are used but the estimates of material, etc., are based upon current market prices. ADDITION TO NORTH DINING ROOM FOR WOMEN, $4,232. Your Honorable Body is requested to appropriate the sum of $4,232 for the construction of an addition to dining rooms of the north wing of main building. A similar addition was made to the south wing dining rooms and has proved so valuable that we ask for this appropriation. The existing dining rooms are too small. ADDITIONAL FIRE PROTECTION,—NEW FIRE PUMP, $2,500. Your Honorable Body is respectfully requested to appropriate the sum of $2500 for the installation of a fire pump in the central station of the hospital. The pump in use was installed in 1885, is too small, is worn out and liable to go out of commission at any moment. It is imperative that the institution should be supplied with adequate fire protection. We would earnestly solicit your attention to this important matter. LAUNDRY MACHINERY, $5,000. Your Honorable Body is respectfully requested to appropriate the sum of $5,000 for a power mangle, surface ironers, and the reconstruction of ironing tables, electric wiring, etc. The present mangle has been in use since 1895 and is not only obsolete in type but about worn out. It is thought the installation of surface ironers and the rearrangement of ironing tables will economize in labor. It is stated by expert authority that one surface ironer performs the work of from three to five helpers. We would respectfully urge this appropriation. FARM PURCHASE, $14,461.50. Your Honorable Body is respectfully requested to appropriate the sum of $14,461.50 for the purchase of 155% acres of land. This land is situated about a half mile west of the hospital grounds and is a valuable property. The purchase price, $93 per acre, is not high. There is a good farm house, two good barns, besides smaller out-buildings. There is also a fine orchard of several hundred trees. The hospital has �26 STATE OF MICHIGAN. a large number of men able to work on the farm. Fruits/, vegetables, hay and grains are cultivated by them and add to the income of the institution. We most urgently ask your attention to this appropriation. It is doubtful if the land will again be offered at this price. An option is held on this property pending your action. PORCH, $750. Your Honorable Body is respectfully requested to grant an appropriation of $750 for the construction of a connecting corridor between Cottage 30 and the congregate dining room for men. RECAPITULATION OF APPROPRIATIONS REQUESTED. Addition to store Addition to cold storage plant Addition to congregate dining room for women Fire protection—fire pump Laundry machinery Additional lands Connecting corridor For building carpenter and paint shop For building industrial building Total $7,000 00 7,215 00 4,232 00 2,500 00 5,000 00 14,461 50 750 00 4,000 00 4,000 00 149,158 50 FARM, GARDEN, STOCK AND GROUNDS. The following tables show the produce from the farm and garden, and cash receipts for farm produce, etc., sold during the biennial period: FARM REPORT FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1916. Mangels, bushels Apples, bushels 2 ,271 12,351 59.50 Melons, musk, pounds 3,900 Apples, crab, bushels Asparagus, pounds 3 ,485 Melons, water, pounds 12,850 Beans, string, bushels 370 Milk, pounds J ,270,482 Oats, bushels 4,126 Beets, bushels 1 , 246 606 Onions, green, dozens 12,550 Beets, sugar, bushels Onions, bushels 426 Beef, pounds 12 ,401 Parsnips, bushels 2,004 Cabbage, heads 32 ,463 Peas, bushels 276 Carrots, bushels 3 , 234 745 Pears, bushels 47 Cauliflower, heads , 387 Peaches, bushels 44 Celery, heads 28 9 Peppers, bushels 28 Ceienac, bushels Pigs, pounds 56 Cherries, quarts 12.,003 174 Plums, bushels Chicken, pounds 1 ,373.50 52,578 90 Pork, pounds Cider apples, bushels 1,915 Potatoes, bushels Corn, green, bushels 1 , 294 Potatoes, sweet, biishels 31 orn, bushels 1 , 120 6.23 10 Pumpkins, food, tons orn stover, tons 17.03 169 Pumpkins, stock, tons Cucumbers, bushels 9,479 193 Radishes, dozens Cucumbers, dozens ,394 36 Raspberries, quarts Ducks, pounds 1,420 861.75 Rhubarb, pounds Eggs, dozens 1,990 6 Ruta bagas, bushels Egg plant, bushels 680 920 Sage, bundles Ensilage, tons 235 341 Salsify, bushels Grapes, bushels 870 400 Spinach, heads Greens, pounds 7.76 55 Squash, tons Green fodder, tons 400 38 Squash, summer, pounds Hay, clover, tons 3,364 90.50 Strawberries, quarts Hay, alfalfa, tons 135 26 Straw, tons Hay, timothy, tons 145 14 Tomatoes, greenhouse, pounds.... Hay, June grass, tons 40 2.50 Tomatoes, green, bushels Kohl Rabi, bushels 1,337 Tomatoes, ripe Lettuce, pounds 9.,715 236.75 Turkeys, pounds Lumber, hardwood, feet 3 , 033 521 Turnips, bushels Lumber, softwood, feet 5 512 8 �TRAVERSE CITY STATE HOSPITAL. 27 CASH RECEIPTS FROM FARM FOR THJE BIENNIAL PERIOD ENDING JUNE 30, 1916. Cattle sold $3,905 75 Prize money on cattle A. R. O 300 00 Sale of apples 3 00 Sale ol milk 13 08 Pedigree of bull 1 00 Sale of gravel 1 30 Sale of roosters 1 25 Sale of hides 310 69 Sale of bones 16 74 Board of horse 2 50 Horse shoes 2 40 Refund freight on feed 3 00 Refund freight on straw 6 75 Refund wages 50 Hauling material 4 00 Freight on hay, refunded 4 40 Sale of cork brick 7 80 $4,584 16 The farm management is divided into the following departments— Farm, Orchard, Garden and Herd, and the head of each department is under the direction of the Steward. There are a number of paid employees in each department, but a great deal of the hand labor is performed by parties of patients in charge of attendants. A number of very important improvements were made during the last two fiscal years, among which were building a new stock barn, completing the installation of barn equipment in the four main stock barns, and also in the new barn; said equipment consists of sanitary steel wood lined stanchions, cork brick floors where the cattle stand, concrete floors and mangers, individual drinking basins and litter carriers. We have also installed Empire Milking Machines with present capacity of sixty cows, the equipment may be extended to milk one hundred cows when necessity requires. RECEIPTS AND DISBURSEMENTS. The total receipts of the hospital for the fiscal year ending June 30. 1915, including cash on hand on special appropriations accounts, were |328,507.12, and the total disbursements for the same period, including special appropriations, were $335,044.04. The total receipts of the hospital for the year ending June 30, 1916, including cash on hand and credits on special appropriations accounts, were $378,439.39, and the total disbursements for the same period, including special appropriations were $391,333.49. There was at the close of the biennial period ending June 30, 1916, $10,885.86, in the hands of the treasurer; $6,813.38 of which amount was to the credit of the current expense account and the balance of $4,042.48, unexpended balance to the credit of special appropriations account. OFFICERS. In 1915 Honorable H. C. Davis, of Traverse City, Michigan was reappointed to the Board. Mr. Davis had served as a member of the Board since 1891. In September, 1914, L. S. Griswold, M. D., of Big Eapids, Michigan, was appointed a member of the Board to fill the unexpired term of Mr. E. S. Wager, deceased. Dr. Griswold resigned in December, 1914, much to the regret of his associates on the Board. �28 STATE OF MICHIGAN. In January, 1915, S. E. Neihardt, M. D., of South Boardman, Michigan, was appointed to the Board. Dr. Neihardt is a well known physician and his experience will be of value to the hospital. In December, 1916, C. E. Miller, M. D., of Cadillac, Michigan, was appointed to the Board to fill the tinexpired term of W. W. Mitchell, deceased. Dr. Miller brings a ripe experience as a physician and doubtless will prove a very valuable acquisition to the institution. J. A. Hall, M. D., who had been connected with the staff since 1910, resigned his position in January, 1916, to accept an appointment at the Willard Parker Hospital in New York City. The doctor carried with him the best wishes not only of the Board but of the staff. In February, 1915, Dr. H. V. Hendricks, of Worcester, Massachusetts, was appointed assistant physician to the staff. Dr. Hendricks came to us highly recommended and has proved a valuable acquisition to the medical staff. In January, 1916, Dr. F. C. Mayne, of Charlevoix, Michigan, was appointed assistant physician on the staff. The doctor came to us highly recommended and is well fitted in every way for the position he occupies. In July, 1914, the Honorable Edgar S. Wager, of Edmore, Michigan, who had been a member of the Board of Trustees since 1909, was removed by death. The following is an abstract of resolutions passed by the Board: Mr. Wager came to us fully equipped by large business experience and gave the best of his ripe experience freely for the benefit of the State of Michigan, as one of the trustees of this hospital. He was deeply interested in the welfare of the institution and was especially valuable as a member of the Farm Committee, in which capacity he served during most of his term. It was apparent that he often came to the institution during the latter months at great personal as well as physical inconvenience. In his death, the State lost a valuable member of the governing board of the hospital and we all miss him as friends and co-workers. In November, 1915, Mr. W. W. Mitchell, of Cadillac, Michigan, passed from the activities of this life. Mr. Mitchell had been a member of the Board of Trustees of this hospital since 1901. He was a valuable trustee. The following is abstracted from resolutions concerning him which form a part of the record of this institution: Only those who have been intimately associated with Mr. Mitchell fully appreciated his character. Goodness and riches too frequently have nothing in common but Mr. Mitchell was well possessed of each. To no group of persons outside of his immediate family was the death of Mr. Mitchell a greater shock than to the Trustees and officers of the Traverse City State Hospital. Mr. Mitchell seemed especially able to reach the proper solution of a question with great rapidity due to his vast experience in problems of momentous import. His judgment went unerringly to the essential features. He never lost sight of details, when details counted, but no mass of unessential things could obscure his view of that which really mattered. The quiet dignity of Mr. Mitchell and his kindness of heart impressed every one who came in touch with him. He passed into the great beyond at the height of his activities and is universally truly mourned. By his death the State and institution lost a valued servant. �TRAVERSE CITY STATE HOSPITAL. 29 In conclusion, we may say that we believe that the officers and employes of the institution have given their best to it. In the conduct of its affairs we have followed a constructive course and have ever attempted to adopt all that is best and to the highest welfare of the patients and of the hospital. We appreciate the fact that steady progress is being made in the management of hospitals in general and that the medical and general care of mental patients is constantly changing for the better. At the same time we have been deeply interested in the movements which look to the prevention of all forms of mental disease and earnestly hope that your Honorable Body will, by the wisdom of its action, put our State in the front rank in mental hygiene and conservation of the public health in general. WILLIAM LLOYD, H. 0. DAVIS, M. F. QUAINTANCE, C. D. ALWAY, S. E. NEIHABDT, C. E. MILLEE. Traverse City, Michigan, June 30, 1916. �30 STATE OF MICHIGAN. TREASURER'S REPORT. ABSTRACTS. OF ACCOUNTS CURRENT OF RECEIPTS ANEr DISBURSEMENTS AT THE TRAVERSE CITY STATE HOSPITAL FOR THE FISCAL YEAR ENDING JUNE 30, 1915. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of Traverse City State Hospital for the above named period as follows. JULY, 1914. CREDITS. Balance on hand July 1, 1914 .................................... Cash from State Treasurer, current expenses .................... Cash from other sources ...................................... --- $30,286 88 25 , 500 08 1 , 441 45 $57,228 41 DEBITS. Account of side track ........................................... Account of repairs, roofs and gutters ............................. Account of porch, Cottage No. 32 ................................ Account of wagoii and implement shed ........................... Account of current expenses ..................................... Balance on hand to new account ................................. $88 33 82 20 108 31 588 57 19,815 91 36,545 09 - $57,228 41 AUGUST, 1914. CREDITS. Balance on hand August 1, 1914 Cash from State Treasurer, current expenses Cash from othersources - $36,545 09 25,500 08 532 37 $62,577 54 DEBITS Account of culvert. Account of side track Account of repairs, roofs and gutters Account of porch, Cottage No. 32 Account of wagon and implement shed Account of current expenses Balance on hand to new account .. $120 60 276 31 189 13 200 94 402 54 28,633 11 32,754 91 $62,577 54 SEPTEMBER, 1914. CREDITS. Balance on hand September 1, 1914 Cash From State Treasurer: Current expenses Laundry extension and dry room Cash from other sources $32,754 91 25,500 10 2,000 00 406 16 $60,661 17 DEBITS. Account of books and musical instruments Account of side track Account of repairs, roofs and gutters Account of reroofing cottages Account of wagon and implement shed Account of current expenses Balance on hand to new account $21 66 533 37 236 30 1028 654 06 25,935 67 33,269 83 — $60,661 17 �TRAVERSE CITY STATE HOSPITAL. 31 OCTOBER, 1914. CREDITS. Balance on hand October 1, 1914 Cash from State Treasurer, current expenses Cash from other sources $33,269 83 24,275 50 1,439 11 DEBITS. Account of repairs on reservoir Account of side track Account of extension to heating plant Account of repairs, roofs and gutters Account of artesian wells Account of wagon and implement shed Account of laundry extension and dry room Account of current expenses. Balance on hand to new account $157 600 60 288 53 256 590 29,454 27,522 86 02 75 49 70 56 00 34 72 $58,984 44 $58,984 44 NOVEMBER, 1914. „ CREDITS. Balance on hand November 1, 1914 dash from State Treasurer, current expenses Cash from other sources , Account of repairs on reservoir Account of books and musical instruments Account of side trjack Account of extension to heating plant..: Account of wagon and implement shed Account of current expenses Balance on hand to new account ' $27,522 72 24,2"75 49 442 63 $48 28 4 69 1,506 65 519 304 52 25,155 68 25,215 83 $52,240 84 $52,240 84 DECEMBER, 1914. CREDITS. Balance on hand December 1, 1914 Cash from State Treasurer, current expenses Cash from other sources $25,215 83 24,275 49 709 16 Account of side track Account of wagon and implement shed Account of current expenses Balance on hand to new account $594 164 27,987 21,454 . 98 25 22 03 $50,200 48 $50,200 48 JANUARY, 1915. CREDITS. Balance on hand January 2, 1914 Cash from State Treasurer, current expenses Cash from other sources $21,454 03 26,953 55 1,625 96 Account of side track Account of extension to heating plant Account of current expenses Balance on hand to new account $45 94 32,050 17,843 24 50 05 75 $50,033 54 $50,033 54 FEBRUARY, 1915. CREDITS. Balance on hand February 1, 1915 Cash from State Treasurer, current expenses Cash from other sources $17,843 75 26,95352 793 74 $45,591 01 �32 STATE OP MICHIGAN. DEBITS. Account of side track Account of current expenses Balance on hand to new account $44 00 26,295 07 19,251 94 $45,591 01 MARCH, 1915. CREDITS. Balance on hand M.arch 1, 1915 Cash from State Treasurer, current expenses Cash from other sources " — $19,251 94 26,953 50 670 21 $46,875 65 DEBITS. Account of side track Account of current expenses Balance on hand to new account $36 19 28,170 75 18,668 71 $46,875 65 APRIL, 1915. CREDITS. Balance on hand April 1, 1915 ' Cash from_State Treasurer, current expenses Cash from other sources . .. $18,668 71 25,152 77 1,393 17 $45,214 65 DEBITS. Account of side track Account of current expenses Balance on hand to new account $37 65 25,900 80 19,276 20 845,214 65 MAY, 1915. CREDITS. Balance on hand May 1, 1915 Cash from State Treasurer, current expenses Cash from other sources $19,276 20 25,152 77 953 22 $45,382 19 DEBITS. Account of culvert Account of side track Account of current expenses Balance on hand to new account $227 32 29,238 15,883 40 65 93 21 $15,883 25,152 10,000 454 21 78 00 31 $82 30 652 26,974 23,749 80 67 86 01 96 $45,382 19 JUNE, 1915. CREDITS. Balance on hand June 1, 1915 Cash from State Treasurer: Current expenses Dining room, cottages for men From othersources $51,490 30 PEBITS. Account of repairs, roofs and gutters Account of side track Account of dining room, cottages for men Account of current expenses Balance on hand to new account $51,490 30 �TRAVERSE CITY STATE HOSPITAL. 33 SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital for the fiscal year ending June 30, 1915. CREDITS. Balance on hand July 1, 1914 Cash from State Treasurer: Account of laundry extension and dry room Account of dining room, cottages for men Account of current expenses Cash from other sources $30,286 88 2,000 10,000 305,645 10,861 Account of repairs, roofs and gutters Account of porch, cottages for men Account of wagon and implement shed Account of culverts Account of side track Account of reroofing cottages Account of repairs on reservoir Account of artesian well Account of laundry extension and dry room Account of books and musical instruments Account of extension to heating plant Account of dining room, cottages for men Account of current expenses Balance on hand to new account S878 92 309 25 2,370 50 348 00 3,826 06 10 28 20614 53 70 590 00 26 35 160 44 652 86 325,611 54 23,749 96 00 00 63 49 $358,794 00 $358,794 00 ABSTRACT. OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE TRAVERSE CITY STATE HOSPITAL FOR FISCAL YEAR ENDING JUNE 30, 1916. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the above named period as follows: JULY, 1915. CREDITS. Balance on hand July 1, 1915 Cash from State Treasurer: Account of current expenses Account of farm barn Cash from other sources Account Account Account Account Account Account Balance $23,749 96 of repairs, roofs and gutters of side track , . .. of laundry extension and dry room of dining room, cottages for men of farm barn of current expenses on hand to new account 27,125 61 2,500 00 1,556 06 — $54,931 63 $107 2 105 939 1,457 31,019 21,299 - $54,931 63 45 55 70 12 82 86 13 AUGUST, 1915. CREDITS. Balance on hand August 1, 1915 Cash from State Treasurer: Account of dining room, cottages for men Account of new grates, boiler No. 3 Account of additional laundry machinery Account of addition, north dining room Account of current expenses Cash items from other sources $21,299 13 5,000 2,500 1,500 2,394 27,125 1,634 00 00 00 75 61 68 $61,454 17 �STATE OF MICHIGAN. Account of side track Account of laundry extension and dry room Account of dining room, cottages for men Account of farm barn '. Account of current expenses Balance on hand to new account $183 79 398 33 4,383 19 1,042 18 24,053 53 31,393 15 $61,454 17 SEPTEMBER, 1915. CREDITS. Balance on hand, September 1, 1915 Cash from State Treasurer, current expenses Cash from other sources ; $31,393 15 27,12.5 62 1,164 53 $59,683 30 DEBITS. Account of side track Account of laundry extension and dry room Account of dining room, cottages for men Account of dining room for men Account of addition, north dining room Account of current expenses Balance on hand to new account $25 169 4,024 3,196 317 23 ,181 28,769 00 27 83" 12 50 02 56 $59,683 30 OCTOBER, 1915. CREDITS. Balance on hand October 1, 1915 Cash from Treasurer, current expenses Cash from other sources - . ... 828,769 56 25,930 55 2,161 73 $56,861 84 DEBITS. Account of repairs, roofs and gutters Account of laundry extension and dry room Account of dining room for men Account of new grates, boiler No. 3 Account of addition to north dining room Account of carpenter shop Account of current expenses Balance on hand to new account $146 80 292 96 3,576 43 1,343 96 930 40 437 70 • 30,324 97 19,808 62 $56,861 84 NOVEMBER, 1915. CREDITS. Balance on hand November 1, 1915 Cashfrom State Treasurer, current expenses Cash from other sources $19,808 62 25,930 56 1,358 72 $«7,097 90 DEBITS. Account of repairs, roofs and gutters Account of laundry extension and dry room Account of dining room for men ; Account 61 new grates, boiler No. 3 Account of carpenter shop Account of addition to north dining room Account of current expenses Balance on hand to new account $127 00 95 52 1,758 75 366 06 908 90 550 30 28,248 98 15,042 39 $47,097 90 DECEMBER, 1915. CREDITS. Balance on hand December 1, 1915 Cash from State Treasurer, current expenses Cash from other sources $15,042 39 25,930 57 1,250 75 $42,223 71. �TRAVERSE CITY STATE HOSPITAL. Account of side track Account of repairs,"roofs and gutters Account of laundry extension arid dry ro om Account of dining room for men ,~. Account of new grates, boiler No. 3 Account of addition to north dining room Account of carpenter shop Account of current expenses Balance on hand to new account . 35 $296 90 68 60 105 60 2,717 74 789 98 114 25 1,725 52 27,881 04 8,524 08 $42,223 71 JANUARY, 1916. CREDITS. Balance on hand January 2,1916 Cash from State Treasurer: Current expenses Carpenter shop Dining room for men Cash from other sources, current expenses Cash from other sources, dining room for men $8,524 28,745 7,452 9,125 2,504 08 06 00 40 16 42 $56,351 12 DEBITS. Account of rerooflng cottages Account of side track Account of laundry extension and dry room Account of dining room for men Account of additional laundry machinery Account of addition to north dining room Account of carpenter shop Account of current expenses Balance on hand to new account $484 25 281 63 132 28 2,260 78 1,500 00 482 30 1,544 82 27,654 11 22,010 95 $56,351 12 FEBRUARY, 1916. CREDITS. Balance on hand February 1, 1916 Cash from State Treasurer, current expenses Cash from other sources • $22,010 95 28,745 06 2,213 34 $52,969 35 DEBITS. Account of dining room for men Account of carpenter shop Account of current expenses Balance on hand to new account $110 34 87 12 24,238 43 28,533 46 $52,969 35 MARCH, 1916. CREDITS. Balance on hand March 1, 1916 Cash from State Treasurer, current expenses Cash from other sources Account of dining room for men Account of carpenter shop Account of current expenses Balance on hand to new account $28,533 46 2,8,745 09 1,771 78 $1621 9 14 30,629 75 28,395 23 $59,050 33 $59,050 33 APRIL, 1916. CREDITS. Balance on hand April 1, 1916 Cash from State Treasurer, current expenses Cash from other sources $28,395 23 25,269 24 2,129 26 . $55,793 73 �30 STATE OF MICHIGAN. Account of dining room for men Account of carpenter shop Account of industrial building Account of current expenses Balance on hand to new account — $599 1,257 25 33,330 20,580 79 36 00 82 76 $55,793 73 MAY, 1916. CREDITS. Balance on hand May 1, 1916 Cash from State Treasurer, current expenses Cash from other sources $20,580 76 25,269 24 1,578 50 $47,428 50 DEBITS. Account of side track Account of track scales Account of carpenter shop Account of current expenses Balance on hand to new account $144 40 1,188 32,162 13,893 00 05 50 04 91 $47,428 50 JUNE, 1916. CREDITS. Balance on hand June 1, 1916 Cash from State Treasurer: Current expenses Fire protection, farm barns Cash from other sources, current expenses Cash account of dining room for men $13,893 91 . 25,269 5,000 2,431 535 28 00 82 30 $47,130 31 DEBITS. Account of side track Account of dining room for men (inclusive of $535.30 returned to account of current expenses, Auditor General's orders, see Voucher No. 39802 dated March 6, 1916) Account of carpenter shop Account of fire protection, farm barns Account of current expenses Balance on hand to new account . . . .. $358 25 1,152 1,761 886 32,114 10,855 80 88 69 83 86 $47,130 31 SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the fiscal year ending June 30, 1916. CREDITS. Balance on hand July 1, 1915 Cash from State Treasurer: Account of farm barn Account of dining room, cottages for men Account of dining room for men Account of nejt grates, boiler No. 3 Account of additional laundry machinery Account of addition to north dining room Account of carpenter shop Account of fire protection, farm barns Account of current expenses Cash from other sources: Current expenses Dining room for men $23,749 96 '. 2,500 5,000 9,125 2,500 1,500 2,394 7,452 5,000 321,211 00 00 40 00 00 75 00 00 49 21,755 33 535 72 $402,724 65 �TRAVERSE CITY STATE HOSPITAL. Account of repairs, roofs and gutters Account of side track Account of laundry extension and dry room Account of addition to north dining room Account of rerqofing cottages Account of dining room for men Account of track scales Account of dining room, cottages for men Account of newgr,ates, boiler No. 3 Account of additional laundry machinery Account of farm barn Account of carpenter shop Account of industrial building Account of fire protection, farm barns Account of current expenses % Balance on hand to new account $449 1,292 1,299 2,394 484 16,328 40 8,408 2,500 1,500 2,500 8,920 25 886 344,839 10,855 37 85 12 66 75 25 08 05 02 00 00 00 94 00 69 38 86 8402,724 65 We have carefully examined the accounts of A. J. Maynard, Treasurer of Traverse City State Hospital, for the biennial period ending June 30, 1916, and have compared the same with the books and vouchers and verified the same by further comparison with the books of the Steward and hereby certify to the entire correctness of them. M. F. QUAINTANCE, C. D. ALWAY, WILLIAM LLOYD, Auditing Committee. �38 STATE OP MICHIGAN. STEWARD'S REPORT. For the biennial period ending June 30, 1916. ANALYSIS OF RECEIPTS AND DISBURSEMENTS. RECEIPTS. Maintenance, etc., of State patients Maintenance, etc., of private patients Treatment, etc., general hospital patients $626,857 12 15,2.96 54 7,936 52 Farm: Cattle sold Prize money on cattle, A. R. O Sale of apples Sale of milk Pedigree of bull Sale of gravel Sale of roosters Sale of hides Sale of bones Board of horse Horse shoes Refund, freight on feed Refund, freight on straw Refund, wages Hauling material . . . .1 Freight on hay, refund Sale of cork brick $3,905 75 300 00 3 00 13 08 1 00 130 1 25 310 69 16 74 2 50 2 40 3 00 6 75 50 4 00 4 40 7 80 Sundry accounts Special appropriations: Laundry extension and dry room Dining room, cottages for men Farm barn New grates, boiler No. 3 Additional laundry machinery Addition north dining room Dining room for men Carpenter shop Fire protection, farm barns 4,584 16 4,799 60 2,000 10,000 2,500 2,500 1,500 2,394 14,125 7,452 5,000 00 00 00 00 00 75 82 00 00 $706,946 51 DISBURSEMENTS. 1. Officers' 2. Food: Wages Meat and fish Butter Flour Coffee Miscellaneous, other foods Tea .. Sugar Fuel Cooks coats salaries 3. Clothing: Wages Clothing 4. Laundry: Wages Machinery Starch Soap making material Soda Bluing and ammonite, Baskets Acetic acid and wax Electric irons $29,227 41 '. $21,163 54,356 35,618 16,600 4,207 37,847 2,499 14,527 2,486 55 05 40 47 70 21 30 43 97 26 86 $4,721 40 32,067 49 $11,322 230 155 1,962 718 70 148 30 114 41 91 43 12 64 00 69 07 63 189,362 74 36,788 89- �TRAVERSE CITY STATE HOSPITAL. Laundry—Continued— Lime Gas Washing powder Soap Truck repairs Laundry lists Extractor Sprinkler Tubs, etc 5. Heating and Light: 6. Floral, greenhouse and grounds: 7. Medical department: 8. Office, stationery, etc.: 9. 10. $52 17 103 45 41 90 66 50 16 83 4 00 293 96 226 79 90 Wages Coal and freight Gas Electrical supplies Oil and kerosene Advertising for coal bids Heat regulator $9,641 70 58,077 35 1,413 27 1,443 19 22 94 29 28 2350 Wages Seeds and bulbs Plants and trees Drain pipe Implements Spraying Survey of grounds and map Garden hose Fencing Benches Fertilizer Wages Drugs, etc Medical supplies Medical bo'oks X-Ray machine, etc Pins for graduate nurses Gas Wages Blank books Postage Telephone and telegraphing Printing, etc Stationery Letter and bill Typewriters Treasurers stationery Amusement and instruction: Music lor patients party Music Graduate nurses class: Ribbons, etc Two addresses Tuning piano Circus tickets Fair tickets Games Books Moving picture machine supplies Christmas candy and entertainment Furniture and household supplies: Wages Dry goods Utensils Soap Hardware Mats, carpet and linoleum Furniture Crockery Brooms Toilet paper Mattresses and material Bedding 39 files $5,956 390 336 85 128 310 20 153 667 221 44 91 64 57 56 15 34 50 03 15 73 00 $115,762 6,596 1,101 142 2,528 30 88 19 47 6"! 96 00 63 $6,463 144 696 1,252 855 440 83 127 42 55 25 70 02 10 31 88 69 70 $15,413 87 70,651 23 126,162 74 10,106 20 $182 00 85 70 4 88 45 00 20 00 156 75 38 50 129 76 112 17 40 12 205 43 $5,179 59 7,059 80 1,990 49 1,806 13 1,230 88 630 79 1,270 94 1,693 49 697 28 859 09 2,076 35 12,299 50 1,020 31 �STATE OP MICHIGAN. 40 Furniture and household supplies—Continued— Refrigerator Gas ranges, stores and fittings Bedsteads Polish Brushes Dusting oil and mops Chambers Baskets, sacks and bags Fijre hose Wax shelf and wrapping paper Roach powder Clocks Ladders Clothes marking machine Paper towels and blotters Mirrors Sponges Dish washing machine fittings Pantosote 11 Carriage barn and vehicles: Wages Auto delivery license Auto delivery trucks Auto delivery supplies Four wheel truck Tire chains. . : Gasoline and oil Blacksmithing Grease 12 Improvements and repairs: Wages Oils and paints Lumber Lime and cement Hardware Glass Iron pipe, etc Steel and iron Wall Brick and bake oven Brushes, tools, etc Plaster I-beams Sewer pipe Radiators Roofing Bath tub Boiler Tile and the flooring Water closets and Wire screens New electric fixtures and wire Sawing lumber Repairs potato peeler Gas tank Fire hose Building tile Belting Pasteurizer 13. Machinery: Packing and gaskets Lubricating oil Machine Stoker repairs Gasoline Belting Soda ash Motors Boiler, sections, etc Steam charts: Gauges and valves Fire, hose, etc Sewing machines Tools Pipe cutter Elv. rope Truck car wheels, etc Sewertraps Standard wagon scale Concrete mixer J97 02 871 06 1,692 75 240 89 214 37 337 30 325 98 143 48 218 05 246 48 5131 64 50 29 45 Ill 40 83 73 25 08 204 98 1092 61 99 $1,413 00 1105 526 00 176 23 36 75 3 50 343 83 ' 7 90 275 finish fittings fittings fixtures fittings ." $33,391 39 2,555 33 1,455 96 580 33 1,344 55 389 86 4,191 18 1,958 40 198 10 1,587 46 445 42 83 63 641 00 165 92 530 49 563 22 94 46 180 73 3,852 66 5,585 54 613 69 421 86 31 43 15 00 140 00 87 71 199 29 11 90 102 90 $459 49 360 82 521 78 727 80 15>9 61 258 97 357 37 10 90 161 93 2 9 26 472 61 47 56 135 32 14 75 434 52 44 17 160 51 26 73 155 00 455 00 841,825 07 2,521 01 61,409 41 4,994 10 �TRAVERSE CITY STATE HOSPITAL. 14. 15. Farm, garden and stock: Wages Feed Testing and registering of stock Spraying Implements Harness, etc Fertilizer Veterinary Seed and trees Blacksmithing Straw Hay Oats Threshing Cattle stalls Fencing Advertising stock Binder twine Stock and horses Bran Dairymens suits Blood meal Gal meal ~ Oil meal Dairy ration feed Land plaster Milking machine Pedigree blanks Herdsman's expenses, H. F. Ass'n Rent of new land... Lime stone Sanitary pig troughs -. Miscellaneous: Wages—Watchmen Amount charged back: Patients expenses home Expenses elopments Refunded money Patients travelling expenses Purchases for patients Undertakers fees Travelling expenses, purchasing carptes Traveling expenses medical superintendent Traveling expenses steward Travelling expenses storekeeper Express on apples, Manistee fair Matches Tobacco pipes Tobacco Pro rata State Fire Insurance General Hospital: Sanitary and pipe Operating tables, etc Hardware Sterilizer Tableware Refunded money Cement blocks Furniture Gas Fruit, etc Telephone Drugs, etc , Lumber.. •. Paint Auto hire Wages $17,191 09 6,603 67 1,142 95 125 03 864 17 181 53 347 68 259 99 784 51 73 34 2,536 17 9,047 64 2,892 48 104 55 540 70 4 40 413 36 37 87 2,,210 83 1,601 64 66 71 9 21 253 63 552 45 498 75 92 34 623 62" 15 25 12 70 296 30 125 91 405 00 • $49,915 58 $3,934 47 271 48 42 28 641 21 318 11 1 50 19 00 10 30 183 45 326 14 8 00 41 25 50 48 57 3,407 78 10,729 23 fittings $155 02 331 71 21 87 103 70 3 07 139 70 10 50 101 80 64 14 11 77 339 159 08 10 50 1 10 8 00 1,595 00 Special appropriations: Side track Porch, cottage No. 32 Wagon and implement shed Repairs, roofs and gutters Culvert Books and musical instruments Reroofing cottages No. 28 and No. 32 Repairs, reservoir Extension heating plant Artesian well Laundry extension and dry room Dining room for cottages for men Farm barn 41 1 —— $5,118 18 309 25 2,370 50 1,328 77 348 00 26 35 494 53 206 14 160 44 53 70 2,000 00 10,000 00 2,500 00 20,017 43 2,720 35 �42 STATE OF MICHIGAN. Special appropriations—Continued— Dining room for men Addition north dining room New grates boiler No. 3 Carpenter shop Addition laundry machinery Industrial building Track scales Carpenter shop, new account Fire protection, farm barns Dining room, men, new account $14,125 2,394 2,500 7,452 1,500 25 40 1,468 886 607 Total 82 75 00 00 00 00 05 94 69 50 $55,926 61 $726,377 53 SUMMARY OF INVENTORY OF THE TRAVERSE CITY STATE HOSPITAL TAKEN AT THE CLOSE OF THE FISCAL YEAR ENDING JUNE 30, 1916. Buildings Land Side track and right of way Stock on farm Dispensary Pathological laboratory Library and chapel Administration building Wards, furniture and Cottage 21, furniture and Cottage 23, furniture and Cottage 24. furniture and Cottage 25, furniture and Cottage 26, furniture and Cottage 27, furniture and Cottage 28, furniture and Cottage 29, furniture and Cottage 30, furniture and Cottage 31, furniture and Cottage 32, furniture and Cottage 34, furniture and Cottage 36, furniture and Cottage 38, furniture and General hospital Sewing room Store Kitchens and bakery Dining room, men Laundry Engine room and shops Farm and barns Clothing Boots and shoes Dry goods . Notions Hardware Silverware, paints and oils Groceries and crockery Meats fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures fixtures : fixtures .. $916,850 00 58,24 00 28,000 00 26,432 60 2,580 09 3,788 00 1,130 65 6,531 06 31,918 75 2,785 91 2,257 58 1,807 77 1,765 29 1,614 36 2,797 06 1,249 27 3,072 81 2,069 15 1,518 57 1,447 08 2,251 97 2,483 51 769 25 1,489 09 976 90 932 63 5,292 63 3,996 53 6,897 63 5,476 03 4,846 93 7,193 62 1,682 28 4,46669 2,711 65 1,098 50 346 29 9,612 55 2,102 72 $1,162,483 40 �TRAVERSE CITY STATE HOSPITAL. 43 EEPOET OF MEDICAL SUPERINTENDENT. To the Board of Trustees: Gentlemen: I have the honor to submit for your consideration the following report of the principal events of the hospital for the biennial period ending June 30th, 191G. The movement of the population has been as follows: TABLE I.—Movement of population in 1014-1915 and 1915-1916. Male. Number in institution June 30, 1914 Admitted: Original a n df i r s tcommitments .... . . . Female. 861 656 1 517 160 30 111 26 25 8 94 21 271 56 10 94 46 217 260 477 35 47 15 97 40 34 9 50 75 81 24 147 2 4 6 196 137 333 882 779 1 661 174 27 6 1 32 4 115 26 7 1 9 2 289 53 13 2 41 6 244 160 404 39 54 13 103 28 32 16 85 67 86 29 188 1 1 2 210 162 372 916 777 1 693 2 As voluntary patients Total admissions . . Discharged : To homes as improved Died Removed to other states Transferred to State Psychopathic Hospital Transferred to other Michigan institutions As not insane Number in institution June 30, 1915 Admitted : Original and first commitments .... ... By transfer from other Michigan institutions As voluntary patients Discharged: To homes as recovered To homes as unimproved Died Deported . . ... Transferred to other Michigan institutions Census June 30, 1916 Total. �STATE OP MICHIGAN. 44 Comparing these statistics with those of the last biennial period, it is found that there were 197 more admissions and 55 more discharges. If the patients transferred from other hospitals, exclusive of the Psychopathic Hospital, are included, there was a net gain of 55 men, 121 women, total 176 patients under treatment in the hospital. If from this number those admitted from other hospitals are deducted, and likewise the drug habituates, a net gain in the district will be shown of 22 men, 17 women, total 39 under treatment in the hospital. The following table is an attempt to classify the causes of death: TABLE II.—SUMMARY.—Showing causes of death. Year ending June 30, 1915. General Diseases: Males. Females . Total. 10 1 1 1 21 11 Pernicipus Anemia 2 2' 2 1 Diseases of Nervous System: Paresis . . . 18 3 I5 Post apqpletic Diseases of Respiratory System: ChTonic bronchitis . . . Diseases of Circulatory System: Diseases of Digestive System: 1 Males. Females . 13 0 10 22 2 7' 4 10 3 12 1 ' 'i' i 1 4 1 1 1 2 3 1 5 32 12 1 IS 5 3 50 17 4 i i 4 11 2 2 32 9 4 4 2 2 6 2 1 1 T 5 1 1 1 2 1 1 1 1 Totals . . 97 147 7 12 1 7 29 12 3 8 7 12 2 1 2 1 1 1 2 1 2 1 2 3 1 1 1 1 85 18S 1 1 1 50 2 2 1 Diseases of Genito-Urinary System: Violence: 28 2 2 21 7 2 1 15 2' Total. o 3 1 i 1 A ... Year ending June 30, 1916. 103 �TRAVERSE CITY STATE HOSPITAL. 45 Two hundred and twelve patients, or 65% of those who died were over 55 years old; and 36 of the number were over 80 years old. The deaths from tuberculosis were 15% of the deaths from all causes, a decrease of 4% during the last two years. We may say that every effort is made to prevent the spread of tuberculosis in the institution. Isolation hospitals are maintained for each sex. Syphilis caused 15%+ of the deaths or slightly more than tuberculosis. Arterial degeneration and consecutive organic diseases caused 45% of the deaths. Diseases of the circulatory system are the cause of a large percentage of mental disease. An analysis of the above summary shows that 81%+ of all the deaths were due to organic and incurable diseases. The following table showing the forms of mental disease is no longer in use, but is inserted to show the classification of patients up to June 30, 1906, since which time a modification of the well known classification of Kraepelin has been used in all the hospitals in Michigan: �TABLE #.. 02 III. From the beginning to July 1, 1906. Forms of insanity. Males. I. Primary • II. Secondary- • B. Incident to the normal and the degenII. Symptomatic of organic disease of the brain Total. . . . . ... a. Melancholia b. Mania c. d. Hallucinatory delirium (primary confusional insanity) — 206 94 Females. Total. 31 216 88 1 23 422 182 1 54 a. Delusional insanity (dementia monomania) b. a. Acute b. Chronic 162 117 29 58 216 158 1 2 378 275 30 60 a. b. c. d. e. a. b. c. d. 16 212 141 180 17 161 3 13 191 8 36 53 124 16 233 85 6 113 24 248 194 304 33 394 88 19 304 a. b. Reasoning insanity c. d. 104 1 425 1 117 6 221 1 724 7 a. Imbecility b. 140 4 81 1 1 221 5 1 Syphilitic Dementia from gross brain lesions (apoplexy, tumors, etc.) Hysteria Hypochondria 2,306 1,884 4,190 02 $1 o "3 k 1—1 Q ffi hH O > z �The following table represents the classification in use from the flrstof July, 1906, to the first of July, 1914: TABLE IV.—Showing the forms of insanity of patients admitted. For the biennial period. Males. Females. 1. Alcohol Insanity due to intoxications Organic brain disease (definite structural changes) { b. Acute alcoholic hallucinosis [ c. Alcoholic paranoid conditions -j 3. Morphinism [ (2) Arterio-sc/ erotic brain disease . . ( ^i ?ffihl ll! ° f braln: 'A 1 "i ThvroEenic insanity 1 (6) Senile insanity ( (,1! M^.°edema Dementia praecox . . . -j (2) Paranoid forms T) • Paranoia 1(1) Classic type { )0( p0,.OTlrt'Ji + 0 + D ( (3) Mixed state Arrested mental development Total { ffi X*;lllty . . From the beginning. Total. Males. Females . 4 3 7 ii)' 2 12' 27 7 17 36 56 2 2 15 8 25 29 9 32 44 81 9 31 51 1 12 1 20 1 99 19 58 125 184 31 23 5 6 35 24 16 14 1 30 1 10 30 20 1 26 48 43 9 41 52 25 7 61 72 59 23 1 47 1 118 l-A 23 15 70 89 43 33 ' 14 75 3 27 9 1 7 19 1 46 9 1 8 416 284 700 9 20 3' 17 9 23 Total. ii 1 21 7 40 33 75 9 33 54 2 18 1 31 2 120 26 98 158 259 89 15 2 10 32 81 86 8 84 186 115 36 21 42 1 5 71 11 2 5 150 225 109 23 154 275 158 69 35 117 4 5 160 26 4 15 1,354 986 2,340 -'2 3 1 6 �STATE OF MICHIGAN. 48 TABLE V.—Showing the forms of insanity in patients admitted and discharged during biennial period. Year ending June 30, 1915. Admitted. Paranoia . . Melancholia involutional Syphilis 81 42 21 5 28 21 12 1 2 1 1 3 1 1 1 3 2 2 1 17 12 9 19 28 . . . . 20 31 20 7 4 8 14 19 1 1 _o> 1 3 2 13 S V "rf "o H "^ S 52 9 7 85 30 19 1 27 15 14 2 4 4 1 1 3 4 3 3 2 ' '3' 2 5 1 OJ OS h 57 14 9 1 2 2 7 33 8 1 34 8 23 7 1 24 7 7- 14 21 6 8 14 5 11 16 40 38 11 20 6 2 17 22 15 30 12 12 27 42 19 26 6 10 25 36 1 15 18 5 23 32 8 10 22 "e' 8 27 'is' 13 1 2 8 16 35 1 1-7 1 6 22 11 32 3 7 18 1 10 4 2 13 "6' 4 40 13 16 12 2 1 42 33 12 2 13 29' 3 45 1 1 1 1 1 1 1 1 1 2 1 1 1 "s' 2 1 3 2 2 1 2 3 1 3 4 i 1 1 1 i 1 1 1 1 1 1 1 84 29 23 2' 14 1 1 1 1. "o H 3 1 1 'as 1 1 1 217 260 477 196 ' 'i' i i 1 2 2 2 • 'Y r i 1 1 2 i 1 2 2 4 1 4 2 5 1 1 1 1 2 333 244 160 404 210 162 372 1 3 2 3 i • 'Y 1 2 2 2 3 2 i 1 2 1 137 1 1 1 7 1 1 1 1 2 1 "3' 1 1 1 Non-insane conditions, juvenile: Totals . . . . ~C3 ~& 1 13 7 1 Basedow's disease Non-insane conditions, adult: 55 18 2 3 2 Cerebral tumor Multiple sclerosis Delirium, unclassified . . Post infectious psychoses f* 26 24 19 2 2 Delirium, infectious. . . S 98 88 27 10 Constitutional criminalities Phsychopathic personalities, adult . . . Psychopathic personalities, juvenile. . Alcohol habituates 16 12 Traumatic insanity :. .. Psychoses associated with pernicious anemia Psychoses associated with articular rheumatism Psychoses associated with myxoedema Psychoses associated with paralysis £ 78 50 15 9 Sexual perversions Senile insanity . . Presenile mental disorders _a> 20 38 12 1 O Discharged. JC 'rf o H H 3 . 'ci I Neuraesthenia Admitted. V "5 4a s Hysteria . Morphine intoxication. . . . Cocaine intoxication . Heroin intoxication Imbecility General paresis. . Discharged. 0) 'c3 S ® "3 Insane conditions: _oj "rf Year ending June 30, 1916. 2 2 1 1 1 �TRAVERSE CITY STATE HOSPITAL. 49 Table V shows, as all previous compilations of this kind, that a large proportion of the patients admitted were suffering from organic and incurable forms of mental disease. There is a constantly increasing number in the imbecile group and a large amount of occurring insanity is recruited from the border line cases or the feeble-minded. With field and social workers and community surveys, these cases would be determined and proper measures taken for their education and medical care. It should be the duty of the State to see that these unfortunates are not only properly cared for but that they should be held in suitable institutions. A great deal of clinical work has been performed and we would respectfully refer you to the report of laboratory work in connection with the Trustees' report. In June, 1916, an X-Eay department was established. It is fitted up with every convenience and promises to be of great value in the diagnosis and treatment of not only mental cases but of general hospital cases. Every effort is made to maintain the medical work at a high state of efficiency and to include in the medical care of patients all that is new and best in medical and surgical methods. The detailed reports presented herewith demonstrate that the strictest economy has been practiced in all departments and that the aim of the officers has been to maintain the hospital at a high standard. The following is the analysis of the different types of mental disease classified according to the recent further modification of Kraepelin's classification which has been adopted by all the State Hospitals of Michigan: MANIC DEPRESSIVE INSANITY. In this group are 48 men and 130 women, total 202, comprising 20.2% of all the cases admitted during the biennial period: Women. Men. No. Per cent. 461 48 No. Per cent. 420 10.4 130 Total. No. Per cent. 881 30.9 178 20.2 �STATE OF MICHIGAN. 50 Age at time of admission. Women. Men. 15 to 20 to 25 to 30 to 35 to 19 years 24 years 29 years 34 years 39 years Total. 4 1 1 7 8 9 14 23 1 9 10 5 18 23 5 6 12 18 3 15 18 4 17 21 8 19 27 3 8 11 3 8 11 1 1 2 1 1 60 to 64 years . 65 to 69 years Heredity. Direct. Atavistic. .2 | 1 o> fc o 18 23 1 2 3 1 1 2 7 9 2 2 2 4 6 1 § Apoplexy or paralysis . . . le s o H 1 1 2 3 1 Brothers and sisters. Collateral. | a £ •sH '=3 7 4 4 Total. 1 Is a £ o H "e3 S pq 10 14 13 33 2 2 4 5 9 14 2 3 1 o 46 2 5 7 7 13 20 29 68 97 Results of treatment. Women. Men. Recovered Died Total. 11 31 42 18 25 43 3 3 3 7 10 16 64 80 �TRAVERSE CITY STATE HOSPITAL. 51 DEMENTIA PRAECOX. This group consists of 59 men and 59 women, total 118, or 13.4% of the number admitted during the biennial period: Women. Men. Total admissions . . . . No. Per cent. 461 59 12.7 No. Total. Per cent. No. 14.0 881 118 420 59 Per cent. 13.4 Age at time of admission. Women. Men. Total. 15 to 19 .... 4 1 5 20 to 24 .... 20 3 23 .... 18 .... 9 13 11 31 30 to 34 35 to 39 .... 3 8 11 2 7 9 10 10 5 8 1 1 25 to 29. ... . 40 to 44 45 to 49 3 50 to 54 20 55 to 59 60 to 64 Heredity. Apoplexy or paralysis . . . Psychopathic Alcoholism None 5 5 7 3 10 10 3 1 3 2 5 1 3 oi "3 2 6 8 3 £ "3 a 1 _q5 "3 Total. 'cS 1 p£ 5 8 ^ 1 OJ •3 Female. a Total. 4 2 6 'd "o EH Female. 3 1 4 a Female. a "cS ^ Brothers and sisters. Collateral. Atavistic. Total. <p "3 Female. Direct. 'S 1 a 11 17 2 2 4 4 6 10 28 9 5 14 26 10 36 7 19 26 �52 STATE OF MICHIGAN. Results of treatment. Men. Women. Total. 2 2 9 29 Unimproved 6 11 Died 1 1 43 75 20 32 PARANOIA AND PARANOID CONDITIONS. The paranoia group is unusually large for the number of admissions, but is due to the fact that it represents a number transferred directly to this hospital from the Pontiac State Hospital. There were ,2 men and 9 women, total 11, or 1.2% of the admissions for the biennial period. In the group of paranoid states there are 24 men and 22 women, total 46, or 5.2% of the admission for the biennial period. Men. No. Women. Per cent. 461 No. Total. Per cent. 420 No. Per cent. 881 2 .4' 9 2.1 11 1.2 24 5.2 22 5.2 46 5.2 Age at time of admission. Men. Women. Total. 25 to 29 4 30 to 34 4 35 to 39 3 3 6 40 to 44 2 3 5 45 to 49 3 5 8 50 to 54 7 7 14 55 to 59 2 1 3 60 to 64 1 4 4 8 65 to 69 3 3 70 to 74 2 2 �TRAVERSE CITY STATE HOSPITAL. 53 Heredity. Direct. o> to "3 g r® ft 3 Atavistic. o> | | o H § •a £ Brothers and sisters. Collateral. <& a 0) 'S o H cs | 1 a Sft "rf 3 4 fH a 1 Total. o5 ce | 'S V s 5 9 14 2 1 3 4 4 3 1 1 i 1 2 1 1 3 1 4 3 1 3 1 4 3 1 4 2 "3 o g 6 4 S 9 9 14 23 Results of treatment. Men. Recovered . Improved Unimproved Died Women. 8 5 2 16 Total. 13 2 26 42 HYSTERIA. There were 6 women admitted during the period classified as hysterical on the basis of certain anesthesias found in existence on physical examination. One of these was transferred from the State Psychopathic Hospital, one from the Pontiac State Hospital, and the other 4 were admitted directly from different counties in our district. One case was a young unmarried girl in a pregnant state who remained with us but a few months and was discharged just before confinement. Another case, with a number of anesthetic areas and certain palsies that by elimination of all other possible conditions, was diagnosed hysteria. The ages of these cases ranged from 24 to 43 years. Two of the cases apparently recovered and the other 4 are still under observation. NEURESTHENIA. Seven cases of neuresthenia, 4 men and 3 women, make up this group. The ages of the men range from 27 to 47 years. All these cases were so classified because of the predominence of a nervous element without adequate corresponding physical states as a basis. The ages of the women range from 23'to 69 years. Two were voluntary cases and remained in the hospital but a short time. The other is still cared for in the hospital. �54 STATE OP MICHIGAN. ANXIETY NEUROSES. Three men were classified as belonging to the type of anxiety neuroses. One had before been a patient in the hospital. All three are still under treatment. Their ages range from 28 to 45 years. SEXUAL PERVERSION. Five cases of sexual perversion were admitted during the period, 4 men and one woman. All 5 were more or less defective in character with the sexual perversion manifested in a pronounced degree in each instance. The 4 men were discharged on trial at the request of authorities or friends interested. The woman is still under observation. PSYCHOPATHIC PERSONALITIES. During the biennial period 4 women were admitted, one transferred from the Pontiac State Hospital, one who had been at Eloise several times and various other hospitals, one from the State Psychopathic Hospital. Their ages range from 35 to 59 years. One was allowed to go home on trial, and the other 3 are still under observation. ALCOHOL HABITUATES. During the last bienniel period the hospital has received a large number of men committed in accordance with an act of the recent legislature. There were 49 men and 2 women, total 51, admitted, of 5.7% of the admissions. Most of these cases have remained away from the hospital; a few have fallen into their former habits and have been returned. An effort has been made to keep a record of these cases after they have left us and in accordance with information received we feel confident that the hospital has done considerable good in this respect. Women. Men. Total. No. Per cent. No. Per cent. No. 461 49 10.6 420 2 .4 881 51 Per cent. 5.7 �TRAVERSE CITY STATE HOSPITAL. 55 Age at time of admission. Women. Men. Total. 20 to 24 .. .. 1 1 25 to 29 . .. 3 3 30 to 34 . . . . ... .. 35 to 39. . . .. . . 40 to 44. . .. .. 9 9 .. 1 6 9 9 10 10 4 4 ... 45 to 49 . . 7 50 to 54 1 4 55 to 59 . .. .. 3 60 to 64 . ... .. 1 1 65 to 69. ... 3 3 70 to 74 Heredity. Alcoholism 11 1 12 2 Unknown 2 13 3 33 1 1 14 3 34 Results of treatment. Men. 35 2 Women. 2 Total. 37 2 Unimproved Died 12 12 �56 STATE OF MICHIGAN. ALCOHOLIC MENTAL DISORDERS. In addition to the cases of inebriety there have been received 20 men or 2.2% of the admissions whose mental condition was directly traceable to the inordinate use of alcohol in some form or another. Men. Alcholic mental disorders Women. No. Per cent. 461 20 4.3 Total. Per cent. No. Per cent. No. 881 20 420 2.2 Age at time of admission. Women. Men. 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 Total. 1 1 2 2 1 1 2 2 3 3 1 1 2 2 5 5 . 65 to 69 70 to 74 1 1 2 2 Heredity. Apoplexy or paralysis. . . 'rf o H ai *& s Brothers and sisters. Collateral. "33 4=a 0 EH Female. S Female. <B C3 Female. Atavistic. Direct. _0 "rf % oi g"3 rotal <K "eS 1 & H J2 "^ s d 'S & 'ci o E-i i i 1 1 1 1 3 3 3 3 5 5 5 5 8 8 1 1 1 1 \. 3 3 �TRAVERSE CITY STATE HOSPITAL. 57 Results of treatment. Women. Men. Total. 3 3 5 5 1 1 11 11 Died MORPHINE INTOXICATION. Since the Harrison Law became operative there have been quite a number of morphine cases sent to this hospital for treatment. During the biennial period there were 15 men and 27 women, total 42, admitted, or 4.7% of all the admissions. A large majority of these cases were greatly benefited and because of the difficulty in obtaining the drug after leaving the hospital we feel confident that most of them have been restored to active and useful lives. Wojnen. Men. Morphine habituates Total. No. Per cent. No. Per cent. No. 461 15 3.2 420 27 6.0 881 42 Per cent. 4.7 Age at time of admission. Men. Women. Total. 25 to 29 1 2 3 30 to 34. 35 to 39 40 to 44 . 45 to 49 50 to 54 . 2 4 6 2 2 3 3 2 2 6 4 60 to 65 to 70 to 75 to 64 69 74 79 . . 1 3 4 3 2 2 4 2 4 6 3 2 2 2 2 �STATE OF MICHIGAN. 58 Heredity. 1 1 1 1 1 s 1 1 2 oj "S "o H 1 1 Female. 0) 1 Total. % Total. Female. 2 2 "ee Female. 2 1 1 Psychopathic 0 H Brothers and sisters. Co llateral. : : : : : : 3 Female. 1 Atavistic. Female. Direct. 3 0 i 1 3 1 .... 10 6 2 33 23 Results of Ureatmenl. Women. Men. 11 Total. 23 34 1 2 2 2 3 1 2 2 Died 1 IMBECILITY. There were classified as imbeciles 67 cases, 35 men and 32 women or 7.6% of the admissions. Men. No. Women. Per cent. No. Per cent. No. 7.6 420 32 7.6 881 67 461 Imbecility. . . . 35 Total. Per cent. 7.6 �TRAVERSE CITY STATE HOSPITAL. 59 Age at time of admission. Men. 15 to 19. .. 20 to 24 . .... Women. Total. 1 2 3 9 3 12 6 4 10 4 1 6 4 10 5 3 8 45 to 49 4 4 50 to 54 2 4 8 6 3 2 5 25 to 29 . ... .. 30 to 34 ... .... 35 to 39 40 to 44 : 55 to 59 60 to 70 Heredity. Direct. * Apoplexy or paralysis . . . Psychopathic. Atavistic. 1 o> -S § § r^ fe "3. Brothers and sisters. Collateral. oj qj "3 s & 2 2 3o 4J •3 .s I Total. s i o § 1 I a; h 7 12 'rf a P 4 „ 11 2 1 3 2 1 2 3 5 2 3 [ 2 6 2 o H o H H 4 1 3 4 0 1C 8 3 j 1 10 11 2 8 6 None Results of treatment. Men. Recovered Improved Unimproved . . Died . . . Women. Total. 10 1 5 3 8 1 3 4 19 25 44 11 �60 STATE OP MICHIGAN. EPILEPSY. About the usual number of epileptics have been received, 36 in all, 14 men and 22 women, or 4% of all the admissions. Men. Women. Total. No. Per cent. No. Per cent. No. 461 14 3.0 420 22 5.0 881 36 Per cent. 4.0 Age at time of admission. Women. Men. Total. 10 to 14 1 1 15 to 19 3 3 20 to 24 2 25 to 29 30 to 34 5 35 to 39 40 to 44 .. 45 to 49 . .... 50 to 54 . . . 55 to 59 . .. 60 to 64 .... . . 1 2 6 6 2 4 3 3 2 7 2 2 1 1 3 4 2 2 1 3 Heredity. Direct, Atavistic. Brothers and sisters. Collateral. Total. i * cS s QJ 2 3o aj "3 2 1 H "cS O 1 fa EH 1 2 1 1 2 2 6 7 J2 d •a s i i I 1 ; sa fa 1 o 2 1 1 £cs 1 S 4 2 fH 1 o EH 6 2 2 4 1 6 7 4 1 ! 11 3 14 �TRAVERSE CITY STATE HOSPITAL. 61 Results of treatment. Women. M'en. Improved Unimproved Died Remaining Total. 3 3 , , 1 2 1 2 3 3 9 18 27 ORGANIC GEOUP. The organic group, representing those cases in which definite degenerative changes are noticeable, has, as heretofore, comprised a large percentage of all the admissions. There were 245 cases, 166 men, and 79 women, or 27.5% so classified. Women. Men. No. Per cent. Tabes dorsalis. 461 61 5 36 11 51 2 36.7 3.0 21.7 6.7 30.7 1.2 Total 166 Total admissions Cerebral syphilis No. Per cent. 420 19 4 36 1 18 1 79 24.1 5.1 45.6 1.2 22.8 1.2 Total. No. 881 80 9 72 12 69 3 245 Per cent. 32.7 3.7 29.3 4.9 28.1 1.3 �62 STATE OF MICHIGAN. Age at time of admission. Men. Women. Total. 1 1 20 to 24 25 to 29 4 4 5 1 6 35 to 39 10 3 13 40 to 44 15 8 23 45 to 49 . 19 5 24 50 to 54 . 15 5 20 55 to 59. 15 3 18 60 to 64. 15 4 19 65 to 69 . 22 11 33 70 to 74. 18 19 37 75 to 79. .. 20 10 30 9 16 30 to 34 . 80 to 89. 1 90 to 95. 1 Heredity. 8 3 11 Psychopathic Alcoholism 12 12 3 3 10 4 14 s 1 3? H 1 § 1 1 1 Total. ^ "o H 1 1 _o> '« g 9 3o ® Us H 3 Female. Apoplexy or paralysis . . £C8 and sisters. Female. Female. 1 oi Brothers Collateral. Female. •a s Female. Atavistic. Direct. 5 14 18 9 1 14 1 .... 1 11 O H 27 14 3 1 'oS 3 4 15 None. 47 9 56 Unknown 73 57 130 �TRAVERSE CITY STATE HOSPITAL. 63 Results of treatment. Improved 6 2 8 Unimproved. . . 2 1 3 1 Died 29 7 36 3 1 Remaining 24 9 33 1 2 1 "(3 H *ci "o EH 3 1 4 1 2 3 4 6 15 21 3 26 18 44 2 S 2 9 13 H ^ 1 1 1 13 4 1 1 3 4 7 34 8 42 i 72 32 104 16 9 25 2 78 39 117 qj e3 S 2 1 10 Total. Tabes. Female. J | S .A rterio. Pre-seniles. Female. c£ Female. i "3 Senility. Syphilis. Female. General paralysis. 1 "I 'cS £ 1 2 1 "03 £ 01 & 5 £ 17 HUNTINGTON'S CHOREA. Two cases of hereditary or Huntington's chorea, one male and one female, were admitted. Their ages were 38 and 44 years, respectively. Both cases are still under treatment. BASEDOW S DISEASE. One woman, aged 36 years, Avas a patient in the hospital but eleven days. There were definite symptoms of exophthalmic goitre. She passed through an attack of excitement, became clear, and has since resided at home with comparative comfort. The exophthalmos is still noticeable and also the rapid heart's condition. TRAUMATIC INSANITY. One man, aged 68 years, was admitted under symptoms of mental trouble following soon after a head injury and directly traceable thereto. After two weeks' treatment in the hospital he apparently regained his normal mental health and was discharged. PERNICIOUS ANEMIA. Two men and 2 women were received at the hospital subject to pernicious anemia and the mental condition was doubtless the result thereof. One of the women had been transferred from the Pontiac State Hospital. One man and one woman were in feeble condition at the time of their admission and died shortly afterwards. The ages of these cases range from 38 to 52 years. PSYCHOSES ASSOCIATED WITH ARTICULAR RHEUMATISM. One woman, aged 31 years, was admitted in a state of delirium following an acute attack of articular rheumatism. She had been treated at home by the administration of the bee sting which may or may not have had to do with the developing delirium. She died about three weeks after her admission to the hospital. �64 STATE OF MICHIGAN. DELIRIUM, INFECTIOUS. There were three cases of infectious delirium, two men and one woman. The latter's condition developed following confinement. She made a complete recovery in a short time. One of the men died two weeks after admission from exhaustion; the other man developed lobar pneumonia and died in a few days. DELIRIUM, TOXIC. There were 8 cases of toxic delirium, 1 man and 7 women. The man came in a state of delirium which resembled delirium tremens from which he made a complete recovery in a few weeks' time. The 7 females admitted were distinctive cases of severe delirium known as delirium grave or Bell's delirium and in most instances represented the second or third attack of mental disease. These cases were comparatively young individuals with the exception of two and in each instance there was a fatal outcome. DELIRIUM, COLLAPSE. Three women were admitted in a state of delirium and classified as above. The delirium represented the outcome of prolonged mental excitement not as characterized by the high temperature of ataxic variety. Each case proved fatal. DELIRIUM, UNCLASSIFIED. One case was admitted, without adequate history, in a state of delirium and passed away two days after. The nature of the delirium was not clear. POST INFECTIOUS PSYCHOSES. There were 5 cases, 3 men and 2 women, admitted as post infectious psychoses. Two of the men were far advanced in tuberculosis and one was a cancer case. All three passed away. One woman developed a psychoses following typhoid fever and one following acute intestinal disturbance. One case apparently recovered. The other is still in the hospital. UNCLASSIFIED CONDITIONS. There were three men and 5 women whose mental condition was not satisfactorily diagnosed. Two of the women manifested but little mental trouble but they had either become involved in family affairs or as the result of coming in contact with the law and were shortly discharged after observation. One case was transferred from the Pontiac State Hospital to this place and died shortly afterwards. Another case died quite suddenly, shortly after her admission, from acute dilatation of the heart. SYDENHAM'S CHOREA. There were two cases of Sydenham's chorea admitted during the biennial period. One died after residence of a few months and the other was taken home on trial. �TRAVERSE CITY STATE HOSPITAL. 65 SYPHILIS. There was one case of syphilitic infection admitted as not insane, and because of inability to provide suitable treatment at large. His condition responded promptly to treatment and after residence of a few months was discharged recovered. JUVENILE CRIMINALS. One boy aged 17 years belonged doubtless in the criminal class. He is still a resident in the hospital. NOT INSANE. There was one case admitted whose mental condition did not appear to justify his retention and he was discharged after a short period of observation. TABLE VI.—Showing the number admitted each month, during biennial period. JULY 1, 1914, TO JUNE 30, 1915. 7. Male. . Female ... Total . . . 6. Total. 23 18 217 21 14 260 49 44 32 477 3. 4. 5. 6. Total. 12. 1. 2. 3. 4. 5. 10 22 28 11 17 25 19 44 10 6 18 24 29 66 38 17 35 2. 8. 9. 10. 11. 23 14 16 10 16 65 11 12 39 79 27 22 JULY 1, 1915, TO JUNE 30, 1916. Male Total 7. 8. 9. 10. 11. 12. 1. 25 14 16 16 27 22 19 ?0 15 24 ?0 244 13 12 10 11 8 14 15 16 160 39 39 32 30 28 29 39 36 404 16 22 24 9 41 36 30 25 26 �STATE OF MICHIGAN. 66 TABLE VII.—Showing occurrence of hereditary factors in patients admitted during biennial period. 5 24 1 1 Psychopathic conditions. 17 20 37 1 1 Alcholism 17 36 2 2 2 7 5 "3 ~c _oj c3 § 13 18 13 19 'sS ^ s 32 34 54 15 10 25 18 23 41 21 17 38 88 104 192 Total. 31 10 «a Total. Female. 20 14 OJ Female. 11 Apoplexy and paralysis EH 2 Total. Female. Insanity ^o5 'ea Female. s 3o _o> "rf Brothers and sisters. Collateral. Total. Atavistic. Female. Direct. Year ending June 30, 1915. 19 3 3 88 i Total heredity 61 67 128 9 2 11 5 13 18 13 22 35 Negative 47 15 62 Unknown 82 141 223 Total 217 260 477 Year ending June 30, 1916. Insanity 14 Apoplexy and paralysis. 11 14 11 4 1 1 12 ' 20 12 4 7 5 11 3 3 1 1 2 2 1 1 Psychopathic conditions. 10 3 13 Alcolohism 21 7 28 56 24 80 Total heredity 14 1 28 3 7 5 25 1 37 33 70 4 21 7 29 136 16 5 17 1 22 16 92 44 48 25 73 Unknown . . 104 91 195 244 160 404 Total. 12 10 Negative. . 9 3 5 32 �TRAVERSE CITY STATE HOSPITAL. 67 TABLE VIII.—Showing age of patients admitted during biennial period. Year ending June 30, 1915. Male. From 50 to 54 years 8 17 28 17 22 19 22 21 From 80 to 84 years 12 16 9 9 4 5 From From From From 20 to 25 to 30 to 35 to 24 years 29 years 34 years 39 years From 95 to 99 years Female. Total. 2 19 24 21 31 28 10 36 52 38 53 47 29 30 17 15 19 8 6 11 51 51 29 31 28 17 10 16 ... . ... Male. 1 6 14 23 22 18 28 23 20 18 17 21 16 8 7 1 Female. Total. 1 2 8 11 14 16 17 8 22 34 36 34 45 43 34 32 24 34 27 17 10 1 20 14 14 13 11 9 3 1 1 1 160 404 1 8 Totals Year ending June 30, 1916. 217 8 477 260 244 TABLE IX.—Civil condition of patients admitted during biennial period. Year ending June 30, 1915. Widowed . . Total .. Year ending June 30, 1916. Male. Female. Total. Male. Female. 94 94 16 7 6 73 135 39 9 4 167 229 55 16 10 74 131 22 13 4 25 89 37 9 99 220 59 22 4 217 260 477 244 160 404 Total, �STATE OP MICHIGAN. 68 TABLE X.—Showing degree of education of patients admitted during biennial period. Year ending June 30, 1915. • Collegiate . Academic Total Male. Female. Year ending June 30, 1916. Total. Male. Female. Total. 4 2 6 5 16 21 37 18 17 35 133 168 301 160 103 263 17 27 44 18 16 34 1 4 5 2 1 3 12 14 26 12 9 21 34 24 58 29 14 43 217 260 477 244 160 404 5 TABLE XI.—Showing occupation of patients admitted during biennial period. Year ending June 30, 1915. Personal service, police and military Manufacturing and mechanical industry . . . Agriculture, transportation, and other out- Student Total Year ending June 30, 1916. Male. Female. Total. Male. Female. 8 13 21 8 4 4 8 12 4 4 8 10 6 16 8 6 14 11 9 20 9 9 18 8 14 22 6 5 11 44 61 105 64 27 91 33 12 45 28 8 36 85 69 154 103 59 162 5 5 8 8 1 1 2 1 2 3 2 35 37 1 8 9 11 27 38 12 20 32 217 260 477 244 160 404 Total. 12 �TRAVERSE CITY STATE HOSPITAL. 69 TABLE XII.—Showing nativity of patients admitted during biennial Year ending June 30, 1915, Year ending June 30, 1916. Total. Male. District of Colunlbia . . . . Illinois Kentucky Massachusetts 2 1 3 Male. 1 1 6 12 18 1 5 6 1 1 1 2 105 116 221 2 1 1 19 3 1 31 13 1 6 1 25 1 10 1 2 1 2 2 I 2 4 1 1 1 Total. 1 4 2 8 2 1 12 Female. 1 2 1 5 2 3 2 6 5 4 Virginia West Virginia Total. 1 2 2 4 4 12 Ohio Female. i 4 3 8 5 167 1 1 388 1 4 1 63 1 2 105 1 1 62 21 23 11 16 39 7 2 1 9 1 64 1 19 2 4 2 2 1 6 32 1 Total United States 157 176 333 174 109 283 606 2 2 1 22 2 1 4 1 36 3 4 2 1 21 3 3 8 3 43 6 9 12 4 79 9 13 2 7 1 5 1 18 3 5 1 2 3 25 4 10 1 2 1 14 1 4 1 3 4 49 5 14 2 5 2 2 1 2 1 3 3 4 1 11 1 1 6 2 22 3 6 1 8 1 2 1 3 3 1 2 3 5 3 2 8 7 3 18 2 1 49 65 114 64 47 111 235 11 19 30 6 4 10 40 217 260 477 244 160 404 881 14 1 3 Wales Total . 1 1 22 2 14 8 1 1 6 2 2 2 4 1 1 �STATE OF MICHIGAN. 70 TABLE XIII.—Shoiving nativity of parents of patients admitted during biennial period. Year ending June 30, 1915. One parent foreign born One parent native, one unknown Both parents unknown . . Total Year ending June 30, 1916. Male. Female. Total. 85 23 60 11 110 33 72 195 56 132 38 5 40 217 260 Male. Female. Total. 16 78 98 25 84 9 28 72 15 42 4 27 170 40 126 13 55 477 244 160 404 �TRAVERSE CITY STATE HOSPITAL. 71 TABLE XIV.—Showing residence of patients admitted during biennial period. Year ending June 30, 1915. Year ending June 30, 1916. Total. Arenac Antrim Bay Clare Male. Female. 4 6 2 6 11 4 1 5 5 11 1 1 9 4 Delta Gratiot 7 3 18 1 Genesee 5 11 4 3 Ionia losco 7 Macomb Manistee . . . . Otsego . Presque Isie Roscommon 3 16 8 7 2 9 17 5 4 6 5 2 3' 1 St Clair. . Shiawassee . . Tuscola Wayne Wexford . . 4 12 Montcalm Total. . .... 217 Total. 6 2 5 6 6 4 1 14 5 4 7 11 2 2 7 1 5 2 4 4 7 7 3 4 9 8 1 1 4 3 3 1 2 2 1 1 25 2 14 1 19 11 10 5 11 2 11 22 5 6 3 14 10 13 11 4 32 6 4 12 22 6 5 7 1 12 2 4 7 23 15 10 6 18 25 6 1 8 9 8 3 2 5 2 1 25 2 14 1 19 15 22 260 i 477 Male. Female. 3 7 2 6 17 7 1 7 Total. 4 14 2 12 30 10 1 2 15 32 7 4 6 5 5 9 4 1 9 7 10 3 2 4 8 2 1 1 i' i 11 18 8 3 16 22 42 10 6 10 13 2 2 2 5 3 9 5 12 9 25 4 23 52 15 1 8 3 24 17 1 26 24 9 77 8 4 22 42 10 13 7 3 19 2 4 18 41 23 13 22 40 67 16 1 14 19 21 5 4 7 2 1 25 2 14 1 19 20 34 244 160 404 881 1 9 2 6 10 3 33 1 6' 13 3 1 1 1 ? 7 3 2 12 1 5 12 1 4 5 8 3 4 2 4 3' 6 9 4 2 7 10 7 1 13 13 5 45 2 10 20 4 8 2 7 �STATE OF MICHIGAN. 72 TABLE XV.—Showing form of insanity of Year ending June 30, 1915. Recovered. 1 2 Insane conditions: 9 1 Improved. _« fa 25 13 •§ 34 1 £ "a S 10 11 3 fa Unimproved. 3o •S •a H 17 9 27 20 3 1 1 1 a t£ i 3 3 1 4 5 6 13 3 3 3 19 1 1 4 4 r 1 Prp-'pnilp mpntal 'ILsorders "r 3 4 5 8 3 1 I 6 913 1 9 4 2 2 15 13 15 3 1 1 1 1 1 1 4 1 7 16 3 12 1 1 9 30 1 1 1 1 1 5 5 4 1 1 5 3 1 15 2 1 5 4 1 1 2 7 6 18 1 14 1 la 1 o H fa 1 1 3 '3 "o EH Died. 1 15 1 i 1 1 1 1 1 3 3 ..1 1 1 1 Pspchoses associated with articular rheumatism 1 1 1 2 1 1 1 1 1 1 1 .... Not insane conditions, adult: 1 3 1 2 1 1 1 1 Not insane conditions, juvenile: Totals 22 40 62 45 34 79 17 12 29 97 50 147 �TRAVERSE CITY STATE HOSPITAL. 73 patients discharged and results of treatments. Year ending . une 30, 1916. 03 ^ 3 o H 03 Recovered. 4X 4& 1 93 s fa jo H 26 24 19 2 55 18 2 3 81 42 21 5 1 1 1 1 2 1 3 "el 1 9 2 18 Unimproved. Improved. 27 2 "el 12 8 5 "ca ~o E-t o3 •3 22 34 1 9 "i' 1 3 8 Female. 4 s Totals. Female. Not insane. 2 2 -2 "o EH 2 6 1 03 1 2 6 1 8 1 l£ 15 11 6 9 1 1 2 4 Not iusai e. Died. 21 12 14 2 •a I 5 & 1 1 TotaK "03 o EH oj .... 1 1 3 1 "3 S c£ 1 27 15 14 2 57 14 9 84 29 23 2 1 1 3 2 5 3 3 l 'l3 1 14 1 1 13 7 1 14 7 T 7 14 21 4 11 20 6 2 17 22 6 13 1 2 8 16 35 1 17 8 10 .22 15 1 1 1 10 3 3 14 9 2 1 2 2 2 1 2 10 4 4 2 3 1 7 3 6 22 1 1 1 3 2 1 1 1 2 2 3 7 10 i 1 1 1 1 1 1 1 i 15 1 1 24 1 1 23 7 1 24 16 1 5 11 2 7 8 29 19 26 6 10 25 36 1 1 3 10 13 23 1 1 12 43 9 13 2 33 2 4 16 1 2 13 29 3 45 1 1 1 2 1 2 2 i i 1 1 2 2 1 2 3 2 1 1 1 1 1 2 .... i 1 1 1 2 7 12 1 1 2 2 1 2 1 3 2 3 1 7 1 2 1 2 '3' 1 1 23 1 1 1 'si' 1 2 1 1 3 3 1 1 1 1 1 1 1 •y 1 7 1 1 2 2 1 2 1 .... i 4 "i' 5 "2 2 1 16 196 137 333 16 28 44 54 36 90 14 12 26 103 85 188 23 1 24 210 162 372 �STATE OF MICHIGAN. 74 TABLE XVI.—Showing the duration o/ residence of all cases discharged during biennial period. Recovered . Improved. !sj Year ending June 30, 1915. Under one month 1 to 3 months . 9 9 6 4 1 3 1 1 year to 18 months 18 months to 2 years 2 13 I 1113 2 6 2 3 1 2 ® 73 _cp CD .2 Unimproved. le o o5 "3 20 «g 10 3 6 3 5 13 10 4 5 2 4 3 2 EH "3 3 pH s 6 9 5 3 2 6 1 2 3o EH 9 14 18 13 6 11 * "cd § 'i 4 4 4 5 1 1 1 1 ' 2' 1 1 i 3 1 3 3 5 7 2 1 6 2 2 2 2 1 1 1 1 25 to 30 years 30 to 35 years Total . . Year ending June 30, 1916. Under 1 month 3 to 6 months 6 to 9 months 9 months to 1 year 35 40 75 47 34 81 6 18 8 6 1 2 12 6 3 1 8 30 14 9 2 7 14 15 6 5 2 9 5 6 4 2 9 23 20 12 9 1 1 2 1 2 t 2 j .... 15 to 20 years . 3 6 1 5 1 1 Total 28 67 54 j 32 86 s 10 10 9 2 4 11 5 17 11 4 3 2 7 .... 2 "3 !£- "d o 7 4 2 2 4 4 17 14 11 4 8 15 1 7 4 3 6 24 15 6 2 3 1 7 9 4 10 3 13 30 97 50 147 1 5 3 2 4 3 3 1 1 2 1 2 5 8 6 3 1 4 1 2 1 8 9 9 6 4 8 11 17 11 6 2 3 5 4 15 6 4 6 4 7 2 3 1 23 15 13 12 8 13 22 25 18 12 9 5 8 5 31 105 85 188 2 :::: I i .... .... 39 oi 17 .. 25 to 30 years 30 to 35 years JV C3 O En Died. 14 17 5 11 8 7 6 �75 TRAVERSE CITY STATE HOSPITAL. TABLE XVII.—Showing ages of patients discharged recovered during period. Year ending June 30, 1916. Year ending June 30, 1915. Male, i Female. From 15 to 19 years From 20 to 24 years From 25 to 29 years From From From From From 30 to 35 to 40 to 45 to 50 to 34 years 39 years 44 years 49 years 54 years From From From From 55 to 60 to 65 to 70 to 59 years 64 years 69 years 74 years Totals Total. I Male. Female. Total 7 12 6 10 10 11 8 7 8 10 6 4 7 4 2 35 biennial 39 28 67 �76 STATE OF MICHIGAN. TABLE XVIII.—Showing age of patients who died during biennial period. Year ending June 30, 1916. Year ending June 30, 1915. Male. Female. 2 From 20 to 24 years 3 5 3 5 3 9 6 13 8 From 30 to 34 years . . . From 35 to 39 years From From From From From From From 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 to 89 years 90 to 94 years 95 to 99 years . . . . Totals 16 7 2 2 4 4 2 2 5 3 2 5 5 5 8 8 3 1 4 2 97 50 Total. Male. 2 5 7 7 9 5 11 11 16 10 21 12 13 12 5 1 ... 147 1 1 1 Female. 3 4 1 9 6 10 6 7 5 18 13 10 7 3 1 1 6 103 2 11 5 10 13 12 11 5 2 2 Total. 1 1 4 5 15 8 21 11 17 18 30 24 15 9 5 2 3 1 85 188 ESTIMATES OF SPECIAL APPROPRIATIONS. The following are the estimates of special appropriations requested by the Board of Trustees and submitted to the State Board of Corrections and Charities for its approval: To the State Board of Corrections and Charities: As required by Section 28, Compiled Laws of 1897, I submit herewith approximate estimates of special appropriations requested by the Board of Trustees of the Traverse City State Hospital, for an appropriation for the purchase of land, for the construction of an addition to store, for an addition to cold storage plant, for addition to congregate dining room for women, for new fire pump, and for laundry machinery; to complete carpenter and paint shop, and industrial building: �TRAVERSE CITY STATE HOSPITAL. I. 77 ADDITION TO STORE. 2,000 ft. concrete wall 80,000 brick laid in wall 18 windows 8 doors and frames 20 squares gravel roofing 12,000 feet lumber 6,000 feet lumber 2,000 feet concrete floor and areas 6,000 feet flooring Excavations, sewers, grading, etc Nails and hardware Wall coping and window sills 3,800 ft. steel ceiling Carpenter work, painting, labor Electric light, wiring, fixtures, labor Heating and plumbing 400 squares plastering One power elevator Stairways, store shelving @ $ 16 20 20 5 22 40 20 00 00 00 00 00 00 10 40 00 08 25 f400 00 1280 00 360 00 160 00 100 00 264 00 240 00 200 00 240 00 250 00 160 00 75 00 304 00 800 00 500 00 500 00 100 00 750 00 317 00 |7000 00 II. ADDITION TO COLD STORAGE PLANT. Using the same specifications as were approved by your Board two years ago, but adding 30% for advance in cost of materials, etc. Cost of this improvement would be III. $7215 00 ADDITION TO CONGREGATE DINING ROOM' FOR WOMEN. 50,000 brick in wall @ 750 ft. concrete wall 1350 ft. tile floor 12 windows 12 doors 1,000 fibs, steel beams 1,350 ft. concrete 600 ft. roofing 4,000 ft. lumber Labor Power elevator, complete Plumbing, sinks, piping, etc Electric wiring, fixtures Painting, labor, and materials $16 00 20 50 20 00 22 00 03y2 10 20 22 00 $800 00 150 00 675 00 240 00 264 00 35 00 135 00 120 00 88 00 300 00 825 00 375 00 150 00 75 00 $4232 00 IV. Fire Pump, installed FIRE PROTECTION. $2500 00 �78 STATE OF MICHIGAN. V. LAUNDRY MACHINERY. Power mangle, surface ironers, reconstruction of ironing tables, electric wiring, etc. VI. FARM. For purchase of land, 155y2 acres VII. $5000 00 @ $93 00 PORCH. For porch at Cottage 28 and connecting way from Cottage 30 to new dining room for men VIII. f 750 00 CARPENTER AND PAINT SHOP. To complete carpenter and paint shop IX. $14461 50 $4000 00 INDUSTRIAL BUILDING. To complete industrial building $4000 00 RECAPITULATION. Addition to store Addition to cold storage plant Addition to congregate dining room for women Fire pump Laundry machinery Farm .' .' Porch To complete carpenter and paint shop To complete industrial building $7,000 00 7,215 00 4,232 00 2,500 00 5,000 00 14,461 50 750 00 4,000 00 4,000 00 $49.158 50 All of which is respectfully submitted, J. D. MUNSON, Medical Superintendent. The following is the report of the State Board of Corrections and Charities, on the above requests for appropriations: STATE BOARD OF CORRECTIONS AND CHARITIES. LANSING, MICHIGAN, November 10, 1916. Dr. James D. Mum-son, Medical Superintendent, Traverse City State Hospital, Traverse City, Midi.: Dear Sir: propriations proved with purchase of At a recent meeting of this Board your estimates for apfor the biennial period beginning July 1, 1917. were apthe exception of item number six, the same being for the 155% acres of land at $93.00 per acre. With the present �TRAVERSE CITY STATE HOSPITAL. 79 acreage of the Hospital, and the amount involved in the purchase of the proposed tract, it is our opinion that the item may be dispensed with. Your estimate therefore is approved in the sum of $34,697.00, instead of f49,158.50. Regarding your over-draft of $1,100.00, we recommend the passage of an Act which will make it possible to use the surplus in other funds to meet the over-draft. Very respectfully, JOHN N. McCaRMicK, Chairman. By order of the Board. M. T. MURRAY, Secretary. CHAPEL SERVICES. Religious services have been conducted regularly by the Chaplain, Eev. D. Cochlin, assisted by Kevs. Mr. Slade, Mr. Irving, Mr. Brown, Mr. Columbus, Mr. Stout, Mr. Thurston, Mr. Ellis, and Mr. Betts, all of Traverse City, Michigan. ACKNOWLEDGMENTS. To the many friends of the hospital who have contributed in any way to the welfare and comfort of patients, our -best thanks are extended. CONCLUSION. In closing this report we may say that the relations of the hospital with the State, with sister institutions, with county officials and all others, have been harmonious, and that there has been cordial cooperation between the institution and the county and state officials in all that pertains to the best interest of the hospital. As a Board you have given more than usual attention to its management; you have devoted much time and thought to the development of the newer and advanced methods of treatment; you have supported in every proper manner the development of preventive measures so far as they pertain to mental disease and to the public health. I believe that earnest work has been done in all directions by the Board, by the staff, and by all employes of the institution and it is largely due to this esprit that the institution has steadily advanced in usefulness and taken its place along with the most progressive. It affords me great pleasure to be able to report that there have been very few occurrences during the last two years that have required your special attention. All of which is respectfully submitted, J. D. MUNSON, Medical Superintendent. Traverse City State Hospital, Traverse City, Michigan, Oct.. 1916. �STATE OF MICHIGAN. 80 OFFICERS AND EMPLOYES OP THE TRAVERSE CITY STATE HOSPITAL, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1916, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Name. Service. $3 2 1 1 1 A. S. Rowley W. D. Mueller . . H. V. Hendric-ks F C Mavne Camp C. Thomas G- B. Pike D Coehlin T. H. Tregea Rate. Assistant physician Accountant C W Nesbitt Edna Skinner Addie McMulIen Stenographer Stenographer Vernon S. Pavton Pharmacist Katherine BeH B P Burns Marie Moon Asst. superintendent of nurses Alfred Newman C M Prall S. G. Howard Chief engineer Dietitian Hans Tobler Ray L Pennell Period. 800 00 900 00 800 00 200 00 300 00 900 1,820 2 500 260 106 00 00 00 00 00 Per annum Per annum. Per annum Per annum Per mouth. Resident Non-resident. Non-resident Non resident Non-resident. 95 70 55 40 50 00 00 00 00 00 Per inonth Per month Per month. Per month. Per month Non-resident Non-resident Non-resident. Non-resident. Non-resident 85 85 65 100 50 00 00 00 00 00 Per month. Per month. Per month. Per month Per month. Non-resident. Resident. Resident. Resident Resident. 1,600 12 00 110 43 43 00 00 00 00 00 Per annum. Per annum Per month Per month Per inonth Non-resident. Non-resident Non-resident Non-resident Non-resident 80 00 1 000 00 14 00 34 00 16 00 Ruth C Adams 30 00 42 00 32 00 40 00 1 25 Clayton M Allen Hattie Allen Per a,-™ ^.^ Per annum Non-resident Per annum Resident Per annum Resident Per annum Resident Per month Non-resident. Per annum Non resident Per month Resident Per month Resident Per month Resident Per month Resident. Per month Resident Per month Resident Per month. Resident. Per day Non-resident. Sewing room assistant Attendant Non-resident. 1 25 Per day. 20 00 Per month. Resident. 20 00 Per month. Resident. 28 00 Per month. Resisent. 18 00 Per month. Resident. Blanche Baertelsen Attendant 19 28 36 28 45 00 00 00 00 00 Per month. Per month. Per month Per month. Per month Resident. Resident. Resident. Resident. Resident. Henry Bowles James Burno Arthur H Bell Attendant Attendant 18 26 28 26 26 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 50 25 38 36 26 00 00 00 00 00 Per month. Per month. Per month Per mointh. Per month. Resident. Resident. Resident. Resident. Resident. May Mallory Winnie Baggiore Norme D. Frost 4 J Clark W. E. Cruse Attendant �TRAVERSE CITY STATE HOSPITAL. 81 OFFICERS AND EMPLOYES.—Continued. Service. Name. Nettie M. Cutting Attendant Eva M. Slover Housekeeper Jennie Dempsey George C. Dell Attendant Evelyn Emerson Attendant Rate. Period. $35 28 35 35 20 00 00 00 00 00 26 24 56 34 18 00 00 00 00 00 50 56 20 45 30 00 00 00 00 00 70 26 55 20 36 00 00 00 00 00 18 26 32 55 26 00 00 00 00 00 Attendant 26 18 18 50 40 00 00 00 00 00 Attendant 61 50 32 56 42 00 00 00 00 00 47 30 30 20 18 00 00 00 00 00 J.'G. Klafsky 22 30 26 26 32 00 00 00 00 00 Mrs G B Howe C W. Foreman 22 28 27 26 20 00 00 00 00 00 50 26 28 28 30 00 00 00 00 00 35 26 18 50 24 00 00 00 00 00 24 20 26 26 32 00 00 00 00 00 D. S. Dean G J Drost R. G. Davidson Blanche E. Cotton Cook Night supervisor Charles L. Easterday Rav Elliott Tillie Thoreson . .... Chet Dillon F. G. Connor Enna Eavreau Attendant Mary Fitzgerald Bert Glass Alvin Gilbert Attendant Glen Ginther WillardJ Getchel George Fuller Marie Goodrich Attendant L. J Hier T H. Griffiths Lena Knight Attendant Myrtle Hartle Lora A. Walsh Martin J. Wilson C. J. Nelson . . . . Attendant. 11 Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. �STATE OF MICHIGAN. 82 OFFICERS AND EMPLOYES—Continued. Service. Name. Rate. Period. Wm C Linn $50 28 26 45 26 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Non-resident. Resident. Resident. Resident. Resident. R E Lackey 22 18 26 30 32 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 18 20 38 19 24 00 Per month. Resident. 00 Per month. Resident. 00 Per month. Resident. 00 Per month. Resident. 00 Per month. Resident. 35 22 19 19 30 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 18 32 28 26 20 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 55 42 26 26 38 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 28 19 28 30 18 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 19 34 36 20 26 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 25 19 18 26 18 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Attendant 19 18 36 42 26 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Attendant 42 18 26 32 22 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 26 26 50 18 28 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 24 35 19 20 50 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Mildred Pepper Attendant Erzella McMillan Mary L. Reynolds Edwin ILenschell Attendant . .-. Gep. R. Newman Vernon Miller John H Miller Ed. McKeller Nina Ramsey Hazel Potter Attendant Attendant Meta Whitson Ernest Storrs Bernice vSmith David N. Ledbetter Assistant cook Attendant Mary E Smith W.E.Bedford Edna Reed F T Smith Chas. Sirnonson Edna S Smith C. P. Tobey .... Charlotte Knauf Anna Shane William J. Weiler Attendant �TRAVERSE CITY STATE HOSPITAL. 83 OFFICERS AND EMPLOYES.—Continued. Service. Name. Attendant $18 18 19 26 26 00 00 00 00 00 Per month. 18 18 22 19 18 00 00 00 00 00 Per month. Resident. Per month. Resident. 19 19 19 18 50 00 00 00 00 00 Per month. Resident. 75 70 55 26 28 00 00 00 00 00 26 19 65 26 26 00 00 00 00 00 35 35 26 38 35 00 00 00 39 00 26 26 35 38 26 00 00 87 00 00 Laundrynian 26 24 30 43 73 00 57 00 00 00 Per month. Non-resident. Lau,n dress 50 21 22 24 22 00 00 00 00 00 Per month. Non-resident. 21 24 21 30 21 00 00 00 00 00 Per mouth. Non-resident. 23 23 26 21 24 00 00 00 00 00 21 23 22 55 2 00 00 00 00 00 1 35 2 50 50 75 00 70 00 00 Attendant II G Penry Attendant Winifred Westbrook Esther Miller Attendant Reah Strickler Shirley Hartle Attendant Helen Whitson E.G. Park Watchman W Bellaw Chef Baker C W Schwartz Wm Snell D Hoxie Baker Baker Attendant Walter Czarniak Robt F Herkner Theodore Payne Cook Harold L. Allen Bessie Dalzell Cook Assistant cook Philip Richard Assistant cook Assistant cook Telephone operator Almon Covey Grace Edwards Laundress Sylvia Wilson Laundress Ethel Rinehart Elizabeth Ruttan Laundress Katie Homrieh G. E. Ball Laundress Ira Smith Period. Rate. Pipefitter Resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Non-resident. �STATE OF MICHIGAN. 84 OFFICERS AND EMPLOYES—Concluded. Name. Service. W Eraser Plumber Pipefitter H Butrick J K Hager C E Mull C. C. Cooper . . J B Kin" Rate. Period. $2 75 2 50 70 00 2 00 1 75 3 IS 2 70 2 70 59 SO 2 70 .... 2 2 2 3 2 70 00 00 00 70 S H MeMiehael Hans W. Tobler 2 70 1 00 1 75 1 75 50 00 N W Hill Geo N.Hill John McGill 5 5 40 29 29 20 20 00 00 00 29 29 29 29 29 00 00 00 00 00 29 29 29 29 29 00 00 00 00 00 29 52 31 38 30 00 00 00 00 00 50 4 31 29 33 00 00 00 00 00 Bernard Wert Abe Whaley \ Nelson Clint Copeland Teamster Teamster T. P ReddinoG W Burrett D W Kelley J. E. Curtis J W Palmer \ E Zodv Frank Steele D M Blodgett Teamster Barnman 1 80 2 00 2 00 2 00 2 00 Joe Brief R W Loeding J D Smith J 0 Edwards 35 00 33 00 75 00 39 00 1 80 Pipefitter 2 2 2 2 65 70 00 80 25 00 Per month. Resident. Per day. Non-resident.. Per month. Resident. �TRAVERSE CITY STATE HOSPITAL. GRADUATES OF THE TRAVERSE CITY STATE HOSPITAL TRAINING SCHOOL FOR NURSES. 1908. Harry Baker. Laura M. Bigbee. Bennett P. Burns. Lena Aldrich Covey. Sadie L. Dockerty. Anna Carrow Evans. Mary Louise Fink. Wesley H. Herriman. John O. Hoppes. Raymond G. Johnson. Esther V. Keller. Louise Kitscher. Dora Bell Lewis. Maria Margaret McDonald. Louise E. McGivern. Catherine McKinnon. Amy Orcutt. Victor A. Patrick. Hattie Holmes Parr. Florence Helen Roest. Lurene Shryer. Lillian Fiath Walsh. Anna M. Warner. Lucinda Hazel Wilson. 1909. Margaret Clark. Edna Crandall. 'Gertrude Eamon. Anna Hanson. Thea Hanson. Flora Hollister. Cora Laisy. Howard Lewis. Ruth Merrifleld. 1910. Ray H. Buttars. Tioura Lela Cronkwright. Leonard A. Cluley. John F. Donovan. Nellie Taube Ellsworth. Anna Maude Grissinger. Ethel Beatrice Hanes. Albert James Howard. Ethel Lillian Johnson. 1910. Jessie Angle Keating. Gertrude A. Kerry. Juliana Mary Leo. Gail Langworthy. C. Harold Leutholtz. Tressie A. Miller. Cleo Von Miller. Ella Orvis Miller. Archie Miller. Anna Thoreson Newman. Idylia Reynolds. Mina Odella Shearer. 1911. Martha Clara Kitscher. Nora Belle Eamon. Lena Amelia Rude. Matilda Delvena Send. Alice Julia Thoreson. Bertha Cornelia Peterson. Hazel Erveilia Edgerley. Marie Esther Orvis. Gertrude Margaret Orvis. Ada Julia Hall. Rosetta Alston. Essie Marie Johnson. Grace Belle Alexander. Erne Florence Grissinger. George Oliver Zeigler. Lee S. Swan. George W. Ashley. Leo S. Chamberlain. Perry A. Tobey. Stephen H. Young. 1912. Judith Evans Kidder. 85 �86 STATE OF MICHIGAN. Frances Edith Soss. Wilhelmina L. Oldenburg. Daisy M. Lahr. Alice A. Smith. Mabel Cowles Willard. Alma E. Leggett. Emma Thum. Otis H. Leland. 1913. Pearl LaFern Emory. Pearl Emily Tyler. Laura M. Eude. Julia Belle Oarsten. E. Margaret Mortenson. Stephen A. Covey. Anna Paulina Smith. Nettie Beulah Nickerson. Leonard ,A. Wright. Emma II. Davis. Effie Leona Bixby. Glen L. Ginther. Hildur Hedenskog. Matilda E. Henschell. 1914. Florence L. Vivian. Ethel M. Edwards. Lena N. Smith. Kathryn B. Huff. Lyla Stieglitz. Maggie E. Heator. Matie Estelle Vincent. Catherine Paffhausen. Alice E. Hanes. Ruby Dale MacLean. Grace L. Stieglitz. Libbie Howe. Flora Dorthy Goynon. Dora Gordon Seaton. 1915. Eose Boyd. Agnes Dumbrille. Minnie Greilick. Hazel Irish. Maude Irish. Francis Martin. Mabel Miller. Icel Northup. Eva ORorke. Johanna Schwartzrock. Inez Strickler. 1916. Winifred Baggiore. Hazel Bostrum. J. Madeline Clifford. Nettie Cutting. Marie Goodrich. Muriel Hanes. Celia Johnston. Lena Knight. Hilda Moran. Mary Stedman. Lora Walsh. Winifred Westbrook. �APPENDIX. �APPENDIX. The state hospitals of Michigan are organized and governed Organic law. under an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government. appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of Asylum Trustees. (Section 8.) The counties comprising the districtdistnctsof the Traverse City State Hospital are: Alpena Leelanau Arenac Manistee Antrim Mason Alcona Mecosta Benzie Midland Charlevoix . Missaukee Clare Montcalmn Crawford Montmorency Cheboygan Muskegon Emmet Newaygo Gladwin Oceana Grand Traverse Ogemaw Gratiot Osceola Isabella Otsego losco Oscoda Ionia Presque Isle Kalkaska Eoscommon Lake Wexford Provision is made by Section 7 for the transfer of patients Transfer from from one asylum to another when conditions make such trans- another"0 to fer desirable. �90 STATE OF MICHIGAN. A patient is not to be committeed to a hospital of a district other than that of which he is a resident unless the court adjudicates that there is no room in the latter, and that there is in the former. (Section 8.) Classes of Patients are divided into three classes: Public patients, patients. private patients, and voluntary patients. (Section 13). Voluntary Voluntary patients are patients who are not insane. They patients. are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for 'because of lack of room. In other words, there must be room for all others seeking admission before any voluntary patients can be received. Sec. 14, Act 155, Laws 1911, as amended by Act 94, Laws 1913, ''Provides that such persons as may have been nor may /hereafter be adjudged to be so addicted to the excessive use of intoxicating liquors, or narcotic or noxious drugs, as to be in need of medical and sanitary treatment and care, for whose person a guardian has or may be appointed with power to restrain his said ward in some suitable hospital or asylum for treatment." Public and Both public and private patients can be received only on private an order from a probate court declaring the patient insane patients. and stating the method of support,—whether public or private. Such an order is void unless patient is sent to the asyOrder void after thirty lum within thirty days after it is issued. (Section 16.) days. Bonds. Besides the order of commitment from the court, there must accompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumAdvance bent upon the court to see that this bond is furnished. Until payment. this bond is furnished the patient is regarded as a public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. New bonds. New bonds may be called for at any time by the medical superintendent, and the laws requires the court to see that such new bonds are provided. (Section 16). Temporary Provision is made (Section 16) for the reception of both orders. public and private patients on temporary orders wherever conditions demand immediate attention. Transfer from Section 21 provides for the transfer of a patient from priprivate to vate expense to public expense where conditions warrant such public. a change. Non-resident. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Provisional Section 32 provides for the return to the hospital without a discharge and new order of patients who have been discharged on trial, readmission of patients. where the duration of the temporary absence does not exceed six months. Insane to be committed to hospital of their district. �TRAVERSE CITY STATE HOSPITAL. 91 The attention of county officers is particularly called to the insane women provisions of Section 40 regarding the state of bodily cleanli- panted°bym" ness and the clothing of patients brought to the hospital, and *t?^ant more particularly to that clause of the section providing for a female attendant for insane women. In conveying a patient to the hospital do not deceive him. Removal of m j - i . ^ i j j . - C • j T. * • -j. j j-i patients from Truth should not be compromised by professing a visit to the home, institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the asylum, by giving patients an impression that they are parties to the deception. Removal to the hospital should never ~be attempted when the patient is much prostrated or laboring under severe bodily illness, and care should be taken that the excitement attending acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what arti- clothing, cles of clothing it is necessary to provide the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemise, 3 pairs of drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, C handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. // such- articles are left in their possession the hospital cannot be responsible for their safe Jt&eping. All letters concerning patients, from individuals having Correspondthe right to make inquiry, will be answered at once; and ence ' friends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information �92 Visiting patients. Application •for admission ...ol patients. STATE OP MICHIGAN. concerning inmates will not be given to casual visitors, except at the written request of friends. Where relatives of patients desire friends who are not members of the family to visit patients, they should, in every instance, furnish these friends with a letter of introduction, authorising the interview. Application for admission should ~be made before the patient is braitght to the hospital. A blank will be furnished the friends which provides for a complete history of the patient's trouble. All correspondence in reference to patients should be addressed to Dr. James D. Munson, Traverse City State Hospital, Traverse City. �INDEX. �INDEX. Accounts, abstract of Accounts, current, summary of Acknowledgments Admissions of drug habituates Admissions by months Admission of public patients Admission of private patients Admission of voluntary patients Age of patients discharged recovered. Table Age of patients who died. Table Alcoholic Habituates Alcoholic mental disorders Appendix Appointments, resignations, etc Appropriations, report of Carpenter and paint shop Chapel Civil condition. Table -Clinical work Clothing Cold storage plant, addition to Community clinics Correspondence Cost of maintenance Daily average of patients Deaths, causes of, etc Deaths, violent Death rate Dementia praecox Delirium. Infectious, toxic, collapse, unclassified Dietetics and food analysis .'. Dining room for men Dining room for women, addition to Discharge of patients, readmissions, etc Domestic arts and sciences Duration of residence of patients discharged. Table Education. Table Epilepsy Estimates of special appropriations Farm and garden Farm purchase Feeble minded Fire protection, addition to Form of disease. Table Grate for boiler Graduates of Training School General Hospital Heredity : » Page 80 33-36 70 90 C5 90 90 90 75 76 54-55 56-57 87 27-28 21-24 24 79 67 10 91 25 10 91 19-20 20 44 39 20 51-52 64 8 22 25 20-21 9 74 . 68 60-61 76-78 26 25 IT 25 46-48 24 85-86 11-15 66 �96 INDEX. Huntington's chorea Page63 Hysteria Harrison Law Imbecility Improvements Increase of patients .. Industrial building , Inventory, summary of Juvenile criminals Laundry machinery Manic depressive insanity Morphinism Movement of population. Table Names of officers and employees. Table Nativity of parents. Table Nativity of patients. Table Needs of Hospital New problems in civics Neurasthenia Neurosis, anxiety Not insane Occupation for men Occupation. Table Officers, names of Organic group Paranoia and paranoid states Patients treated in county houses, jails, etc Patients, suicidal, homicidal, etc Pernicious enemia Porch Psychopathic personalities Psychosis associated with articular rheumatism Recapitulation Receipts and disbursements Removal of patients to hospital Repairs to roofs and gutters Report of medical superintendent Report of State Board of Corrections and Charities Report of board of trustees Report of treasurer Report of steward Report of auditing committee , Residence of patients. Table Results of treatment of patients discharged. Table Sexual perversions . Store, addition to Social work Syphilis Syphilis, control of Sydenham's chorea Traumatic insanity Title and addresses Training school for nurses Transfer of patients Unclassified group Visiting patients X-Ray department 53 11 58-50 21 19 23 .42 05 25 49-50 57-58 43 80-84 70 69 24 15-17 53 54 65 9 68 5-6 61-63 52-53 19 19 63 2& 54 63 26-78 27 01 22 43 78-79 7-20 • 30-37 38-42 3T 71 72-73 54 24 3 5-17 65 11 64 63 3' 9 19-90* 64 92: 18-1 £» .' , I � https://localhistory.tadl.org/files/original/28f310d9e4727d327e0606e227af5e31.pdf 5deb9f8c57e551ed9587fdc4df4c4634 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees of the Traverse City State Hospital at Traverse City June 30, 1918. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report published by the State of Michigan and addressed to the Governor and Legislature of the State of Michigan for the biennial period ending June 30, 1918. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Fort Wayne: Fort Wayne Printing Company. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1918 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0004 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT OF THE BOARD OF TRUSTEES OF THE TRAVERSE CITY STATE HOSPITAL AT TRAVERSE CITY JUNE 30, 1918 BY AUTHORITY FORT WAYNE PRINTING COMPANY CONTRACTORS FOR MICHIGAN STATE PRINTING AND BINDING �TITLE AND ADDRESSES. THE TRAVERSE CITY STATE HOSPITAL, TKAVEESE CITY. Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is §1,215,409.01. The property consists of 51 buildings, occupying a tract of land containing 883.5 acres. It cares for 1,G93 patients. Act No. 21, Public Acts of 1911, provides that the Northern Michigan Asyluiu shall be hereafter known as the Traverse City State Hospital. This law went into effect July, 1911. OFFICERS OF THE TRAVERSE CITY STATE HOSPITAL. TRUSTEES. WILLIAM LLOYD H. C. DAVIS J. S. WEIDMAN C. D. ALWAY S. E. NEIHARDT, M. D C. E. MILLER, M. D MANISTEE TRAVERSE CITY MT. PLEASANT TRAVERSE CITY SOUTH BOARDMAN CADILLAC RESIDENT OFFICERS. JAMES D. MUNSON, M. D ............................. MEDICAL SUPERINTENDENT A. S. ROWLEY. M. D .............................. ASST. MKDICAL SUPERINTENDENT MARY JANE FOLEY, M. D ................. ~) H. V. HENDRICKS, M. D ................... ^ ................. ASST. PHYSICIANS PAUL H. PIPER, M. D ..................... J NON-RESIDENT OFFICERS. G. B. PIKE W. P. MANTON, M. D STEWARD DETROIT, MICH., GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN.. ..TRAVERSE CITY TREASURER. A. J. MAYNARD.. . . . .TRAVERSE CITY �TITLE AND ADDRESSES. THE TRAVERSE CITY STATE HOSPITAL, TRAVERSE CITY. Grand Traverse County, Michigan. ESTABLISHMENT. The Northern Michigan Asylum for the Insane was organized in 1881, and located at Traverse City, Mich. Its first cost was $522,430.68, and its present value is $1,215,409.01. The property consists of 51 buildings, occupying a tract of land containing 883.5 acres. It cares for 1,693 patients. Act No. 21, Public Acts of 1911, provides that the Northern Michigan Asyluiu shall be hereafter known as the Traverse City State Hospital. This law went into effect July, 1911. OFFICERS OF THE TRAVERSE CITY STATE HOSPITAL. TRUSTEES. WILLIAM LLOYD H. C. DAVIS J. S. WEIDMAN C. D. ALWAY S. E. NEIHARDT, M. D C. E. MILLER, M. D MANISTEE TRAVERSE CITY MT. PLEASANT TRAVERSE CITY SOUTH BOARDMAN CADILLAC RESIDENT OFFICERS. JAMES D. MUNSON, M. D A. S. ROWLEY. M. D MARY JANE FOLEY, M. D H. V. HENDRICKS, M. D PAUL H. PIPER, M. D ^ > J MEDICAL SUPERINTENDENT ASST. MEDICAL SUPERINTENDENT ASST. PHYSICIANS NON-RESIDENT OFFICERS. G. B. PIKE W. P. MANTON, M. D STEWARD DETROIT, MICH.. GYNECOLOGIST CHAPLAIN. REV. D. COCHLIN.. TRAVERSE CITY TREASURER. A. J. MAYNARD.. , TRAVERSE CITY �MEDICAL OFFICERS. Medical Superintendent: James D. Munson, M. D., 1885. Assistant Medical Superintendents: 3. H. Dawson, M. D.—1885 to 1890. Resigned. C. G. Chaddock, M. D.—1890 to 1892. Resigned. A. S. Rowley, M. D.—1895 . Assistant Physicians: G. G. Chaddock, M. D.—1885 to 1890. Promoted to Assistant Superintendency. W. A. Stone, M. D.—1880 to 1891. Resigned to accept the Assistant Superintendency of the Michigan Asylum for the Insane. Henry Hulst, M. D.—1888 to 1889. I. L. Harlow, M. D.—1889 to 1891. G. C. Crandall, M. D.—1890 to 1894. A. S. Rowley, M. D.—1891 to 1895. Promoted to Assistant Superintendency. M. Rockwell, M. D.—1891 to 1892. C. G. Speer, M. D.—1892 to 1896. Robert Howell, M. D.—1893 to 1898. H. J. Kennedy, M. D.—1894 to 1895. L. C. Stillings, M. D.—1894 to 1895. E. L. Niskern, M. D.—1895 to 1898. G. L. Noyes, M. D.—1895 to 1900. G. B. Furness, M. D.—1896 to 1897. F. P. Lawton, M. D.—1898 to 1901. C. A. Good, M. D.—1898 to 1900. Fonda Nadeau, M. D.—1898 to 1899. J. F. Canavan, M. D.—1889 to 1907. Died. D. L. Harris, M. D.—1899 to 1899. W. D. Mueller, M. D.—1900 to 1918. Lieutenant U. S. M. R. C. Minta P. Kemp, M. D.—1900 to 1903. W. J. Kirkbride, M. D.—1901 to 1902. F. H. Newberry, M. D.—1902 to 1904. Beatrice A. Stevenson, M. D.—1903 to 1909. B. F. Sargeant, M. D.—1904 to 1905. H. D. Purdum, M. D.—1906 to 1910. R. E. Wells, M. D.—1907 to 1912. Guy M. Johnson, M. D.—1908 to 1910. Adah Epperson, M. D.—1910 to 1918. E. G. Williams, M. D.—1910 to 1911. J. A. J. Hall, M. D.—1910 to 1916. S. C. Niles, M. D.—1911 to 1913. G. V. Sigler, M. D.—1913 to 1913. R. F. Wafer, M. D.—1913 to 1915. H. V. Hendricks, M. D., 1915-—. F. C. Mayne, M. D.—1916 to 1918. Mary J. Foley, M. D.—1918. Paul H. Piper, M. D.—1918. Steicards: J. D. Billings, 1885 to 1886. John Goode, 1886 to 1887. J. P. C. Church, 1887 to 1894. C. L. Whitney, 1894 to 1911. G. B. Pike—1912. Chaplains: Rev. W. D. Puddefoot, 1886 to 188S. Rev. D. VanAlstin, 1888 to 1890. Rev. D. Cochlin, 1890 . �REPORT OF THE BOARD OF TRUSTEES. To the Governor and Legislature of the State of Michigan: The Trustees of the Traverse City Hospital have the honor to submit their report for the biennial period ending June 30, 1918, together with the reports of the Medical Superintendent, Treasurer and Steward. Regular monthly meetings have been held. The period, owing to the war, was fruitful of new problems of gravest importance. The work of supervision became more intensive, as new situations developed almost from day to day. "If a year ago anyone had predicted half that has come to pass, we should have stoned him as an evil prophet, and declared his predictions impossible." The fuel shortage of last winter brought anxiety to many, actual distress to some, but all of its difficulties were successfully met by the hearty co-operation of the Government and people. Control, by the Government, of foods and other supplies was rapidly established, and our meatless and wheatless days, etc., were accepted without protest, and without real deprivation. "What is most remarkable is the fact that most of our regulations are extra legal, imposed for reasons of public welfare, accepted and observed by common consent, and enforced by public opinion." Coupled with the domestic reorganization, required by these regulations, was an inadequate supply of help, caused by need of labor in the great manufacturing centers, and the lure of higher wages paid to men engaged in Government work,—by enlistments, by conscription, etc. Necessity is the mother of invention, and in trying to meet these new situations, some progress has been made in hospital management. We are all familiar with the basal facts of the situation. As a result wages rose rapidly and unequally, and it became impossible to secure men at former wages. The institution was obliged to raise its schedule of wages several times, and the end is not yet. We were obliged to employ help largely outside the military age, and from all sources from which it offered. Surveys were made of every department, the most rigid economy established, and patients employed to the fullest extent in the conduct of the institution. Many of the food regulations have come to stay, and many of the food substitutes will become established articles of diet. It has been demonstrated that we can live on less meat, butter and sweets without bodily impairment, and in many instances with benefit to health. At the beginning of the biennial period it was recognized that efficiency preparedness must be established if the institution was to be maintained within possible bounds. Active co-operation of the officers and chiefs of departments led to greater economy and the adoption of new ideas. The experience gained in this way was of the highest instructive practical value. New problems, and new aspects of the old problems, received more consideration than ever before, with the object in view to lessen the burden of the hospital cost as much as possible. Recovered patients, or quite recovered patients, have been �8 STATE OF MICHIGAN. employed in various departments of the hospital, and some of the best workers on the farm, in the store, laundry, bakery, etc., are ex-patients, a-nd, what is more important, they are happy and contented with their work. Patients have also acted as ward orderlies and have rendered excellent service. Great care was taken to adapt the patients as far as possible to their previous occupations and their mental fitness for work. The object in the employment of patients was not to exploit their labor, but to interest them in normal lines of effort, and to side track, as it were, in this manner, morbid obsessing thoughts. The various activities of the hospital give quite a range for adaptive occupations. While all occupations are health-giving, yet they are not of equal therapeutic value. In general terms, those that excite keen interest and hold the attention are most useful. "Profit sharing," wherever practical, is of great value in sustaining "interest" till the work is accomplished. The environment of the workers is important, and the supervision, no matter what the occupation, should be educational; instructive and cheerful. It is the "directive force" that most helps the mental patient to recovery. All patients are drafted, as it were, into such service as they are able to perform, and as. a result the institution has no able-bodied idlers. In this, way, the aggregate cost of labor has been somewhat reduced, but the average increase in wages was 14.4% greater than last -year. The general work of the hospital has been well maintained. The medical staff has been from two to four members short, and only the most necessary attention could be given patients. No patient, however, has been neglected. Our interest in the great problems of public health is not less than formerly, and we would urge your Honorable Body to make possible health surveys for the after-care of mental patients, care of delinquent and backward and feeble-minded children, community clinics, school nursing and general mental hygiene work. While our energies are largely bent in the aid of the Government, we are not unmindful that we must try to control all the causes which lead to human decay. We believe that the mental hygienist and the social workers are of prime importance in the control of all forms of degeneracy. The social worker must be thoroughly well trained, and the mistake must not be made that an ordinary nurse is fitted to take up this work, for to be successful in these lines of effort, the person should have a broad education, at least equal to that required for the profession of medicine. As Miss Jarrett points out: "If social case-work is understood to mean the effort to organize all elements within the individual and his environment, so that he shall be adapted to social life as successfully as possible, it is clear that it should always be in some degree psychiatric. In the same way all social casework may be regarded as medical social work, in so far as the bodily health of the individual is of primary concern in every case. In short, all matters of individual human life are in some degree the common factors of case-work, whether the work is being done for dependent families, neglected children, homeless men, unmarried mothers, delinquents, or sick persons. The distinguishing feature of any specialization is the emphasis of a point of view, which leads to growth of knowledge along the line of special interest and to particular skill in dealing with cases �TRAVERSE CITY STATE HOSPITAL. 9 of a certain type. The characteristic, then, of psychiatric social work is that it approaches social case-work or social research from the standpoint of psychiatric and psychological analysis of personality, and for the purpose of adding to psychiatric knowledge. It may be carried on in hospital, court, factory, or social agency. It requires workers with a training that will fit them to collect social data necessary to psychiatric diagnosis, to understand the significance of the physician's diagnosis, and to afford social care that will contribute to medical treatment. It presupposes training in the general principles and methods of social casework, which, however, may be acquired through clinical work with psychiatric cases, as well as with any other group of cases, since the fundamental factors are common to all types of cases, and since also in the families of psychiatric patients all other types are sure to appear. Adequate equipment, which is not yet provided by any university or school, calls for at least two years graduate work with advanced courses in psychology and sociology, some elementary knowledge of medical science and psychiatry, and at least a year of experience in case-work." We hope our Legislature will see its way clear to make it possible to establish these courses in connection with our training schools. There is no doubt that with the vast increase in mental cases that will follow as a result of the great war that there will be a very great demand for psychiatric nurses, and every effort should be made to bring our training schools to the highest standard, and to offer proper inducements for young men and women to enter them. As our soldiers begin to return from Europe, we shall be brought face to face with serious problems. History shows that all great periods of stress lead to increased mental and nervous breakdown. To quote from an editorial in the Modern Hospital August 19, 1918, "Now the war is not something that the hospitals can consider solely from the point of view of the number of stars in their service flags and the number of Liberty Bonds bought by the employes. In war, of all times, we cannot tolerate sickness and resulting inefficiency. Now, with so many of our physicians away at the front, hospitals are more necessary to the health of the community, even than they are in times of peace. . . . . We must consider among other topics . . . . the prevention of the further breaking up of teaching staffs of nursing schools and the relief of communities which, as a result of the war, are left without adequate medical and nursing service." We wish to have our hospital able to do more than its full share in the medical and nursing care of disabled that will only too surely be returned to us. The anti-narcotic laws have saved many people from mental shipwreck, and the anti-alcoholic laws will directly and indirectly save thousands from mental and physical impairment. Epilepsy, imbecility, feeble-mindedness and delinquency are largely caused by intemperance, and we shall have, with the next succeeding generation, a lessening of these disorders, if the present laws are enforced. It will require at least a generation to fully demonstrate the value of these laws in the uplift of the race. We may say that the period just closed has been marked by much intensive work, in reorganizing and readjustment of many of the activities, to bring about the best economic result. �10 STATE OF MICHIGAN. The cost of maintenance for the first half of the period was 53 cents, for the last year 70 cents per person per day. These charges include officers' salaries and the cost of fire insurance, and workmen's compensation insurance, which amounts to nearly 4 cents per patient per day. A record of the per diem cost of maintenance for each year appears on page 24 of this report. BOARD OF STEWARDS. Many supplies of the hospital have been purchased by this Board. During the last year it was difficult to make contracts, as prices advanced so rapidly. Coal had to be purchased wherever it could be found at the price fixed by the Fuel Administrator. The winter of '17-M8 was severe, and the cost of heating 130% greater than during 1914. The outlook for the coming year is more favorable for fuel, and we are glad to report that the institution has a full supply for the coming year. Nearly all foods cost more. As compared with 1914 the cost of foods is 30% greater, and the cost of medcal care and nursing 14.4%, and of the farm 80%. As the larger portion of this increase took place during the last half of the last fiscal year, i. e., January 1 to June 30, 1918, it is clear, if present prices prevail, the cost of maintenance will be still greater than last year. DIETICS. Foods and their preparation have received much attention. The value of this work is recognized as being of the highest economic and therapeutic value. "The medical part of dietics is as much a part of therapeutics as drug treatment, and can be administered only by the physician. There is, for example, no heart disease diet or nephritic diet that can be made out in the form of a list available for the laymen, any more than there is a heart disease or a nephritic drug list that can be used in the same way. There are certain general principles of treatment in each disease, or better, certain general principles of treatment, of which the dietetic treatment is an inseparable part.". (F. H. McCardin, Boston Medical & Surgical Journal, July 18, 1918.) But with any individual patient, the diet and the drugs given depend on the condition as a whole in that particular patient. Among our patients there are many who are weak, under-nourished and anemic, many who are suffering from gastric disorders, and who are greatly benefited by scientific regulation of their diet. Apart from the purely medical value of dietetics, the careful cooking and serving of foods adds greatly to the health and comfort of patients. The work of this department is very important. The supervision of the canning of fruits, of the care of the kitchens, in fact, everything that relates to the care of foods and their preparation for the table, comes under the charge of the dietitian. Many patients, both men and women, assist in the work. A class in home economics continues to be of value, and many patients return to their homes better fitted for the work of their households than ever before, by virtue of the training that they have received here. During the past two years we have succeeded in making a few changes in this department, which have proven very beneficial, both from a �TRAVERSE CITY STATE HOSPITAL. 11 standpoint of economy and efficiency. The first is the establishment of a central station for the distribution of all fruits and vegetables. At this station potatoes are dressed, washed and sent out to the various kitchens daily. This is an improvement over the old system, in that there is none of that waste due to careless paring, which not only wastes quantities of the vegetable, but much of the valuable mineral matter found near the outer portion of the potato is also lost. Since the establishment of this system, the waste has been reduced to a minimum. The milk supply of the institution is also being sent to a central station for daily distribution by weight to all kitchens. This has eliminated almost entirely the sour milk problem. Since we have been called upon to "Hooverize" in the use of certain food materials (meat, butter, sugar, wheat flour), we have reduced our dietaries to comply with these conditions. Although the caloric value seems low, it complies with the best authorities on the subject and has proven itself very adequate. Following are analyses of the foods used in some of our cottages and the men's general dining room. These standards are taken from Prof. Rose's "Feeding the Family," Prof. Rose having made a careful study of "war" dietaries: Standard Portion of Protein in Diet 10—15% of day's energy requirement. Standards for fat, one-third of remaining requirement. Standard for carbo-hydrate, remainder of energy requirement. Requirement Requirement Requirement Requirement Requirement Requirement Requirement Collage 38 for man at light muscular exercise for man at moderate muscular exercise. . 2,700 to for man at active muscular exercise. . . . 3,500 to for woman at rest 1,600 to for woman at sedentary occupations 2,000 to for woman at light muscular exercise. . . 2,200 to for woman at moderate muscular exercise 2,500 to Men at active muscular exercise, standard 3,500—If,000 1011+ grams per patient 143-f grams per patient Fat Carbo-hydrate — 3,294 grams per patient 470+ grams per patient 2,500 calories 3,000 calories 4,000 calories 1,800 calories 2,200 calories 2,500 calories 3,000 calories calories. daily daily daily daily daily daily daily Standard 10 — 15% of days 572 calories. 108 — 200 grama 1,422 calories. Remainder of days energy 1,880 calories. Total 3 874 calories. Nutrient ratio 1:6. �12 STATE OF MICHIGAN. Dining-room for men.—Men at light muscular exercise.—Standard 2,500 calorics. Standard 10 — 15% of days 1 Fat 328 calories 93 grams 80 —200 grams Carbo-hydrate . . . 2,912 grams per patient per week Total . 416 grams per patient per day Remainder of days energy requirement .. 1,664 calories. 2 712 calories. Nutrient ratio 1:6+ Cottage 21. Fat Women at light muscular evercise.—Standard 2,000—2,200 calories daily. per week day per week day Standard 10—15% of days energy requirement 50 — 80 grams 70—200 grams Carbo-hydrate 1,713— grams per patient 244.7 grams per patient per Remainder of days energy Total 978.8 calories. 2 260 8 calories. Nutrient ratio 1:6. Cottage SI (Tuocrcular) Protein Women at light muscular exercise.—Standard 2,000—2,200 calories. 569 grams per patient per 81 grams per patient per Standard 10—15% of days 324 calories. 70— 200 grams Carbo-hydrate 2,758 grams per patient 394 grams per patient per Remainder of days energy 1,576 calories. 2 880 calories. Total Nutrient ratio 1:7. It will be observed that at Cottage 38 (working men) 3,874 calories were supplied per day, or a ratio of 1:6; (light muscular exercise) 2,712 calories were consumed, ratio 1:6-f-; and at the remaining cottage a ratio in food value of 1:7 was maintained. �TRAVERSE CITY STATE HOSPITAL. 13 DOMESTIC ART AND SCIENCE. This department continues to be of value. Every effort is made to interest women patients in some form of useful occupation. It may be lace-making. It may be some other form of fancy needle-work. At any rate, much interest is often awakened in patients by the methods employed, much to their mental and physical well-being. All patients who are able to perform fancy work share in the proceeds accruing from the same, and this is a great incitement to effort on their part. If the interest of the patient can be directed into new lines of effort, with careful training, the delusional content of mind will gradually fall into the background and greatly lose in intensity. This work has been interrupted somewhat during the last year by the Assistant Superintendent entering into the Eed Cross Army service. Every effort is made to keep the organization in this'department up to a high standard, as it offers many possibilities and will undoubtedly grow in usefulness and therapeutic value from year to year. TRAINING SCHOOL FOR NURSES. The training school for nurses has been an important factor, not only in preparing persons for the care of the mentally sick, but in general medical and community welfare work. Much attention is given to the school and during the last two years its standards have been advanced and its teaching improved and extended. Besides the teaching material furnished by the hospital and General Hospital, which is very great, the school is in affiliation with the training school for nurses of the University of Michigan, where the senior pupils finish their course. Here they receive practical work in pediatrics, infectious diseases, and in maternity cases. Fourteen nurses graduated in June, 1918, eight of whom have since passed the examination of the State Board of Nurses, and have received their R. N. degree. Several of the nurses have enlisted in the Eed Cross service of the United States and are now awaiting their assignments. We quote from our 1916 report: "There has been a great change in our attempt toward the nursing of mental cases. The old idea of repression, punishment, seclusion, etc., of patients has given away to the care of sympathetic, enlightened, and unselfish nurses. Not only will the hospital cases come more than ever under her care and require of her the most varied accomplishments and great resourcefulness, but she perforce must become the leader in social work, mental hygiene work, child welfare work, eugenic work, school and district nursing, and in the great field of preventive medicine." During the last year the hospital has supplied nurses to physicians in the surrounding country, and often as many as four or five are out at a time. The constant effort is being made to better the teaching; to widen the scope of instruction, and to graduate competent nurses. It is hoped that the General Hospital department may have a children's and maternity ward attached to it. If so, the training school will be complete in practical training material, and will not have to secure affiliation with other schools before its pupils can receive the R. N. degree. The hospital training school has a large class, and one of the �14 STATE OF MICHIGAN. greatest purposes of the school is to prepare thoroughly trained nurses to care for patients throughout the institution. It is also hoped that the institution will be enabled to supply social and mental hygiene nurses, Red Cross nurses for the United States Army, and for the nursing and rehabilitation of disabled soldiers as they return from the war. A great demand is already being made upon the country for nurses, and every effort will be made by this training school to educate as many as possible for this special work. We cannot refrain from saying that your Honorable Body must not be inattentive to the importance of this branch of civics, and by proper legislative measures make it legal for all forms of preventive work to become a part of the hospital service. CLINICAL WORK. The research and clinical laboratory work has been under the general direction of Doctors H. V. Hendricks and W. P. Stowe. The following is a brief report of the examinations and other work performed in the laboratory: Examinations: Urines 842 Blood counts 59 Throat cultures '. . . 29 Sputums 25 Widal test 22 Urethral smears 2 Stomach contents 2 Diazo test 1 Autopsies 10 Pathological diagnoses 12 Wassermann cerebro spinal fluids 45 Men positive • 31 Men negative 8 Women positive • 4 Women negative 2 Ross-Jones test 33 Cell count 33 Colloidal gold test 11 Mastric test 10 Wassermann blood total 794 Men positive 60 Men negative 432 Men doubtful 19 Women positive 19 Women negative 242 Women doubtful 12 Percentages: Men positive 14.25 Men doubtful 4.50 Men negative 81.25 Women positive 7. Women doubtful 4.50 Women negative 88.50 �TRAVERSE CITY STATE HOSPITAL. 15 Out of the 732 Wassermann examinations of the previous biennial period, positive reactions were found in 19% of the men and in 9% of the women. If the statistics of the last biennial period are compared with those of '15-'16, it will be noted that there has been a marked decline in the number of luetic patients admitted. The Wassermann blood tests, however, include the very aged as well as the very young patients. If patients under eighteen and over sixty are excluded, the percentage of luetic infection would be much greater than reported. We believe the greatest field of effort for preventive medicine is in the control of venereal diseases. A large percentage of mental disease is due to this cause, and with thoroughly organized scientific community survey work, this fatal factor could be practically eliminated. The stamping out of the luetic diseases depends upon the control of its source, and cannot be reached until sanitary laws are made and enforced by trained medical and social workers. Under the operation of the Harrison Law and anti-alcoholic laws of the State, it will be found, from a study of the statistical tables given in this report and compared with previous reports, that there has been a great falling off in drug cases and also a lessening in the number of alcoholics. The alcoholic prohibition laws have not been sufficiently long in operation to show their full value as sanitary and preventive measures. Unquestionably, however, there will be a decrease in the number of patients suffering from the psychoses, just as it will be immediately noticed that there will be a lessening number of juvenile and delinquent court cases and all other forms of crime. THE GENERAL HOSPITAL. The General Hospital is fast becoming indispensable to our institution and to the people of the surrounding country. Patients are received from many counties of the State and from other States than Michigan; Iowa, Virginia, Missouri, Illinois, Ohio, etc., having been represented during the last two years. About 950 patients have been treated in the hospital from its beginning, and it has been practically at its full capacity at all times. The General Hospital, in addition to the teaching facilities it affords to nurses in training, supplies nurses to outside patients, and the demand for this service is greater than the supply. Nurses have been supplied at the request of physicians to both mental and general cases in many districts in the State, and that without criticism from any source. On the contrary, many testimonials, expressing appreciation of the kindness and skill of these nurses, have been received. From more extended experience, we believe that our State Hospitals, with their great equipment, should become standardized General Hospitals for the reception and treatment of people suffering from all forms of illness, mental, surgical, infections, etc., as well as maternity and children's diseases. We respectfully urge upon your Honorable Body to make a sufficient appropriation to build and equip a modern hospital. Not only would it be of value to the population at large, but would become the social and welfare center for the district, and also would be a great factor in caring for the many soldiers who will be returned to us disabled in body and mind and who will require medical and nursing care of the highest order. The hospital training school should be widened in scope, and the most practical instruction given in this new domain of civics �STATE OF MICHIGAN. 16 which is opening up before us. The State Hospital, we believe, should become a co-ordinating center from which preventive work should be directed. There are many problems in sanitary and preventive work forcing themselves to the fore, and we believe a co-operative effort should be made by the Legislature, and by all organized societies interested in public welfare work, to promote preventive measures, particularly in their relation to feeble-mindedness, insanity, delinquency and to the suppression of prostitution and syphilis. The problem of the feebleminded is of vast importance. To quote Mr. Bish: "A feeble-minded person can never be normal, and especially if he displays abnormal tendencies, should be placed for life in some institution where he can be given work suitable to his competency, and where he can be made as happy and as useful as possible." The admissions to the General Hospital for the biennial period ending June 30, 1918, were as follows: Men 315 Women . 420 Total 735 Of this number, 173 were medical cases and 562 surgical. Out of the 735 patients treated in the General Hospital, there were 57 deaths, or 7.7%. This is a low mortality rate, especially as several patients were admitted immediately after severe injuries and only lived a short time after their reception at the hospital. The following tabulation of medical and surgical cases will afford a most comprehensive review of the work which has been accomplished: Improved. Cured. Diagnosis. 1 Appendicitis Arteriosclerosis Births Bronchitis Bruises left thigh Cardiac dilation Cardiac—nephritic Cerebral hemorrhage Cholecystitis Unimproved. MEDICAL BEPOET OF GENERAL HOSPITAL July 1, 1916 to July 1, 1918. 2 3 1 i 6 1 1 i i 1 1 2 .' H 2 1 1 1 , 3o T) g 3 1 1 1 1 2 1 2 1 1 1 1 1 1 1 2 2 1 7 i i 2 1 - 1 1 5 2 1 �TRAVERSE CITY STATE HOSPITAL. 17 •d<D 3 1 1 1 Cystitis Total. Improved. Cured. Diagnosis. Unimproved. MEDICAL REPORT—Continued. 2 1 - 1 1 2 2 1 1 1 1 Injuries —internal—abdomen 1 1 Pneumonia—pleuro . Poisoning—ivy Puerperal fever Renal calculi Retention of urine Rheumatic fever —acute Sprained ankle Tuberculosis—hip Tuberculosis— pulmonary Tuberculosis— sacrum Typhoid fever Typhoid pneumonia . Vaginitis . . 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .... 1 1 9 1 1 1 1 1 2 1 2 1 1 2 1 1 1 1 1 1 Injuries to liver Insanity— manic depressive ... Iritis Neuresthenia Orchitis Paralysis^-below first cervical Peritonitis—general . . 1 1 1 1 1 1 Hemorrhage—pulmonary 2 1 2 2 1 1 2 2 1 1 Gonorrheal infection — eyes 1 1 1 1 1 1 1 2 3 1 1 1 1 1 1 2 1 1 1 1 1 3 1 12 2 1 2 2 1 1 2 1 2 1 6 2 1 1 14 1 1 1 1 1 2 14 2 1 �STATE OF MICHIGAN. 18 SURGICAL REPORT OF GENERAL HOSPITAL. Improved. Cured. Diagnosis. Unimproved. July 1, 1916 to July 1, 1918. 4 8 1 9 1 •d 1 o H aQ 4 • 1 1 11 11 4 2 4 193 2 2 5 1 3 5 194 1 1 2 1 3 1 1 2 6 5 1 • 1 1 1 44 42 42 4 47 5 1 4 1 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1 1 5 4 2 1 1 1 3 2 1 1 2 Fracture of patella 1 2 1 2 3 Fracture of radius Fracture of skull 1 1 1 1 2 3 • 1 1 1 1 1 1 1 1 3 1 2 22 4 8 1 2 9 1 Gastric ulcer Herniotomy — inguinal 5 1 1 1 1 44 33 5 1 4 1 Gastrojejunostomy 4 1 1 1 1 2 5 5 1 Fracture (compound) of fibula and tibia 8 2 10 1 1 1 3 1 22 3 �TRAVERSE CITY STATE HOSPITAL. 19 Improved. Cured. Diagnosis. Unimproved. ' SURGICAL REPORT—Continued. ~5 o H T3 s 03 2 Q 4 1 4 2 9 4 1 4 1 3 1 Ovariotomy 4 Paracentesis 99 2 1 ^ 2 3 21 1 2 1 Plastic operation on eyelid Relief of intussusception of bowels 1 3 1 4 99 2 1 1 4 1 2 2 4 1 47 29 Removal of bullet and cleaning of gun shot 1 1 1 1 1 1 Removal of cyst between peritoneum and 1 5 1 14 3 1 1 6 1 1 1 1 1 1 1 1 1 Removal of tumor from groin 1 1 3 Repair of abdominal wounds and ruptured bladder 1 1 Watkin's operation 1 1 3 1 75 1 2 1 • 1 5 90 2 1 75 19 1 2 �20 STATE OF MICHIGAN. The following will show the receipts and disbursements on account of the General Hospital for the period just closed: Total receipts for the year ending June 30, 191.7 Total receipts for the year ending June 30, 1.918 $12,949 88 12,889 82 Total Total disbursements for the year ending June 30, 1917 Total disbursements for the year ending June 30, 1918 $25,839 70 f9,163 07 f 6,335 58 Total Balance to the credit of the General Hospital June 30,1918.. $15,499 25 $15,556 62 X-RAY DEPARTMENT. This department has become one of great clinical importance. All doubtful cases of tuberculosis, all cases of gastro intestinal diseases, diseases of the bones, fractures, dislocations, location of foreign bodies, etc., etc., are positively diagnosed by this method. Although it has been in operation for more than two years, yet owing to many conditions that could not be controlled, a regular operator has not been maintained, consequently the work has not developed rapidly. We now have, however, a competent roentgenologist, and many outside patients are coming for clinical examination. We venture to say that this department will become one of the most valuable in connection with the institution. The following is a summary of X-ray cases from June, 1916 to June, 1918: Part examined. Patients. 3 Shoulder Outside cases. 3 8 1 Foot 1 Hip Employes. 7 1 5 0 2 9 12 5 11 6 7 1 Teeth 2 1 Pelvis 1 1 2 2 2 5 5 5 8 8 11 5 12 28 12 6 11 Calculi Chest 14 6 6 Spinal . . . . . Total. 32 29 32 �TRAVERSE CITY STATE HOSPITAL. 21 LIBRARY. The accompanying tables give in detail the work of the library for the past year. Results are not yet what we wish, but substantial advancement has been made along two lines; number of loans in every branch of our work, and a more general distribution of loans to the several wards. On July 1, 1917, we had 938 volumes available for loans. Received during the year by purchase 50, by donation 35. Old library volumes resurrected 5. Total gains 90. Losses 19 (3 lost or destroyed, 16 worn out past repair). Net gain 71, or 1,009 volumes now available. The number of worn out books will increase more rapidly in the future, as so many are very old. We have rebound during the year the same number of volumes as last year—34. Have otherwise repaired 281. In the librarian's report for last year may be found the following statement: "We would increase our efficiency from 50 to 100% if a small sum were expended for the right kind of up-to-date books." That this is true is shown by a glance at Table No. 2, months of JanuaryMarch as compared with April-June. For the first period the average of monthly loans of books was 659; for the last three months (after purchase of 50 new books) the average was 945, a gain of 286, or 43%; this at an expense of f25 only. We ask for the same amount for fiction; $25 for juvenile (which, next to fiction, shows the greatest efficiency), and $25 for travel. In the last two named subdivisions we have nothing at all late, and but few titles anyway. If to these were added $25 for 50-cent war books, it would only mean $100, and would double the number of book loans. Every year makes a library of less value, aside from the number of books worn out, unless new material be added. A library never stands still; it must progress or retrograde. TABLE No. 1. Loans classified by catalog sub-division. Loans. Biography Fiction Travel Miscellaneous Total books Magazines Material not listed Aggregate . . . . . Loans per title. 4 15 3 16 238 56 5,942 380 516 136 1 008 60 175 25 226 26 171 20 596 8,872 230 933 7,962 29 2,552 . Average No. titles. 19 386 3 6 8 8 7 • 9 8 6 2.4 9 5 275 �STATE OF MICHIGAN. 22 TABLE No. 2. Loans by months. , 1917. In 3 eS 3 0 C3 677 705 293 a a ao g O t> o 0 1 "3 < 644 715 728 674 661 519 584 581 ' 626 687 627 69 83 260 228 209 221 Not listed 1918. . X <£ & V a 0} 666 o 3 A h s 634 700 667 1,007 S>> cS c$ § 736 311 247 R 696 354 985 740 306 a >-> 03 844 761 374 ce o EH 8,872 7 962 2,552 19,386 TABLE No.—3. Loans by wards. Books. Hall. 1 3 5 7 9 11 13 15 17 19 Catalog 21 23 25 27 29 31 North side ^outh side Employes Total Magazines. 314 104 79 Hall. 556 140 62 105 255 275 343 397 73 113 139 287 24 26 28 30 375 267 266 317 ' '38 53 192 216 32 34 36 38 48 240 532 277 83 53 18 117 130 47 340 196 54 10 12 14 43 54 174 20 " 247 ' 47 86 31 26 192 508 4 121 137 2,464 5 621 16 18 Catalog 192 6 1,268 787 4 657 2,037 8,872 7,962 Material not listed (2,552 loans) not included. Magazines. 1,235 350 716 116 150 4 6 8 10 42 Books. 1,114 443 2 283 5,621 105 234 247 5 4,657 �TRAVERSE CITY STATE HOSPITAL. 23 TABLE No. 4. Magazine loans. ^American *Century 310 224 211 369 Literary Digest McClure's Modern Priscilla ^Metropolitan 444 Country Gentleman Delineator Everybody's *Harper's 240 379 132 250 203 274 09 (4 mo.) *Illustrated Review 283 Illustrated World . .. 384 Ladies' Homo Journal . . ' . . . . 163 46 (6 mo.) Outlook *Physical Culture *Popular Mechanics. . . . Review of Reviews Round Table Sat. Evening Post Scientific American . Travel Woman's Home Conip'n World's Work 391 259 139 251 288 290 409 18 262 216 18 Quarterly. 456 382 225 147 227 . 7,962 Total magazines (listed) . . . *Publications not listed 2,552. * Donated. FIRE IN LAUNDRY. On the morning of November 7, 1917, the laundry was practically destroyed by fire. Unfortunately much new machinery had just been installed and was badly damaged. The loss, as adjusted by the Fire Commission, was f 12,301.30. This sum was paid to the institution in full by the State. The laundry is being restored, and when finished will be a fire-proof building. The source of the fire is not known, but it is believed to have been started from overheating of clothing in one of the dryers. > VIOLENT DEATHS. One woman patient committed suicide, and four patients—two men and two women—died from suffocation during epileptic seizures. These cases were investigated by the coroner, and death certificates in each case were signed by him. TRANSFER OF PATIENTS. During the year ending June 30, 1917, thirty women were received from the Pontiac State Hospital,, and twelve patients—five men and seven women—from other State Hospitals. During the year ending June 30, 1918, one hundred patients—seventy-five men and twenty-five women— were received from Eloise and thirty-eight patients-^sixteen men and twenty-two women—from the Kalamazoo State Hospital; and four women from other institutions. During the fiscal year ending June 30, 1917, fifteen men were transferred to the farm colony for epileptics at Wahjamega, and four patients—three men and one woman—to other State Institutions. During the fiscal year ending June 30, 1918, four patients were transferred to other hospitals—one man to the Pontiac State Hospital, and one man to the Ionia State Hospital, one man to the home for the feeble-minded at Lapeer, and one woman to the Newberry State Hospital. �24 STATE OF MICHIGAN. INCREASE IN PATIENTS. The gain in patients during the period was, men 72, women 90, total 162. If the number of patients received from other State Institutions—96 men and 88 women, total 184—less the number of patients discharged to other State Institutions—-21 men and 2 women, total 28—is deducted from the admissions, the gain in patients in the hospital district for the period has been one patient. We may add that the hospital can comfortably care for one hundred additional patients. COST OF MAINTENANCE. 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Cents. 53 52 51 50 49 49 48 48 48 -. 47 46 44 42 44 44 44 44 (The above exclusive of officers' salaries)...'. 44 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 49 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 47 (Inclusive of officers' salaries) 48 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 50 (Inclusive of officers' salaries) 49 (Inclusive of officers' salaries) 50 (Including officers' salaries' and pro rata of Ins. fund, $5,193.93) 51 (Including officers' salaries and pro rata of Ins. fund, $5,143.93, and working men's Ins. 1341.37) 50 (Including officers' salaries and pro rata of Ins. fund, $5,143.93, and working men's Ins. 1341.37) 50 (Including officers' salaries and pro rata of Ins. fund, |5,844.47, and working men's Ins., $745.77) 53 (Including officers' salaries and pro rata of Ins. fund, $5,280.86) 70 �TRAVERSE CITY STATE HOSPITAL. 25 DISCHARGE OF PATIENTS,, READMISSIONS,, ETC. There were 811 patients discharged during the period; 504 men and 307 women. Of this number, 134 were discharged recovered, 157 improved, 65 unimproved, and 580 died. The percentage of recoveries on the whole number under treatment was 3 plus; on the number admitted 13.7%. The death rate was 85 per thousand in 1916-17, and 89 per thousand in 1917-18. The readmissions for the period were men 59, women 47, total 106. The readmissions from the beginning have been men 493, women 466, total 959. The total number of patients admitted 8,365, representing 7,406 individuals. The daily average of patients for the period was 1,753.4. The number of weeks spent in the institution by patients was 182,858 6-7. This was an increase of 123 in daily average, and an increase of 10,528 3-7 weeks' board over the preceding period. On June 30, 1918, there were 1,806 patients under treatment at State expense and 49 at private expense. There were two hundred eighty-five persons employed in the hospital June 30, 1918, in the positions, and at the wages given in the schedule accompanying this report. ORDINARY REPAIRS AND IMPROVEMENTS. During the year ending June 30,1917, the cost of repairs was $27,761.28, and for the year ending June 30, 1918, $23,074.03. Notwithstanding the increased cost of labor and material, the expenditures for repairs were $10,754.10 less than for the preceding period. While there were a large number of minor repairs made during the year, yet none involving large expenditures of money were undertaken. The principal improvements were those made to Cottage 32 and in the gardener's residence, the establishment of a garbage cooking vat at the pig pens, and the installation of a milk aerator in the dairy. The electrical wiring in the main building was found to be defective and had to be made safe. Owing to the constant flooding of the ground immediately surrounding the bakery, considerable grading, cementing and drainage was required to correct this defect. One of the most important improvements during the period was that of fire-proofing, as far as possible, the attics of the main building. The electric wiring and telephone wiring was more perfectly insulated, and the roof ceiling and floors were given two coats of whitewash. All flues that opened into the attics were closed with metal, and wherever possible were dampered, so as to prevent drafts in case of fire. Many of the porches had to be practically rebuilt, as they had become so weakened by decay that they threatened collapse. Many minor changes, such as improvements to the roofs and gutters, to the sanitary appliances, etc., etc., were carried out. During the coming period, no doubt, a larger expenditure will be required to keep the building in order. SPECIAL APPROPRIATION., $4,232. This appropriation was granted by the Legislature of 1917 for an addition to the dining room for women. The addition has been completed and finished, with the exception of the service elevator. The fund remaining in this appropriation, $343.71, is not sufficient to install this appliance, and an appropriation will be asked of the coming Legislature to install a proper elevator for this dining room. �26 STATE OF MICHIGAN. SPECIAL APPROPRIATION, $2,500. This appropriation was made by the last Legislature for the purpose of installing a pump for fire protection. We would respectfully report that the pump has been installed within the amount of the appropriation, and has proved to be entirely satisfactory. SPECIAL APPROPRIATION, $5,000. This appropriation was granted by the last Legislature for the purchase of laundry machinery. This machinery was installed within the amount appropriated, but unfortunately much of it was damaged and some of it destroyed by the fire in the laundry last November. The insurance received from the State was, however, sufficient to make good the loss. SPECIAL APPROPRIATION, $14,461.50. This appropriation was made by the Legislature of 1917 for the purchase of 1551/2 acres of land. The State entered into possession of this land immediately after the passage of the act. It is an excellent farm, and will add greatly to the economy of the institution. SPECIAL APPROPRIATION, $750. This appropriation was made by the last Legislature for the construction of a porch and covered passageway between Cottage 30 and the dining room for men. Owing to the enhanced prices of material, etc., this improvement could not be made within the amount appropriated. It has reverted to the State. NEEDS OF THE HOSPITAL. The following requests for appropriations are for additions to the buildings, and for special improvements. We would call your attention to the fact that the boilers and grates, etc., now in use are worn out and will soon have t.o be replaced. As the boiler capacity of the institution is not much in excess of its daily needs, it is imperative that provision should be made at once for the installation of a boiler larger than we now have in use. The hospital is growing in usefulness and, while the conditions at the present time are unusual and we are bending every energy to meet war conditions, we must keep up the institution so that it may do its part in the service of the commonwealth. The requests that follow were decided upon after the most careful consideration. You will note that, outside of the additions to the store, no building operations are contemplated. ADDITION TO STORE, $28,096.60. Your Honorable Body is respectfully requested to appropriate the sum of $28,096.60 for enlarging the store building. The building is inadequate for the needs of the hospital. A large amount of supplies is stored in this building, and the danger from loss by fire is great. The store is too small and overcrowded, and the handling and rehandling of supplies necessitated adds greatly to the overhead expense for foods, etc. We cannot too strongly urge this addition. �TRAVERSE CITY STATE HOSPITAL. 27 WATER TUBE BOILERS AND CHAIN GRATE STOKER, $18,000. This boiler is to replace two small boilers, one of 175-horse-power and one of 150-horse-power. It is very important that a new boiler be installed at the earliest possible date, as the old boilers are likely to fail at any time. The hospital has outgrown them, and no doubt a large boiler would soon pay for itself in saving of fuel. ELECTRIC ELEVATOR FOR DINING ROOM FOR WOMEN,, $3,500. The appropriation made for the dining room, as above reported, was not sufficient to cover the cost of a mechanical elevator. We would respectfully ask your Honorable Body to appropriate the sum of $3,500 for the purchase and installation of an electric elevator for this dining room. The estimates, as prepared by the Otis Elevator Company, provide for an automatic electric elevator, auto-operable from the basement or stories—one of sufficient power to lift one thousand pounds from the basement to the third story. All labor and materials are included. This improvement is very necessary. ASH CONVEYOR, $2,500. This machine is to automatically remove ashes from the boiler ash pits in the sub-basement to a bin outside of the boiler room. The coal consumption per day during the winter months varies from 40 to 60 tons, and the elevator iii use is too small to handle the coal and the ashes from the boiler to the dump above. The sub-basement is small and is connected with the outside by a narrow stairway. Consequently the ashes accumulate, and it is almost impossible, under existing conditions, to remove them l>y hand. We would strongly urge this improvement, and believe it would much more than pay for itself within the coming period. OVERDRAFTS, $6,001.27. The Legislature of 191.5 made an appropriation of $8,000 for a shop building. The building was not completed until two years later, and during that time the cost of labor and material appreciated greatly, so that the building cost, completed, $4,670.77 more than the appropriation. This amount was paid from the current expense funds of the institution and treated as an overdraft against the special appropriation. There was an overdraft on the dining room for men, of $1,640.60, and one of $265 for architect's fees against the special appropriation for the industrial building for women. The total overdraft on account of these special appropriations was $6,001.27. The overdraft on the industrial building for women of $265 was paid to the architect. The appropriation for this building was transferred, by the last Legislature, to the appropriation for addition to store, and has not been drawn from the State Treasury. We would respectfully -ask your Honorable Body to pass a deficiency bill to cover these amounts. These buildings were near completion and not to have finished them would have caused inconvenience and loss to the institution. It was decided, as a business proposition, to secure the use of them at the earliest possible date, and to ask the Legislature to refund the money spent for their completion. �28 STATE OF MICHIGAN. REPAIRS TO ROOFS AND GUTTERS, $2,500. Your Honorable Body is respectfully asked to appropriate the sum of $2,500 for repairs to the rooms and gutters of the hospital. Every winter the roofs sustain more or less damage from snow and ice which accumulates on them, and it requires a considerable outlay to keep them in order. Often it becomes necessary to make scaffolds to reach the cornices and gutters, and the outlay for this purpose is often as great, if not greater, than the cost of the repairs themselves. If, however, it becomes the policy of the State to treat such improvements at the State institution, as a charge against the general fund, this request will be canceled. RECAPITULATION OF APPROPRIATIONS REQUESTED. Additions to store Water tube boilers and chain grate stoker.... Electric elevator, etc Ash conveyor Eepairs to roofs and gutters Overdrafts $28,096 60 18,000 00 35,000 00 2,500 00 2,500 00 6,001 27 ,597 87 FARM, GARDEN, STOCK AND GROUNDS. The farm is in fine condition and is becoming better year after year. It shows the results of the scientific methods of agriculture, which have been applied to it. Especial attention is being paid to soil conservation, to drainage, the use of fertilizers and soilage crops. Rotation of crops is carried out to the fullest possible extent. It will be seen from the accompanying table that a tremendous amount of produce is supplied to the institution by the farm, and when given a money value it represents a very large amount and is a decided asset and a great saving to the taxpayers of the State. During the last two fiscal years there have been no new buildings constructed on the farm. Considerable woven wire fence has been built, replacing old board or rail fences, which were in bad condition. The Legislature of 1916 generously granted the appropriation for the purchase of 155% acres of additional farm land. This land is proving a valuable acquisition and was much needed. It is believed that the purchase of still more land is advisable, as we could easily furnish the patient labor to till it and, with more land, we could produce more of the necessities of life and thereby become more nearly self-sustaining and less of a burden to the taxpayers of the State. During the coining year we expect to rent a nearby farm of 80 acres, and we aim to be constantly on the watch for desirable farm property that can be purchased for the hospital. We regretfully report the death on -February 18,1918, of Mr. Dennis W. Kelly, former farm manager. Mr. Kelly found employment with the institution for thirty-two consecutive years, and held the position of farm manager from October, 1903, to the time of his death. The position of farm manager was filled by the employment of Mr. L. L. Drake, who assumed the duties of the position April 17, 1918. Mr. Drake came very �TRAVERSE CITY STATE HOSPITAL. 29 well recommended and fortified by years of experience and college education, being a graduate of the Michigan Agricultural College. The following tables show the produce from the farm and garden, and cash receipts for farm produce, etc., sold during the biennial period: FAKM REPORT FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1918. Apples, bushels .............. 3,010 Mangels, bushels 4,739 Apples, crab, bushels .......... 151.50 Melons, musk, pounds 4,450 Melons, water, pounds Asparagus, pounds ........... 3,100 6,950 Beans, string, bushels ......... 407 .1,706,522 Milk, pounds Benns, navy, pounds .......... 3,231 Oats, bushels 2,086 Onions, green, dozen 15,005 Beans, hog feed, pounds ....... 990 Beef, pounds .................. 35,115 Onions, bushels 820 Beets, bushels 1,768 Parsnips, bushels 1,544 29,005 Peaches, bushels 54 Cabbage heads. . . 6,222 Peppers, bushels 17 Carrots, bushels. . . Pears, bushels Cauliflower, heads. 538 66.50 9 Celeriac, bushels. . Peas, bushels 235 Plums, bushels 370 Cherries, quarts. . . 23,955 1,082 Pork, pounds Chickens, pounds. . . 46,111 Potatoes, bushels Celery, heads 28,950 1,770 Cider, gallons 2,008 Potatoes, bushels, sweet 25 Pumpkins, pounds 60,120 Corn, green, bushels 1,782 Cucumbers, dozen 310. Radishes, dozens 8,825 Raspberries, quarts Cucumbers, bushels 515 5,208 Rhubarb, pounds Currants, quarts 5,648 12,730 Ducks, pounds 90 Rutabagas, bushels 3,668 Eggs, dozen 412% Rye, bushels 75 Egg plant, bushels 4 Sage, bundles 750 Salsify, bushels 115 Ensilage, tons 1,046 Grapes, bushels 186 Spinach, pounds 5,730 Squash, pounds Greens, pounds 1,680 61,140 Squash, summer, bushels 206 Green fodder, tons 145.50 Hay, alfalfa, tons 65 Straw, tons 10 Strawberries, quarts Hay, clover, tons 113 13,191 Hay, mixed, tons 196 Suet, pounds 145 Syrup, maple, gallons Hay, June grass, tons 28 10 Tallow, pounds 54 Hay, timothy, tons 30 Head meat, pounds 107 Tomatoes, greenhouse, pounds. 3,210 Tomatoes, green, bushels.... 88 Hearts and tongues, pounds. . . . 788 692 Kohl rabi, bushels 2 Tomatoes, ripe, bushels Lettuce, pounds. . .-: 9,560 Turkey, pounds 168.50 Turnips, bushels Livers, pounds 1,315 .50 1,506 Lumber sawed, feet 3,577 CASH RECEIPTS FROM FARM FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1918. Young bulls, sold $5,312 75 133 50 Prize money on cattle A. R. O. Purchase option on land, refunded. 100 00 Sale of one colt 50 00 Sale of hides 833 08 Sale of wood 189 00 Sale of feed sacks 213 70 225 80 Sale of hay Sale of buckwheat 9 50 Sale of vegetables 16 27 2 32 Sale of steel fence post Sale of arsenate of lead 16 00 Sale of hog serum 25 00 Freight on feed, refunded 48 47 $7,325 39 RECEIPTS AND DISBURSEMENTS. The total receipts of the hospital for the fiscal year ending June 30, 1917, including casli on hand and credits on special appropriations accounts, were -f397,758.19, and the total disbursements for the same period, including special appropriations, were |400,720.39. The total receipts of the hospital for the fiscal year ending June 30, 1918, including credits on special appropriations accounts, were f505,053.30, and the total disbursements for the same period, including special appropriations, were $501,067.25. There was at the close of the biennial period ending June 30, 1918, $1,023.85 in the hands of the treasurer; $2,649.1.3 being to the credit of the current expense account and an overdraft of $1,625.28 on account of special appropriations. �30 STATE OF MICHIGAN. OFFICERS. In September, 1917, C. E. Miller, M. D., of Cadillac, Mich., was reappointed to the Board. Dr. Miller has been a valuable member of the Board, and his reappointment is a just recognition of his services. F. C. Mayne, M. D., who had been connected with the staff since 1916, resigned his position in February, 1917, to accept an appointment in an emergency hospital in Detroit. Dr. Mayne carried with him the best wishes of all the officers and employes of the institution. In March, 1918, Dr. W. D. Mueller, who had been connected with the staff since 1900, received a lieutenant's commission in the Medical Reserve Corps of the United States Army. In March, 1918, Dr. Adah Epperson, who had been the woman physician of the hospital since 1910, resigned to accept a position with the Westinghouse Company of Pittsburgh, Pa. Dr. Epperson has the best wishes of all connected with the institution for success in her new field. Hon. C. D. Alway, who had served as a member of the Board for about five years, received a commission in the Army of the United States. He became first lieutenant in the Sixtieth United States Infantry and was assigned to duty at Camp Greene, North Carolina. Subsequently he went overseas, and has since been serving with his regiment on the battlefields of France. Mr. Alway carried with him the best wishes of his associates on the Board, and all earnestly pray that he may safely return to his home and country. By resolution of the Board of Trustees, officers and employes entering the military service of the United States are resigstered as temporarily absent and may resume their positions after the war. In June, 1918, Dr. Paul H. Piper was appointed as assistant physician on the staff. He came highly recommended by the medical faculty of the University. Dr. W. P. Stowe, who has been acting as roentgenologist, has accepted a position on the staff, and will begin his duties next month. He comes from the University Medical School, and is highly recommended. The following is the roll of honor of the institution: Dr. W. D. Mueller. .Lt., U. S. Army C. Eoutsong Army Win. Coursons Army H. Denoyer Army C. J. Nelson Army E. Denoyer Army E. F. Gray Army L. King Army W. T. Ferguson Army A. Korb Army D. M. McKinstry Army H. Allen Army E. A. Hamberg Army L. Shelda Army E. Hinchell Army L. Denoyer Army G. A. Lenhard Army P. Hindges Army N. F. Young Army G. Zalin Army W. Cruse Army R. Skiver Army N. Parker Army L. Cornell Army A. Elliston Army C. Priest Army G. Bixby Army H. Wellacker Army R. Coleman Army W. Weiler Army F. J. Zenek Army F. Johnson Army L. Schoner Army I. Yenish Army R. Shelda Army C. A. Banelt Army �TRAVERSE CITY STATE HOSPITAL. 31 H. Rohr Army Gail Langworthy Red Cross L. Hoxie Navy Alice J. Thoreson Red Cross H. O'Leary Navy Libbie Howe Red Cross M. Couturier Navy Lula Stieglitz Red Cross F. Norris Navy Grace Stieglitz Red Cross F. Hannaford Navy Hazel Bostrum Red Cross H. Fitch Navy Blanche E. Beitelieu... .Red Cross Wm. Shields Navy Marie E. Husby Red Cross H. DeWitt Navy Niva E. Ramsey Red Cross C. Farnham Navy Metta M. Whitson Red Cross W. Fahenstalk Navy Blanche E. Cotton Red Cross Julia Leo Red Cross Katherine Bell Red Cross Jessie Keating Red Cross In conclusion we may say that there has been the most devoted effort on the part of the officers and employes of the institution to do their best for the hospital and their country. In the conduct of the affairs of the hospital, the heads of the departments have shared more than ever before in the study of conditions, and carrying out of suggestions for its welfare. Despite conditions due to the great war, steady progress has been made in the hospital management, and many things have been learned from the experiences of the year that will forever stand to the welfare of the institution. The patients have not suffered for medical care, and have been supplied with every comfort necessary to their best welfare. The outlook for the coming year, with the great drain that is to be made on the man power of the country, is not so favorable, and yet we believe that as problems arise they will be successfully met and that we may feel assured that all will be well with our institution and with our people and our country. We earnestly desire that your Honorable Body, by the wisdom of its acts, will make it possible for the State to take high rank in the progressive work of conservation of public health. WILLIAM LLOYD, H. C. DAVIS, C. D. ALWAY, S. E. NEIDHARDT, C. E. MILLER, J. S. WEIDMAN. Traverse City, Michigan, June 30, 1918. �32 STATE OF MICHIGAN. TREASURER'S REPORT. ABSTRACTS. OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT TUB TRAVERSE CITY STATE' HOSPITAL FOE THE FISCAL YEAR ENDING JUNE 30, 1917. THE STATE OF MICHIGAN, In account with A. J. Mayna-rd, Treasurer of the Traverse City State Hospital, for the above named period, as lolloios: JULY, 1916. CREDITS. Balance on hand July 1, 1916 Cash from State Treasurer : Account of current expenses Cash from other sources $10,855 86 27,979 78 2,685 57 $41,521 21 DEBITS. Account Account Account Account Account Account Balance of repairs, roofs and gutters of side track of carpenter shop of industrial building of fire protection, farm barns of current expenses on hand to new account $15 293 632 120 3,183 28,540 8,736 84 00 52 00 09 70 06 $41,521 21 AUGUST, 1916. CREDITS. Balance on hand August 1, 1916 Cash from State Treasurer: Account of current expenses Cash from other sources $8,736 06 27,979 78 1,915 37 $38,631 21 DEBITS. Account Account Account Account Account Balance of of of of of on side track carpenter shop industrial building fire protection, farm barns current expenses hand to new account $135 00 646 33 120 00 65 69 28,428 13 9,236 06 $38,631 21 SEPTEMBER, 1916. CREDITS. Balance on hand September 1, 1916 Cash from State Treasurer : Account of current expenses Cash from other sources 27,979 82 1,947 96 $30,163 84 DEBITS. Account of side track Account of dining room, men Account of carpenter shop Account of fire protection, farm barns Account of current' expenses Balance on hand to new account $180 11 1,185 261 37,375 148 25 70 64 84 70 71 $39,163 84 �TRAVERSE CITY STATE HOSPITAL. 33 OCTOBER, 1916. CREDITS. Balance on hand October 1, 1916 Cash from State Treasurer : Account of current expenses Cash from other sources Cash loan from Traverse City State Bank $148 71 27,574 30 2,275 36 7,000 00 $36,998 37 DEBITS. Account Account Account Account Balance of of of of on side track carpenter shop fire protection, farm barns current expenses hand to new account $95 57 87 34,377 2,380 05 65 29 75 63 $36,998 37 NOVEMBER, 1916. CREDITS. Balance on hand November 1, 19.16 Cash from State Treasurer: Account of current expenses Cash from other, sources $2,380 63 55,099 87 2,486 58 $59,967 08 DEBITS. Account Account Accotmt Balance of of of on carpenter shop fire protection, farm barns current expenses hand to new account $299 515 37,821 21,330 63 40 13 92 $59,967 08 DECEMBER, 1916. CREDITS. Balance on hand December 1, 1916 Cash from State Treasurer : Account of current expenses Cash from other sources $21,330 92 20,048 76 1,941 79 $43,321 47 DEBITS. Account Account Account Balance of of of on carpenter shop fire protection, farm barns current expenses hand to new account $380 21 34,608 8,311 06 90 18 33 $43,321 47 JANUARY, 1917. CREDITS. Balance on hand January 1, 1917 Cash from State Treasurer: Account of current expenses Cash from other sources $8,311 33 20,631 30 3,377 42 . $32,320 05 DEBITS. Account of current expenses Balance on hand to new account $28,500 63 3,819 42 $32,320 05 FEBRUARY, 1917. CREDITS. Balance on hand February 1, 1917 Cash from State Treasurer: Account of current expenses Cash from other sources. $3,819 42 20,631 32 2,380 92 $26,831 66 DEBITS. Account of current expenses Balance on hand to new account $22,769 07 4,062 59 $26,831 66 �34 STATE OF MICHIGAN. MARCH, 1917. CREDITS. Balance on hand March 1, 1917 Cash from State Treasurer: Account of current expenses Cash from other sources $4,082 59 40,631 32 2,272 70 $46,966 61 CUBITS. Account of current expenses Balance on hand to new account $30,254 72 16,711 89 . $46,966 61 APRIL, 1917. CREDITS. Balance on hand April 1, 1917 Cash from State Treasurer: Account of current expenses Cash from other sources $16,711 89 26,920 77 6,376 10 * $50,008 76 ^^^^^^^^=^=^^ DEBITS. Account of current expenses Balance on hand to new account $36,048 91 13,959 85 $50,008 76 MAY, 1917. CREDITS. Balance on hand May 1, 1917 Cash from State Treasurer: Account of current expenses Cash from other sources $13,959 85 26,920 78 8,303 01 $49,183 64 DEBITS. Account Account Account Balance of track scales of fire protection, farm barns of current expenses on hand to new account $1,459 129 36,300 11,293 95 83 34 52 $11,293 26,968 3,033 2,962 52 49 21 20 $49,183 64 JUNE, 1917. CREDITS. Balance on hand June 1, 1917 Cash from State Treasurer : Account of current expenses Cash from other sources Balance (overdrawn) to new account $44,257 42 DEBITS. Account of current expenses $44,257 42 SUMMARY. THE STATE OF MICHIGAN, In account with A. J. Maynara, Treasurer of the Traverse Gity State Hospital, for the fiscal year ending June SO, 1917. CREDITS. Balance on hand July 1, 1916 Cash from State Treasurer : Account of current expenses Cash loan from Traverse City State Bank. Cash from other sources Balance (overdrawn) to new account $10,855 349,366 7,000 38,995 2,962 86 29 00 99 20 Account Account Account Account Account Account Account $150 2,028 3,201 11 240 4,265 399,282 84 25 83 70 00 04 68 of of of of of of of repairs, roofs and gutters.. side track carpenter shop dining room, men industrial building fire protection, farm barns. current expenses $409,180 34 $409,180 34 �TRAVERSE CITY STATE HOSPITAL. 35 ABSTRACTS. OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE TRAVERSE CITY STATE HOSPITAL FOR THE FISCAL YEAR ENDING JUNE 29, 1918. THE STATE OF MICHIGAN. In account with A. J. Maynard, Treasurer of the Traverse City State Hospital, for the al)ove named period, as follows: JULY, 1917. CREDITS. Cash from State Treasurer : Account of current expenses Account of addition, dining room, women Account of fire pump Account of laundry machinery Account of farm Cash from other sources Balance (overdrawn) to new account $30,893 4,232 2,500 5,000 14,461 2,816 489 06 00 00 00 50 12 80 $60,392 48 Balance Account Account Account (overdrawn) June 30, 1917 of addition, dining room, women of farm of current expenses DEBITS. •. $2,962 696 14,461 42,271 20 89 50 89 $60,392 48 AUGUST, 1917. CREDITS. Cash from State Treasurer : Account of current expense Cash from other sources $45,893 06 1,999 82 $47,892 88 DEBITS. Balance Account Account Balance (overdrawn) August 1, 1917 of addition, dining room, women of current expenses on hand to new account $489 488 37,079 9,835 80 16 30 62 $47,892 88 SEPTEMBER, 1917. CREDITS. Balance on hand September 1, 1918 Cash from State Treasurer : Account of current expenses Cash from other cources $9,835 62 40,893 06 1,761 83 $52,490 51 DEBITS. Accoun of addition, dining room, women Account of current expenses Balance on hand to new account $599 03 37,033 33 14,858 15 $52,490 51 OCTOBER, 1917. CREDITS. Balance on hand October 1, 1917 Cash from State Treasurer : Account of current expenses Cash from other sources $14,858 15 31,776 55 3,150 25 $49,784 95 DEBITS. Account of repairs, roofs and gutters Account of addition, dining room, women Account of fire pump Account of current expenses Balance on hand to new account $81 507 58 38,624 9,508 00 46 14 80 55 $49,784 95 �36 STATE OP MICHIGAN. NOVEMBER, 1917. Balance on hand November 1. 1917. Cash from State Treasurer : Account of current expenses... Cash from other sources $9,508 55 Account Account Account Account Account Balance $624 189 4,771 973 40,442 6,513 of of of of of on 41,776 55 2,230 67 addition, dining room, women. fire pump laundry machinery laundry fire repairs current expenses hand to new account 93 62 67 OS 70 77 $53,515 77 $53,515 77 DECEMBER, 1917. CREDITS. Balance on hand December 1, 1917. . Cash from State Treasurer : Account of current expenses... Account of laundy fire repairs. Cash from other sources $6,513 77 Account Account Account Account Balance $208 57 3,394 34,034 20,223 of of of of on 36,776 58 12,361 30 2,267 24 addition, dining room, women. fire pump laundry fire repairs current expenses hand to new account $57,918 89 98 07 62 95 27 $57,918 89 JANUARY, 1918. CREDITS. $20,223 27 Balance on hand January 1, 1918. Cash from State Treasurer : Account of current expenses. . Cash from other sources Account Account Account Account Account Balance of of of of of on 65,810 27 3,955 25 $455 5 36 209 32,305 56,977 addition, dining room, women. fire pump laundry machinery laundry fire repairs current expenses hand to new account 46 00 00 54 25 54 $89,988 79 $89,988 79 FEBRUARY, 1918. CREDITS. Balance on hand February 1, 1918. Cash from State Treasurer : Account of current expenses... Cash from other sources Account Account Account Account Balance of of of of on addition, dining room, women. fire pump laundry repairs current expenses hand to new account $56,977 54 15,810 27 1,822 46 $74,610 27 $234 1,027 463 29,976 42,909 20 25 35 26 21 $74,610 27 �TRAVERSE CITY STATE HOSPITAL. 37 MARCH, 1918. CREDITS. $42,909 21 Balance on hand March 1, 1918. Cash from State Treasurer : Account of current expenses. Cash from other sources Account of Account of Account of Account of Balance on 35,810 30 2,422 08 addition, dining room, women. fire pump laundry lire repairs current expenses hand to new account $2 874 126 49,697 30,440 10 64 88 13 84 $81,141 59 1,141 59 APRIL, 1918. CREDITS. $30,440 84 31,612 38 3,281 04 Balance on hand April 1, 1918. . . . Cash from State Treasurer : Account of current expenses. Cash from other sources Account Account Account Balance of of of on $61 70 45,027 20,173 addition, dining room, women. fire pump current expenses hand to new account 95 94 64 73 $65,334 26 $65,334 26 MAY, 1918. CREDITS. Balance on hand May 1, 1918. .. Cash from State Treasurer : Account of current expenses. Cash from other sources. .. . 31,012 38 3,219 42 Account Account Account Account Balance $315 9 1,988 47,440 5,252 of of of of on repairs, roofs and gutters. .. . addition, dining room, women. laundry fire repairs current expenses hand to new account 82 13 36 10 12 $55,005 53 $55,005 53 JUNE, 1918. Balance on hand June 1, 1918.. .. Cash from State Treasurer : Account of current expenses. Cash from other sources $5,252 12 26,612 51 2,295 _35 Account Account Account Account Balance $217 1,074 192 31,652 1,023 of of of of on fire pump laundry fire repairs. . . laundry machinery. . . . current expenses hand to new account. 34 19 33 27 85 $34,159 $34,159 98 �38 STATE OP MICHIGAN. SUMMARY. Tim STATE OF MICHIGAN, In account with A. J. Maynard, Treasurer of the traverse City State Hospital, for the fiscal year ending June %9, 1918. CREDITS. Cash from State Treasurer : Account of addition, dining room, women $4,232 00 Account of fire pump 2,500 00 Account of laundry machinery 5,000 00 Account of farm 14,401 50 Account of laundry fire repairs 12,361 80 Account of current expenses 435,276 97 Cash from other sources 31,221 53 $505,053 30 DEBITS. Balance (overdrawn) July 1, 1917 Account of repairs, roofs and gutters Account of addition, dining room, women Account of fire pump Account of farm Account of laundry machinery Account of laundry fire repairs Account of current expenses Balance on hand to new account -. . $2,962 396 3,888 2,500 14,461 5,000 5,230 466,590 1,023 20 82 29 00 50 00 02 62 85 '$305,053 30 We have carefully examined the accounts of A. ,J. Maynard, Treasurer of Traverse City State Hospital, for the biennial period ending June 30, 1918, and have compared the same with the books and vouchers and verified the same by further comparison with the books of the Steward, and hereby certify to the entire correctness of them. H. C. DAVIS, S. E. NEIDHAKDT, C. E. MILLEK, Auditing Committee. �TRAVERSE CITY STATE HOSPITAL. 39 STEWARD'S REPORT. For the biennial period ending June 80, 1918. ANALYSIS OF RECEIPTS AND DISBURSEMENTS. RECEIPTS. Maintenance, etc., of State patients Maintenance, etc., of private patients Treatment, etc., general hospital patients Farm: Prize money for A. R. O. records, Holstein cows Refund of amount paid on purchase option on land Freight on feed refunded Sale of: Bulls Colt Hides Wood Feed sacks Hay ' Buckwheat Vegetables Steel fence post Arsenate of lead Hog serum $784,64;! 26 23,110 37 25,839 70 $233 50 100 00 48 47 5,312 75 50 00 883 08 189 00 213 70 225 80 0 50 16-27 232 16 00 25 00 Sundry accounts 7,325 39 12,321 38 Special appropriations: Fire protection, farm barns Addition, dining room for women Fire pump Laundry machinery Farm Laundry fire repairs (insurance) 151 4,232 2,500 5,000 14,461 12,361 73 00 00 00 50 30 $891,955 63 DISBURSEMENTS. 1. Officers' salaries 2. Food: Wages Meat and Butter Flour Coffee Tea Sugar Other provisions Fuel for cooking $28,352 10 fish $23,793 55,227 44,034 42,097 5,628 2,382 18,105 66,471 4,994 76 52 91 00 94 75 48 68 84 3. Clothing: Wages Clothing and material $4,477 17 47,396 01 4. Laundry: Wages Gas Soap and soap-making material Electric irons Baskets Machine fittings Duck and felt Washing soda Starch Blue $9,421 138 4,236 51 133 47 300 1,903 136 28 80 76 33 61 68 19 04 47 03 62 262.736 88 51,873 18 16,397 53 �STATE OF MICHIGAN. 40 5. Heat'mq and Light: Wages Coal and Kerosene Electric supplies freight 6. Floral, greenhouse and (/rounds: Wages Survey and map of grounds Implements Seed Trees and plants Hose Fencing 7. Medical department: Wages Drugs Medical supplies, etc Medical books 8. Office, stationery, etc.: Wages Postage Telephone and telegraph Blanks and forms Stationery Typewriters Filing eases 9. Amusement and instruction: Wages, librarian Books Flags Pins for graduate nurses Tickets to circus and fair for patients Moving picture films Games, etc Tuning pianos Music for patients' parties., 10. Furniture and household sup-plies: Wages Soap Polish, etc B^loor oil Brooms, brushes, etc Furniture Bedsteads Bedding Carpets, rugs, etc Dry goods Stoves Hardware Utensils Baskets and tubs Crockery Wrapping paper Toilet paper Matches -. 11. Carriages, barn and vehicles: Wages Auto trucks Automobile supplies and repairs Gasoline Lubricating oil Registration of trucks Dray • 12. Improvements and repairs: Wages Electric supplies Hardware Lime and cement Glass Roofing Rope Implements Paints and oils Brick , $9,964 112,819 16 632 64 08 10 95 $7,753 761 342 214 172 172 578 26 05 69 19 42 68 85 $135,749 3,459 3,022 18 41 25 03 00 $7,588 830 1,314 261 1,158 126 123 16 70 64 43 41 90 42 $405 159 102 31 125 47 254 10 86 — - 00 55 33 72 62 73 66 50 00 $3,897 2,812 238 120 2,289 743 1,450 17,056 655 4,749 259 449 3,005 72 2,229 232 1,229 66 53 26 89 88 35 80 60 67 23 18 58 39 09 98 62 97 45 82 $2,286 1,879 687 1,021 59 24 50 80 20 56 31 48 00 00 $31,007 1,023 1,400 1,658 445 422 154 374 2,897 192 14 99 43 62 96 81 91 68 94 10 $123.432 77 9,995 14 142,248 69 11,403 66 1,223 11 41,560 29 6,008 35 �TRAVERSE CITY STATE HOSPITAL. 12. Improvements and repairs—Continued: Asphalt and shingles Tin Wire porch panels Lumber Sash and doors Iron pipe and fittings Iron and castings Boiler repairs Steel rails, etc Water closets Sewer pipe Radiators Machine repairs Belting Pump . and motor Stoker repairs Driving well " Refrigerators Gas 13. 14. 15. Machinery: Lubricating oil Vegetable paring machines Packing Soda ash Fire hose Stoker parts Machine fittings, etc Boiler insurance . > .-. Farm, garden and stock: Wages: Teamsters, etc Barnmen Registry and testing stock Advertisinfl stock Hay Straw Feed Calf meal Oil meal Corn Oats Spraying material and paris green "..... Limestone Land plaster Fertilizer Implements Milking machine Boiler Binder twine Dairymen's coats Blacksmithing Shavings and sawdust Horses Harness Veterinary Bull purchased Hogs purchased Disinfectant Hog serum Rent of land i Seed and trees Express and freight on stock sold Freight on cow to Marquette and return Traveling expenses inspecting and purchasing stock... Miscellaneous: Wages Traveling expenses : Medical Superintendent Steward Pathologist Engineer Assistant Physician Alcohol bond Tobacco Fire insurance premium Accident insurance premium Firemen's coats Services of Traverse City Fire Department Redemption of taxes on side track lots Recording deeds of side track lots 41 $156 33 42 1,307 79 4r,4Sl 1,380 303 179 336 151 299 127 286 807 254 175 787 6 80 74 50 94 19 68 31 36 24 07 47 58 68 69 00 61 00 00 87 — $411 12 625 00 136 43 483 35 180 00 144 84 7730 171 00 $14,449 39 7,013.54 1,821 75 808 98 13,138 26 4,130 81 19,194 64 391 56 915 46 1,642 18 4,034 93 785 14 360 01 123 20 1,554 56 1,283 15 243 40 62 45 72 00 37 73 110 81 197 65 3,403 19 406 64 478 40 200 00 40 02 80 21 165 62 787 39 1,500 94 93 16 55 60 82 54 $3,638 23 114 188 12 4 14 10 5,279 11,125 745 55 25 203 3 50 70 36 00 00 00 48 33 77 50 00 19 75 $50,835 31 2,229 04 79,665 31 �42 STATE OF MICHIGAN. 15. Rtiscellvncovs—Continued: Half-tones for report Attorney's fees for collection of delinquent accounts... Settlement of damage to fruit trees by patient Patients' expenses home, elopements, etc Refunded money Purchases for patients : 16. General Hospital: Wages Drugs X-ray supplies, etc Gas Refunded money Furniture Electric fans Sterilizer Electric current Architect's plans Telephones 17. Special appropriations: Side track Repairs, roofs and gutters Fire protection, farm barns Farm Addition, dining room for women Fire pump Laundry machinery Dining room for men Carpenter shop Industrial building Laundry fire repairs Total $22 50 75 1,054 775 11 45 00 00 88 66 84 $4,789 101 1,252 242 566 27 133 90 64 166 66 28 74 96 39 65 80 82 50 26 00 90 $703 412 4,265 14,461 3,889 2,500 5,000 11 3,201 240 8.230 . 30 66 04 50 29 00 00 70 83 00 02 $23,409 64 7,502 30 42,914 34 $901,787 64 SUMMARY OF INVENTORY OF THE TRAVERSE CITY STATE HOSPITAL TAKEN AT THE CLOSE OF THE FISCAL YEAR ENDING JUNE 30, 1918. Buildings $916,850 00 Land 70,680 00 Side track and right of way 28,000 00 Stock on farm 48,819 50 Dispensary : 2,654 40 Pathological laboratory 3,813 50 Library and chapel 835 13 Office fixtures, etc 2,456 43 Administration buildings 2, 3 and 4 4,382 22 Wards, furniture and fixtures 36,875 40 Cottage 21, furniture and fixtures 2,849 05 Cottage 23, furniture and fixtures 2,990 15 Cottage 24, furniture and fixtures 1,973 63 Cottage 25, furniture and fixtures 1,737 29 Cottage 26, furniture and fixtures 2,054 05 Cottage 27, furniture and fixtures 3,010 10 Cottage 28, furniture and fixtures 1,280 60 Cottage 29, furniture and fixtures 3,397 59 Cottage 30, furniture and fixtures 2,789 53 Cottage 31, furniture and fixtures 1,679 41 Cottage 32, furniture and fixtures , 1,644 06 Cottage 34, furniture and fixtures 2,506 67 Cottage 36, furniture and fixtures , 2,744 36 Cottage 38, furniture and fixtures 733 79 General hospital 1,741 81 Sewing room 1,262 16 Industrial building 1,392 07 Kitchens and bakery 5,056 48 Dining room, men 3,918 40 Laundry 10,104 36 Engine room . . . . '. 39,250 72 Store fixtures 743 13 Farm and barns 5,176 02 Groceries 24,798 20 Meats 4,178 40 Clothing 20,359 11 Boots and shoes 4,878 05 Notions 5,372 06 Dry goods 10,713 51 Crockery 1,027 32 Silver and plated ware 106 01 Hardware 1,654 78 $1,288,498 45 �TRAVERSE CITY STATE HOSPITAL. 43 REPORT OF THE MEDICAL SUPERINTENDENT. To the Board of Trustees: Gentlemen: The following statistical tables of the hospital during the biennial period ending June 30, 1918, have been prepared under more or less difficulty. The American Medico-Psychological Association, which represents the most scientific work along the lines of mental diseases, has recognized that the statistics from the various hospitals throughout the United States have been so various and varied that it has been difficult to secure anything like uniformity. A committee appointed by this organization eventually adopted a uniform classification and recommended its use in all the hospitals of this country. This classification of mental diseases, together with the accompanying tables, was adopted after the close of our biennial period, and it necessitated going back over the two years' work, reclassifying and completely remodeling our former statistical tables. In the future we anticipate that the change will be of great benefit, not only to the American Medico-Psychological Association, but to each individual hospital caring for nervous and mental cases. The forms for these tables have been furnished for use and publication by the Bureau of Uniform Statistics, The National Committee for Mental Hygiene. All information requested on these tables cannot be furnished at the end of this biennial period. In future years, with our books modified to meet the demands, it may be possible to provide uniform information. TABLE I.—GENERAL INFORMATION.—Data correct at end of institution year, June 30, 1911. Date of opening as an institution for the insane, November 30, 1885. Type of institution: State, county, endowed private, or unendowed private? State. Hospital plant— Value of hospital property— Real estate including buildings $1,003,040.00 Personal property 157,488 51 Total. 31,160,528 51 Total acreage of hospital property (includes grounds, farm and garden and sites occupied by buildings) Acreage under cultivation during previous year Men. Medical service— 883 560 Women. Total. 1 1 4 1 5 5 1 6 Clinical assistants Total physicians ... .... �STATE OF MICHIGAN. 44 TABLE I—GENERAL INFORMATION—Concluded. Men. Employes on pay roll (not including physicians)— Graduate nurses Other nurses and attendants. All other employes Women. 12 83 20 18 147 105 155 115 270 50 % 916 35 % 816 1,732 64 85 Total employes Patients employed in industrial classes or in genera.1 hospital work on date of report Patients in institution on date of report (excluding paroles) Total. TABLE II.—Financial statement for the fiscal year ending June 30, 1917. RECEIPTS. For maintenance of patients— Balance on hand from previous fiscal year From appropriations—public patients From paying patients—private patients From all other sources Total receipts for maintenance For all purposes other than maintenance including new buildings, additions, improvements, etc.— Balance on hand from previous fiscal year From all other sources $ 6,813 349,366 9,632 34,751 38 29 89 42 $400,563 98 $ 4,042.48 151 73 $ Total receipts 4,194 21 $404,758 19 DISBURSEMENTS. Expenditures for maintenance of patients— Salaries and wages Provisions Farm and garden Clothing Furniture and furnishings Fuel and light Ordinary repairs and shops Medical supplies Transportation of patients Miscellaneous, including general supplies, lawns, roads, grounds, etc Total expenditures for maintenance .' Expenditures for all purposes other than maintenance including new buildings, additions, improvements, etc $145 ,300 37 115,008 04 32,174 54 23,28B 75 11,370 18 37,113 31 10,280.16 2,997.32 593 74 21,158 27 $399,282 68 8,437 71 Total expenditures Amount returned to state treasurer or other officials less overdraft Total disbursements, less overdraft $407,720 39 2,962 20 $404,758 19 TABLE III.—Movement of INSANE patient population for year beginning June SO, 1916, and ending June 30, 1917. Includes all patients admitted as insame who are on books of institution regardless of the method of admission, whether voluntary, committed, emergency, temporary care, for obaservation or otherwise; but does not include those who are only dispensary or out-patient cases. Males. Females. Insane patients on books of institution at beginning of institution rear Admissions during year— a. First admissions b. Eeadmissions Total admissions c. Transfers from other institutions for the insane.. Total received during year Total under treatment durig year. Total. 916 777 1,693 177 43 102 31 279 74 220 133 5 42 2 9 37 42 42 7 278 1,194 179 956 457 2,150 13 �45 TRAVERSE CITY STATE HOSPITAL. TABLE III.—Concluded.—Movement of insane patient population. Males. Females. Discharged from books during year— e. Transferred to other institutions for the insame Insane patients remaining on books of institution at end of insti- Totals. 21 41 14 66 16 33 37 18 118 1 68 19 186 278 140 418 916 816 1 732 74 29 73 15 7 TABLE IV.—Nativity of first admissions and of parents of first admissions for the year ending June SO, 1917. 156 1 1 ' 2 Belgium 1 26 China Cuba Denmark . . England *Europe Finland France Germany Greece Hawaii Holland .... . ... India Ireland Italy Japan Philippine Islands Poland Porfco Rico 238 1 1 101 ' '2' 4 3 3 9 4 35 22 82 1 6 1 6 1 *Not otherwise specified. 52 61 113 2 4 2 6 26 28 50 2 9 4 23 4 6 34 ' '4' 1 1 9 1 5 1 2 6 2 1 7 1 7 2 3 3 6 8 9 1 2 3 4 6 7 "d o ' 3 13 1 1 6 1 5 2 1 15 1 1 2 17 3 5 8 5 9 2 2 4 7 14 3 3 6 2 3 14 1 10 2 21 2 1 4 1 2 i 1 3 2 3 1 6 3 9 5 1 6 7 4 1 11 1 10 1 9 1 19 2 5 5 10 1 1 2 .... EH 2 2 3 13 1 Wales tWest Indies Total ~5 g i 99 200 1 1 1 2 3 6 1 1 1 2 i 2 14 2 3 20 1 11 2 6 Scotland South America Spain ~3 § 0 EH Females. Africa *Asia w V "S Totals. Males. Females. Nativity. Females. Parents of male Parents of female patients. patients. Patients. 230 111 • 2 12 14 26 5 6 11 341 230 230 460 111 111 222 flncludes Newfoundland. (Except Cuba and Porto Kico. �46 STATE OP MICHIGAN. TABLE V.—Citizenship of first admissions for the year ending June 30, 1917. Males. Citizens b y birth . . . . Citizens by naturalization Aliens . ... .... Total Females. Total. 117 71 188 26 22 48 3 33 1 6 4 39 179 100 279 TABLE VI.—Psychoses of first admissions for the year ending Juno 30, 1917. Psychoses Senile psychoses, total (d) Depressed and agitated states in addition to deteriorate) Paranoid states in addition to deterioration Psychoses with cerebral arteriosclerosis -. Alcoholic psychoses, total Males. Females. 26 18 1 1 6 26 29 2 Total. 13 6 2 1 1 3 8 5 1 39 24 2 2 2 9 34 34 3 1 1 1 1 11 11 2 . _ . 2 3 1 1 4 1 1 4 (a) Opium (and derivatives), cocaine, bromides, chloral, 4 6 24 8 11 28 13 11 5 4 9 14 3 8 1 2 2 35 5 8 20 2 1 (h) 2 1 1 1 1 1 1 52 21 22 1 1 1 2 21 2 19 i 1 �TRAVERSE CITY STATE HOSPITAL. 47 TABLE VI.—Concluded.—Psychoses of first admissions. Psychoses. . Paranoia and paranoic conditions . . (a) Deterioration . . ( c ) Other conditions .... .... ( a ) Hysterical type . . . . . .... (c) Neurasthenic type Psychoses with constitutional psychopathic inferiority Undiagnosed psychoses (a) Epilepsy without psychosis (c) Drug addiction without psychosis (d) Constitutional psychopathic inferiority without chosis (e) Mental deficiency without psychosis . . (f) Others Males. .... ... .... .... .... .... .... psy- Females. 14 6 4 2 2 4 5 5 4 2 4 1 20 8 2 3 10 2 1 53 3 10 2 9 7 1 5 16 3 62 42 2 5 42 7 2 2 3 8 2 2 6 3 6 3 Total. �TABLE VII.—Race of first admissions clasiified with reference to principal psychoses, for the year ending June 30, 1917. Traumatic. Total. With cerebral arteriosclerosis. Senile. General paralysis. With cerebral syphilis. J! 1 fe I t With Huntington's chorea. Race 1i 3 3 1 12 112 Greek Hebrew Irish jj fS 3 £ jj I 1 J & 1 3 iS S a 1I I i& I 8 1 A & s, I 1 9 1 13 S £ I 1i i i 8 1 3 1 1 4 17 4 7 2 24 6 3 11 2 2 7 25 16 3 19 13 54 166 1 1 11 35 •> 1 19 8 24 2 1 11 i With Due to With other brain drugs and brain or nervous Alcoholic. other exotumor . diseases. genous toxins. 16 4 20 18 2 •>: 2 5 3 "3 3 2 i 1 7 1 1 i i 3 3 1 1 i 2 9, 1 2 1 1 2 1 ^ 2 Italian* Scotch 1 1 1 2 1 1 i 2 1 i i 1 S fe i f �10 8 18 1 15 q 13 1 28 10 3 2 3 1 1 6 3 3 ' Turkish Welsh "West Indian § Mixed Total '10 111 341 9 ', 96 13 31 'B s 2 1 9 1 14 ") 5 34 1 1 1 1 ' *Includes "North" and "South." tNorwegians, Danes and Swedes. tincludes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, Ruthenian, Servian, Slovak, Slovenian. §Except Cuban. 1 1 1 1 2 i § i» CO H O ffl O S3 �TABLE VII.—Continued.—Race of first admissions classified with reference to principal psychoses. 1Vith pe lagr a With other somatic diseases. With conParanoia With Unand Epileptic Psychoneu- stitutional mental diagnosed paranoic psychoses. roses and psychoneuroses. pathic deficiency. psychoses. conditions. inferiority. Involution Dementia Manicdepressive. r melanpraecox. cholia. Not insane. Race. 1 S f£ 3 $ j I 3 j£ S 8 1 S £ 1 1 i & I 1 a tS 1 H 1 I 1 i 1 £ J 1 1 s S 1 S eS 1 1 (S £ "rt S [=i I J 1 1£ H 1£ I i 1 American Indian 3 £ Bulgarian Cuban 2 East Indian English Finnish i 1 2 12 1 n 2 2 1 1 8 7 15 4 3 f 1 5 3 1 4 1 1 2 5 2 1 4 2 5 1 2 Greek Hebrew Irish 3 23 3 4 1 1 1 7 i 3 4 4 3 7 1 1 1 1 1 2 3 1 .23 — 7 4 27 2 5 'i a 1 1 2 2 1 1 7 5 8 1 1 1 "2 i "i i 2 Italian* Scandanavianf Scotch ii 1 1 i 1 1 1 1 3 1 2 5 1 2 1 3 1 1 1 2 1 1 i 1 1 1 "i 7 1 �o 2 I 1 9 3 1 9, 3 3 3 1 1 1 1 1 1 1 1 1 1 •> ? 4 3 2 1 4 ? Turkish Welsh West Indian? 1 Mixed 1 2 Total . . ... 4 f, 3 6 •>4 ffl 9 ^» 2 9 n 14 11 14 6 ?o 4 4 S 5 5 10 9 9 2 9 1 1 3 3 5 ft m 16 *Includes "North" and "South." fNorwegians, Daaea and Swedes. ^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, Ruthenian, Servian, Slovak, Slovenian, ' 1 1 9 3 53 ^Except Cuban. q «' fel O M H H OB w o 02 �52 STATE OF MICHIGAN. TABLE VIII.—Age of first admissions classified with reference Under 15 years. Total. 15—19 years. 20—24 years. 30—34 years. 25—29 years. Senile 26 With cerebral arteriosclerosis . . . 26 29 With cerebral syphilis 2 I 13 8 5 39 34 34 3 1 1 11 1 "03 -5 "o H M s j! fa JS "rt I Females. 1 13 Females. m 03 Females. Psychoses. 1 s J 3 1 1 1 4 1 With Huntington's chorea With other brain or nervous 11 1 1 1 Due to drugs and other exoWith pellagra With other somatic diseases 4 24 2 21 2 28 14 6 52 2 35 Paranoia or paranoic conditions 14 Epileptic psychoses 4 Psychoneuroses and neuroses. . 5 With constitutional psycho2 pathic inferiority With mental deficiency 6 6 4 5 20 8 10 2 3 10 5 16 2 1 53 2 9 Undiagnosed psychoses Total 1 2 3 .... 62 230 111 341 1 2 1 1 . . . . "4' 2 10 2 3 1 3 1 4 2 5 3 2 8 i 7 2 9 6 6 12 2 2 1 1 1 1 2 2 .... 3 1 1 i 2 1 1 1 1 "4' "a 12 12 7 1 6 6 "3' i '"4 1 2 1 2 7 2 6 1 7 5 2 19 22 16 38 15 10 25 �53 TRAVERSE CITY STATE HOSPITAL. "f 45—49 years. i fe 1 1 .... "«' 6 1 1 1 "§' "9 '12' "2" 4 "e" i 4 3 1 2 1 3 1 1 1 1 2 1 1 8 "2 1 27 21 2 1 3 •3 3 £ 1 tS 1 "<>' 1 5 1 2 1 .... 3 "3' 1 5 1 1 1 1 '"i 48 21 jg 7 1 5 1 3 3 1 5 1 "§' 1 4 2 1 4 1 1 1 2 7 1 1 1 1 1 2 4 2 2 1 2 2 1 9 3 1 2 1 1 3 1 60—64 years. S "i 2 4 7 2 2 1 1 1 i 2 i 3 2 i 3 1 70 years and over. 69—65 years. js J I 2 1 1 £ I 4 10 4 9 2 6 3 1 1 1 1 « A _QJ « "o3 1 1 ta 3 2 1 3 &- 16 12 I g 3 24 15 2 2 1 1 1 3 3 1 1 10 55—59 years. "•>' 2 2 1 50—54 years. Females. s1 40—44 years. Females. 35—39 years. Females. to principal psychoses, for the year ending June 80, 1917. 1 7 4 1 5 7 1 8 3- i 4 30 20 7 27 20 8 28 21 7 28 1 1 .... 1 4 1 1 1 5 1 20 5 25 11 5 1 1 16 29 1 14 43 �STATE OP MICHIGAN. 54 TABLE IX.—Degree of education of first admissions, classified with reference principal psychoses, for the year ending June SO, 1917. Illiterate. Reads and writes. Total. High school. Common school. With other brain or nervous diseases . . . Due to drugs and other exogenous toxins With pellagra Dementia praecox Paranoia or paranoic conditions Paychoneuroses and neuroses With constitutional psychopathic inferiority Undiagnosed psychoses Total £ 1 1 fo 26 13 39 3 26 8 34 29 5 34 "2 2 1 3 ii 1 1 4 2 i 11 "2 4 2 6 24 28 52 i 2 21 14 35 •3 "rt 1 £I 1 2 3 53 9 62 3 1 1 "i 'e 1 "3 230 111 341 13 i 'i 3 5 1J "ca &* $ i i 4 6 2 2 1 8 'ie 15 31 i 1 4 11 10 21 4 "4 8 5 2 7 i 1 .1 1 4 '5 3 13 'is 11 I i 4 5 16 2 5 4 g 2 5 i i i i "i i i "2 rS _f 6 1 1 2 3 "5 3 i "i ' -3 £ £ 4 "7 'is "7 25 1 4 18 5 23 2 2 19 2 21 9 i 2 14 6 20 4 4 8 5 5 10 2 3 5 6 10 16 "3 I 1 Females. 03 Senile With cerebral arteriosclerosis General paralysis With cerebral syphilis 8 3 m "ca i 1 1 2 1 1 1 1 i i i "i "2 3 16 29 18 47 143 70 213 27 11 3g jj ^ •a8 £ s fe 2 2 7 "3 i i "i ^ 3 1 3 1 i i i i i i i i i '3 i i 11 4 15 "1 "2 "2 3 9 1 2 3 27 g 35 "7 Unascertained College Psychoses. to 1 "i i 1 i "2 i i 5 12 �TRAVERSE CITY STATE HOSPITAL. TABLE X.—Environment of first admissions, classified with reference to principal psychoses, for the year ending June SO, 1911. Total. Urban. Unascertained. Rural. Psychoses. J "3 Senile 26 26 29 2 General paralysis J & 1 1 13 g 5 1 39 34 34 3 11 10 11 1 £ 7 3 3 t£ 18 ' 9 13 16 14 17 1 1 '5' ii' .... With other brain or nervous diseases Alcoholic 'li 4 24 2 21 14 4 5 2 6 1 53 With constitutional psychopathic inferiority 1 2 28 14 6 4 5 3 10 2 9 11 "5" "ji' "i' 5 2 1 88 48 136 113 H 21 19 1 | fe H . . . . '_' 7 6 .... 1 1 .... 4 2 6 2 52 10 16 '26 14 12 2 1 "3' 1 35 6 9 i2 "8 2 20 3 5 10 3 8 3 2 5 ... 1 4 2 10 3 7 2 5 1 1 1 16 "T 2 3 2 5 1 3 2 3 62 22 5 3 25 24 230 111 341 Total 1 I "2" '"2 4 2 26 . . . . 20 3 13 2 1 1 3 .... 3 7 3 2 i 3 Y 6 2 2 "3 6 i 29 7 i 8 53 166 29 10 39 TABLE XI.—Economic condition of first admissions, classified with reference to principal psychoses, for the year ending June 30, 1917. Dependent. fotal. Marginal. Comfortable. j§ £ Unascertained. Psychoses. | | H s '20' is' 8 5 1 39 34 34 3 16 15 7 1 1 11 i s Senile With cerebral arteriosclerosis General paralysis 26 29 2 £ & "9 3 3 1 H & "8' '25' 18 10 10 21 1 1 "i 4 1 1 $ S £ S "3 i i "J' 2 2 1 i 1 1 "9 14 22 1 2 1 1 1 9 'Y | & £ With Huntington's chorea it With pellagra 9 .... 4 24 Manic-depressive 2 Involution melant-holia 21 Dementia praecox 14 Paranoia or paranoic conditions 4 Epileptic psychoses Psychoneuroses and neuroses 5 With constitutional psychopathic inferiority . . . 2 6 With mental deficiency Undhgnosed psychoses 1 53 Total 1 2 28 ii 6 4 5 3 10 2 9 6 "5' 3 2 "3 18 52 2 2 "8 16 35 "3 2 12 1 20 8 2 6 4 4 10 "3 '3 2 5 4 9 13 2 16 1 1 1 3 62 '22' 4 26 30 230 111 341 yi 75 44 119 139 2 20 '9 4 1 4 i i 4 5 38 2 25 16 1 8 2 3 2 34 52 191 "3 5 Y i i i i i i 13 .... 15 1 8 .... .... 2 1 2 .... 1 "i 2 28 3 3 �56 STATE OP MICHIGAN. TABLE XII.—Use of alcohol by first admissions, classified with reference to principal psychoses, for the year ending June 30, 1S1.1. Total. Abstinent. Temperate. Intemperate. Unascertain ed. Psychoses. Senile General paralysis With cerebral syphilis jj t J -a 1 1 H 26 26 29 13 8 5 39 34 34 2 1 3 1 1 11 11 | 3 4 6 4 p£ I 11 8 1 15 14 5 1 & 1 2 20 2 25 1 6 2 4 14 11 20 14 4 5 Psychoneuroses and neuroses With constitutional psychopathic inferiority . . . 2 6 6 4 5 3 10 1 20 8 .... 10 5 16 4 3 3 1 9 5 3 4 1 9 1 53 2 9 3 62 "i' 1 6 1 10 2 i 81 115 38 15 34 5 1 J 4 2 14 12 13 9 i 1 7 .... 1 2 2 1 1 "3' '45' 53 84 3 "o B 12 13 9 1 2 "i' ' "3 12 11 3 7 7 fe 1 1 13 "2' 2 1 5 1 6 52 "5 2 9 35 230 111 341 i 11 2 28 Total &K 1 4 24 2 21 Paranoia or paranoic conditions H 6 "z "S " 4 5 "3" 5 2 6 13 3 1 1 •a g| 1 "o "2' 11 i .... 3 1 7 2 9 1 2 2 2 1 1 2 2 5 2 2 2 4 7 3 3 4 4 '46' 1 2 1 1 2 3 87 74 12 86 �TRAVERSE CITY STATE HOSPITAL. 57 TABLE XIII.—Marital condition of first admissions, classified with reference principal psychoses, for the year ending June SO, 1917. Total. Single. Married. Widowed. J S to Unascertained. Separated. Divorced. ~csi Senile With cerebral arteriosclerosis General paralysis With brain tumor With other brain or nervous diseases. . . ji Is 8 "s3 fe 1 26 13 39 26 8 34 29 5 34 2 1 3 ii 1 1 11 Due to drugs and other exogenous toxins Females. Psychoses. ssS £ "S 3 2 5 14 1 1 2 21 4 4 20 "i £ 2 1 2 "3 s H 3 17 3 24 4 24 1 3 J o "3 6 i 6 3 o "ea ~o & E-< S & H 8 8 16 4 4 8 3 - 1 4 'i 1 'i i J & "S J "ea 1 1 £I 1 1 "i i i Paranoia or paranoic conditions Psychoneuroses and neuroses With constitutional psychopathic in- 4 2 6 3 1 5 24 28 52 'io "2 i2 11 21 32 3 1 2 2 1 21 'ii 35 i9 "s 27 2 "5 7 14 4 5 6 20 4 8 5 10 2 3 5 6 10 16 Not insane Total . . . 5 2 3 3 5 8 2 -2 6 2 1 1 2 5 8 13 1 2 3 59 9 62 "l4 ' 2 1 33 1 1 1 6 1 1 5 13 3 5 1 3 1 1 3 1 1 2 3 4 37 '2 1 1 1 2 1 EH i With pellagra Manic-depressive Involution melancholia Dementia praecox 3 o i i 1 i •1 i i i 1 i 1 i "i i. "i 2 i 1 2 i 2 3 2 2 230 111 341 70 28 98 126 56 182 23 18 41 3 4 5 5 10 3 3 'ie 7 �58 STATE OF MICHIGAN. TABLE XIV.—Psychoses of readmissions for the year ending June 30, 1917. Males. Traumatic psychoses , (a) Simple deterioration Females. Total. 3 2 3 1 1 2 (d) Depressed and agitated states in addition to deteri3 2 General paralysis 2 3 4 Tabes 3 3 (d) Acute paranoid type 1 1 (f) Chronic hallucinosis 1 1 1 1 Alcoholic psychoses, total (a) Pathological intoxication . (a) Opium (and derivatives), cocaine, bromides, chloral, (d) Other exogenous toxins .. Manic-depressive psychoses, total 9 (d) Mixed type (e) Circular type Involution melancholia . 2 (a) (b) (c) (d) Paranoid type Katatonic type Hebephrenic type Simple type . . .... 15 6 1 8 18 8 27 2 1 4 1 6 1 21 3 1 1 1 4 15 7 7 3 1 9 1 1 3 1 2 2 1 2 (d) Anxiety neuroses 1 (b) Alcoholism without psychosis (d) Constitutional psychopathic inferiority without psychosis (f) Others 7 7 4 4 1 1 2 2 �TRAVERSE CITY STATE HOSPITAL. 59 TABLE XV.—Discharges of patients, classified with reference to principal psychoses and condition on discharge, for the year ending June 30, 191T. Recovered. Total. Psychoses. 1 s Traumatic Senile With cerevral arteriosclerosis With cerebral syphilis 4 3 1 1 Unimproved. i J, J jg & I i 5 6 3 2 3 2 1 Improved. 1 J — i£ i J 1 1 1 3 2 3 1 1 & 1 2 '3' 3 2 1 1 1 6 ' 1 i i Not insane. | | •a H S (^ "o f 67 7 '74 67 7 74 1 "2 2 1 1 1 2 With Huntmgton'a chorea 1 With other brain or nervous diseases 12 1 1' 4 15 4 6 14 29 6 2 2 "'S Due to drugs and other exogenous toxins With pellagra 22 30 52 15 11 26' Paranoia or paranoic conditions 5 Kpileptic psychoses 17 Psychoneuroses and neuroses 8 With constitutional psychopathic inferiority . . . 2 5 3 6 2 "2 Total 160 i 3 4 4 2 2 6 6 1 2 "2 7 4 5 7 6 is 8 4 12 1 4 1 15 1 1 1 1 2 16 1 1 74 72 232 .... "2 ii 1 1 67 10 20 . . . . 14 2 4 i2 is' "2 21 16 37 41 33 74 31 1 16 47 �STATE OF MICHIGAN. 60 TABLE XVI.—Causes of death of Patients, classified with re Total. With cerebral arteriosc erosis. Senile. General paralysis. Alcoholic. Manicdepressive. J 1 General diseasesMalaria Smallpox i 3 S ™ 1. Females. 1 Females. Causes of death. Jj I 8 1 (S i& J8 1 S £ •a 1 3 •aS 1 iS (5 s f£ I 1 Scarlet fever Diphtheria Dysentery Pellagra Acute articular rheumatism Other forms of tuberculosis Spyphilis (non-nervous forms) Diabetes Other general diseases 2 3 2 2 i 4 3 3 13 6 1 19 1 9 2 1 1 Nervous system— Cerebro-spinal meningitis Diseases of spinal cord Apoplexy (cerebral hemorrhage). . . . "§ 'is" '2!' General paralysis of insane 26 6 32 Cerebro-spinal syphilis 1 1 2 Exhaustion from other mental diseases 9 11 20 Brain tumor Other diseases of brain Epilepsy 5 11 6 Chorea Other diseases of nervous system . . . 1 1 Circulatory system— Acute myocarditis Chronic pericarditis Acute endocarditis Chronic endocarditis Total 1 1 2 5 5 1 1 1 i 1 5 19 12 1 4 1 55 8 2 2 "2 84 2 7 2 .... 'e' 7 1 11 139 14 i 1 2 2 i L i 'i' 2 1 2 1 2 2 8 8 1 1 15 16 2 •i' ' 4 1 4 •y 1 -1 2 14 26 29 6 5 32 35 1 �«0 (£• to *-*-::: • • Males. Females. Males. Total. Females. - : : : : : : : : : : : : : : : : : : to- • • Total. Females. Males. Totals* Females. Males. Total. to • • • • to cc • ** .,_,.. Females. Total. Females. - • i-- Males. Total. ~ • : : : : : : : : . . . i—i : : : : : : „ : : CO Males. Crt- • • i--- • . • • ^- • • • • to. • : : h-i • • • to- : : • ; CO *- *•• ES : : : : : - Females. : : : : tO Males. to • • • 1—> • CO ID Total. Females. Males. ill *i ""^ g-3 8- IT s-sS o B _, �62 STATE OP MICHIGAN. TABLE XVI—Continued.—Causes of deaths of patie With cerebral arteriosclerosis. Senile. Total. General paralysis. Alcoholic. depressive. Circulatory System — Continued. Arteriosclerosis 18 £ 8 i S J s 1 &*i H S 26 4 2 6 12 2 2 2 2 10 .... 2 *oi I 6 18 2 2 2 1 1 S •a S a I 1 TO S 3 "=3 1 fc< £ Females. J Females. 8 *e3 Females. Causes of death. 1 Other diseases of circulatory system. Respiratory system — 2 2 2 2 Other diseases of the respiratory Digestive system — Other diseases of the stomach (cancer excepted) Other diseases of digestive system (cancer and tuberculosis excepted) Genito-urinary system — 7 Other diseases of kidneys and annexa 3 "i" 1 3 2 .... 1 1 1 Other diseases of genito-urinary sysDiseases of the skinOther diseases of the skin Diseases of the bones and locomotor system (tuberculosis and rheuma- i Violence— Total 1 i 1 1 1 2 1 3 118 68 186 1 1 25 8 33 27 8 35 29 ^(T 35 3 — 3 1 1 2 16 18 �TRAVERSE CITY STATE HOSPITAL. 63 Involution melancholia. Paranoia or paranoic conditions. Dementia pracox. j 1& 11 13 $ 1 £ 9 ~o H J "« 22 *lncludes group 22 "not insane." j & 4 3 1 4 Epileptic psychoses. J5 1 ta I 1 1 1 1 2 1 3 13 9 22 Psychoneuroses and neuroses. With constitutional psychopathic inferiority. Females. nts classified with reference to principal psychoses. s*rt •3 *C3 £ 1 1 £ J *ca I 1 1 1 With mental deficiency. i 2 •3 "o H 1 1 1 3 'All other psychoses. J 2 4 1 "o 1 H 1 1 6 10 �STATE OF MICHIGAN. 64 TABLE XVII.—Age of patients at time of death, classified Under 15 years. Total Under 15—19 years. 20—24 years. 30—34 years. 25—29 years. Senile 25 With cerebral arterosclerosis . . . 27 General paralysis 29 With cerebral syphilis 1 With Huntington's chorea 1 J 1 ^J & 11 £ "rt "o H J 1 "55 "o H a <U 1 8 33 8 35 6 35 1 2 2 2 Females. 1 •3 Females. J Females. Psychoses. -/, 1 1 1 2 3 "i "2 i 7 7 1 — £ 2 •3 "o H 2 4 3 3 With other brain or nervous 3 S With pellagra With other somatic diseases Dementia prfpcox Paranoia or paranoic conditions Epileptic psychoses, tote- Due to drugs and other exo"l" "i 16 18 13 9 22 4 4 9 •22 is .... 1 2 1 1 1 2 1 "2' 2 1 .... 2 '"3 With constitutional psycho2 Not insane Total 1 118 1 1 1 1 3 1 1 68 186 i 1 1 1 4 3 7 3 7 10 �TRAVERSE CITY STATE HOSPITAL. with reference 1 & 9 to principal psychoses, for the year ending June 30, 1917. 40—44 years. 35—39 years. | 1j 9 6 65 1 1 2 45—49 years. 50—54 years. i i *3 | H 7 1 2 1 [S 6 1 "(>' •a 2 2 55—59 years. S 3 £ 5 "i' 2 3 60—64 years. | 1 I 3 2 1 2 1 1 S 4 4 1 1 65—69 years. 70 years and over. J £ 1 H 2 1 1 5 8 (S 1 1 1 S 6 9 20 13 11 7 5 3 ^ 1 "3' 1 1 1 2 1 1 3 1 13 1 3 3 1 3 1 1 2 1 4 3 1 3 2 4 3 4 2 i 1 1 1 1 1 1 1 1 1 i 3 1 1 2 3 1 2 1 2 1 1 1 7 9 1 16 3 T 2 1 1 1 7 9 16 13 5 18 9 3 12 9 5 14 2 14 6 27 18 3 1 1 2 1 1 2 38 18 56 2 1 1 1 1 20 1 �66 STATE OF MICHIGAN. TABLE XVIII—Concluded.—Total duration of hospital life of patients Less than 1 month Total. 1—3 months. 4—7 months. 1 I 1 8—12 months. 1—2 years. Psychoses. g 1 3 tS Senile 25 With cerebral arteriosclerosis. . . 27 29 1 J J8 | 1 £ 8 33 8 35 6 35 1 2 2 2 5 9 2 S I 3 5 9 2 4 6 5 1 £ I 1 1 i 5 8 5 1 3 5 8 'i 2 1 •a £ j§ "rt as 1 £ 4 3 2 5 . 5 3 9 2 I 5 8 2 i j| "rt "ea 4 1 10 2 3 4 £ 1 1 I 6 4 14 1 1 With other brain or nervous <t 1 2 2 Due to drugs and other exWith pellagra With other somatic diseases... . Paranoia or paranoic conditions 2 2 2 16 4 18 13 9 4 9 22 4 22 1 1 1 1 3 1 1 'is' With constitutional psycho2 1 Total 118 68 186 1 1 18 2 9 1 3 10 1 1 1 1 13 31 1 16 3 19 18 i 2 5 1 1 1 1 3 23 10 7 1 1 17 1 18 1 1 1 2 2 1 2 3 1 1 18 36 �TRAVERSE CITY STATE HOSPITAL. 67 dying in hospital classified according to principal psychoses. 9—10 1 1 2 1 1 2 1 £ I 1 1 1 *60 [£ 1 1 1 I 2 1 fS 1 13—14 years. years. « J "rt 1 11—12 years. years. 3 1 1 iS I S 1 fe 20 year andsover. 15—19 years. I "efl Females. 1 2 i i 7-8 5—6 years. 3—4 years. 8 I "s J £ 1 "3' 1 1 1 1 i 1 2 2 2 2 4 1 1 3 1 1 4 1 1 1 5 2 3 12 9 2 7 5 2 7 fc 1 1 1 3 1 2 1 1 9 1 1 5 1 1 4 9 1 1 2 2 3 1 1 1 1 3 1 3 i 1 1 1 4 1 7 1 1 2 2 1 3 1 1 2 2 3 5 8 2 6 14 �69 TRAVERSE CITY STATE HOSPITAL. TABLE I.—GENERAL INFORMATION.—Data correct at end of institution year, June 30, 1918. Date of opening as in institution for the insane, November 30, 1885. Type of institution: State, county, endowed private, or unendowed private? State. Hospital plant Value of hospital property— Real estate including buildings $1,015,530 00 Personal property 272,968 45 Total »1,288,498 45 Total acreage of hospital property Acreage under cultivation during previous year 883 560 Women. Men. Medical service— Assistant physicians Total physicians 1 3 1 1 4 4 1 5 Women. Men. Employes on pay roll— Other nurses and attendants . . . . Patients employed in idustrial classes or in general hospital Patients in institution on date of report (excluding paroles) . Total. Total. 19 77 24 26 142 112 160 120 280 50% 988 35% 867 1,855 7 65 88 �70 STATE OF MICHIGAN. TABLE II.—Financial statement for the fiscal year ending June SO, 1918. RECEIPTS. For maintenance of patients— Balance on hand from previous fiscal year From appropriations—public patients From paying patients—private patients From all other sources Total receipts for maintenance For all purposes other than maintenance including new buildings, additions, improvements, etc.— Overdraft from previous fiscal year From all other sources $ 2,741 435,276 13,486 17,735 25 97 48 05 $469,239 75 $ 5,703 45 38,554 80 Total receipts 32,851 35 $502,091 10 DISBURSEMENTS. Expenditures for maintenance of patients— Salaries and wages Provisions Farm and garden Clothing Furniture and furnishings Fuel and light Ordinary repairs and shops Medical supplies Transportation of patients Miscellaneous, including general supplies, lawns, roads, grounds, etc Total expenditures for maintenance Expenditures for all purposes other than maintenance including new buildings additions, improvements, etc $147,707 31 121,419 52 37,439 92 24,109 26 11,811 55 82,073 68 10,366 91 3,413 55 461 14 27,787 78 $466,590 62 34,476 63 Total expenditures Amount returned to state treasurer or other officials Balance on hand at close of year $501,067 25 None 1,023 85 Total disbursements, including balance on hand $502,091 10 �TRAVERSE CITY STATE HOSPITAL. 71 TABLE III.—Movement of insane patient population for year beginning June SO, 1917, ana ending June 30, 1918. Includes all patients admitted as insane who are on the books of institution regardless of the method of admission, whether voluntary, committed, emergency, temporary care, for observation or otherwise; but does not include those who are only dispensary or out-patient cases. Males. Insane patients on books of institution at beginning of inAdmissions during year— c. Transfers from other institutions for the insane Females. 916 816 1 732 132 41 113 33 245 74 173 146 319 91 34 51 21 142 55 298 218 516 1 214 1 034 2 248 Females. Males. Discharged from books during year— e. Transferred to other institutions for the insane Total discharged and died during year Insane patients remaining on books of institution at end of Total. Total. 15 41 13 34 4 119 23 28 15 17 1 83 38 69 28 51 5 202 226 167 393 988 867 1 855 939 6 12 9 941 12 2 1 780 18 14 g 15 3 5 SUPPLEMENTARY DATA Average daily number of Insane patients actually in instiNeurological cases Epileptics (not feebleminded) Feebleminded cases (not epileptics) Feebleminded epileptics 3 4 1 �STATE OF MICHIGAN. 72 TABLE IV.—Nativity of first admissions and of parents of first admissions for the year ending June SO, 1918. Parents of male Parents of female patients. patients. Patients. Nativity. S United States Africa *Asia Australia Belgium Bohemia tCanda Central America China Cuba England *Europe Finland France Greece Hawaii Holland Hungary Ireland Italy . Japan Mexico Norway Philippine Islands Poland Porto Rico Portugal Roumania Russia Scotland Spain Sweden Turkey in Asia Turkey in Europe Wales JWest Indies Other countries Unascertained Total *Not otherwise specified, 1 £ I 1 §t 1 69 74 143 59 68 127 4 2 2 4 3 3 6 1 11 1 36 24 24 48 1 19 1 15 2 34 1 1 5 3 3 4 1 20 1 3 4 4 2 17 1 6 7 8 '3 37 2 1 3 2 1 5 1 13 1 11 2 24 1 1 107 95 202 1 3 25 1 4 3 3 10 1 ... « 1 1 5 1 15 1 1 1 2 2 4 2 2 4 2 2 2 2 4 4 1 1 2 10 5 15 8 6 14 3 1 4 5 3 8 1 1 2 5 2 7 6 6 12 3 3 6 1 4 8 12 7 1 3 1 4 7 1 6 1 6 1 12 1 1 2 1 2 166 5 .1 2 4 4 7 6 13 11 12 23 134 300 166 166 332 134 134 268 flncludes Newfoundland {Except Cuba and Porto Rico. �TRAVERSE CITY STATE HOSPITAL. 73 TABLE V.—Citieenship of first admissions for the year ending June 30, 1918. • Males. Citizens by birth .. Citizens by naturalization Females. Total. 106 95 201 30 24 54 24 15 39 166 134 300 6 Aliens Citizenship unascertained Total 6 TABLE VI.—Psychoses of first admissions for the year ending June 30, 1918. Psychoses. Females. Males. Traumatic psychoses Senile psychoses, total 31 (d) Depressed and agitated states in addition to deterior(e) Paranoid states in addition to deterioration Psychoses with cerebral arteriosclerosis Psychoses with cerebral syphilis 4 1 2 3 2 3 4 6 23 19 is 38 26 1 i Alcoholic psychoses, total (a) Pathological intoxication (c) Acute hallucinosis (e) Korsakow's psychosis (f) Chronic hallucinosis (g) Chronic paranoid type Manic-depressive psychoses, total (a) Manic type . . (b) Depressive type (c) Stupor (d) Mixed type . . (e) Circular tvpe Involution melancholia (a) Paranoid type (b) Katatonic type (c) Hebephrenic type Paranoia and paranoic conditions (a) Deterioration Psychoneuroses and neuroses, total 6 1 2 1 1 1 1 1 2 1 1 2 1 1 44 1 21 8 1 11 1 14 3 3 1 2 24 (c) Drug addiction without psychosis (d) Constitutional psychopathic inferiority without psy- 2 1 2 1 1 (d) Anxiety neuroses 7 1 1 6 8 2 6 . 18 12 49 34 5 22 (b) Presbyophrenic type Total. 3 12 6 4 9 36 15 14 2 4 1 13 4 5 3 1 17 20 2 4 1 1 34 12 6 14 2 8 6 1 5 22 9 4 5 3 4 1 21 1 55 5 1 1 2 2 12 1 6 6 1 1 4 3 14 18 5 15 �74 s 3 e •3 T j-4 ^ Due to drugs and other erogenoua olic, I! il 5.2 With other brai or nervous diseases. •mi •mi • (M-* • • -<N -i-l i^ CO g - S C4OS STATE OF MICHIGAN. -N • 10 • g •* •C^ffH •CON �1« 1 1 1 18 9 41 14 3 3 166 114 inn q 7 1 2 1 1 2 1 2 f) 1 f> 1 1 1 1 1 1 fi It Turkish Welsh West Indian§ Mixed Total "Includes "North" and "South". Ruthenian, Servian, Slovak, Slovenian. 1 'S 5 fNorwegians, Danes and Swedes. §Except Cuban. 1 1 4 <j 11 1R 4<t '1 IS 18 1Q 1 1 1 1 1 7 'fi 1 1 1 1 ? (Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, H O M H H oo B O �TABLE VII—Concluded.—Race of first admissions classified with reference to principal psychoses. With pellagra. With other somatic diseases. Manic- Involution depressive. melancholia. With constituParanoia UnPsychoneuWith tional and diagnosed Not Epileptic mental paranoic psychoses. roses and psychopsychoses. insane. neuroses. deficiency. pathic conditions. inferiority. Dementia praecox. Pace. J •as 1 £ £ S I o> J w 1 cS 1 | 1s H J 1 J ri ^ S 1 .— 1 |"3 .— — S £ b 12 & g S '", H & a ^ i i^ i n — 1 iS I s I I£ S . ._ 1 i Cuban Dutch and Flemish , East Indian Finnish 9 1 1 9 French 2 Greek 4 1 4 Irish 2 4 13 17 Females. „ 4 6 f 1 4 3 7 1 1 2 4 3 "i 2 4 5 8 13 1 1 1 2 1 1 2 1 1 1 1 1 2 i ii 2 12 11 23 1 4 1 1 2 5 4 2 "fl 1 3 2 Italian* 1 1 1 1 1 1 1 VFemales. 1 1 1 2 1 Portuguese j Scotch... ' . . . . ' . 1 1 ?, �2 Turkish 4 9 4 9 9 1 1 9 2 1 1 .... I Welsh West Indian § Mixed 1 1 4 ?, Total . . "Includes "North" and "South". Ruthenium, Servian, Slovak, Slovenian, ?, 2 4 9 8 31) 44 fNorwegians, Danes and Swedes. §Eicept Cuban. 4 1 1 >i 3 1 •>1 13 34 14 ?, 5 R ?,?, ? 3 2 6 4 q 1 5 a 1 ? 7 1 1 1 1 1 9 4 1 1 34 K 1 '1 1' 1 55 {Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, as H Q i—I H Kl a Wo 02 �STATE OF MICHIGAN. 78 TABLE VIII.—Age of first admissions classified with reference Under 15 years. Total. 15—19 years. 20—24 years. 25-29 years. 30—34 years. -^ I 1 3 £ 18 49 15 38 7 26 1 1 1 1 2 31 With cerebral arteriosclerosis. . . 23 19 With Huntington's chorea. . . . J "rt 2 Females. 1 1 J •a E£ 1 s Females. $ « Females. Psychoses. I 1 3 J J &H I 2 2 With other brain or nervous fi fi Due to drugs and other exWith pellagra 2 8 1 21 Paranoia or paranoic conditions 14 3 Psyche-neuroses and neuroses. . 1 With constitutional psycho- Total 36 13 8 6 5 2 44 1 34 22 9 6 i i 1 1 1 1 2 3 3 2 5 1 6 3 9 4 1 5 1 1 2 9 1 1 1 2 2 4 2 1 1 'si' 21 55 i i 4 4 3 166 134 300 i i 6 6 12 6 7 1 3 3 2 "21 9 1 2 1 0 3 4 1 5 4 3 7 18 16 10 26 14 11 25 �TRAVERSE CITY STATE HOSPITAL. 79 to principal psychoses, for the year ending June 30, 1918. 1 1 1 2 9 "2 2 2 2 4 jjj "rt £ 1 3 2 5 i 55—59 years. ji •a S f£ I 1 1 2 2 1 1 2 1 "i' 2 1 1 1 fc 5 5 1 4 5 2 5 7 5 5 1 1 "i 3 3 1 1 1 "2' 2 1 1 1 4 1 1 2 1 2 1 2 2 2 1 1 1 1 1 4 3 7 4 2 6 3 5 8 3 1 15 13 28 17 13 30 6 21 27 11 9 "i 3 1 H 1 5 2 1 1 5 2 2 1 4 2 1 1 6 "i' S3 8 1 7 60—64 years. Females. p£ J8 1 50-54 years. 45—49 years. Females. 40—44 years. 35—39 years. 65—69 years. 70 years and over. _• J H 1 l£ H a 1 2 3 10 8 21 6 16 8 37 14 1 1 1 1 26 53 1 7 1 1 i ii i 4 1 5 1 1 2 4 4 3 1 2 5 1 4 2 1 2 1 4 i 1 2 20 13 10 23 13 7 20 8 5 1 fx< & 1 1 1 1 2 3 15 8 23 1 1 27 �STATE OF MICHIGAN. 80 TABLE IX.—Degree of education of first admissions, classified with reference to principal psychoses, for the year ending June 30, 1918. Illiterate. Reads and writes. Total. High school. Common school. College. \« Unascertained. jj 6 6 ? 8 1 21 14 3 1 36 44 1 13 34 8 22 6 9 5 6 Due to drugs and other exogenous With constitutional psychopathic inferi- 2 2 4 .1 1 34 21 55 "6 Total 9 1 1 1 1 4 1 1 166 134 300 10 tS i S "c3 1 5 1 6 22 8 30 2 6 6 12 11 23 1 "i 2 18 5 23 1 1 1 1 1 2 4 2 ? Js 13 a £ 31 18 49 1 i 23 15 38 2 2 19 7 26 1 1 1 1 2 Senile 11 1 fe I 1 1 1 1 1 "4 1 6 1 Females. 1 8 "1 I S Females. S Females. Psychoses. i 1 11& H 2 2 4 1 1 2 2 1 1 1 1 1 t t 8 14 13 27 10 1 1 1 2 3 5 i 1 1 1 1 3 1 1 4 5 2 1 3 1 1 1 1 1 1 1 f 6 '27 33 1 1 ] 15 7 22 6 6 12 } 2 2 4 1 5 6 JS J! 9 2 2 2 ? "2 2 1 2 1 1 ~1 1 2 12 2 2 5 15 24 15 39 102 86 188 17 12 •29 7 4 11 6 12 18 TABLE X.—Environment of first admissions, classified with reference to principal psychoses, for the year ending June 30, 1918. I Jrban Potal Unasc grtaiD ed. ]feral s "ea Tra Senile .11 ?.1 19 1 Females. Psychoses. 3 £ S i£ 1 18 15 7 1 1 4t 18 ?6 1 ?, 11 q 15 14 1° 7 '! 91 22 1 1 ? n 6 2 44 1 34 ?? 1 S 1 1? 6 f, 8 1 21 14 3 1 If) f, t, \ 11 8 6 5 34 Total lid 111 q f> J3 J 13 q 1 1 a £ 11 11 4 3 3 1 1 ?3 16 4 1 1 5 '1 1 '« q 7 2 1 6 5 1 ? 15 1? 1 3 6 11 4 M •3 J [£ 1 1 1 1 1 6 I1! 7 6 S S 1 18 1 11 11) n i 4 1 W 1 9 s 1 97 11 4' 7 100 17 S7 184 fi7 1 51 118 9 1 1 i 1 �TRAVERSE CITY STATE HOSPITAL. 81 TABLE XI.—Economic condition of first admissions, classified with reference to principal psychoses, for the year ending June 30, 1918. Psychoses. $ jl "=3 PM Senile Dependent. 1 1 18 49 4 15 38 10 7 26 2 1 I 1 1 6 '.'«' ".?'- With brain tumor 2 8 36 1 21 13 14 8 3 6 1 5 Total... eS 3 2 i i •>, 44 2 1 34 1 22 5 ' 2 9 6 "l 1 2 2 1 34 21 4 1 55 6 1 166 1,14 inn 34 1 1 S 2 3 8 7 2 3 i 7 12 2 2 2 £ "a 25 10 9 8 33 11 21 4 13 1 1 3 "3' "3 2 1 5 1 20 5 8 2 3 2 1 3 'i?' 1 9 '29' . . . . 4 & 13 3 4 7 4 4 'i?' 1 2 3 1 1 4 10 24 15 18 Comfortable. » OJ 1 F*4 31 23 19 Marginal. Females. Total. 52 log 1 22 3 £ 9 5 11 .... 20 I, 4 1 39 4 2 7R 187 23 38 fil TABLE XII.— Use of alcohol ~by first admissions, classified with reference to principal psychoses, for the year ending June 30, 1918. Total. • Abstinent. Temperate. Intemperate. J 1 Unascertained. Psychoses. Senile General paralysis With cerebral syphilis J iS S fe i £ 18 49 15 38 7 26 1 1 1 1 2 8 8 2 13 8 21 16 Tota' ~S 31 23 19 6 Psychoneuroses and neuroses J "^ S J "3 § 2 8 36 1 21 13 14 8 3 6 1 5 2 6 2 44 3 '36' 'S3' 1 34 "5' 'l2' 'i?' 22 3 7 in 9 3 5 8 2 6 2 TO ~S 1 S 1 &i s 4 24 2 4 6 2 8 1 g 3 iS 1 S 1 8 1 9 8 11 1 12 6 9 1 1 1 1 5 5 1 2 "i 1 4 "i 1 1 1 3 1 6 "l 1 5 7 2 3 1 3 'r 1 1 7 3 iS S 3 7 1 1 1 14 19 7 1 1 1 2 "2" 1 4 5 7 5 7 1 1 2 2 4 1 1 '34' 21 55 1 2 3 2 16 18 6 2 8 16 2 18 'in' 1 1 '"i 11 sno 35 95 130 26 18 44 52 2 54 55 17 72 166 134 �STATE OF MICHIGAN. 82 TABLE XIII.—Marital condition of first admissions, classified with reference to principal psychoses, for the year ending June 30, 1918. Total. Psychoses. s 1 &a "3 | Married. Single. i 1 i 1 s E£ "(3 1 "3 B PH 31 18 49 1 2 3 14 23 15 38 3 1 4 13 11 5 19 7 26 11 1 1 1 1 2 "i Senile i 6 Alcoholic Due to drugs and other exogenous Paranoia or paranoic conditions Psychoneuroses and neuroses With constitutional psychopathic inferiority Total 6 3 4 6 5 1 3 & Widowed. Separated. Divorced. 3 1& 2 2 4 2 2 4 1 1 '34 21 55 '20 "3 23 13 14 27 1 1 1 1 1 1 2 2 1 1 1 1 3 3 i 1 8 8 i 3 & £ i i i 1 1 i 2 28 30 1 1 4 4 8 6 3 9 3 3 "i 4 5 s $ 8 •a 'oS 8 3 •a 1 E£ B fa H 3o 18 15 12 27 19 5 8 13 1 1 10 1 3 1 2 2 1 8 '36 44 4 3 7 1 ] 21 13 34 16 9 25 14 8 22 4 4 3 6 9 2 2 4 1 5 6 j2 Unascertained. i i i 2 5 7 i i i 5 6 1 2 t 4 1 1 4 166 134 300 68 22 '90 59 72 131 27 37 64 4 1 5 "i "i 2 2 TABLE XIV.—Psychoses of readmissions for the year ending June 30, 1918. Psychoses. Males. Females. 1 1 Psychoses with cerebral syphilis (a) Acute hallucinosis (b) Depressive type . (d) Mixed type Involution melancholia (a) Paranoid type (c) Hebephrenic type Epileptic psychoses, total . Clouded states Psychoses with constitutional psychopathic inferiority (a) (b) (c) (d) (e) (f ) Epilepsy without psychosis Alcoholism without psychosis Drug addiction without psychosis Constitutional psychopathic inferiority without psychosis Mental deficiency without psychosis Others 2 1 1 1 2 1 1 16 10 5 18 11 6 1 1 1 5 2 1 2 3 1 1 1 2 7 1 4 7 3 4 1 1 1 1 3 i 2 Total. 2 2 2 1 2 1 1 34 21 11 1 1 1 12 5 5 2 4 2 2 1 3 10 1 5 2 1 1 1 1 �TRAVERSE CITY STATE HOSPITAL. 83 TABLE XV.—Discharges of patients, classified with reference to principal psychoses and condition on discharge, for the year ending June 30, 1918. 2 6 With other brain or nervous diseases Due to drugs and other exogenous toxins 1 3 1 4 3 7 1 1 5 "&' 2 25 35 1 15 'ii 7 5 3 "5 With constitutional psychopathic inferiority . . . 2 2 •? 3 1 34 Total 107 17 1 3 £ j§ I 2 5 2 2 84 191 15 23 38 41 3 i£ S 1 1 2 1 5 "i' "i' 1 3 3 1 1 1 2 60 11 '22' 33 14 1 .„. 1 6 26 "i 12 4 1 3 5 4 2 2 6 1 1 1 51 Unimproved. 1 24 1 13 7 1 4 4 1 3 2 4 io' •y 3 28 69 I 1 2 1 2 2 2 1 1 Not insane. Females. Senile. . 3 tS Improved, Females. •a Females. Psychoses. Recovered. Females. Total. 1 34 17 "jii 34 17 51 $ J "3' "3' "9" 3 2 i 17 3 2 1 1 1 16 12 5 2 1 1 2 33 �STATE OF MICHIGAN. 84 Total. With cerebral arteriosclerosis. Senile. General paralysis. Alcoholic. Manicdepressive. JS Females TABLE XVI—Causes of death of patients classified wilh reference ^ s & 8 1 ~s I J^ 1 Females. 8 Females. Causes of death. I S 1 "rt I 00 I 1 1 I General diseasesMalaria Smallpox Measles Diphtheria 1 Acute articular rheumatism. . Tuberculosis of lungs Other forms of tuberculosis . . Syphilis (non-nervous forms) Cancer Tumor (non-cancerous) .... Other general diseases Nervous system— Cerebro-spinal meningitis .... 1 3 1 1 2 4 8 3 13 21 3 "2 1 1 1 Apoplexy (cerebral hemor- Exhaustion from other mental diseases 11 "3 Other diseases of nervous system 1 17 27 1 i 10 21 3 3 2 1 "5' 1 1 1 1 1 1 3 4 2 6 8 'l9' "8 1 1 1 1 27 5 1 "5 1 1 ^ 5 7 12 1 1 1 13 21 1 Circulatory systemAcute myocarditis Chronic myocarditis Acute pericarditis Chronic pericarditis 2 3 Chronic endocarditis 2 2 72 52 124 Total .... 10 8 1 Other diseases of brain 1 1 1 "s "i' 1 7 General paralysis of insane . . . 19 1 "i i 2 1 4 4 1 i "i 9 3 12 4 1 1 i 1 7 11 20 8 28 1 1 3 3 8 �TEA VERSE CITY STATE HOSPITAL. 85 to principal psychoses, for the year ending June 30, 1918. Involution Melancholia. 8 •3 Paranoia or paranoic conditions. Dementia praeeox. 8 J 1 i£ 3 *C3 I fe sS 1 & I \ 5 4 9 2 2 1 1 T 1 2 3 1 Psychoneuroses and Neuroses. Epileptic psychoses. I •a iS 1 1 "l 3 H ^ 3 1 CO 1 fe I With mental deficiency.f 1 fe 1 1 2 '2 1 ,; 1 With constitutional psychopathic inferiority. i 2 2 3 •All other psychoses •a ^ iS i 1 : 1 0 \ 2 1 1 '"i ""i i i i ""i i i i i i 5 3 2 5 i i 14 1 8 1 1 22 "a" "2 1 2 3 1 6 7 *Includcs group 22 "not insane." "a 4 4 8 3 H 3 "2' 6 6 2 8 �86 STATE OF MICHIGAN. TABLE XVI—Concluded.—Causes of death of patients S Respiratory system— Bronchitis Bronehopneumonia &H I 22 51 2 2 .... 2 2 1 Pleurisy Gangrene of lungs Other diseases of the respiratory system Digestive system— Ulcer of stomach Other diseases of the stomach (cancer excepted) Diarrhea and enteritis 4 Appendicitis Intestinal obstruction ... 1 Other diseases of intestines. . . Cirrhosis of liver Other diseases of liver 1 Other diseases of digestive systen (cancer and tuberculosis excepted} Genito-urinary system— Acute nephritis Chronic nephritis Other diseases of kidneys and annexa Diseases of bladder Diseases of genital organs .... Other diseases of genito-urinary system 3 $ « 6 19 12 2 1 .... 2 1 1 J5 "3 Circulatory System — Contd. Arteriosclerosis 29 Other diseases of the arteries . Other diseases of circulatory system Females. Causes of death. 2 J 13 13 I 11 23 General paralysis. 8 13 6 1 1 1 1 1 2 2 Females. With cerebral arteriosclerosis. Senile. Females. Total. "e5 Alcoholic. Manicdepressive. J J J "c3 &J H 1 3 £ 1 i 2 dS l 3 g 3 i '"i 1 1 6 '3 1 9 1 1 2 2 fi 6 2 2 17 27 Diseases of the skin- Diseases of bones and locomotor system (tubercu!f p losis and rheumatism exf f cepted) ' Violence— Suicide Fractures Dislocations ! Homicide Other external violence F Total... 1 119 1 1 1 83 199 26 in 3fi 20 18 38 20 a 28 10 �TRAVERSE CITY STATE HOSPITAL. 87 1 1 1 fa i 3 Paranoia or paranoic conditions. Epileptic psychoses. i § 1 2 1 "rt H 3o EH 1 Psychoneuroses and neuroses. I J "ea J "g ^ With constitutional psychopathic inferiority. With mental deficiency. £ J 13 03 a £ I 1 •AH other purposes. Females. Dementia praecox. Females. 1 Females. Involution melancholia. Females. classified with reference to principal psychoses. 3 S J a iS 5 8 6 2 H 3 1 1 4 1 1 2 2 1 1 1 1 1 1 5 9 — 21 9 30 3 'Includes group 22 "not insane" 9 12 4 3 «• 8 �88 STATE OF MICHIGAN. TABLE XVII.—Age of patients at time of death classified with 1 M-i Total. Under 15 years. 15—19 years. 25—29 years. 20—24 years. 30—34 years. Traumatic With cerebral arteriosclerosis. . With cerebral syphilis With other brain or nervous £ 13 S J &J •a"o H J "rf J 1 "^ H S Females. 3 •as$ f£ § Females. Psychoses. n "o El 3, "3 tS 3 "o S3 1 1 £ 1 4 2 1 1 "i' H ID R 's'fT 26' 10 20 18 38 20 8 28 1 1 1 1 1 6 1 a 1 6 Due to drugs and other exoWith other somatic diseases .... 1 1 1 1Q 'l?' 27 21 9 30 3 4 9 5 12 9 3 5 8 i .... ""2 9 Paranoia or paranoic condiEpileptic psychoses With constitutional psycho- Not insane Total 4 4 119 83 202 ..„ 1 1 1 1 1 2 2 4 11 1 .1 4 i 5 7 �TRAVERSE CITY STATE HOSPITAL. 89 reference to principal psychoses, for the year ending June 30, 1918. S 6 •a &H 2 3 £ S 8 3 2 "2: 1 1 1 i' ::3 "2 fe i 2 3 £ 3 1 6 i 2 2 "3 "5 .... . . . . 1 6 13 1 1 2 1 1 g rt 6 12 5 9 14 I 60—64 years. f 3o C3 "c3 tS f-l 1 1 "3 3 3 1 1 1 1 2 1 2 2 7 7 i "2" 3 i i 1 2 18 9 1 i 1 6 2 6 '3 12 2 1 3 5 4 4 S « I 1 1 &H 1 1 2 2 6 1 2 3 4 1 1 1 J •a s e' 4 1 3 i 3 i 1 2 2 '3 1 1 1 1 27 8 7 70 years and over. 65—69 years. 1 2 1 6 55—59 years. OT i i 1 S 3 50—54 years. i 1 7 "s Pq 45—49 years. 15 15 8 1 Females. g 40—44 yeara. 6 '26' 9 7 Eo' 35—39 years. 3 ^ 1 30 20 .... 1 1 3 2 1 "3 2 7 1 8 3 "i' i "2' "i 1 ..„ .... 23 43 "i' '"i i 16 69 �STATE OF MICHIGAN. 90 TABLE XVIII.—Total duration of hospital life of patients dying in hospital Less than X month. ' Total. 1—3 mouths. 4—7 months. 8—12 months. 1—2 years. Psychoses. J 13 26 With cerebral arteriosclerosis . . . 20 20 With other brain or nervoua "3 PH 3 £ 10 36 18 38 8 28 1 1 1 1 1 fi 1 A 1 10 1 27 3 4 9 5 30 12 9 3 5 8 J "ea "c3 2 5 1 fe "e' I ~a 2 11 1 5 6 4 I nvolution melancholia Paranoia or paranoic conditions Psychoneuroses and neuroses . . . With constitutional psycho- Total i?' 2! "9' 4 4 119 83 202 3 3 2 1 Due to drugs and other CKOWith pellagra With other somatic diseases .... - [§ 1 3 "7 1 1 8 9 6 5 1 5 (S 2 5 1 1 s iS 1 7 6 6 1 .... "2' 2 1 1 4 1 3 1 1 (S 5 4 8 2 1 3 1 2 i 26 16 11 27 11 9 20 5 7 5 11 1 1 1 2 4 1 1 1 1 2 22 11 33 1 i 14 "I 1 1 1 12 & 'rt 1 3 10 1 H 3 nj J A S 1 3 8 �TRAVERSE CITY STATE HOSPITAL. 91 classified according to principal psychoses, for the year ending June 30, 1917. 4 1 1 2 2 6 3 1 1 1 1 1 1 2 8 2 1 1 1 1 1 1 3 1 1 2 1 1 2 1 2 21 9 2 2 5 J P=H I i 1 & 1 i i 1 3 1 J 1 J I 1 i 4 1 2 3 £ i 1 'i 20 years and over. 15—19 years. 13—14 years. .... 1 1 1 2 1 2 3' 1 1 1 3 2 1 13 3 "^ 2 1 1 1 3 1 11—12 years. 9—10 years. Females. 3 £ Females. 33 J_ &* 7-8 years. 5—6 years. Females. 3—4 years. 1 1 3 ES fu i >s 1 1 1 1 1 "i' 1 1 3 S 1 '"i 1 1 i 2 3 2 3 1 3 3 1 14 2 2 1 3 15 5 2 1 1 2 5 14 4 1 5 3 1 4 2 1 3 2 1 3 4 7 11 21 6 27 �92 STATE OF MICHIGAN. ESTIMATES OP SPECIAL APPROPRIATIONS. The following are the estimates of special appropriations requested by the Board of Trustees and submitted to the State Board of Corrections and Charities for its approval: TRAVERSE CITY STATE HOSPITAL Traverse City, Mich., Sept. 17, 1918. To the State Board of Corrections and Charities: Gentlemen: As required by Section 28, Compiled Laws of 1897, I submit herewith approximate estimates of special appropriations requested by the Board of Trustees of the Traverse City State Hospital, for a fire-proof addition to store building, for a 500 horse power boiler and automatic stoker, for an electric elevator for dining room for women, for overdrafts on special appropriations, for an ash conveyor and for repairs to roofs and gutters of hospital. I. ADDITION TO STORE. The last Legislature transferred the appropriation of |8,000.00 made by the Legislature of 1915 for an industrial building, less architect's fees (1265.00), to the appropriation to addition of store. In addition to this sum, |28,09(!.60 will be required to construct the building. Plans and estimates of cost for this addition are being prepared by the architect and will be sent to you as soon as completed. From $20,000.00 to $30,000.00 worth of goods are cared for in the present store, and the danger to them from fire is unusually great. The building is also inadequate for the needs of the hospital. Goods are stored in various parts of the basement, which renders their safeguarding more difficult. The overcrowding of the store adds to the cost of handling the supplies. The present store has no provision for the care of dried fruits, eggs, butter and other foods that require cold storage if they are to be carried in stock in any great quantity. The proposed building will include cold storage equipment for the care of such supplies. II. WATER TUBE BOILER,, CHAIN GRATE STOKER, ETC. This boiler is to replace two small boilers—one of 175 h. p. and the other of 150 h. p. The estimated cost of these improvements is as follows: Boiler $9,947 00 Setting 4,000 00 Stoker 3,000 00 Erection of stoker 1,053 00 Total $18,000 00 This equipment is very important, since the small boilers are old and likely to fail at any time. They are too small to use fuel economically. A large boiler would be not only much more efficient, but would save each year in amount of coal consumed a fair percentage of their cost. III. ELECTRIC ELEVATOR FOR DINING ROOM FOR WOMEN. The amount requested for this improvement is based upon estimates furnished" by the Otis Elevator Company. It provides for an automatic �TRAVERSE CITY STATE HOSPITAL. 93 electric elevator, automatic operation for either basement or stories, and of sufficient power to lift one thousand pounds from basement to third story. The cost of this machine is $3,500.00. All material and labor are included. This improvement is imperative. IV. ASH CONVEYOR. This machine is to automatically remove ashes from the boiler ash pits in the sub-basement to a bin outside of the boiler room. An ash conveyor is almost imperative, since during the winter months the hoist in use for conveying coal and ashes to and from the boilers is not of sufficient capacity to do the work. Last winter much difficulty was experienced in removing the ashes fast enough. The consumption of coal is from forty to sixty tons per day, and the hoist can scarcely more than handle this amount. Consequently the ashes would accumulate in the pits, as they could not well be removed by hand. We would strongly urge this improvement. The cost will be as follows: Conveyor, etc , f 1,650 00 Ash bin 600 00 Labor . . . . . . . . 250 00 Total |2,500 00 V. OVERDRAFTS. The Legislature of 1915 appropriated $8,000.00 for a shop building. Owing to the appreciation in the cost of labor and material, the cost of the building when finished was $12,670.77, or $4,670.77 more than the appropriation. This sum was paid from the current expense funds of the institution, and has been treated as an overdraft against the special appropriation. There is also an overdraft on the appropriation for dining room for men of f 1,164.60, and one of $265.00 for architect's fees against special appropriation for industrial building. The total overdraft on account of these special appropriations is f 6,001.27. We would respectfully request your Honorable Body to approve of a deficiency bill in the coming Legislature to repay the institution the money it advanced on account of these special appropriations. VI. REPAIRS TO ROOFS AND GUTTERS. There are many repairs needed for the roofs and gutters of the hospital. As their cost would be a large drain on its maintenance fund, a special appropriation of $2,500.00 is asked for these repairs. Should it become the policy of the State to treat such improvements at the State institutions as a charge against the general fund, this request will be omitted. I would respectfully add that the institution has many other needs, but, owing to the unusual economic conditions of our country, our requests have been limited to those which seem to us absolutely necessary. We do not believe it would be wise to bar the institution from the improvements above specified, and believe it will be to the best interest of the State in the long run to supply the funds to install them. �94 STATE OF MICHIGAN. RECAPITULATION. Addition to store Water tube boiler and chain grate stoker Electric elevator, etc Ash conveyor Repairs to roofs and gutters Overdrafts Total • All of which is respectfully submitted. $28,096 60 18,000 00 3,500 00 2,500 00 2,500 00 6,001 27 160,597 87 J. B. MUNSON, Medical Superintendent. MICHIGAN BOARD OF CORRECTIONS AND CHARITIES. LANSING,, MICHIGAN, November 1, 1918. Dr. James D. Munson, Medical Superintendent, Traverse City State Hospital, Traverse City, Mich. My Dear Sir: At a recent meeting of this Board your estimates for appropriations for special purposes for the ensuing biennial period were given final consideration. It is the opinion of this Board that appropriations should be made for items number 4 and 5 in the sum of $8,501.27, the same being for an ash conveyor $2,500.00, and for overdrafts f6,001.27. Item number 6 for the sum of $2,500.00 for repairs to roofs and gutters being an expenditure for upkeep, should, in our judgment, be treated as a current expense item. It is believed that appropriations for the other items may be deferred, and the estimate is therefore approved in the sum of $8,501.27 instead of $60,607.87. Very respectfully, JNO. N. McCORMICK, Chairman. M. T. MURRAY, Secretary. CHAPEL SERVICES. Religious services have been conducted regularly by the Chaplain, Rev. I). Cochlin, assisted by the Revs. Mr. Coolege, Mr. Kruse, Mr. Brown, Mr. Columbus, Mr. Ford and Mr. Elliott. ACKNOWLEDGMENTS. To the many friends of the hospital who have contributed in any way to the comfort of patients, our best thanks are extended. CONCLUSION. The period just closed has been one of great activity, and one associated with much anxiety, owing to the great war and the rapidity with �TRAVERSE CITY STATE HOSPITAL. 95 which our country prepared itself to meet the great struggle. The man power of the country was rapidly enrolled in the service of the United States, and as a result, during much of the time for the last two years, the hospital has been short of help and has been obliged to recruit as much of its help as possible from men outside the military age. It has been stated that 25% of the male population of this particular region is either in actual service in the Army and Navy, or is engaged in Governmental work. The Council of National Defense and the Red Cross organizations have been of service in organizing and helping in public service work, and have heartily co-operated with the institution in its efforts to maintain the high standard of care for its patients. Your Honorable Board has taken an intense and active interest in the institution, and I am glad to say that every employe has given their best for its safety and welfare. Many of the economic measures of the period incident to the unusual conditions of the country have proved of great service, and will in the end add much to the progress made in hospital management. The co-operative work between the Board, the Officers and heads of departments has been more general and has proved its value in almost every direction of our effort. I thank each and every member of the Board and every employe of the hospital for personal aid and support and for the patriotic efforts that have been made in behalf of the institution. All of which is respectfully submitted. J. D. MUNSON, Medical Superintendent. Traverse City State Hospital, Traverse City, Mich., November 27, 1918. �STATE OF MICHIGAN. OFFICERS AND EMPLOYES. OF THE TRAVERSE CITY STATE HOSPITAL, AND THE WAGES OR SALARIES PAID EACH, JUNE 30, 1918, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Name. Service. A.S.Rowley H V Hendricks Paul H. Piper Mary Jane Foley 2nd Asst. Physician Woman physician G. B. Pike D Cochlin C. W. Nesbitt Accountant Ina Hardy Stenographer Pearl Mahn Stenographer B.P.Burns Marie Moon General supervisor C M Prall S G Howard Phi f Anthony Klaasen Assistant store keeper Asst. Medical superintendent t Hans Tobler C. D. Lyon Mrs. Ella Sargent Gertie Flack Helene Johnson Rose McGill Jessie Tweddle W. G. Dobson J. Aniskonski Clayton M. Allen Su e ' - ' Asst. supt. sewing room Attendant Hattie Allen Hildred Brown Ruby Boulby Henry Bowles M E Baird W R Carmien Attendant Period. Rate. $3,800 00 2,900 00 1 800 00 1,200 00 1,200 00 2 500 260 1,500 65 50 00 00 00 00 00 50 50 75 100 55 00 00 00 00 00 105 00 70 00 I 800 00 1 350 00 125 00 Per annum. Non-resident. Per annum. Resident. Per annum. Resident. Per annum. Non-resident. Per month. Non-resident. Per month. Non-resident. Per month. Resident Per month. Resident. 60 55 2 100 80 00 00 00 00 00 Per month. Non-resident. 14 24 16 14 24 00 00 00 00 00 Per month. Resident. 45 2 40 68 50 00 00 00 00 00 45 22 20 38 20 00 00 00 00 00 40 20 26 20 65 00 00 00 00 00 20 45 58 49 20 00 00 00 00 00 20 22 38 46 68 00 00 00 00 00 Per day. Non-resident. Per month. Non-resident. Per month. Resident. Per day. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. �TRAVERSE CITY STATE HOSPITAL. Name. Service. 97 Period. Rate. Arthur J. Clark Earl Clark William Courson James Coyne Wm. Cosier $50 40 60 40 45 00 00 00 00 00 Per month. Resident. Per month. Resident. Per month. Resident. Essie M. Covey Mabel Carmien Wm. Childs Blanch E. Cotton 24 48 22 40 30 00 00 00 00 00 Per month. Per month. Per month. Per month. 24 22 20 65 73 00 00 00 00 00 Per month. Resident. Per month. Resident. 63 24 50 40 22 20 00 00 00 00 00 00 Per month. Non-resident. Geo. C. Dell R Dumbrifle James E. Elder Charles L. Easterday Ruth Fife 73 40 45 80 20 00 00 00 00 00 Per month. Non-resident. Geo Fate Erma Favreau J A Ford Cena Flanders 65 40 40 22 38 00 00 00 00 00 Per month. Resident. Per month. Resident. Wilma Gilson Bert Glass Alvin Gilbert Glen Ginther James McGarry 22 65 50 68 40 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Bertha Glaesmer 38 48 22 24 30 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 58 24 48 22 40 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 32 45 65 40 40 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 22 40 22 22 40 00 00 00 00 00 Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. 20 38 20 40 24 40 00 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Per month. 38 30 45 65 38 00 00 00 00 00 Per month. Resident. Per month. Resident. Evelyn M. Clark Mabel Case D. S. Dean G.J. Drost Roy Dobson Night Watchman A. S. Dobson Millie Day Attendant Marjorie GiHett Hazel Groesser Attendant Harry Ginther Grace Holly Margaret Heator Claribel L. Hawkins Attendant Attendant Atte~f"Attendant Mrs. G.B.Howe L J Hier W. B. Hamilton Loyd Haltley Attendant Nellie Hill John H. Hine Edith Hermal Cramer Judd Attendant Anna Johnson Waldemar J. C. Muehling Mary E. Knapp Charlotte Knauf Fred Krone Attendant , Attendant Attendant *. Resident. Resident. Resident. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Resident. Resident. Resident. Resident. Resident. Resident. Per month. Resident. Per month. Resident. �STATE OF MICHIGAN. Name. Rate. Service. Ruby Lane Clarence Lautncr Norma LaRue E. Lehn $26 20 40 20 58 00 00 00 00 00 22 40 50 28 68 00 00 00 50 00 30 22 30 52 20 00 00 00 00 00 26 '26 40 20 20 00 00 00 00 00 Per month. Resident. 22 40 65 38 29 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. 40 65 24 63 35 00 00 00 00 00 Per month. Resident. 30 20 40 22 38 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 24 00 40 00 24 00 . 38 00 40 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 73 22 24 20 20 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Non-resident. Resident. Resident. Resident. Resident. 50 24 40 45 40 00 00 00 00 00 Per Per Per Per Per month. month. month. month. month. Resident. Resident. Resident. Resident. Resident. 55 50 50 50 45 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 38 24 22 24 40 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. 22 40 20 38 30 40 00 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Per month. Resident. Resident. Resident. Resident. Resident. Resident. Attendant Esther Lewis R. E. Lackey Cecile M. LaFayette Attendant Esther Moran J. Mason, Jr Irma MacMichael Erzella McMillan Esther Miller. . Ethel McGuire Attendant Edna Morton D. S. Martin Chas. McGregor Dorothy Moser Hazel Mason Attendant .* Attendant A. "W. Nelson Jennie Nelson Attendant Agnea Nostirk Myrtle Oler Loraine OToole John Pekarik Tena Peterson Edith Pascoe . S. M. Perry F.G Park Anna Perria Pearl Rohr Flora Resell. . . Frank Rosell E. E. Sauter... F. T. Smith . Attendant . . . . Marie Skellet. . Attendant . Attendant Attendant Tillie Thoreson *. . . . Period. ' Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Per month. Resident. Resident. Resident. Resident. Resident. Resident. Per month. Resident. Per month. Resident. �TRAVERSE CITY STATE HOSPITAL. Name. Service. Perry Tobey Stanley Tobin Gladys Tharp Rate. Period. 868 24 40 22 40 00 00 00 00 00 Per month. Resident. W. Weiler Attendant Milton Walker Attendant 65 38 45 61 22 00 00 00 00 00 G. M. Yenish Attendant Chef Baker 40 24 80 80 00 00 00 00 eo oo Per month. Non-resident. 00 00 00 00 00 Per month. Resident. Cook Cook Cook 30 30 65 60 45 Per month. Resident. 65 55 35 35 35 00 00 00 00 00 30 30 40 30 40 E.G. Davidson Bessie Dalzeil Cook Cook .. A C Cline Ross Shannon Assistant cook R J Quick Delbert Orcutt Karl A. Ufcr Theodora Benson Telephone operator Dr. Sobie Ide Alraan Covey Laundryman Alice Smith Esther Phelps Alice Millet Laundress Adah Clark Mattie Smith E. D. Clakins S N McMichael R. W. Loeding J B King T P Redding Assistant engineer Carpenter Per month. Resident. Per month. Per month. Resident. Resident. Per month. Resident. Per month. Resident. Per month. Per month. Resident. Resident. 00 00 00 00 00 Per month. Resident. 30 35 40 35 15 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. 78 65 21 15 17 00 00 00 00 00 Per month. Non-resident. Per month. Resident. Per mouth. Non-resident. Per month. Resident. 21 18 28 23 28 00 00 00 00 00 Per month. Per month. Per month. Per month. Per month. Non-resident. Resident. Non-resident. Non-resident. Non-resident. 70 80 70 65 65 00 00 00 00 00 Per Per Per Per Per month. month. month. mouth. month. Non-resident. Non-resident. Non-resident. Non-reisdent. Non-resident. 2 3 2 2 3 50 50 50 50 25 Per Per Per Per Per day. day. day. day. day. Non-resident. Non-resident. Non-resident. Non-resident. Non-resident. 3 3 3 3 3 25 60 00 00 00 Per day. Per day. Per day. Non-resident. Non-resident. Non-resident. Per day. Non-resident. 3 2 2 2 60 35 00 50 50 00 Per day. Per day. Non-resident. Non-resident. Per day. Non-resident. Per month. Resident. Per month. Resident. Per month. Resident. Resident. Resident. Non-resident. Non-resident. Non-resident. �100 STATE OF MICHIGAN. Name. Service. L L Drake Rate. Period. $100 35 70 60 50 00 00 00 00 00 40 40 40 40 40 00 00 00 00 00 40 40 40 40 40 00 00 00 00 00 40 40 40 40 40 00 00 00 00 00 Chas. Denstaedt 40 40 40 47 40 00 00 00 00 00 0. C. Ballard Paul Stenke Walter Stenke George Leibrock JohnMcGill.. 40 40 43 2 45 00 00 00 50 00 L. L, Moulton E. Stanwick. . W. Frazer Mike Brooder. 2 2 90 3 55 00 00 00 25 35 G. M. Burrett A. Whaley.... David Russell , Teamster Teamster Martin Laskey. , Ed Phillips A. S. Mock. . . Joseph Rombach .... Per month. Resident. �TRAVERSE CITY STATE HOSPITAL. 101 GRADUATES OP THE TRAVERSE CITY STATE HOSPITAL TRAINING SCHOOL FOR NURSES. Anna Maude Grissinger. 1908. Ethel Beatrice Hanes. Harry Baker. Albert James Howard. Laura M. Bigbee. Ethel Lillian Johnson. Bennett P. Burns. Jessie Angie Keating. Lena Aldrich Covey. Gertrude A. Kerry. Sadie L. Dockerty. Juliana Mary Leo. Anna Carrow Evans. Gail Langworthy. Mary Louise Fink. C. Harold Leutholtz. Wesley H. Herriman. Tressie A. Miller. John O. Hoppes. Cleo Von Miller. Raymond G. Johnson. Ella Orvis Miller. Esther V. Keller. Archie Miller. Louise Kitscher. Anna Thoreson Newman. Dora Bell Lewis. Idylia Reynolds. Maria Margaret McDonald. Mina Odella Shearer. Louise E. McGivern. Catherine McKinnon. 1911. Amy Orcutt. Victor A. Patrick. Martha Clara Kitscher. Mattie Holmes Parr. Nora Belle Eamon. Florence Helen Roest. Lena Amelia Rude. Lurene Shryer. Matilda Delvena Send. Lillian Fiath Walsh. Alice Julia Thoreson. Anna M. Warner. Bertha Cornelia Peterson. Lucinda Hazel Wilson. Hazel Erveilia Edgerley. Marie Esther Orvis. 1909. Gertrude Margaret Orvis. Ada Julia Hall. Margaret Clark. Rosetta Alston. Edna Crandall. Essie Marie Johnson. Gertrude Eamon. Grace Belle Alexander. Anna Hanson. Effle Florence Grissinger. Thea Hanson. George Oliver Zeigler. Flora Hollister. Lee S. Swan. Cora Laisy. George W. Ashley. Howard Lewis. Leo S. Chamberlain. Ruth Merritield. Perry A. Tobey. Stephen H. Young. 1910. Ray H. Buttars. Loura Lela Cronkwright. Leonard A. Cluley. John F. Donovan. Nellie Taube Ellsworth. 1912. Judith Evans Kidder. Frances Edith Soss. Wilhelmina L. Oldenburg. �102 Daisy M. Lahr. Alice A. Smith. Mabel Cowles Willard. Alma E. Leggett. Emma Thnm. Otis H. Leland. 1913. Pearl LaFern Emory. Pearl Emily Tyler. " Laura M. Rude. Julia Belle Carsten. E. Margaret Mortenson. Steven A. Covey. Anna Paulina Smith. Nettie Beulah Nickerson. Leonard A. Wright. Emma R. Davis. Effle Leona Bixby. Glen L. Ginther. Hildur Hedenskog. Matilda R. Henschell. 1914. Florence L. Vivian. Ethel M. Edwards. Lena N. Smith. Kathryn B. Huff. Lyla Stieglitz. Maggie E. Heator. Matie Estelle Vincent. Catherine Paffhausen. Alice E. Hanes. Ruby Dale MacLean. Grace L. Stieglitz. Libbie Howe. Flora Dorthy Goynon. Dora Gordon Seaton. 1915. Rose Boyd. Agnes Dumbrille. STATE OF MICHIGAN. Minnie Greilick. Hazel Irish. Maude Irish. Francis Martin. Mabel Miller. Icel Northup. Evt O'Rorke. Johanna Schwartzrock. Inez Strickler. 1916. Winifred Baggiore. Hazel Bostrum. J. Madeline Clifford. Nettie Cutting. Marie Goodrich. Muriel Hanes. Celia Johnston. Lena Knight. Hilda Moran. Mary Stedrnan. Lora Walsh. Winifred Westbrook. 1918. Blanche B. Bertleson. Blanche E. Cotton. Marie E. Husby. Charlotte M. Knauf. Bertha L. Larson. Erzella B. McMillan. Esther L. Miller. Irene M. Moran. Clara M. Nelson. Mna E. Ramsey. Mae Tompkins. Metta M. Whitson. Naoma R. Winters. Edith E. Zimmerman. �TRAVERSE CITY STATE HOSPITAL. 103 APPENDIX. The State hospitals of Michigan are organized and governed Organic lawunder an act known as Act 217, Laws of 1903. This act has for its title "An Act to revise and consolidate the laws organizing asylums for the insane and to regulate the care, management and use thereof, and to provide for the apprehension of persons believed to be insane, and for their care and custody." The above act was modified in no essential respect as regards commitment of patients by the Laws of 1907, but Section 72, Public Acts of 1907, contains very important provisions regarding the care of persons who are not legal residents of the State of Michigan. The act is too long to justify its insertion, but all officers and persons interested in the commitment of patients, whose residence is in doubt, are requested to study the different sections of this act. The government of asylums is vested in boards of trustees Government. appointed by the Governor. (Section 3.) The State is divided into districts by the Joint Board of Trustees. (Sections.) The counties comprising the district of the Traverse City State Hospital are: Alpena Lake Arenac Leelanau Antrim Manistee Alcona Mason Bay Mecosta Benzie Midland Charlevoix Missaukee Clare Montcalm Crawford Montmorency Cheboygan • Muskegon Clinton Newaygo Emmet Oceana Gladwin Ogemaw Grand Traverse Osceola Gratiot Otsego Isabella Oscoda losco Presque Isle Ionia Roscommon Kalkaska Wexford Provision is made by Section 7 for the transfer of patients one'Sstrict0 from one asylum to another when conditions make such trans- to another. fer desirable. �104 Insane to be committed to hospital of their district. Classes of patients. Voluntary patients. Public arid private patients. Order void after thirty days. Bonds. Advance payment. New bonds. Temporary orders. Transfer from private to public. Non-resident Provisional discharge and readmission of patients. STATE OF MICHIGAN. A patient is not to be committed to a hospital of a district other than that of which he is a resident unless the court adjudicates that there is no room in the latter, and that there is in the former. (Section 8.) Patients are divided into three classes: Public patients, private patients, and voluntary patients. (Section 13.) Voluntary patients are patients who are not insane. They are kept and maintained without expense to the State, but cannot be received so long as there may be applications for the admission of public or private patients not cared for because of lack of room. In other words, there must be room for all others seeking admission before any voluntary patients can be received. Sec. 14, Act 155, Laws 1911, as amended by Act 94, Laws 1913, "Provides that such persons as may have been or may hereafter be adjudged to be so addicted to the excessive use of intoxicating liquors, or narcotic or noxious drugs, as to be in need of medical and sanitary treatment and care, for whose person a guardian has or may be appointed with power to restrain his said ward in some suitable hospital or asylum for treatment." Both public and private patients can be received only on an order from a probate court declaring the patient insane and stating the method of support,—whether public or private. Such an order is void unless patient is sent to the asylum within thirty days after it is issued. (Section 16.) Besides the order of commitment from the court, there must accompany a private patient a bond guaranteeing the payment of his bills. The law (Section 16) makes it incumbent upon the court to see that this bond is furnished. Until this bond is furnished the patient is regarded as a public charge. There is also required an advance payment of fifty dollars. Future payments are made at the close of each quarter. New bonds may be called for at any time by the medical. superintendent, and the laws requires the court to see that such new bonds are provided. (Section 16.) Provision is made (Section 16) for the reception of both public and private patients on temporary orders wherever conditions demand immediate attention. Section 21 provides for the transfer of a patient from private expense to public expense where conditions warrant such a change. Section 30 provides for the temporary reception and care of insane who are not residents of this State. Section 32 provides for the return to the hospital witKout a new order of patients who have been discharged on trial, where the duration of the temporary absence does not exceed six months. �TRAVERSE CITY STATE HOSPITAL. The attention of county officers is particularly called to the provisions of Section 40 regarding the state of bodily cleanliness and the clothing of patients brought to the hospital, and more particularly to that clause of the section providing for a female attendant for insane women. In conveying a patient to the hospital do not deceive him. Truth should not be compromised by professing a visit to the institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the asylum, by giving patients an impression that they are parties to the deception. Removal to the hospital should never ~be attempted when the patient is much prostrated or laboring under severe bodily illness, and care should lie taken that the excitement attending acute mental disease be not mistaken for physical strength. As friends of patients are often in doubt as to what articles of clothing it is necessary to provide, the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and vest, 2 pairs of pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair of shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemises, 3 pairs of drawers, 4 pairs hose, 3 night-dresses, 3 cotton-flannel skirts, 6 handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day, it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the institution. Jewelry should not be brought with patients. // such articles are left in their possession the hospital cannot be responsible for their safe keeping. All letters concerning patients, from individuals having the right to make inquiry, will be answered at once; and friends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at the written request of friends. 105 Insane women to be accompanied by female attendant. Removal of patients from home. Clothing. Correspondence. �106 Visiting patients. Application for admission of patients. STATE OF MICHIGAN. Where relatives of patients desire friends who are not members of the family to visit patients, they should, in every instance, furnish these friends with a letter of introduction, authorizing the interview. Application for admission should be made before the patient is brought -to the hospital. A blank will be furnished the friends which provides for a complete history of the patient's trouble. All correspondence in reference to patients should be addressed to Dr. James D. Munson, Traverse City State Hospital, Traverse City. �INDEX �INDEX. Accounts, abstract of Accounts, current, summary of Acknowledgments Admission of drug habituates Admission of public patients Admission of private patients Admission of voluntary-'patients Age of first admissions—Table 8 Age of patients at time of death—Table 17 Alcoholic first admissions—Table 12 Analysis of foods Appendix Appointments, resignations, etc Appropriations, report of Board of Stewards Boiler Chapel Clinical work Clothing Community work Correspondence. . .' Cost of maintenance Citizens of first admissions—Table 5 Causes of death—Table 16 Daily average of patients Deaths, violent Death rate Dietetics and food analysis Discharge of patients—Table 15 Domestic arts and science Degree of education—Table 9 Establishment Estimates of special appropriations Electric elevator Environment—Table 10 Economic condition—Table 11 Fire in laundry Financial statement—Table 2 Graduates of training school General Hospital General information—Table 1 Harrison Law Improvement Increase of patients Index Inventory, summary of Laundry machinery Library, report of Movement of insane population—Table 3 Marital condition of patients—Table 13 Names of officers and employes % : „ Page 32 32-34 94 104 104 104 104 52-53-78-79 64-65-88-89 56-81 11-12 103 30 25-28 10 27-92 94 14 105 8-9 106 24 46-73 6O-61-62-63-84-85-86-87 25 23 25 10-12 59-82 13 54-80 3 92-94 27-92 '. . 55-80 55-81 23 44-70 101-102 15-20 43—44—69 9 25 •. .. . 24 107 42 26 21-23 44—45-71 57-82 96—100 �110 INDEX. Page Nativity of parents—Table 4 Nativity of patients—Table 4 Needs of hospital Overdrafts O fficers, names of Porch Public health Psychoses of first admissions—Table 6 Psychoses of readmissions—Table 14 Recapitulation Receipts and disbursements Removal of patients to hospital Repairs to roofs and gutters Report of Medical Superintendent Report of State Board of Corrections and Charities Report of Board of Trustees Report of Treasurer Report of Steward Report of Auditing Committee Roll of Honor Race of first admissions—Table 7 Store, addition to Social work. Total duration of hospital life—Table 18 Visiting patients 7 Wassermann reactions X-Ray department , '. - 45-72 45-72 26 27 5—6 26 8 46-47-73 58-82 28-94 29 105 28 43 94 7-31 32-38 39-42 38 30 48-51-74-77 •. 26-92 8-9 66-67-90-91 106 15 20 � https://localhistory.tadl.org/files/original/0ae5f7fd0d569368dc9660f745b4082c.pdf 09840143b03d1baae19ffa87b24e5c08 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Report of the Board of Trustees or the Northern Michigan Asylum at Traverse City June 30, 1896. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Report of the Board of Trustees of the Northern Michigan Asylum for the biennial period ending June 30, 1896. This report includes the reports of the medical superintendent, treasurer and steward. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Lansing: Robert Smith Printing Co., State Printers and Binders. Date A point or period of time associated with an event in the lifecycle of the resource 30 June 1896 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0018 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text REPORT BOARD OF TRUSTEES NORTHERN MICHIGAN ASYLUM CITY JUNE 30, 1896 BY AUTHORITY LANSIN& EGBERT SMITH PRINTING CO., STATE PRINTERS AND BINDERS 1896 ��OFFICERS OF THE NORTHERN MICHIGAN ASYLUM. TRUSTEES. H. H. NOBLE, THOS. T. BATES, GEO. A. HART, . . . LORIN ROBERTS, . . . H . C . DAVIS, - - ' • . W . W . CUMMER, - • , - . . - ' • - ' . - - - - . ELK RAPIDS. TRAVERSE CITY. MANISTEE. TRAVERSE CITY. TRAVERSE CITY. CADILLAC. RESIDENT OFFICERS. JAMES D. MUNSON, M. D., A. S. ROWLEY, M. D., G. G. SPEER, M. D., ROBERT HOWELL, M. D., E. L. NISKERN, M. D., G. L. NOTES, M. D. MEDICAL, SUPERINTENDENT. \SST. MEDICAL SUPERINTENDENT. 1 ASSISTANT PHYSICIANS. j NON-RESIDENT OFFICERS. O. L . WHITNEY, W. P. MANTON, M. D., - STEWARD. DETROIT, MICH., GYNECOLOGIST. CHAPLAIN. REV. D. COCHLIN, - TRAVERSE CITY;- TREASURER, J. T. HANNAH, TRAVERSE CITY. �NORTHERN MICHIGAN ASYLUM. �REPORT OF THE BOARD OF TRUSTEES. To the Governor and Legislature of the State of Michigan: In accordance with the requirements of the law, the trustees have the honor to submit their report for the biennial period ending June 30, 1896, and also the reports of the medical superintendent, treasurer and steward. Twenty-four regular meetings of the board have been held, and monthly inspections of the asylum have been made by the visiting committee of the trustees. Many improvements to the buildings and grounds have been effected, and a new laundry has been constructed. We are pleased to report that we have ever found the hospital in excellent condition and the patients skillfully and kindly oared for. We can only reiterate what has been said in former reports, that the medical care has been intelligent and painstaking, and that the attendants have performed their duties faithfully and well. There have been comparatively few changes among the chief attendants, but many in the corps of assistants. Some effort should be made to render the service, if possibe, more permanent. The causes which lead to or induce frequent changes in the staff of attendants should be studied, with a view to their removal or modification if they arise from anything wrong in the conditions imposed upon the service by the institution. Sufficient pay, proper hours of labor, and comfortable homes or quarters to which the attendants can retire for rest and recreation when off duty, would tend to the permanency of the staff. With the establishment of these improvements, the position of attendant would be much more sought after by capable men and women, and that with a view of making it a life work. In this manner a still higher humanitarian spirit of caring for the insane would be inculcated. Many of our attendants are non-residents, and so far as the system affects the care of patients we can only speak highly of it. It affords the attendants a few hours each day of freedom from responsibility, a few hours of quiet rest and converse with family and friends. It should be the duty of the asylum to provide homes for its nurses, and it should be the duty of your honorable body to furnish the means for the accomplishment of this worthy purpose. During the period just closed the institution was free from epidemio diseases, and no deaths or serious injuries resulted to patients from personal violence. In August, 1894, Mrs. L. H. received fatal injuries from the falling of a tree upon her. She was sitting with a number of ladies among the trees in front of cottage "0, " The air was calm, but suddenly �NORTHERN MICHIGAN ASYLUM. a tree broke off about fifteen feet from the'ground and fell upon her. It was a singular and sad accident. Three patients committed suioide during the period. In each oase a coroner's inquest was held and a verdict rendered in aooordanoe with the facts. These were sad endings of unfortunate lives. The number of patients under treatment during the period was—males, 755; females, 614; total 1,369. The number of patients admitted was— males, 224; females, 185; total, 409. Of this number there were admitted at county expense as follows: Alger Alpena Antrim Arenac Alcona Baraga Bay Benzie Charlevoix Clare Crawford Cheboygan Chippewa Delta Dickinson Emmet Gogebic Grand Traverse Gratiot Houghton Huron Ionia Isabella losco Kalkaska Lapeer Lake... 1 13 14 2 5 2 —. 1 3 7 3 - 1 15 3 4 7 - 7 9 16 21 8 1 14 5 12 2 1 6 Leelanau Luce Mackinac Manistee Marquette Mason Mecosta Menominee Midland Missaukee Montcalm Montmorency Muskegon Newaygo Oceana Ogemaw Osceola Otsego Oscoda Ontonagon Presque Isle Roscommon Saginaw Schoolcraft St.Clair Wayne Wexford „ . Non-resident State State patients transferred from Michigan asylum Admitted at private expense 8 3 3 11 15 5 15 11 8 7 14 2 1& 9 5 1 7 3 1 3 1 1 1 8 4 2 6 13 25 18 Of the 409 patients admitted: 23 had been confined in county houses. 98 had been confined in jails. 50 had been treated in other asylums. 62 were said to have been destructive. 58 had attempted or threatened suicide. 77 were homicidal or had made homicidal assaults. 10 had been treated in hospitals. t6 had been confined or restrained at home. This shows that over one-third of the patients admitted had been dangerous to themselves or others, not taking into consideration those confined in jails and those destructive to property. It also shows how imperative the asylum becomes for the care of these unfortunate individuals. In November, 1895, fifty-four patients, and in January, 1896, fifteen patients, were transferred to the Upper Peninsula Hospital for the Insane. The room thus made was soon taken; thirty patients from the Michigan asylum, originally committed from Ionia county, were transferred to this institution, and the balance of the existing room was soon occupied by �REPORT OF THE BOARD OF TRUSTEES. 7 patients who had been awaiting admission from the various counties of the asylum district. The joint board of trustees at its meeting in July, 1895, owing to the approaching completion of the buildings at Newberry, made a new division of the counties of the State into asylum districts. By this arrangement all the counties of the upper peninsula were detached from the Northern Michigan Asylum district to form the district of the Upper Peninsula Hospital for the Insane; and Ionia county was detached from the district of the Michigan asylum and added to that of this institution. This redistrioting of the State greatly contracted the district of this institution, and doubtless it will be able to provide room for the care of all oases within its precinct for the next two years. A few patients have been received from the Eastern Michigan Asylum district, but not enough to afford it much relief. Although accommodations for one hundred patients will be provided at Newberry within the present year, yet these will not be sufficient in which to care for the accumulated oases in the State, to say nothing of the six or eight hundred new oases that will occur within the next two years. Doubtless your honorable body will be urged to make additional provisions for the care of the insane. The district of the Northern Michigan Asylum consists of the following counties: Alpena, Arenac, Antrim, Alcona, Benzie, Charlevoix, Clare. Crawford, Cheboygan, Emmet, Gladwin, Grand Traverse, Gratiot, Ionia, losco, Isabella, Kalkaska, Lake, Leelanau, Manistee, Mason, Mecosta, Midland, Missaukee, Montcalm, Montmorency, Muskegon, Newaygo, Oceana, Ogemaw, Osceola, Otsego, Oscoda, Presque Isle, Roscommon, Wexford. As nearly as can be determined, the number of insane persons in 1884, receiving public care in the State, was about 2,650. In 1894 the number had increased to about 3,600, or an increase of thirty-three per cent of insane persons, while the increase of population for the same period was about twenty-one per cent. In 1884 there were fourteen insane persons to each 10,000 of population; in 1894, sixteen insane persons to each 10,000 of population, which gives a small fraction of one per cent increase of insanity in the State during the last decade. Doubtless if the statistics for 1884 had been as accurately compiled as those for 1894, this percentage of increase of insanity would have been somewhat less. There is another factor that should be taken into consideration relative to the increase of insanity in our State. The public has gained much in confidence, and patients are now committed with less hesitancy than they were ten years ago. The circle of mental diseases which are now judged best treated in asylums is much enlarged, and many patients are now committed to the hospitals whose admission would not have been sought a few years ago. Notwithstanding the slight increase of insanity in the State, the burden of taxation for the support of this class of dependents is less than it was at the beginning of the decade. In 1885 the rate of maintenance for each patient per day was fifty-three cents, in 1886, fiftythree cents; 1887, fifty-two cents; 1888, fifty-one cents; 1889, fifty cents; 1890, forty-nine cents; 1891, forty-nine cents; 1892, forty-eight cents; 1893, forty-eight cents; 1894, forty-seven cents; 1895, forty-six cents; and for 1896 it has been placed at forty-four cents. The present �8 NORTHERN MICHIGAN ASYLUM. rate as compared with that of 1885 affords a saving in the cost of maintaining the insane of $32,850 for each 1,000 patients under treatment and $7,300 for each 1,000 patients less than in 1895. The cost of maintenance includes all care, medical supplies, attendants, board, and all the miscellaneous expenses of the institution and necessary repairs to buildings and the plant generally. When the rate charged, $3.08, is compared with the cost of maintaining the insane in institutions located in the same latitude, it will be found largely in favor of our institutions. It should also be remembered that there was over seventy per cent increase in the assessed valuation of the State in the decade from 1880 to 1890. The net increase of patients for each biennial period since the opening of the asylum has been as follows: From 1886 to 1.888, 148; 1888 to 1890, 131; 1890 to 1892, 123; 1892 to 1894, 150; 1894 to 1896, 53; total for ten jears, 605. Additional accommodations have been made in connection with this institution for over 400 patients, at a cost slightly under $300 per patient. Of the 409 patients admitted a large percentage were incurable. It is doubtful if ten per cent of the patients under treatment today in any of our institutions can be regarded as curable. The number of patients discharged during the period was 202 males and 154 females, total 356. Of this number 62 were discharged recovered, 155 improved, 41 unimproved, and 98 died. The number discharged improved is large, for the reason that it includes most of the patients transferred to the Upper Peninsula Hospital for the Insane. The re-admissions for the period were 16 males and 20 females, total 36. The re-admissions from the beginning have been 68 males and 63 females, total 131; therefore the total number of admissions, 2,271, represents but 2,140 individuals. The daily average number of patients for the period was 994^. The number of weeks spent in the asylum by patients was 103,723 1-7; this shows an increase of 129| in the daily average and 13,550 3-7 weeks' board over the last proceeding period. On June 30, 1896, there were 798 patients under treatment at State expense, 198 at county, and 17 at private expense. There were 224 persons employed by the asylum June 30, 1896, in the positions and at the wages shown by the schedule accompanying this report. During the period some changes were made in the division of labor of the officers. The scope of the steward's duties was enlarged, that he had general direction of the farm, garden, grounds, laundry, shops, store and bakery and the help employed therein. The right is reserved to the medical superintendent to direct what work shall be done in these various departments, but the steward is held responsible for the results obtained from them. This saves time to the superintendent for special observation of cases and medical work A complete change was also made in the method of issuing food supplies and of preparing the same for use. Pood supplies are all issued on requisition based on a ration containing proper amounts of proteid, fat and carbo-hydrates. A competent chef was placed in charge of the kitchen, and the results obtained have more than justified expectations not only from an economical standpoint, but in better cooking and a much wider variety of foods. �REPORT OP THE BOARD OP TRUSTEES. $ IMPBOVEMENTS. The wear and tear of the institution ia necessarily great, and if it is to be kept in perfect order, the replacement of worn out or obsolete fittings and machinery, furniture, renovation of corridors and rooms, will involve considerable expense from year to year. During the period just closed several of the wards have been repainted, many of the floors in the water closets, bath rooms and lavatories, which were decayed have been replaced with tile floors. Similarly worn out furniture and carpets have been replaced in various wards of the asylum. ICE HOUSE. An ice house 30x40 feet was erected in the fall of 1894 at a cost of about $600. The storage room for ice had previously been insufficient, and when the bay failed to freeze difficulty was experienced in obtaining a wholesome supply of ice. With the new storage house a two years' supply can be carried, so that a shortage of this very necessary article is not likely to occur again. STEWARD'S EESIDENOE. As we deemed it highly important that the steward should reside on the asylum grounds, it was decided to build a house for his use. This residence is located at the corner of Eighth and Division streets, It is an eight room, two story frame building and it is supplied with water and light from the asylum. Its cost, complete, was about $2,500. ft brings the steward in close contact with his work and with the interests of the asylum, and is an outlay which well repays the institution. TELEPHONES. In October, 1895, the Bell telephone system was discontinued and replaced with the American telephone, These phones cost $15 each, and thirty-five were purchased. At six per cent interest this is a rental of $31.50 per year for the entire system, a handsome saving over the rental previously paid. The apparatus is attractively made and has thus far given entire satisfaction. OPERATING BOOMS. Several surgical oases occurred during the period which demonstrated the need of suitable rooms in which operations could be performed under all the requirements of modern antiseptic surgery. No such rooms were originally provided in the hospital, and their need was so urgent that the construction of a small operating room was authorized in connection with the infirmaries for men and women respectively. They are 14x18 feet in size, and are connected with the infirmaries by corridors. They are fitted with porcelain sinks, etc., and the floors are laid with tile. They are lighted from three sides and from the roof, and each has a dark room for ophthalmosoopio and laryngosoopio examination. In the construction and fitting up of these buildings the effort was made to have them as little liable to infection or lodgment of germs as possible. The oeil2 �10 NORTHERN MICHIGAN ASYLUM.. ings are dome shaped; the corners are rounded, and the wall and floor line join on a curve, so that there ia little liability to the accumulation of filth in inaccessible angles. All parts of these rooms can be thoroughly washed and disinfected. As little wood as possible was used in their interior finish. The base of the walls is of Portland cement and above this they are in hard finish coated with enamel. We feel that in these rooms little, if any, risk from infection during surgical operations will ensue to patients. LOSS OF BABN. In May last the large farm barn located south and west of the asylum was fired, by lightning and consumed. It was built at a cost of $1,500, complete, and was used for the storage of hay and vegetables, and a portion would have been required for stable room. As it could not be spared from the farm needs the coming winter, it became a matter of necessity to replace it. It had long been contemplated to remove the other farm barns to the site of the one destroyed and concentrate the stock buildings about it. As is well known, the asylum owns a valuable herd of thoroughbred Holstein cattle, and as the burning of this barn necessitated the construction of new stables, it was thought best to so rebuild that the stock could be oared for without overcrowding and with special reference to light, ventilation and water supply. Much care has been given to the preparation of the plans of these barns. The most recent ideas in dairy stable construction have been incorporated in them, especially those which relate to the separate care of a small number of animals, so as to avoid the introduction or development of tuberculosis, or, if it should be introduced, to be able to limit its spread. Taking all these facts into consideration, it was thought better to construct several small stables rather than to rebuild the large barn which accommodated about 45 cows. These buildings, five in number, are plainly but substantially built and will accommodate our herd of about 100 cattle. SPECIAL APPROPRIATION, $7,500. This appropriation was made by the last legislature for the erection of a new laundry building and laundry machinery for the same. The site of the new laundry is in the rear of the shop buildings. The building is constructed of stone and brick and has a basement under a portion of it to contain the water and steam pipes and the gas-making machinery. As shown in the accompanying floor plans, the building has the general outline of a cross. It is 112 feet in length and 99 feet in width. The wings or arms, are 13 feet, 6 inches in height, and over the central portion a dome is carried up to 24 feet in height. This dome above the roof line contains a series of windows on each side through which light and ventilation for the central portion are furnished. As the floor plan shows, the wash, mangle, ironing and drying rooms are all contained in one space, which arrangement is most perfect for the supervision of the work and for the oversight of patients employed in the building. The receiving and distributing rooms, as well as the engine, soap making, stove and cloak rooms are walled off from the main room. Windows are freely placed in the partition walls, so that a view can be had from the main laundry room at any time of any part of the building, �iu IU A A B D QUO J 1 E.JR. !j!j|i||!ili|ll|[|!!ll Hlllj ',• 5 lljjjii / / 13 / , S.M.R. J i WTC1. / M. sL/-si FLOOR PLAN / / S.R. X. / / OF LAUNDRY: C. Cocheres. C. R. Cloak, Roorrv. D.R.I. Distributing Room. D.R. Jurying ROOJIV. E.R.£fi.fjine Room-. 1 2 3 4 Washers. TunM&r. Mangle/. SMrtlroner1. S.R. Stave Room. S.M.Ri. Soap Malting Room/. S.fi.X. SterilizingROOTTIJ. S. Sewer W.C'.M. Water Closet, Men. W.C.W. » " Womew. 7 Collar- Cuff Ir oner, Soap Boiler: R.R. Receiving Room. 5 6 8 9 -Exf/raclor. 10 Ironing Tables. 11 Tables. 12 Starch/ TanJc. 13 �REPORT OP THE BOARD OP TRUSTEES. 11 The building has a flat roof, tinned, which has four downfalls from it inside the building through which the water falling upon the roof is discharged. In locating the machinery care was taken to save unnecessary transfer of clothing from one part of the building to another. Starting from the receiving room, each garment on its passage through the laundry retraces no steps, thus economizing to the fullest extent the labor of the help. The machinery consists of five metal washers, one tumbler, one American Mammoth mangle, one Tolhurst extractor, one collar and cuff ironer, one shirt ironer and one staroher. The sad-irons are heated by gas on the ironing tables. The building is heated and lighted from the main building, and its sewers empty into that of the old laundry. The laundry has been in operation seven months and the cost of the work shows a saving thus far of about $2,000 per year over previous years. A sterilizing room is constructed in connection with the laundry. It is supplied with dry and moist heat, and a high degree of temperature can be obtained. The cost of the laundry was as follows: Labor... Stone and brick Lumber, door frames, etc Nails, pipe fittings, etc Lime Machinery — Total $2,739 12 1,602 29 1,054 59 818 69 229 08 1,056 23 $7,500 00 We regret that the appropriation was not sufficient to finish the building. It was thought that much of the old machinery and drying room apparatus could be transferred from the old to the new laundry. When the transfer was attempted nearly all the old machinery was found to be worthless; consequently new machinery, as well as new fittings for the drying room, had to be purchased. However, the outlay is one that will amply repay itself in the greatly reduced cost at which the laundering of the institution can be done. The new laundry is complete in all its appointments and is said to be second to none in the country. SPECIAL APPROPRIATION, $2,500. This appropriation was authorized by the last legislature for painting of towers, cornices, window jambs and sash of the asylum. The work was commenced last year and will be soon finished. On the 30th of June, 1896, $1,681.23 remained in the hands of the treasurer to the credit of this fund. The appropriation will not be sufficient to complete the work. SPECIAL APPROPRIATION, $2,000. This appropriation was made by the last legislature to repair the roofs and gutters of the main building of the asylum. The appropriation will be expended within a few weeks. On June 30, 1896, there was in the hands of the treasurer $706.11 to the credit of this fund. Thus far $5,500 have been expended on these repairs, and much remains to be done. It will cost at least $2,000 more to complete them. The building is being much damaged and should not be neglected. �12 NORTHERN MICHIGAN ASYLUM. .SPECIAL APPROPRIATION, $500. This appropriation was authorized by the last legislature for an addition to the asylum library. About 600 volumes of standard fiction, history, biography, travel, etc., etc., were purchased. These books ar& a source of much pleasure and profit to the patients. LAND PURCHASE. In May, 1896, twenty-nine acres of land were purchased from Hon. Perry Hannah at $100 per acre and forty acres from Mr. E. H. Grant and Mrs. Esther Grant at $40 per acre. (See map accompanying this report.} The deeds for this property were made to the people of the State of Michigan, registered in Grand Traverse county, and forwarded to the Secretary of State at Lansing for filing. Likewise the vouchers in payment of these lands were forwarded to the Auditor General, the same as is doue with other vouchers of the asylum. The Honorable Secretary of State declined to receive the deeds for filing, on the ground that the trustees had no authority to purchase these lands, and the Auditor General for the same reason refused to audit the accounts. We thus briefly present to your honorable body the facts relating to the purchase of these grounds, and, in case we had no legal right to acquire this property for the use and welfare of the asylum, that your honorable body investigate the matter and take such action as you may deem wise to adjust it We maintain that section 1930a3, Howell's Statutes, gives to the board absolute direction and control of all the property as well as the affairs of the asylum. Under this interpretation of the law the purchase of these lands was made. They were not acquired until after mature deliberation. The tract purchased from Mr. Hannah, located on the southeast frontage of the asylum, is intrinsically worth all, if not more than was paid for it. Mr. Hannah had been offered $200 per acre for acre tracts of this ground. We deemed it of the highest importance for the institution to secure these grounds, in order to insure it walks for patients comparatively secluded, and to obviate for all time the development along its frontage of a lot of small houses and gardens with their accompaniments of outhouses, etc., etc. It was not deemed wise to wait longer to secure this property; if so, it might have been too late to have secured it, or it might have been held at such a price as to preclude the possibility of its purchase. The Grant tract was purchased at a low figure. If an option had been asked upon it pending legislative action, not only would its price have been placed at a much higher value but it would have been stripped as much as possible of its timber. This land, besides being one of the best fruit tracts in the region, continues the timber line of the asylum property to the south and west and contains the springs from which the water supply of our barns takes its source. Another very important reason for the purchase of this tract was that it has no possible outlet except through the asylum farm. Had it fallen into certain hands, a permanent road could have been forced from it through the asylum property. FARM, GARDEN AND GROUNDS. The terms farm, garden and grounds here used include not only what belongs to the farm and garden, as the orchards, vineyard and plats of �REPORT OP THE BOARD OF TRUSTEES. 13 small fruits but the whole of the extensive grounds, with the streets, walka, reservoirs, groves, and outbuildings of all kinds thereon. When we speak of the cost of maintenance of the farm and garden we include the cost of all material and labor for improvements upon the grounds and the expense of their maintenance, also the cost and maintenance of teams and vehicles used in the conveyance of people, mail and express and the hauling of material to the asylum and the distribution of the same upon the premises. The improvements upon the farm and grounds have been steadily pushed during the past two years. Seventy-five acres of land have been chopped off, yielding logs to the value of $580.87, posts and poles worth $427.10, and wood valued at $5,218.75, in the aggregate $6,326.72 for the labor of patients and their attendants from land costing the State $4,687.50. We have stumped, ditched and tiled 40 acres or more of land and tiled out some 25 acres more, making 65 or more acres acres reclaimed daring the period and plowed and cropped for the first time. In the clearing and draining we have used $741.28 worth of dynamite and $954.41 worth of tile, To more successfully drain these and adjacent lands, it has been found necessary to deepen, straighten and clean out the channel of the creek flowing through the State property. The bed of this stream has been lowered on an average of two feet, enabling the many lateral drains to easily discharge their contents. We have now about 85 acres more of land chopped and in the process of being stumped and drained and made ready for the plow and cultivation. We have now under cultivation 260 acres, to which will soon be added the 85 acres just mentioned, making 345 acres of tillable land now ready, or soon to be ready, for crops, garden, meadow or pasture. The rest of the farm, 195 acres, is occupied by buildings and the grounds adjacent and the forest needbd for their protection. More land is sadly needed upon which patients may be employed, preparing and cultivating the same for crops and especially for meadow and pasture for our herd of cattle. During the two years~past our orchards, vineyard, and small fruit acreage have each been largely increased, so that we expect returns in the near future. We have now five acres of peach trees that will bear some next year, when we shall also have five acres of strawberries in bearing and about the same area of raspberries and currants, to say nothing of the 100 or more grape vines now very heavily laden with fruit. Extensive plantings of shade ornamental trees and shrubs have been made, to better beautify and protect the grounds. During the biennial term just closed we have constructed more than two miles of fence, inclosing portions of the farm not before fenced, and upwards of two miles of good plank walk has been constructed upon which the patients daily exercise, the expense of which improvements has been charged to the farm, garden and grounds. The asylum farm has not been free from drawbacks and hindrances incident to other farms during the time, but we have had one season of extreme drouth and two seasons of the grasshopper plague besides sickness among our swine. The drouth sadly lessened the yield of our crops of roots and hay and shortened the little pasture we had. The grasshoppers have taken entire two crops of cabbage, turnips and mangels and one crop each of onions, carrots and two years' young seeding, �14 NORTHERN MICHIGAN ASYLUM. besides injuring greatly the hay, grain, peas, corn and potatoes. This spring these insects have done irreparable damage to vineyard, small fruit plants and a young orchard of fifteen acres has been entirely stripped of its foliage and many of the trees are no doubt killed. With all hindrances and expenditures the farm still makes a fair showing of profit. The expenditures of all kinds, shown under another head, figure $39,424.93 for the two year period, while the receipts elsewhere analyzed amount to $42,090.33, a balance in favor of the farm of $2,665.40. The Holstein herd, the pride of this asylum, will be of interest to the taxpayers of the State. A portion of the herd was purchased in April, 1894, so that we entered upon the biennial term with sixteen thoroughbred cows and a large number of grades, some of them nearly full blood and many of them excellent milkers. With this herd, even, several hundred pounds of milk had to be purchased daily to supply the wants of the inmates of the institution. In the spring of 1895 it was decided to purchase ten more thoroughbred Holstein cows. The purchase was made from one of the best herds in Iowa, and the new cows arrived at their destination March 29, 1895. The wisdom of this purchase was soon apparent. For nine months before the asylum had bought 80,046 pounds of milk at a cost of $1,600.92, an average expenditure of $177.88 per month. For the remainder of the period, or from April 1, 1895, to July 1, 1896, fifteen months, not a pound of milk has been bought, the new cows easily supplying what was before lacking, which at the same rate we had been paying, $177.88 per month, would have cost the State for the fifteen months $2,668.20. The ten cows purchased cost in Iowa $750. The cost of purchase and transportation was $131. The^cost of keeping the cows fifteen months and the labor to care for them was $975, making the entire cost of purchase and keeping fifteen months $1,856, or $812.20 less than the milk would have cost, and we have that in the treasury and the cows in good condition on hand and two bull and five heifer calves we have raised from them. The asylum herd of thoroughbreds now consists of twenty-seven cows giving milk, ten two-year-old heifers soon to be added to the list of milkers, eight yearlings, three heifer calves, forty-eight females, one aged bull and three bull calves, fifty-two in all, registered or eligible to registry in the Holstein-Friesian^ Herd Book, worth and will readily sell for $3,000. To show the relative value of the thoroughbreds and grades as milkers we give some facts from the last year's record of the herd. Each cow's milk is weighed as soon as milked and the cow credited with the amount upon the stable books, from which a montly report showing the daily record of each cow is made. The twenty-six thoroughbred oows milked last'year gave 239,631 pounds of milk, worth $4,722.62, an average of 9,216 3-5 pounds to each cow worth $184.33. These oows were milked on an average 300 days during the year, which would make the average per cow per day of 30| pounds, worth 61^ cents. The twenty-six grades milked gave 199,817 pounds of milk, worth $3,996.34, or 7,685J pounds per cow on an average, worth $153.70, which for 300 days would give 25§ pounds, worth 514f cents per cow per day and with no perceptible difference in the cost of feed or care. Had the whole herd been thoroughbreds at the same rate the yield of milk would have been 479,262 pounds of milk, worth $9,585.24, or $796.28 more than was received, enough to buy ten more thoroughbred oows. �REPORT OF THE BOARD OF TRUSTEES. 15 By careful selection and keeping the best of the herd and fattening for slaughter the inferior ones, we hope soon to have a herd whose yearly average per cow will be thirty-five pounds of milk per day, enough, and more than enough, to supply the wants of the institution. The greatest present need of the farm now is more land for pasturage, that the milch cows of the herd may be kept/more in the open air and not be so liable to the diseases resulting from keeping cattle too much in close stables. We wish it borne in mind that the farm of this hospital has been made what it is by the efforts of the management by the use of the labor of patients and attendants and funds saved from the running expenses of the farm, without a cent of cost to the taxpayers of the State. KECEIPTS AND DISBURSEMENTS. The total receipts of the asylum for the fiscal year ending June 30, 1895, including cash on hand to the credit of the general fund, officers' salaries and special appropriations for roof repairing and repairing of roofs and gutters, new laundry and laundry machinery, and addition to library, were $226,140.89; and the total disbursements for the same period, including amounts expended in special appropriations and officers' salaries, were $184,431.48. The total receipts of the asylum for the fiscal year ending June 30, 1896, including balance on hand, officers' salaries and special appropriation for new laundry and laundry machinery, were $255,266.94; and the total disbursements for the same period, including the amounts expended of officers' salaries, and of special appropriations, were $205,646.52. There was at the close of the fiscal year ending June 30, 1896, $47,292.48 in the hands of the treasurer to the credit of the current expense fund of the asylum, and $2,327.94 to the credit of special appropriations. In August, 1894, Mr. J. P. C. Church resigned his position as steward of the institution, and Mr. C. L. Whitney, of Muskegon, Mich., was appointed to the office. Dr, L. C. Stillings, of Keene, N. H., was appointed assistant physician, August 1, 1894, and resigned October 1, 1895, to accept the superintendenoy of a private hospital at Rutland, Vt. Dr. Harry J. Kennedy, assistant physician, resigned his position February 7, 1895, and Frank Hamilton, Esq., treasurer, resigned January 1, 1896. In July, 1895, Dr. E. L. Niskern, of Muskegon, Mich, was appointed assistant physician, and in October, 1895, Dr. G. L. Noyes, of Burlington, Vt., was appointed assistant physician. These gentlemen have proved themselves to be thoroughly capable in the performance of their duties. On January 1, 1896, J. T. Hannah, Esq., was appointed treasurer of the asylum, vice Frank Hamilton, resigned. We would most respectfully invite your careful inspection of the asylum and its methods, that you may thoroughly learn its aims and objects and further the best interests of the insane. The Michigan system of caring for the insane is admitted to be among the best and most progressive in the country. The proper care of the insane is a matter that is more and more engaging the thought and attention not only of the specialist and philanthropist but the people at large, and while this is true, �16 NORTHERN MICHIGAN ASYLUM. the fact is also recognized that the cost of maintenance must be reduced to the lowest point possible and consistent with the comfort and well being of patients. The trustees and officers of the asylums are in full sympathy with this object. In conclusion we would testify to our appreciation of the able manner in which the officers have performed their duties, and of the valuable services which the attendants and all others in the employ of the asylum have rendered. H. H. NOBLE, T. T. BATES, LOEIN ROBEETS, H. C. DAVIS, G. A. HAET, W. W. CUMMEE, Trustees. Traverse City, June 30, 1896. �TREASUEEE'S EEPOET ABSTRACTS OFJACCOUNTS:CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE NORTHERN MICHIGAN ASYLUM, ON ACCOUNT OF CURRENT EXPENSES FOR THEBFISCAL YEAR ENDING JUNE 30, 1895. THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern Michigan Asylum for month ending July 31,1894. CREDITS. By balance on hand July 1,1894 Cash from State treasury: Account of officers' salaries Account of roof repairing Cash from earnings of institution S20r129 99 2,237 50 2,000 00 5,149 56 To disbursements: Account of officers'salaries Account of current expense Balance on hand to new account _ $2,237 50 13,297 63 13,981 92 $29,517 05 839,517 05 THE STATE OF MICHIGAN, In account with Frank Samilton, Treasurer of Northern Michigan Asylum for month ending August 31,1894. CREDITS. By balance on hand August 1,1894 Cash from earnings of institution $13,981 92 35,504 35 To disbursements: Account of roof repairing Account of current expenses Balanceon hand to new account 8339 51 10,440 76 38.706 00 $49,486 27 $49,486 27 �18 NORTHERN MICHIGAN ASYLUM. THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending September 30,1894, By balance on hand September 1, 1894 Cash from earnings of institution To disbursements: Account of roof repairing Account of current expense Balance on hand to new account $38,706 00 340 26 $617 62 19,253 11 19,175 53 _.. !39,046 26 $39,046 26 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending October 31,1894. By balance on hand October 1, 1894 Cash from State treasury: Account of officers' salaries Cash from earnings of institution To disbursements: Account of officers'salaries Account of roof repairing Accountof current expense Balance on hand to new account 819,175 53 2,30706 1,866 62 __ _ ^—- _. __ $2,307 06 311 50 16,079 99 4,65066 $23,349 21 §23,349 21 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending November 30, 1894. By balance on hand November 1, 1894 Cash from earnings of institution $4,650 66 37,650 06 To disbursements: Account of roof repairing Account of current expense Balance on hand to new account __ _ $338 50 23,369 93 18,592 29 $42,300 72 $42,300 72 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending December 31,1894. By balance on hand December 1,1894 Cash from earnings of institution To disbursements: Accountof roof repairing Account of current expenses Balance on hand to new account $18,592 29 3,753 73 -- __ $117 45 14,340 69 7,887 88 1 03 $32,346 02 �REPORT OP THE TREASURER. 19 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending January 31,1895. CREDITS. By balance on hand January 1,1895 Cash from State treasury: Accountof officers'salaries Cash from earnings of institution To disbursements: Aocountof officers' salaries Account of current expense Balance on hand to new account $7,887 88 3,437 50 4,770 66 $15,096 04 DEBITS. $2,487 50 10,687 95 1,970 59 . S15.096 04 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending February 28,1895. CREDITS. By balance on band February 1,1895 Cash from earnings of institution $1,970 59 50,417 97 852,388 56 DEBITS. To disbursements: Account current expenses Balance on hand to new account $11,771 29 40,617 27 $52,388 56 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending March 31,1895. CREDITS. By balance on hand March 1,1895 Cash from earnings of institution $40,617 27 3,281 95 843,899 22 DEBITS. To disbursements: Account of current expense Balance on hand to new account 811,070 79 32,828 43 : $43,899 22 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending April 30, 1895. CREDITS. By balance on hand April 1, 1895 Cash from State treasury: Account of omcers'salaries Cash from earnings of institution... $32,828 43 2,317 50 39,03569 $74,181 62 DEBITS. To disbursements: Account of officers' salaries Account of current expense Balance on hand to new account $2.317 50 10,169 89 61,694 23 $74,181 62 �20 NORTHERN MICHIGAN ASYLUM. THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending May 30, 1895. By balance on hand May 1,1895 Cash from earnings of Institution .'.. To disbursements: Account of current expenses Balance on hand to new account $61,694 23 2,947 99 817.660 33 46,981 89 $64,642 22 THE STATE OF MICHIGAN, In Account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for month ending June 30,1895. By balance on hand June 1,1895 , Cash from State treasury: Accountof repairing roofs and gutters Account of painting towers __ Account of laundry and machinery Account of library Cash from earnings of institution $46,981 89 2,000 00 2,500 00 3,500 00 500 00 1,492 49 To disbursements: Accountof current expense Balance on hand to new account 815,264 98 41,709 40 $56,974 38 $56,974 38 SUMMARY, THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum for fiscal year ending June 30,1895. CREDITS. By balance on hand July 1,1894 Cash from State treasury: Account of officers' salaries Account of roof repairing Account of painting towers Account of repairing roofs and gutters Account of laundry and machinery Account of library Cash from earnings of institution To disbursements: Accountof officers'salaries Account of roof repairing Account of current expense Balance on hand to new account _.. _ _ _ _ $30,129 99 9,299 56 2,000 00 2,500 00 2,000 00 3,500 00 500 00 186,211 33 $9,299 56 1,724 58 173,407 34 41,709 40 $226,140 88 8226,140 88 �21 REPORT OP THE TREASURER. ABSTRACTS OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT THE NORTHERN MICHIGAN ASYLUM, ON ACCOUNT OF CURRENT EXPENSES FOR THE FISCAL YEAR ENDING JUNE 30, 1896. THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending July 31, 1895. CREDITS. By balance on hand July 1,1895 Cash from State treasury: Account of officers' salaries.— Cash from earnings of institution $41,709 40 2,387 60 6,748 09 DEBITS. To disbursements: Account of officers' salaries.. Account of painting towers Account of lanndry and machinery Account of cnrrent expense Balance on hand to new account i $50,844 99 ' $3,387 50 100 00 473 14 12,379 36 35,504 99 $50,844 99 1 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending August 31,1895. CBEDJTS. By balance on hand August 1, 1895 Cash from earnings of institution $35,504 99 40,i90 82 -„ To disbursements: Account of painting towers Account of laundry and machinery Account of current expense Balance on hand to new account. $75,795 81 DEBITS. $208 00 1.423 85 15,731 96 58,432 00 $75,795 81 THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of the Northern Michigan Asylum, for month ending September 30,1895. CREDITS. By balance on hand September 1,1895.. Cash from State treasury: Account of laundry and machinery Cash from earnings of institution To disbursements: Account of repairing roofs and gutters Account of laundry and machinery Account of roof repairing _ Account of current expense.Balance on hand to new account $58,432 00 4,000 00 534 84 882,966 8* DEBITS. $198 75 2,952 79 459 07 13,771 18 45,585 05 $62,966 St �22 NORTHERN MICHIGAN ASYLUM. D THE STATE OF MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for month ending October 31,1895. By balance on hand October 1,1895 Cash from State treasury: Account of officers'salaries Cash from earnings of institution $45,585 05 2,593 74 37,455 63 _. To disbursements: Account of officers' salaries Account of repairing roof and gutters Account of laundry and machinery Account of current expenses Balance on hand to new account - $2,593 74 612 38 1,602 49 15,846 89 64,978 92 • - $85,634 43 $85,634 42 THE STATE OF MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for month ending November 30,1895. By balance on hand November 1, 1895 Cash from earnings of institution To disbursements: Account of repairing roofs and gutters Account of painting towers Account of laundry and machinery Account of current expense Balance on hand to new account $64,978 92 1,973 01 DEBITS. _. $280 06 151 25 467 58 17,986 03 48,067 0] THE STATE OF MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for month ending December 31,1895. CREDITS. By balance on hand December 1, 1895 Cash from earnings of institution To disbursements: Account of laundry and machinery Account of current expense Balance on hand to new account — $48,06701 2,235 28 $50,302 29 $580 15 19,185 14 30,537 00 THE STATE OF MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum, for month ending January 31,1896. By balance on hand January 1,1896 Cash from State treasury: Account of officers'salaries Cash from earnings of institution To disbursements: Account of officers' salaries Account of library Account of current expense Balance on hand to new account 830,537 00 2,61250 18,797 62 $2,612 50 500 00 13,531 87 35,302 75 $51,947 12 $51,947 12 �REPORT OF THE TREASURER. 23 THE STATE OP MICHIGAN, In account with Julius T, Hannah, Treasurer of the Northern Michigan Asylum, for month ending February 29,1896. CREDITS. By balance on hand February 1, 1898 Cash from earnings of institution $35,302 75 44,749 46 $80,052 21 DEBITS. To disbursements: Account current expense Balance on hand to new account 512,791 78 67,260 43 $80,052 21 THE STATE OP MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum, for month ending March 31, 1896. CREDITS. By balance on hand March 1, 1893. Cash from earnings of institution $67,260 43 1,916 30 $69,206 73 DEBITS. To disbursements: Account of current expense Balance on hand to new account . $9,939 54 59,267 19 869,206 73 THE STATE OP MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for month ending April 30,1896. CREDITS. By balance on hand April 1, 1896 Cash from State treasury: Account of officers'salaries Cash from earnings of institution $59,267 19 - 2,612 50 6,627 68 $68,50737 DEBITS. To disbursements: Account ot officers'salaries Account of current expense.. Balance on hand to new account 82,612 50 14,939 92 50,954 95 868,507 37 THE STATE OF MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for month ending May 31,1896. CREDITS. By balance on hand May 1, 1896 Cash from earnings of institution To disbursements: Accountof current expense... Balance on hand to new account L 850,954 95 36.315 92 $87,270 87 DEBITS. $18,278 28 68,992 59 _ $87,270 87 THE STATE OP MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum for the month ending June 30,1896, CREDITS. By balance on hand June 1,1896 Cash from earnings of institution $68,992 59 1,676 65 870,669 24 �24 NORTHERN MICHIGAN ASYLUM. To disbursements: Account of repairing roofs and gutters Account of painting towers Account of current expense Balance on hand to new account - $302 TO 418 92 20,437 20 49,620 42 $70,669 24 SUMMARY. THE STATE or MICHIGAN, In account with Julius T. Hannah, Treasurer of the Northern Michigan Asylum, for fiscal year ending June 30,1896. CREDITS. By balance on hand July 1, 1895 Cash from State treasury: Account of officers'salaries Account of laundry and machinery Account of earnings of Institution To disbursements: Account of officers' salaries Account of roof repairing Account of painting towers Account of laundry and machinery Account of repairing roof9 and gutters... Account of library Account of current expense Balance on hand to new account $41,709 40 10,206 24 4,000 00 199,351 30 _. ..- $10,206 34 459 07 878 17 7,500 00 1,29389 500 00 184,809 15 49,620 42 11 $255,266 94 We have carefully examined the accounts of J. T. Hannah, Treasurer of the Northern Michigan Asylum, for the biennial period ending June 80, 1896, and have compared the same with the books and vouchers; and verified the same by a further comparison with the books of the steward and hereby certify to the entire correctness of them. LOEIN EGBERTS, W. W. CUMMER, THOS. T. BATES, Auditing Committee, �STEWAED'S EEPOET FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1896. ANALYSIS OF RECEIPTS AND DISBURSEMENTS FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1896. RECEIPTS. Maintenance, etc., State patients Maintenance, etc., county patients Maintenance, etc., private patients Sundry accounts: Interest, miscellaneous... Special appropriations: Officers' salaries New laundry and new laundry machinery Painting of towers Repairing roofs.. Repairs to roofs and gutters Addition to library $273,549 66 98,083 38 8,303 21 5,627 38 19,505 80 7,500 00 2,500 00 2,000 00 2,000 00 500 00 $419,568 43 DISBURSEMENTS. SALARIES AND WAGES FOOD: Meat andflsh Butter Flour... Tea Coffee Sugar Miscellaneous CLOTHING LAUNDRY EXPENSES: Wages... Soda Gasoline Indigo Starch Soap Coal Tubs Irons Marking ink Baskets Stove Machines Repairs ol machinery 4 $80,507 75 $34,838 12 18,048 05 8,92728 2,731 08 4,69373 8,839 58 23,487 20 - 101,565 04 28,335 07 , ... $5,111 44 180 6U 353 68 39 20 195 15 871 65 1,26224 3 60 9 60 5 00 148 61 16 80 2,709 24 50 24 10,957 05- �NORTHERN MICHIGAN ASYLUM. HEATING : Wages Opal..."/..."../. Pipe covering, etc Charcoal - _ - -- 13,029 15 19,382 38 147 29 - UJ-5 - $2,184 75 482 17 5369 9 41 $22,57017 LIGHT: Wages Electric light Oil Lanterns fixtures •- Coal MEDICAL SUPPLIES: Drugs and in&truments STATIONERY, PRINTING, ETC.: Printing Blanks and blank books Postage stamps, etc Ink, stationery, etc Telephones and telegraphing Mail bags Typewriters Treasurer's stationery 5,13291 3,172 82 - AMUSEMENT AND INSTRUCTION : Games Book and papers Circus tickets Dancing Concerts Entertainments Fireworks HOUSEHOLD SUPPLIES: Dry goods Brooms Hardware Soap Crockery Stoves Sewing machine Clocks.. Cooking utensils Pictures Baskets Miscellaneous -JWl?. .. - , .. IMPROVEMENTS AND REPAIRS: Wages Nails and hardware Paints and oils Hose Lumber Brick, lime, stone, etc Wireguards Glass Furnace, pipe and iron Tile and mantel Cisterns, etc FREIGHT AND TRANSPORTATION: Superintendent's expenses to board meetings, etc Steward's expenses for purchases Transfer poor commissioners - 2,97U 82 897 93 171 03 73 50 141 50 27 00 89 00 525 $2,729 43 52334 1,18525 1,48074 1,576 48 347 11 39 20 4 00 1,589 93 398 71 68 00 680 12 • .-- FURNITURE AND BEDDING : Furniture Beds Bedding Carpets Curtains $935 22 413 44 428 00 231 20 720 91 1500 IPO 00 37 05 $1,23677 28 40 3,768 15 2,213 9» 173 98 $20,518 39 1,281 36 2,067 17 451 72 2,836 67 1,376 56 251 50 21888 4,909 00 275 81 631 08 8156 80 169 71 850 10,622 31 7,421 29 34,818 U 335 01 �27 REPORT OP THE STEWARD. MISCELLANEOUS: Purchases for patients, amounts charged back Patients'expenses home Expenses elopements Transfer of patients to upper peninsula hospital Refunded money Undertakers' expenses Insurance Collection of accounts . Cemetery lots Miscellaneous $571 94 718 15 27 33 490 50 92 86 200 30 100 00 78 37 63 00 2,017 54 _ SPECIAL APPROPRIATIONS: New laundry and new laundry machinery Addition to library Officers' salaries ; Repairing roofs.... Painting of towers Repairs to roofs and gutters TOOLS AND MACHINERY: Tools , Brushes Belting. Water motor Pump Boiler insurance Boiler compound Boilers Packing Lubricating oil ... FARM, GARDEN, STOCK AND GROUNDS: Wages Seeds Feedandhay Implements Blacksmithing Repairs of harness, etc Paris green and plaster Veterinary's charges Vehicles and repairs Fencing Stock Tiling Dynamite Manures Trees Wagon-sprinklers Flower pots Glass, (greenhouse) Horsepower Brooder Hose Land purchases 'Total 7,500 00 500 00 19,505 80 2,183 65 878 17 1,293 89 , - - $4,359 99 $30040 17 20 79 31 220 50 188 24 60 00 4495 783 60 19 23 205 55 1,918 98 S13,204 16 1,187 16 13,636 71 1,422 97 549 75 241 99 205 07 16177 13 40 437 74 3,520 53 954 91 742 28 458 25 92581 365 00 59 26 24 31 114 68 97 18 101 00 4,500 00 $390,07800 �28 NORTHERN MICHIGAN ASYLUM. RECEIPTS AND DISBURSEMENTS FOR FARM, GARDEN AND GROUNDS FOR THE BIENNIAL PERIOD ENDING JUNE 30,1896. Inventory value of farm, farm buildings and stock, etc., June 30, 1894 Inventory value of farm, farm buildings and stock, etc., June 30, 1896 Increase in value of farm property for the (including land and additional stock purchased, stock raised, and permanent improvements) land, valued at purchase price.. 1(39,713 33 47,364 58 ' 7,95125 DISBURSEMENTS. Wages Seeds Feedandhay Implements Blacksmithing Repairs, harness, etc Paris green and plaster. Veterinary's charges Vehicles and repairs Fencing Stock. Tiling Dynamite Manures Trees Wagon-sprinklers Flower pots Glass, green-house Horse power Brooder Hose Land purchases. Total. $13,204 16 1,187 16 13,636 71 1,422 97 54975 241 99 205 07 161 77 13 40 437 74 3,52053 954 91 742 28 458 25 925 81 365 00 59 26 24 31 11468 97 18 101 00 4,500 00 $42,923 93 �29 REPORT OF THE STEWARD. Quantity. Article. Price. 53 2,204 $0 05 10 Apples, bushels 25 30 40 Beans. 8 52 103 75 1 00 Beets, 978 29 30 40 Asparagus, pounds Beef, pounds •Corn, bushels... Cabbage, heads •Cairots, bushels Calves Cedar poles Cellery, dozen. bunches Cucumbers, dozen. bushels . Chickens, pounds Currants, quarts.. " bushels. Cherries, quarts Cauliflower, heads. Eggs, dozens- - 72 102 180 152 106* 305 00 1,089 15 50 60 1 00 42 305 34 10,188 1,500 7,100 $223 05 147 40 05* 06 06!f 06* 07 05 540 18,800 1,415 2,500 3 105 83 65 220 40 Total. 18 70 1,019 6,998 569 1,038 5,535 2,455 180 158 305 Amount. 03H 04 $18 00 75200 58 96 120 00 31 35 40 $13 60 106 75 1360 1 00 25 01M 01* 02 81 127 22 142 25 35 50 00 15 30 40 50 1 00 1 50 810 30 72 76 106 74 80 60 00 00 50 25 10 12 12V 15 763 230 121* 876 20 27 60 15 19 45 $3 80 62 70 33 45 28 24 155 60 45 344 11-12 1,344 5-6 178 30 264* 13 $3 60 3 36 1 50 06 0634 08 $9 30 3 75 3 60 10 12 15 16 18 20 30 94* 28* $34 49 157 78 22 25 3 90 39 67 4 80 16 98 5 70 10 61 489 80 95396 133 95 17 00 10500 293 10 370 15 119 44 65 50 8 46 16 65 296 18 Fodder: Bye and corn, tons. 26 28* 2 4 5 6 50 00 00 00 $81 28 130 171 25 00 00 00 �30 NORTHERN MICHIGAN ASYLUM. BECEIPTS.—Continued. Article. Fodder: it ft Hides Kola Rabi, bushels . _, ... i i i Quantity. Price. 54 15 $7 00 10 00 $378 00 155 00 8 46 74 6 1 50 10 00 1000 7 00 $460 00 740 00 43 00 67 1,260 110 3,038 410 2,905 975 40 (i2 05 10 12 15 20 $25 5 303 49 435 195 20 50 80 20 75 00 124,308 32,393 2,928 2,974 3 00 5 00 9 00 10 00 $372 161 26 29 92 96 35 74 2,410 4,650 4(10 815,937 1,550 4,655 920 3.000 961 254 830 Milk *( tt Oats, Peas, .» f< .- 5,619 2,131 3,320 « t( Pork, pounds . < - Posts (cedar) t 50 108 87 119 334^ ._ ti i t » i t i * c Amount. 01 01^ $24 10 69 75 30 02 01 05 03 04 10 35 50 $15 50 232 75 27 60 12000 98 10 88 90 415 00 35 40 50 80 1 00 $17 50 4320 43 50 95 20 324 50 20 25 35 81,123 80 532 75 812 00 14,920 200 01 01* $149 20 3 00 1,910 2,495 11,280 33,695 2,204 9,960 05 05« 05% 06 06 % 07 $95 130 620 3,021 146 697 50 98 40 70 51 20 80 35 40 50 $32 00 17 50 5 6,442 2,010 103 16 45 75 05 02 04 05 10 $40 20 4 12 80 4 50 01 02 03 03% 04 05 10 12 15 20 30 30 $1 22 55 21 246 237 214 39 359 106 13 21 132 1,130 1,835 570 6,165 4,552 2,145 325 . 1,728 531 45 73 32 60 05 38 60 60 50 00 20 20 50 90 Total. $938 25 ia oo 1,242 00 30 48 26 80 1,014 45 590 97 93 85 120 00 16,318 74 99580 17 50 506 40 2,468 55 152 20 3,712 29 49 50 3 75 322 10 49 62 1,22885 �31 REPORT OP THE STEWARD. RECEIPTS.—Continued. Article. Hutta bagas, bushels Strawberries, quarts. " quarts Salsify, bushels Quantity. . \% . Tomatoes, pounds 260 700 220 3,150 45 28000 25,000 . 986 525 350 182 73H 196 176 26 70 Price. SO 30 02 15 2 00 06 50 01 oiy Amount. 878 00 14 CO 33 00 3 00 189 00 $280 TO 375 00 03 01 05 06 10 50 90 1 00 30 S29 21 17 10 7 98 90 26 21 58 00 50 92 35 00 75 00 00 40 00 00 00 Turnips, bushels n " tt ti 2,267 650 50 10 20 30 40 50 8453 195 20 5 Veal 3612 245 07 08 8253 84 19 60 235 987 1,974 1 25 1 00 2 00 $293 75 987 00 3,948 00 75 70 $52 50 " fct ft.), " Wheat, bushels _ . - . Stock purchased during period and still on hand, Total ... Total. $78 00 14 00 225 00 21 50 65500 322 10 673 40 272 44 52 50 247 00 842,335 33 4,500 00 3,451 25 850.286 58 The above analysis shows a net earning from the farm, including land purchased, stock on hand, etc., of $7,362.65 during the period. As stated in the trustees' report, the disbursements include not only the cost of all material and labor for improvements upon the grounds, and the expense of their maintenance, but also the cost and maintenance of labor and maintenance of teams and vehicles used in the conveying of people, mails and express and the hhuling of material to the asylum and the distribution of the same upon the premises, etc. If the cost of the latter had been charged to miscellaneous expense instead of to the farm, the net earnings of the latter would have been'muoh increased. C. L. WHITNEY, Steward. �SUMMARY. Summary of Inventory Northern Michigan Asylum, June 30,1896. Farm and grounds Buildings Stock on farm Farm and garden produce Farm implements and barn Administration building Pathologicallaboratory Dispensary—stock and Library Chapel Wards 1 Cottage A B C D B FandG Engine room and work shops Laundry Kitchens and bakery Stores, groceries and provisions boots and shoes clothing and furnishings dry goods crockery notions hardware and miscellaneous silver plated ware fixtures meats Total... . . . . . . . $39,199 58 599,165 00 6,765 00 43,090 33 3,094 B7 9,095 59 700 55 1,02412 856 9S 818 45 30,018 65 3,14835 2,00900 2,679 26 3,558 84 1,099 90 4,467 64 2,205 54 4,662 94 6,138 95 4,488 95 857 32 2,094 88 3,461 56 403 85 703 99 361 30 1307 82 15 136 31 fixtures fixtures ...... $774,40267 �REPOKT [OF THE MEDICAL SUPERINTENDENT. To the Board of Trustees: " • GENTLEMEN—As required by law, I have the honor to submit the following report of the principal operations and events of the asylum for the biennial period ending June 30, 1896. The movement of population has been as follows: For the Biennial Period. Patients. Admitted Total under treatment " improved Died .. Males. Females. Total. 531 224 429 185 960 409 755 202 614 154 1,369 356 553 460 1,013 38 84 24 56 24 71 17 42 62 155 41 98 From the Beginning. Patients. Total admitted ._ Discharged recovered improved " unimproved ___ Died Total discharged Remaining under treatment June 30, 1896 Males. Females. Total. 1 285 986 2271 301 241 45 245 129 189 31 177 330 430 76 422 732 526 1258 553 460 1,013 �34 NORTHBKN MICHIGAN ASYLUM. This shows a net gain of fifty-three patients for the period. To show the net gain for the district we must add sixty-nine transferred to th& Upper Peninsula Hospital for the Insane less thirty transferred from the Michigan Asylum, or thirty-nine, which added to fifty-three is ninetytwo, the net increase of patients for the district during the two years past. The smallest number of patients under treatment in any one day was 949; the largest number 1013. The death rate upon the whole number under treatment for the year ending June 30, 1895, was 4.2 per cent for the year ending June 30, 1896, 4.22 per cent. The following table will show the sex, age, form of mental disease and cause of death in each of those wbo died: TABLE II. Sex. Male Male Male Age. 77 (?) 40 59 43 Female — Male Male Female — (?) 50 45 42 40 Male Male Male 64 (?) 78 34 40 Male Unknown Sweden Ohio . Sweden Michigan Male Male 48 70 27 42 41 Male Male Male Male Male 22 51 55 78 86 Michigan Female Male Male Male 53 49 78 54 25 Male Female — Male Male 28 26 52 40 Male Male 24 28 63 Female.... Male Female — Male Male Female. -J. Male (V) 17 60 60 35 49 41 73 Form of Disease. Nativity. Unknown Canada England _ Pennsylvania Connecticut Canada FinlandGermany Ireland Cause of Death. Old Age. Cardiac Disease. Phthisis Pulmonalis. Carcinoma. Phthisis Pulmonalis. Traumatism. Paretic Seizure. Organic Brain Disease. Phthisis Pulmonalis. Phthisis Pulmontlis. Organic Brain Disease* B, II, Brain Disease Phthisis Pulmonalis. Bright's Disease. B. II, Senility Phthisis Pulmonalis. Paretic Seizure. B II, General Paralysis Peritonitis. A. I, Melancholia B. II, Brain Disease Organic Brain DiseaseSuicide. C. I, Neurasthenia Suicide. Paretic Seizure. Phthisis Pulmonalis. C. II, Paranoia Apoplexy. Cardiac Disease. B. II, Senility Old Age. B. II, Senility Phthisis Pulmonalis. A. II, Delusional Paretic Seizure. B. IT, General Paralysis Cardiac Disease, B II, Senility B. 11, Brain Disease Organic Brain Disease. Paretic Seizure. B. II, General Paralysis Organic Brain Disease. B II, Brain Disease-. Status Epilepticus. C. I, Epilepsia Paretic Seizure. R. II, General Paralysis .. Paretic Seizure. B. II, General Paralysis Organic Brain Disease. B 11, Brain Disease Organic Brain Disea-e. B. II, Brain Disease Paretic Seizure. B. II, General Paralysis Exhaustion. Phthisis Pulmonalis. A. I, Mania C. I, Neurasthenia Phthisis Pulmonalis. A II, Delusional .. . Cardiac Disease. B. 11, Brain Disease Organic Brain Disease. Cardiac Disease. A. II, Dementia B II Delirium Grave Meningitis. B 11, Senility B B. A. A. A. B. C. II, Senility II, Senility , II, Delusional II, Dementia I, Melancholia '. II, General Paralysis II, Paranoia �REPORT OF THE MEDICAL SUPERINTENDENT. TABLE II.—CONTINUED. Sex. Age. Male Male Female.... 59 3T 53 74 40 Nativity. Holland Holland Indiana Form of Disease. C 11 Paranoia C. I, Epilepsia Phthisis Pnlmonalis Status Epilepticus.' B. II. General Paralysis Paretic Seizure. Peritonitis. 66 31 56 39 55 Unknown Ohio Michigan Male 35 40 24 42 41 Michigan A. I, Hallucinatory C. I, Epilepsia C. I, Epilepsia.- Male Female. .. Male Male 50 28 28 48 55 Finland Michigan C. Ill, Imbecility. Fern ale ... 24 69 79 56 40 Ireland Unknown B. II, Senility B. II, Senility Male Male Male Male Female... Female. ._ Female. .. Male Male Female- .. Male Male _ Male Male Canada Ohio Unknown 30 30 53 41 38 New York.... Male .... Male . . 72 55 53 (?) 43 Male ... Female Female Female Female 62 36 64 69 45 Female... Male Male.., 29 32 54 C I, Epilepsia Phthisis Pulmonalis. Exhaustion, ... . Phthisis Pulmonalis. Apoplexy. New York . . 37 59 52 37 48 60 25 47 40 30 Female. -Male Male Cause of Death. New York C. I, Epilepsia.B. II, General Paralysis _.U. I, Epilepsia Sweden Ireland B. II, General Paralysis Ohio C. II, Paranoia Canada Finland B. II, C II, B. II, C III, Senility Paranoia Brain Disease Imbecility Michigan New York Scotland Michigan C. C. B. C. Epilepsia Paranoia Senility Paranoia. Sweden C. I, Neurasthenia C II. Paranoia B. II, General Paralysis ... Ohio-- Cardiac Disease. Pernicious Anaemia. Peritonitis. Cardiac Disease. Paretic Seizure. Cerebral Abscess. Pneumonia. B. II, General Paralysis I, 1 f, II, II, Exhaustion. Suicide, Paretic Seizure. Phthisis Pulmonalis. Bright's Disease. ___ Cardiac Disease. Exhaustion. Old Age. Carcinoma. Phthisis Palmonalis, Paretic Seizure. 35 �36 NORTHERN MICHIGAN ASYLUM. Summary. Males. Females. Total. Phthisis Peritonitis Old age -• - 12 16 5 9 2 1 1 2 1 1 2 1 1 1 55 9 1 11 4 3 2 2 1 2 2 1 2 1 1 42 21 17 16 13 5 3 3 3 3 3 2 2 2 1 1 1 1 97 As compared with the last preceding biennial period, the death rate from phthisis was one per cent less; from general paralysis 0.4 of one per cent, more; from cardiac disease 0.3 of one per cent less, and from organic brain disease 0.3 of one per cent less. The death rate computed on the daily average number of patients was 1.3 per cent less than for the immediately preceding period. In the deaths from cardiac disease for the last four years we find that they were nearly twice as frequent in women as in men. Much attention has been given to the limitation of the spread of phthisis. Patients, whenever possible, have had single rooms assigned to them and much care has been taken in the disposal of sputum and disinfection of clothing and bedding. A patient far advanced in the disease usually eats by himself, and special attention is given to the cleanliness of the table service. Whether these precautions have had aught to do with the marked decrease of the disease within the hospital cannot be said. At any rate, we should not like to disregard the precautions taken. Wherever possible, autopsies have been made. Frequently interesting diseased conditions were found, not only of the brain and nervous system, but of the various other bodily organs. L. H., female, aged thirty(?), was received September 7, 1892, suffering from melancholia. She was considerably confused and somewhat depressed. She gradually demented and showed marked retarded mental reaction. On the afternoon of August 13, 1894, while sitting with a party of patients under a group of trees near one of the cottages, an apparently healthy tree, afterwards found to be wormeaten, broke off a few tee% above the ground, though at the time little or no wind was blowing. The other patients escaped, but she being more deliberate in her movements Was caught by the falling tree, which struck her across the pelvis, pinning her to the ground. She did not appear to be much bruised externally, but suffered from extreme shock. She was at once put to bed and restoratives administered, but to no avail. She died two hours after the accident. A postmortem examination revealed a rupture of the bladder, hemorrhage in the lower extremity of the reotus muscles, and a fracture of the ascending ramus of the pubic bone. �REPORT OP THE MEDICAL SUPERINTENDENT. 37 S. W,, male, aged thirty-three, was received March 13, 1893. He was treacherous, frequently taking stones and large nails into his room with which to assault the attendants. His method of eating was peculiar, on account of stricture of the oesophagus received from drinking lye sometime before his entrance to the hospital. He fed himself with his fingers and passed an oasophagela bougie during his meals. He was very dirty in his habits. Primarily defective, his whole characteristics were those of a moral imbecile. On the morning of April 21, 1896, the night nurse found him lying crosswise in his bed apparently in a severe convulsion, the first since his admission, which was followed by another later in the morning, epileptic in character. Following these seizures until the time of his death patient was continually attempting to do himself bodily harm, falling to the floor, throwing himself from his chair, or trying to fall on the stairs. These falls may have been in part due to weakness, but it is quite evident that most of them were made with suicidal intent, He died May 28, 1896, from exhaustion due to the constant disturbance preceding his death. A post-mortem examination of the head was made. The skull cap was adherent to the meninges, but after separation both surfaces were perfectly smooth. There was also a slight adhesion between the meninges and brain. Brain of the characteristic imbecile type. The frontal lobes were small and the convolutions much less complex than in the normal brain. C. R., female, Norwegian, aged thirty (?), was received February 15, 1894. She was primarily defective, but had married and given birth to two children in the old country, also an illegitimate child. On her admission she was very much demented. She was noisy and untidy and required a great deal of personal care. During the past year she had not been able to take regular exercise on account of cardiac disease. She was confined to her bed continuously from February 21, 1896, to the time of her death. She gradually grew weaker, but until the evening of April 6 there was nothing unusual in her condition. That day she had eaten less and had failed more rapidly. She took egg and milk for breakfast, no dinner, and a little egg and milk for supper. Was very filthy during the night. The next morning she was in a general state of oontracture, the left leg drawn up, and general stiffness of the whole body, which was increased to little short of a general spasm when an attempt was made to straighten the leg. Pupils dilated, the left being wider than the right. Eyes elevated and turned to the right. Head turned to the left. Teeth bleeding. Temperature, 105°; pulse eighty-four, feeble; respiration twenty-two, heavy. At 2:30 p. m, pupils were dilated though equally, and reacted to light equally. The conjunctiva! reflexes were present; all other reflexes absent. The left muscles of the face were apparently paralyzed, the mouth being drawn to the right. Right side of face flushed, left pale. Veins of neck blue and prominent. Flexor muscles of both arms contracted, and a tendency to external rotation of hands. Right arm when raised remained upright one minute and twenty seconds; left arm would fall at once, but did not appear to be paralyzed. Cutis anserina was marked. Sordes had gathered on teeth. Temperature at 2:30 p. m. 106° and at 6:30 p. m. 108°. Bye reflexes still active; breathing heavy but regular. At 8:50 p. m. temperature 1062-5° and patient in more complete stupor. Mouth open and dry. Pupils dilated. Eyes still turned to the right, and reflexes acute. Fingers flexed. Breathing heavy but regular. Pulse just perceptible at wrist. During the next day �38 NORTHEEN MICHIGAN ASYLUM. patient lay in a comatose condition with a temperature of 105° or higher, which was partially controlled by cold sponge baths. Nourishment was administered by enemas of milk and whisky. The failure was gradual, death occurring at 10:17 p. m. April 8, 1896. Post-mortem examination twelve hours after death showed the following conditions: Skull cap unusually thick. There was a large amount of effusion in and around.,the meninges. Brain normal in shape, size and consistency, but simple in arrangement of convolutions. The spinal cord was removed and was apparently healthy. Bladder empty, and although previous to her death the bowels had been apparently active, the colon contained a large amount of hard faecal matter its whole length. The intestines appeared to be normal. Gall, bladder and liver normal. Eight kidney normal; left surrounded by an unusual amount of fat, showed contracted furrows, and was dark in appearance. Spleen normal. Lungs, diaphragm and pericardium normal. Heart about normal in size, surrouded by the usual amount of fluid. Pulmonary and aortic valves in good condition. Eight ventricle contained an ante-mortem blood clot. Eight auricle largely dilated, with insufficiency of tricuspid. Mitral valves also deficient. C. H., female, aged fifty-two, admitted August 13, 1895,' suffering from dementia. Physical examination showed the following conditions: Temperature 98°; pulse 100 with marked systolic m u r m u r ; respiration 20, moist rales every where present throughout the chest. Apparent bodily health poor. Totally blind; pupils dilated and reacting under strong light. Partially deaf. Skin at times livid. Speech incoherent, but articulation unimpaired. Gait hesitating and feeble. About three weeks after admission there appeared in the left inguinal region, following the nerve supply nearly to the knee, numerous blisters from the size of a pin head to J in. in diameter, filled with clear serum, but in a few instances with serum discolored with blood. Patient was very difficult to care for on account of her destructive, resistive and untidy characteristics. At times she was very noisy, evidently actuated by visual and auditory hallucinations. She would become considerably excited, making it necessary for someone to hold her in bed to keep her from falling. Her conversation, which was carried on in Swedish, appeared to be wholly incoherent. Appetite voracious, For the last few days of patient's life she failed rapidly, dying on the evening of April 7, 1896, Post-mortem examination revealed a small gliorna about the size of a hazel nut on the left auditory nerve. The brain tissue was somewhat softened and the occipital lobes shrunken. The gross appearance of the brain failed to satisfactorily explain the patient's blindness and deafness. J, L,, female, aged twenty-four, admitted August 4, 1895, suffering from dementia. Physical examination revealed the following: Temperature 99, circulation 100 with mitral and regurgitant murmur. Eespiration 18 with more or less roughened breathing at both apices of the lungs. Was very emotional, apprehensive, and easily excited to tears. Her delusions were numerous and more or less fixed; appetite became capricious, and she complained of diarrhoea. She became noisy and disobedient, and refused to take food or medicine, making it necessary to feed her mechanically. About November 1 her physical condition began to show much impairment. She was pale and showed signs of weakness, and it was very difficult to get her to take sufficient nourishment. Prom this time she rapidly failed. On the 9th her temperature was 103°; respiration 54; pulse 120, with signs of heart failure. The next day she was considerably �REPORT OF THE MEDICAL, SUPERINTENDENT. 39 improved under the action of heart tonics and nutrient enemas. However, she gradually failed, dying the morning of the 12th. Post-mortem examination was held four hours after death and revealed the following: Brain healthy in appearance, except some slight adhesion of dura mater and skull cap on right side. Bowels normal. Liver much enlarged and adherent on its upper surface to the diaphragm. The chest was carefully opened. On separating the ribs at junction of costal cartilages and turning back the sternum the pericardium was found to be firmly adherent to the chest walls and laterally and posteriorly to the surrounding viscera. There was a little more than the normal amount of perioardial fluid. The heart was greatly distended, but there appeared to be a little or no hypertrophy. Post-mortem clot in right auricle; ante-mortem clot in left ventricle extending into the aorta. Mitral valves slightly thickened and deficient. Lungs adherent over their entire surface to the walls of the thorax, the adhesions being stronger on the right side than on the left. Eight lung almost wholly hepatized; induration having begun in the left. W. K., male, aged fifty-three, admitted April 22, 1893, suffering from mild dementia. Was quiet and somewhat depressed in manner. On the morning of July 2, 1895, while moving about the ward attending to his usual duties, though not in such a manner as to cause any undue excitement, he complained of feeling ill, and within ten minutes afterwards was dead. Post-mortem examination revealed a rupture of the descending aorta about three inches above the diaphragm. 0. F. A., male, aged forty-seven, admitted December 7, 1895, suffering from dementia. During the past year patient had had infrequent attacks of vomiting accompanied by pain in the abdomen, and became quite caohectio. An examination showed an oval tumor about six inches long and four inches wide situated in the lower left portion of the epigastric region and the upper left portion of the umbilical region. April 18, 1895, he was seized with a severe chill amounting to a rigor, followed by a temperature of 102|, with vomiting and pain. After this the attacks of vomiting were very frequent and it was with difficulty that he retained a sufficient amount of nourishment. The last two days of his life he was troubled by hiccough and had frequent chills. He failed rapidly, and general peritonitis took place, followed by great distension in the abdomen. He died November 2, 1895. Post-mortem examination revealed the following: Abdominal cavity much distended and filled with pus. A large tumor was found involving the pylorus, transverse colon and pancreas, and adherent to the walls of the abdomen. J. B., male, aged thirty-five, was received February 19, 1894, suffering from gross brain lesion. He was slightly deaf and totally blind, with a very expressionless countenance. Speech slow and hesitating; gait ataxic. He showed marked symptoms of cystitis, and was very helpless; refused food and required mechanical feeding. Patient gradually failed, dying April 15, 1895. Post-mortem examination revealed a large tumor between the frontal lobes with its base on the body of the sphenoid. The optic tracts and olfactory bulbs were entirely destroyed by the pressure. O. M. P., male, aged thirty-nine, admitted June 29, 1889, suffering from melancholia. With the exception of a discharge from the middle ear of left side, patient had been in excellent health. On the morning of February 8, 1896, he was taken with a chill, followed by what appeared to be a stroke of apoplexy, from which he died within a few hours after the attack. The post-mortem made revealed the following: On remov- �40 NORTHERN MICHIGAN ASYLUM. ing the skull cap the veins were found to be engorged. On the left side in the temporo-sphenoidal region there was a large effusion of offensive pus lying between the dura mater and brain. On removing the brain it was noted that the abscess had its origin in the mastoid cells communicating through the petrous portion of the sphenoid with a large cavity in the inferior and middle temporo-sphenoidal lobes of the brain about 3 in. x 2 in. in size. 0. A., male, aged thirty-eight, was received June 19, 1890, suffering from dementia, At the age of four he developed chorea. His mental powers began to fail when he was fifteen years old, but he continued to work as a miner until his nineteenth year, when the severity of his disease rendered him useless as a laborer. At the time of his admission he was restless, irritable, and had a tendency to wander. He also had visceral and perseoutory delusions, While the olonic contractions of the muscles closely resembled chorea, they pointed more closely to a case of disseminated sclerosis. The left leg and arm were more affected than the right. When tired, the left leg dragged and the arm hung limp and helplees. Articulation was jerky and indistinct, and the patient spoke only in monosyllables. There was a slight tremor of the head, but by an effort he could control it. About a year before his death there were signs of general inco-ordination followed by a complete loss of all motor functions. The last two months there was marked muscular atrophy. Patient died February 23, 1895. Post-mortem revealed the fact that the brain tissue was somewhat atrophied and not as firm as normal. The cord was removed, and a series of microscopical sections showed degeneration of the posterior columns throughout its entire length. Out of the 2,271~admissions only 434 were classified in group A as primarily incident to the normal brain. The balance of the oases fall into the organic and degenerate groups. The first group contains all the purely functional psychoses and nearly all the curable oases, whioh is less than twenty per cent of the whole number. Fifteen per cent of the oases were organic, and sixty-five per cent were classed in the degenerate groups. These statistics need no special commentary. The public attention must be directed to the prevention of insanity as well as to the humane and scientific care of patients. Philanthropists and scientists are studying the oauses of degeneracy and pointing out some of the means for its prevention, but it remains for our legislators to investigate these causes and remedies before practical results can be obtained in the prevention of mental degeneracy or its clinical varieties of insanity, pauperism and crime. �a j ffl •9'['BTn9lg; TWtoi -9t«H '9113ra9J[ 'I'BJOJj N -H »M S§S -<*"t- O>0 w5i S3 » S CO rH N« 2S CO*-COOS 30 OSCO <M»f3 ~- SK COCO OS-H -^ ^J—''-'JO -trl-H-*ia U3i—ItDO tCDr-1 CD iffl •* "* O OS .t- iOt-* tNiJO >O S §5 -* "3 IcO»O J OS l—cc O C M C * t- O ^-HC<—*Oi (M '^Tl i-f ^ (M frl CO ; i—<t» fH COW5!(M CO J - —» f-^ -^OCOtH CD ; CD ^-1 ; ; CS i-^— £ 'S t4 00 ^a 6 !1 ori '« S a o d 0 'pH 'o a g O 3. M JO & i-i Ol ?-H OO ^H gs- - i§ — - IS •* OSi-1 O3 I i—1 J ^•*H ^Ot-i CO »O t—t s S-1 •= g ; !|lla I . | | 1SJ 3 Silli Mil fd ® •^ /ri c^JD cjfd M 1 S M"J «& a'C B PH a " •d A2 Q l£ a « o a S » 2 a § ^ CD eS^ c5t3 s 53 Q a 4^ B •< '-i_| •"= gn -S a9 ° c ^> eS-O £| sl s^s sa^s la 1H O ^0 0> *d pj e3 S 0 u_r 0 o 1 1 3^ >>* 02 OS l-i 'S ^ 1 s 1 CD tH 3J aa 4 *- ®-t-= .d <£ S-5 Oft ~£ r"i 1 1 5 II cd S <o 0? s 41 I S |Q CO i j s- S i TO t--* S REPORT OP THE MEDICAL SUPERINTENDENT. M S a 0? a 2 o ft h ^ r-»»o -«l^K S3 fe eg § a cs 1 1 a a '2 ~ ce § r». 1 § « co M rH £££• >»^ a §9 ss ffSlg , -. 11 £ ££>%£ | ^ -9-9 '3 es,o a • 'a ° a t 1' as "c aff cd.0 0 •6 1 .1 ^ DJ M '3 £ o ,a 1 3 p S S 4J s 'g '3 a h-( *ai ^ Svtmilitic.-. a Acute Chronic C3 Delusional insanity (der Dementia (terminal) . . d Hallucinatory deliriu fusional. insanity .. *n | & 1 d M o t-t a" so Melancholia Mania �42 NORTHERN MICHIGAN ASYLUM. ACUTE PRIMARY CONFUSIONAL INSANITY. In our last report a few words were said in regard to this interesting form of mental disease, and during the last two years several oases have come under observation which form the basis of the following remarks. Doubtless acute confusion occurs episodically and as a secondary phenomenon in the various forms of insanity, and it is also quite true that it may be idiopathio and constitute a distinct form of alienation. Formerly these oases have been regarded as clinical varieties of mania and melancholia, and if only the surface symptoms of these derangements, depression or elation, are taken into consideration, the disease in question is entirely overlooked. Mental confusion is not dependent upon hallucinations and illusions of the senses, but these sense disturbances are frequently associated with it and add to the distress and bewilderment of the sufferer. Wille regards acute primary confusion as intermediate between the purely functional psychoses, mania, melancholia and paranoia, and those due to anatomical changes, as toxic insanities and general paralysis of the insane. Sohule states that with certain reservations we may say that the mental states of mania and melancholia, as well as the absence of mental action in stupor, may occur in acute confusion, but in mania and melancholia the psychological reactions are primary and not secondary as in confusion, just as the "motor acts in mental confusion are not spontaneous, but reflexly induced by the rapidly changing mental states, impulsions, and especially by multiple kaleidoscopic illusions." As be points out, these different clinical states may be transformed into one another, i. e., a melancholia may, under the influence of increased illusions, become confusional, or, inversely, an acute maniacal confusion may pass into a true mania. States of mental depression, exaltation and lethargy may alternate in the same individual, but in our experience such modifications have not been frequently observed. As Sohule further states, it is only in outward appearance that these several clinical modifications present a resemblance, since psychologically they rest upon an entirely different foundation. The patient may from an apparently stuporous state suddenly become agitated in mind and body, repeat the most senseless jargon, gesticulate, or throw himself about in the wildest fashion. There is manifested great disassociation in both the intellectual and motor spheres, either partial or complete, and an inhibition of will, all of which is probably induced through hallucinatory or illusory impressions. Sense impressions are not combined to form mental images, and consequently external objects are not recognized, or become the basis of bewildering, frightening concepts in the mind of the individual. The same is true of all the mental operations of the individual. We see modifications in the association of ideas from slight to absolute inooherency. Spitzka defines the disease as follows: "Primary confusional insanity is a form of mental derangement characterized by incoherence and confusion of ideas without an essential emotional disturbance or true dementia." Kraepelin groups under states of acute exhaustion of the central nervous system delirium of collapse, hallucinatory confusion and acute dementia, as different degrees of the same fundamental disorder. He �REPORT OF THE MEDICAL SUPERINTENDENT. 43 defines the delirium of collapse as a profound mental confusion of exceedingly rapid development with hallucinatory dream-like disturbance of the senses, changing emotions, ideorrboei, and active motor excitement, while acute dementia is characterized by a rapid and profound paralysis of all the higher psychical functions. Acute mental confusion, according to this author, occupies an intermediate place, and is characterized by a dream-like confusion of acute development, and with hallucinatory or illusionary perversion of perception. Chaslin gives the following provisional definition of thedisaaae: "Primary, idiopathiomental confusion is an affection ordinarily acute, consecutive to the action of a cause usually appreciable and generally an infection, which ia characterized by somatic phenomena of denutrition, and by mental symptoms, the essential basis of which the primary result of the bodily condition is constituted by a form of mental enfeeblemant and intellectual disasaooiation and mental confusion, which may ba accompanied or not by deluaions, hallucinations, and agitation, or, on the other hand, by motor inertia with or without marked ohaaga of tha e u o t i o n i l state." CAUSATION. All debilitating influences may ba regarded as etiologioal factors. Overexertion, either mental or physical, ill health, or any cause which saps the vital forces and leads to impaired nutrition of the brain may predispose to or excite the disease. Acute physical diseases, rheumatism, typhoid, exanthemata, la grippe, hemorrhage, alcoholism, trauma, etc., seem to especially excite it. Often the disease follows quite remotely the physical causes, and it may be fairly questioned whether infection is always necessary in the production of the malady. In the moat of our oases it immediately followed typhoid, la grippa, rheumatism and the puerperal state in about equal numbers. Typhoid and la grippe have receded the severest oases. Aa to the modus oparandi of thesa causes ttle is definitely known further than a condition of brain exhaustion, with hyper-excitability, is rapidly induced, That organic brain changes are not present, as a rule, is shown by the recovery of the majority of the patients. No attempt has been made to classify the clinical varieties of the disease. The following of Schule's forma are those which we have been able to distinguish. S SIMPLE PRIMABY MENTAL CONFUSION. This form is usually preceded by a short prodromal stage of vague nervous symptoms, restlessness, fugitive pains in various parts of the body, irritability, querulouaness and sleeplessness. Physically, there is loss of appetite, constipation, coated tongue, fetid breath and loss of weight. The patient gradually but sometimes suddenly, sinks into a. state of mental helplessness. The countenance is puzzled and the individual is unable to express his thoughts. If questions are addressed to him, they are either comprehended imperfectly or not at all, and there will be either no response or a mumbled phrase, at first possibly intelligent, but ending abruptly or in meaningless words. Often words themselves are mutilated. The patient is unable to grasp an idea or to express one. The whole �44 NORTHERN MICHIGAN ASYLUM. aspect of the individual is expressed by the word "helpless." His atti-. tude shows the chaos of^ his mind. If standing, he seems relaxed, and his gait is hesitating and his movements are aimless. He cannot express himself in language or in writing. The circulation is generally impaired, the heart's action weakened and accelerated, and the extremities are usually cold and blue. The temperature is usually normal, but sometimes sub-normal. There is no stupor in these cases. The patient seems to observe, but can only express himself in the most fragmentary manner, if at all, Hallucinations and illusions are not manifested. The emotions are rarely deranged. The duration of the disease is short. In simple confusion, incoherenoy is not always present. There is simply an inability to arrange or sort out the thoughts for intelligent expresion. The following note is an example taken from such a case. The illustration utterly fails, however, to give a likeness of the helplessness of the man and of the effort required for him to give the answers made: Q. Have you always lived with your father and mother? A. Father and mother? Yes. Q. What led to your coming here? A. No; I don't. Q. Never bad any idea? A. What kind of coming is that? Q. Never had any idea, did you? A. Why, no; not as I know of. Q. Did you ever have any trouble where you came from? A. No. Q. Did you ever work on a farm? A. Work on a farm? I don't know. Q. What kind of work did you do? A. What kind of work? What kind of work is that? Q. What kind of work did you do at home? A. Why, you'll have to tell me. Q. I can't tell you. I didn't know you before you came. A. Didn't know me? Yes, you'll have to tell me. Q. That will be impossible. I asked you. Don't you remember what you did? A. Why, no. Q. Did you ever milk cows? A. What's them? Q. Don't you know what a cow is? A. A cow? Q. Would you know one if you were to see it in a field? A. What's a cow? Q. Never saw a cow? A. Can you tell me what's a cow? Q. It's an animal. A. An animal? Q. You lived on a farm—don't you know what a cow is? A. What's a farm? Q. What did you do in your boyhood? Did you ever go to school? A. No, I don't know. What kind of a school is that? Q. Well, there are different kinds of schools. A. Different kind? What different kind is that? �REPORT OP THE MEDICAL SUPERINTENDENT. 45 in the agitatedlform of simple primary mental confusion there is great inooherenoy of expression as well as motor excitement, with impulsions to violence towards self or others. Hallucinations are not present. The emotions are involved and the patient may weep or laugh, manifest anger or joy, aggressiveness or fear, in a strangely mixed fashion. There is emaciation, rapid pulse, and a rise of temperature from f ° to 1° or more above the normal. In one of our patients it rose to 102°. The severe cases of this form in their symptomatology in many ways resemble acute delirious mania. Keoovery, as a rule, is rapid, although death sometimes occurs from exhaustion. In some of these cases the ideas are excited by events in or from the surroundings. A question from the physician, the presence of an attendant or another patient, or the conversation of associates, sets in motion & series of expressions which seem to be continued automatically. The patient becomes under such circumstances more and more agitated, shows great distress,'and finally becomes completely confused in utterance ACUTE HALLUCINATORY MANIACAL CONFUSION. Sohule very accurately describes this disease: "The prodromal period, usually short, is characterized first by a simple nervous state, eeoond by maniacal excitation of short duration with moderate flow of ideas, affected language, excessive pretensions, and constant occupation, and third, frequently by sudden perplexity and hypoohondriaoal preoccupations which agitate the patient. He complains of great fatigue, of despondency, of prickling in the head, sensations of interior chilliness, sudden shocks in the arms, and the fear that poison is introduced into his blood, or dangerous substances into his body, etc. Multiple hallucinations then break forth and lead to confusion of intellect. The patient is suddenly plunged, as it were, into a world of dreams." The hallucinations of sight and hearing are intense. The patient hears the voice of God, of friends, of enemies, and sees visions of devils, angels and spirits. He shouts and gesticulates, and is sometimes elated, sometimes depressed, according to the content of the hallucinatory impressions. He may not recognize friends or surroundings, may throw himself from the bed or on the floor, tear his clothing, destroy furniture and soil his room, or run and shout and offer violence to those about him. He may present brief lucid moments in which he is able to answer questions and take nourishment, but soon relapses again into his confused excitement. A patient during one of these lucid intervals said she felt as if drunk, and accused her nurses of giving her intoxicants. They are often elated, always extremely incoherent and noisy, and often cannot be quieted by any proper or legitimate measures. There is usually rapid loss of weight, increased temperature, rapid pulse and sleeplessness, whioh lead rapidly to exhaustion. The course of the disease is rapid and ends either in exhaustion or death, or recovery. The following is a stenographic note of the conversation of a patient of this class. His motor excitement was great, and he required constant watching to keep him in his bed and room. He had previously taken 1-50 grain of hyoscine, and his temperature was 99° and pulse 88. " Right, left, right, left, pa, ma, I tell you, you never kill me, I don't care if you kill me in 1,400 years, what county is this in? It appeared away back there. Ma is my m j and nobody else's ma. A,- B, 0, D, A, �46 NORTHEEN MICHIGAN ASYLUM.' B, C, D, psb, whsb, psb, whsb, A, E, I, A, E, I, take my world, split the difference between this whole world, etc., etc." This condition lasted four days, after which the patient made a rapid recovery. PRIMARY EXPANSIVE MENTAL CONFUSION. This form has a paranoiac tinge and may be combined with hallucinations. It usually develops suddenly after overwork, shock, prolonged religious excitement, etc. Incoherenoy is not marked, but there is an extremely confused and exaggerated condition of ideas. The following are stenographic notes of the case of Mr. M. At the time of his admission he was pleasant in manner, brisk in gait and gestures, and fairly well controlled. He conversed in a rambling disconnected way about his great wealth or the great things that he bad done or was going to do. He could not converse outside his dominating ideas, neither could he express himself in writing. He soon improved and gave up his grandiose ideas: "I have bought this place for $250,000, $50,000 for the church. I have got all the land between here and Detroit that is mortgaged, and all the good farms. I am going to put men on the farms, fix up their houses, tear down their fences for wood, and clean out all these little oat holes. I am going to build a church here in this grove. I think it will be about 2,000 or 3,000 feet across it. We'll build it round. McAllister will be there, and these little girls will be angels, dressed with lace wings on their arms, red, white and blue flags with my advertisement on them. We'll have the picture of Jesus Christ as large as we can get it conveniently in the church, in flesh colors, with angels, the children like that when they 1 Come unto me, little children.' I have talked with the Lord about it. (Here followed a rambling account of his various exploits.) We are going to build a church just as big as we can between that hill and the other. These mounds will be all evergreens and flowers and everything nice, and people can come from the end of the world to this church if they want to free of charge. I think I own the Michigan Central R. R. We are going to have 8 or 10 electric cars. Here will be two oars that will hold about 16, or 18, or 20 people. They'll run through the end of the church, and slack up to let the people get off. The pulpit will be 60 or 70 feet high. The people will be one above the other. Here's going to be Hell at the end of the car track. I'm going to have a couple of live lions by the door, tame lions that I'm going to pick up. I've got fellows traveling over the road after them. Well, these boys pick up the sinners in the street, and the minute a sinner sits onto that electric oar he is dropped right off into that hell of fire and brimstone. I've talked with the Lord about this. We'll have the Lord big enough so that he can be out of sight and talk, etc., etc." This patient was always self-controlled, and made himself useful in many ways about his ward. There were no perseoutory ideas, and with the exception of his statement of having talked with the Lord concerning his great schemes, presented no hallucination. In many ways his disturbance resembled simple maniacal xaltation, but lacked the coherency and logic of this derangement, The following is a stenographic note of a harangue, after questioning, that P. R. gave vent to. This patient presented much motor agitation and required much special attention to make him comfortable. He presented! many grandiose ideas in addition to those mentioned in the note: �REPORT OF THE MEDICAL SUPERINTENDENT. 47 "I've been all over the United States; in every town in the United States. I've got the best lawyers in the United States retained. I've ot an uncle that's dead now and I'm going to settle the estate as soon as can get to it. Free ride all over the United States and Canada, on any road, any boat. I've got about fifteen million dollars. I've got the last degree in Masonry, the last degree in any secret society in the United States. How muoh do you think it costs to get it now? I don't know myself, but when I got it it cost $70, and I'll give it to you now," and so on. In another patient there were marked hallucinations and the inooherency was great. The manner was pleasant, but the ideas were grandiose, a mixture of religious, erotic and extravagant fancies. f ACUTE HALLUCINATORY CONFUSION OF DOUBLE FORM, EXPANSIVE DEPKESSIVE. AND This clinical variety of confusion, like the preceding, is due to some exhausting cause. There may be a prodromal stage of several weeks' duration marked by sleeplessness, extravagant ideas, sinking of bodily health, and strange or irregular conduct on the part of the individual. Suddenly the patient becomes acutely hallucinated. He is bewildered and anxious, and constantly occupied in attending to his hallucinatory impressions. He talks incessantly, and seeks for the source of the voices under the bed, in the ceiling, etc. He speaks of people being in various parts of the building, on the grounds, or in the country, and insists that he can both see and hear them. His expression is blank, puzzled and bewildered, and he is greatly depressed over his condition. He does not smile, is inclined to be resistive and irritable, and sits in a sad, dejected manner, whispering and talking in an agitated incoherent manner to hie imaginary personages. If his attention can be gained, he may answer questions correctly but briefly, and soon forgets that he is addressed and goes on with his whispering, talking and gesticulation. During more lucid moments he speaks of his wealth, of his horses, the magnificent buildings he is going to construct, or of other grand schemes which seem to give him much satisfaction. These two states go hand in hand, the hallucinatory being, however, the most marked. We have a patient who is just emerging from this condition. The hallucinatory phenomena have disappeared, but the ideas of grandeur continue, but in a modified form. Physically, there is tremor of the tongue and hands, unequal dilitation of the pupils, and many of the somatic signs of general paralysis. Diagnosis can only be established by the course of the disease. ACUTE DEPEESSIVE MENTAL CONFUSION. This form resembles melancholia, but is lacking in the logic of its delusions. In melancholia, there is usually the feeling that the sufferings which the patient endures are just, and are often regarded as punishments for some imaginary wrong or crime that he has committed. ID depressive mental confusion the delusions are marked and lead to extreme agitation. There is often senseless repetition of some set phrase, words or ideas, without any appreciation of persons or surroundings. The following will show the agitation andjj distress of a patient who sufferedJfrom this disease: �48 NORTHERN MICHIGAN ASYLUM. "Oh, why did I do such a thing! Oh, dirty wretch. Can't I come in? Let me come in You was one of them that helped do it. Well, my God! Oh. woman! Oh, you dirty wretch! Oh, what did I do such a thing for! Oh, for Heaven's sakes! Ob, shame, shame, to out up such a fool trick! You old hag, you helped to do it! Oh, shame, shame, shame! I ain't got any home. See here. Oh, don't! Look here! I've got fire on me. I hadn't ought to holler, O, don't! etc., etc." It is difficult to express the agitation that accompanied these words. The condition continued for several weeks, and finally she entered upon convalescence. Cases of this description are usually classified as agitated melancholia, but as has been said before, they are entirely wanting in the logic of true melancholia and the power to reason correctly on topics indifferent to them. It is doubtless true that the confusion is the primary disorder in all these forms. As Kegis says, "The hallucinations are only accessories. The outward appearance and the acts of the sufferer vary from moment to moment; he is expressionless, mutters incoherently and yields to acts, sometime co-ordinated but frequently incomprehensible, but which appear to be more or less related to hallucinations." According to Chaslin, the fundamental condition of mental confusion consists in the impaired power of association of ideas and its perversion. This disorder affects in reality all the successive degrees of association, from the synthesis which forms perception to the synthesis more vast, of space, time, personality and appreciation. The clinical aspect of the disease is briefly explained in this way: The patient recognizes exterior objects imperfectly; that is, sometimes external impressions no longer awaken the mental images that they should excite in order to give the exact notion of the object For the same reason external objects may appear deformed, or finally they may be completely unrecognized. In a certain number of oases, however, the perceptions are correct, but the superior reasoning which the mind of the patient must accomplish to utilize these perceptions does not take place or is very incomplete. These troubles which rest upon an imperfection in all degrees in the unification of the mental images affect in a similar manner the motor images. The will is involved the same as the intelligence; the acts are painful, incomplete and unskillful. The loss of association of sensory images is aoompanied by a loss of association for motor images; the necessary synthesis fora voluntary act is incomplete, difficult, or even impossible. Attention, which is one of the elements of this synthesis, is impaired, speech and writing are badly adapted, phrases are unfinished, and even words are imperfectly spoken. It would be interesting to follow the physiological psychology of the disease as laid down by Chaslin, but the narrow confines of a report of this description are too limited for the purpose. The treatment of the disease consists in rest in bed, isolation, careful attention to feeding, tonics, antiseptic remedies, baths, and anodynes to produce quiet and sleep. Dr, Rowley, of the medical staff, contributes the following study on hysterical insanity. HYSTERICAL INSANITY. In the biennial report of 1894 some space was devoted to the consideration of this form of mental derangement. Special reference was therein made to five oases selected from those under treatment from the opening �REPORT OP THE MEDICAL SUPERINTENDENT. 49 of the institution. The results in each instance, together with the general method of treatment, were mentioned. The field for observation in hysterical insanity is a broad one. The cases presented two years ago only partially covered the ground, and in this report it is intended to briefly present some other phases of hysterical insanity as evidenced by such oases as have come under observation during the past two years. Although hysteria with its protean manifestations is rather a common malady today, sanitariums, retreats and hospitals for nervous invalids being well patronized, still the number of cases of hysterical insanity that reach insane hospitals is not large. Of the 409 oases admitted during the biennial period, only five, or 1.2 per cent, were classified as hysterical, i. e, the basis of the insanity had been hysteria in which neurosis.had been present for some time in each case before the mental breakdown, These five oases (females) represent but 2.7 per cent of all the female patients admitted during the period. Below has been tabulated, for clearness as well as brevity, some of the more interesting facts of each one's preliminary history, Civil No. Age. Condition . Nativity. 1 38 2 21 3 23 1 52 5 25 Neurotic Ancestry. Married.. Maine — Father hysterical and addicted to opium. Married .. Mich '. Mother very hysterical. S ngle.._. Mich Mother, father, brother Insane. Single Ireland .. One sister insane, one sister hysterical ; brother imbecile. Mother hysterical; paternal Married.. Mich uncle insane. Duration. Ultimate Cause of Insanity. 1 year.. Ill health and use of opium. 2 years. Domestic infelicities. 2 years. Dysmenorrhoea. 4 mos... Fright. 4 years- Disappointment in married life. Hysteria is not alone confined to the female sex, although thus far no oases of hysterical insanity in the male have been recorded in the institution. There is nothing particularly suggestive in the ages or civil condition of the five oases. Each had passed the epoch of puberty. Three had married, although only one had borne children. One has passed the menopause. The most interesting feature of the above table and the one that materially will require some consideration, is the column of neurotic ancestry. As indicated there, each of the five patients has had t h e burden of ancestral weakness resting upon her. Certain oases have been especially unfortunate in that regard. Hysteria was present in many of the relatives; in fact, each case has had one or more immediate relatives who were thus afflicted. Only one of this number, however, became sufficiently deranged to require asylum treatment. The present inmates (oases under consideration) succumbed earlier in life to hysteria than the antecedents, and in addition became insane, passing beyond the oare of relatives. From a neurotic ancestry such as the above one would scarcely look for the highest standard of endowment in the progeny. It would seem that there need be no difficulty in recognizing hysteria as a neurosis and a distinct mark of degeneracy. Two years ago the histories of oases were suoh as to make the above statement evident. The present group serves the further purpose of confirming Charoot's belief that hysteria was directly hereditary. 7 �50 NORTHERN MICHIGAN ASYLUM. "! The column of duration of disease previous to commitment represents, as well as the friends of patients can ascertain, the time of the onset of insanity. As was inferred before, each of these five individuals had been hysterical for years, the exact time in no instance being obtainable. The assigned cause of the mental trouble will be noticed as being variable. The cause would, without an intimate knowledge of the circumstances, appear entirely inadequate. In a normal individual such results would not have obtained. Mental instability in these five individuals is demonstrated by the small resistive power with which they were endowed. The most instructive and valuable information that could be obtained would consist in an accurate knowledge of the daily lives, surroundings, etc., of the several patients. Such information rarely becomes the property of the asylum physician, who must-be satisfied with the clinical aspects of the cases as they present themselves to him. The cause (ultimate) means that a multitude of forces have been at work undermining the individual, and that the last has been far less important, practically speaking, than the train of antecedent events. After this brief historical summary there will naturally follow the clinical status of each, as representing types of hysterical insanity. In the first place, the question naturally arises, What constitutes hysterical insanity? The inference would reasonably follow; an hysterical individual, undoubtedly so, whose neurotic condition has through a process of reduction led its possessor out of the realms of sound reasoning, proper emotionality, or normal volition. One would naturally from the above statement expect the manifestations of the hysterically insane to be as varied as the domain of pathological mentality, and as a matter of fact such has been observed to a certain extent in our oases. Four of the five individuals came to the institution in a very excitable condition, each more or less dominated by hallucinations of hearing, and three possessed of delusional ideas of the melancholic type. Two had been quite inclined to suicide, both having made several desperate attempts during their paroxysms of excitation. Visceral illusions were present in every one of the five. These illusional ideas were not fixed. Often the patient did not fully believe in them, although in her actions and sayings controlled to a large degree by them. One patient thought that her head was being pressed out of shape and that in a short time her friends would be unable to recognize her. This idea presently gave way to the next, that she could not articulate. Kindred ideas, one after the other, took possession of her. Illusional ideas are undoubtedly misinterpreted sensations. The above expressions of this patient had their foundation in parsethesias of the scalp and in a parched, furred and swollen tongue, the latter condition resulting from lack of food. The patient was more or less subject to suggestions, and when told that she could talk conversed very freely, although previous to that time she had remained mute for several days. Case No. 1. having been ill for a year at last became uncontrollable at home. When admitted she was in a helpless condition, constantly talking, and full of fears concerning herself and those about her. Hallucinations of sight were very troublesome, She could see people dying about her, and felt impelled to pinch them to bring them to consciousness, believing it was within her power so to do. She became very much wrought up in her feeble efforts to save life, and exhaustion naturally resulted. Many of the most interesting of vasomotor phenomena, based �REPORT OF THE MEDICAL SUPERINTENDENT. 51 on hysteria was exemplied in this case. She had been the subject of periodical hemorrhages from many mucous surfaces. Attacks of haematuria, haemoptysis and epistaxis had been observed. Her pulse rate and respiration were much accelerated, and her temperature remained elevated two or three degrees for several days, gradually becoming normal as her excited mental state was relieved. The existence of hemorrhages from so many sources, the result doubtless of reflex vasomotor changes, was peculiar to this one patient. Extremely few instances are on record. There have come to our notice a few similar oases which have alone been cited by the German authorities. These hemorrhages continued long after the patient ceased to be excited and her temperature had become normal. Relatives state that these hemorrhages had occurred for years. At first she was thought to be suffering from vicarious menstruation. It became evident after a while that this was not the case. As she improved mentally, these peculiar hemorrhages became less frequent and less severe, although they never ceased to recur while she remained under treatment. This patient at times had typical hysterical seizures, waa likewise hemiansesthetio, hyperaesthetic, and very emotional. Her pupils were also quite irregular, fibrillary twitohings of the eyelids and muscles of the ohin were often noticeable; in fact, this patient simulated so many characteristics of organic brain and cord disease that the diagnosis of her real state was for a time questionable. During the second month of her treatment she was persistently mute. Very few of our oases have presented such a wide range of mental and nervous peculiarities as this one. She has at times been intensely persecuted, believing almost everyone her bitterest enemy, and having confidence in the statement of no one. She has likewise possessed the most grandiose ideas; has been vicious and has assaulted both attendants and physicians. After a continuous treatment of nearly a year the patient was very much improved and has at present resided at home for about five months. Case No. 2 remained in the institution about six weeks. She was considerably excited when admitted, soon thereafter became mute and remained so for several days; was very much hallucinated. She persisenty refused food, and required mechanical feeding once. Her case was in, many respects a very satisfactory one to treat. Although she had been more or less deranged for two years, still her extremely disturbed state had been of only ten days' duration. She responded quickly to treatment, her appetite returned, and she rapidly gained in flesh. This patient has been at home about four months. Case No. 3 differs from the preceding ones in that she was possessed of a depraved character, the unfortunate inheritance of several generations. Her fondness for mischief-making was especially noticeable at times. When admitted she resisted considerably, and frequently during her residence made assaults on officers, attendants, and other patients. When in an excited, hallucinated state of mind she was very difficult to control. Many of her visceral illusions had especial reference to the sexual organs. She believed herself afflicted with certain diseases and no amount of assurance to the contrary would convince her. This patient has recently been removed from the institution by her friends. She has improved considerably, and is probably up to her standard of mental health, Case No. 4 in many respects presents the most interesting train of visceral illusions and delusions of any of the five. She is seldom free from intense suicidal impulses. Her desire is not, however, primarily to de- �52 NORTHERN MICHIGAN ASYLUM. stroy self, but she feels called upon to resort to that means in order to be rid of devils that she believes are within her abdomen. Twice since her admission has she by means of a blunt instrument opened the abdominal wall. Patient experienced no pain whatever in having the wounds stitched. She is almost entirely anaesthetic in certain regions, although, strange to say, it is concerning these same localities that her painful delusions relate. In contradistinction to the anesthetic areas, patient has hypereesthesiaof the scalp and of the limbs. This patient is the only one who has maintained a fixed delusion regarding her viscera. She has in addition at different times given expression to numberless other ideas equally outlandish; has been exceedingly vicious and aggressive during the last few months. Her treatment has continued for about a year, but her condition does not appear much improved. Case No. 5 came voluntarily to the institution. She, more than anyone else of her family, seemed to realize the nature of her condition. Periodically, she has become much excited, hallucinated and destructive. Her visceral illusion had special reference to the circulatory apparatus. Frequently she has rushed up and down the hall in an anxious frame of mind. When remonstrated with,'she has invariably stated that she must do so in order to keep her heart pulsating. Patient's vasomotor system is a very susceptible one. She has been subject to frequent attacks of pallor as well as of localized hypersemia. She almost constantly studies her sensations. At times finds it impossible to read or to sit still. She tires of talking, the sound of her own voice being especially disagreeable to herself. Becomes very nervous if talked to. If not permitted to follow out her own inclinations, is very apt to be exceedingly irritable and aggressive. There has been during her stay of over a year some improvement, although the change has not been a satisfactory one. Cases of hysterical insanity are not very amenable to treatment. Asylum life with its salutary discipline and methodical ways is almost always beneficial, but seldom curative. If patients can but be restored to their former standards of mental health, all has been accomplished that could reasonably be expected. Much has been accomplished in the use of proper remedial agents, suggestions in the awakening and hypnotic state have always been serviceable. Visceral illusions are often based on pathological conditions that are to a certain extent removable. Forced feeding, rest in bed in some cases, judicious exercise and plenty of fresh air in others, have acoompished much. No definite line of procedure can be laid out for each case in advance. Conditions as they arise must be met. It is to be deplored that patients are not placed under judicious treatment earlier in the course of their disease, in order that the chances for improvement may be more enhanced. The following paper on the opim-bromide treatment of epilepsy is contributed by Dr. E. L. Niskern of the medical staff. TREATMENT OF EPILEPSY WITH OPIUM AND BROMIDE OF POTASSIUM, AND WITH ADONIS VERNALIS. The following notes show the results that have been obtained so far in the treatment of epilepsy in the manner outlined by Fleohsig, although his method has not been strictly adhered to in each case. He advises that powdered opium be given in gradually increased amounts until the �EEPORT OF THE MEDICAL SUPERINTENDENT. 53 daily dose of one gramme is reached, and that the patient then take this dose for one month; then that the opium be discontinued, and bromide of potassium in daily doses of seven grammes, well diluted, be substituted. This dose ordinarily is continued for about two months, and then gradually diminished until only a small amount, or none at all, is taken. Our experience shows that about three weeks is the required time in which to reach the maximum dose of opium. A few examples are given below, indicating the daily increase of this drug. The notes on the treatment with adonis vernalis are unsatisfactory inasmuch as the use of this remedy was begun here but recently. Only a few oases have been tried, and the dose given has undoubtedly been too small. Case No. 1. L. B. Age 24. Has suffered with epilepsy for 12 years, Admitted October 13, 1894, and received bromide of potassium in varying doses until August 1, 1895, when the bromide of potassium was discontinued and powdered opium was begun in doses of .015 gramme. This was gradually increased until August 15, when the dose reached 1.00 gramme per day. This dose was continued until September 15, and potassium bromide 7.00 grammes per day was substituted. October 20 the dose was reduced to 6.00 grammes per day which was continued until November 4, when the patient was transferred to the Upper Peninsula Hospital. The following table shaws the number of patient's convulsions for the two weeks preceding the opium treatment, while he was receiving bromide of potassium 4,00 grammes per day. 16 17 19 21 23 25 26 27 28 29 31 July 2 2 1 2 2 1 2 2 1 1 1 the total being 17, most of which were of ths severe type. The following table indicates the number of convulsions he had during the course of opium. 1 2 8 9 10 11 12 15 16 17 18 19 20 21 24 25 26 27 30 31 Aug. 2 1 1 1 1 1 1 1 1 1 1 1 2 4 2 1 1 1 2 1 1 3 5 6 8 9 10 11 12 13 14 1 1 1 2 1 2 3 1 4 1 2 total, 46 convulsions in six weeks, being an average of nearly 8 convnlsions for each two weeks, or about half as many as while he was receiving bromide. During the period beginning September 15, and ending November 4, patient had three convulsions, one on each of the following days: September 15, October 1, and November 4. Patient has not been heard from since his transfer. Case No. 2. E. H. Age 29. Duration of disease 24 years. Admitted November 30, 1885. For a considerable length of time previous to August 1, 1895, bromide of potassium in daily doses of 3.00 grammes had been given. On that date the bromide of potassium was discontinued, and powdered opium in a daily dose of ,06 gramme was begun, and gradually increased until �54 NORTHERN MICHIGAN ASYLUM. August 15, when a dose of 1.00 gramme per day was reached. This was continued until September 15, when bromide of potassium 7.00 grammes per day was substituted, October 14 the dose was decreased to 5.00 grammes per day; November 9 to 4 grammes per day, and on the 30th of the same month it was discontinued entirely. During the month of August patient had 44 convulsions, 10 of which were light. In September, up to the 16th he had 14, 7 of which were light. Prom September 16 until December 22 he was entirely free from convulsions During the remainder of December he had 3 convulsions. In January, 1896, 2; in Feburary, 6; March, 4; April, 8; May, 6; June, 8, al! of which were severe. Case No. 3. D, L. Age 29, Duration of disease 24 years. Admitted June 30, 1888. September 1, 1895, bromide of potassium, 3.00 grammes per day, which patient had been taking, was discontinued, and powdered opium, .06 gramme per day was begun and gradually increased to 1.00 gramme per day, September 24, and was continued in the same dose until October 4. It was then discontinued, and bromide of potassium, 7.00 grammes per day, substituted. November 12, this dose was decreased to 5.00; November 20, increased to 6.00 grammes per day; December 15, changed to 4.00 grammes, and January 1 it was further reduced to 3.00 grammes per day. His convulsions have occurred as follows: During the month of August, 1895, 7 severe convulsions; September, 8 severe and 3 light; October up to the 25th 11 severe and 8 light. From October 26 until November 17 he was free from seizures. On the latter date he had one severe convulsion. During December, 1; January, 1896, 5; February, 2; March, 4; April, 4. During the first 9 days of May he had 4 convulsions. March 31 the bromide of potassium was discontinued, but on May 10 he began taking each day bromide of potassium 2.00 grammes, codeine sulphate 0.01 gramme, and fluid extract adonis vernalis, .36 c.o. Daring the remainder of the month he had but one convulsion, and in June, 3. Case No. 4. G. A. H, Age 29. Duration of disease 18 years. Admitted October 21, 1891. September 15, 1895, bromide of potassium which he had been receiving in daily doses of 3.00 grammes was discontinued, and powdered opium was begun in doses of ,04 gramme and gradually increased to 1.00 gramme er day, which was reached September 24, and continued in the same ose until October 24, when bromide of potassium 7.00 grammes was substituted. November 4 this dose was reduced to 5.00 grammes daily, and January 1, 1896, the dose was further reduced to 3 00 grammes. During the month of August patient had 4 convulsions, all of which were severe. During September, 5 severe and 5 light ones. During October, up to the 24th, he had 13 severe and 3 light convulsions. From October 25 until December 10 be was free from seizures. During the remainder of December, he bad 3 severe attacks. In January, 1 light and 2 severe attacks, February, 6 severe attacks. Jauuary 19 a similar course of treatment with opium was again begun. February 20 the opium was discontinued, and bromide of potassium was again begun in daily doses of 6.00 grammes. March 2 it was reduced to § �REPORT OP THE MEDICAL SUPERINTENDENT. 55 5.00 grammes, and on the 6th was further ^reduced to 3.00 grammes, and continued in the same dose until the present time. The following is a list of convulsions since the second course of opium treatment. February 21, 1; March 2, 1; March 28, 1; April 12, 2; April 23, 1; May 14, 1: June 6, 2; all of which were of the severe type. Case No 5. J. G, Age 37. Duration of disease, 18 years. Admitted January 9, 1896, from Michigan Asylum. During the greater part of his residence at said asylum, he received bromide of potassium, 3.00 grammes per day, and his convulsions were as follows: During 1894, March, 1; April, 6; May, 9; June, 1; July, 1; August, 0; September, 0; October, 7; November, 0; December, 0; January, 1895, 8. January 18, 1896, he began to take powdered opium the following named daily doses: .02, .02, .03, .04, .05, .07, .10, .12, .14, .16, .18, .20, .22, .24, .26, .28, .30, .32, .36, .40, .45, .50, 55, .60, 66, .72, .80, .90, 1.00, the last named dose was given on February 15, and was repeated the two succeeding days, and then discontinued, bromide of potassium being submitted in daily doses of 7.00 grammes. Beduoed to 5.00 grammes on March 7; increased to 7.00 grammes March 16, and was continued in the same dose until May 1, when the daily dose was decreased to 3.00 grammes. This treatment remained unchanged up to May 14. His convulsions since his admission to the institution have been as follows: 10 11 12 13 14 18 28 TflTI CJ QJJ* 4 2 1 2 3 1 1 total, 13 light, and 1 severe. 1 3 4 5 7 11 12 13 14 15 16 17 1 1 1 2 1 1 1 4 2 3 5 3 total, 10 severe, and 15 light. From Feburary 18 until March 12 he was free from convulsions. During the remaining part of the month he had 1 severe and 23 light convulsions; April, 6 light convulsions; up to May 14, 7 severe and 11 light. At that time he began to receive fluid extract of adonis vernalis .36c.o. daily, bromide of potassium 3.00 grammes daily being continued. During the remaining part of the month he had 1 severe and 10 light convulsions and in June, 23 severe and 11 light, no change in medicine being made. Case No. 6. L. F. Age 42. Duration of disease 16 years. Admitted June 1, 1887. On January 18, 1896, the bromide of potassium which patient had been taking in daily dosea of 3 00 grammes was discontinued, and powdered opium was given in daily doses as follows: .01, .01, .02, .03, .04, .05, .06, .07, .08, .09, .10, .12, .13, .14, .15, .16, .17, .18, .20, 22, .24, .26, .28, .30, .34, .38, .42, .45, .50, .55, .60, .65, .70, .75, .80, .85, .90, .95, 1.00, the last named dose being reached February 25. The opium was continued in 1.00 gramme doses until the 1st of March, when it was discontinued, and bromide of potassium in daily doses of 7.00 grammes was substituted. March 7 the daily dose of bromide of �56 NORTHEKN MICHIGAN ASYLUM. potassium was reduced to 5.00 grammes, and on April 1 was reduced to 4.00 grammes. June 1 it was further reduced to 3.00 grammes per day. His convulsions have occurred as follows: January, 2 severe, 13 light; February, 1 severe, 14 light; March, 2 light; April, 2 severe; May, 2 severe, 5 light, June, 10 severe and 10 light. Case No. 7. G. G. O. Age 25. Duration of disease 5 years. Admitted April 9, 1896. His history states that he had been receiving bromideof potassium previously to his admission to this institution. April 10 he began taking powdered opium, the daily doses being as follows: .02, .03, .05. .07, .08, .10, .12, .15, .20, .25, .30 .35, .42, .50, .60, .70, .60, .60, .60, .70, .75, .80, .90. From May 4 until June 7 be received a daily dose of 1.00 gramme. From June 8 until the present time he has received bromide of potassium 7.00 grammes daily. His convulsions since he has been in the institution have been as follows: April 17, 1; May 4, 1; May 21, 1; all of which were severe. Patient stated that before he entered the institution he was having convulsions at the rate of 2 or 3 a week, although not very much dependence can be placed upon his word. From May 2, until the present time he has been entirely free from convulsions. Some difficulty was experienced with this patient both at the beginning of his treatment with opium and bromide. From April 13 until April 27, patient suffered so much from dizziness and nervousness that it was found necessary to give him bromide of potassium with the opium, at first in doses of 2.00 grammes daily, and later, 1,00 gramme daily. From the latter date he bore the opium very well up to the time it was discontinued, but after the first two doses of bromide of potassium, June 9, he suffered so much with headache that he refused to take the third dose. His headache lasted two days longer, and he refused to take any more medicine until June 12, when he was induced to begin again, taking 4.33 grammes during the day. June 13 the dose was increased to 6.33 grammes, and on the following day he began taking the regular amount prescribed, since which time he has been very comfortable indeed, being able to do a considerable amount of light outdoor work. Case No. 8. H, L. Age 42. Duration of disease 16 years. Admitted November 30, 1885. Since the 1st of January he has been taking bromide of potassium 2.00 grammes daily, and his convulsions have been as follows: January, 14; February, 6; March 20; April, 5; May, 8. June let he began taking in addition to the bromide of potassium fluid extract of adonis vernalis ,36 o. c. daily, and during the month following he had 14 convulsions. Case No. 9. O. O. Age 28. Admitted August 1, 1892, since which time he has been treated with bromide of potassium in varying doses. Since February 1, 1896, the dose has been 2.00 grammes daily. During the month of June he has taken in addition codeine sulphate .03 gramme and fluid extract of adonis vernalis .36 c. o, His convulsions during this period have been as follows: February, 8; March, 6; April, 4 ; May, 9; June, 6; all of which have been severe. �REPORT OP THE MEDICAL SUPERINTENDENT. 57 SUMMAB7. It is to be noticed that in all of the above cases but one, the disease is of long duration. Oases 5 and 6, which gave the most unsatisfactory results, received the opium in one gramme doses only two and four days, respectively. In none of the oases except No. 7 was the bromide of potassium given in massive doses as long as the time required by Fleohsig, although there was no indication for diminishing the dose except in cases No. 4 and No. 6. In the above mentioned cases, no trouble was found in the administration of opium, except as explained in connection with case No. 7. These patients, however, are all fairly well developad both physically and mentally. The treatment was attempted with several idiots, but the physiological effect of the opium proved too severe for them, and it had to be discontinued. In two or three instances it was found impossible for the patient to do without the bromide of potassium to which they were accustomed, long enough to carry out the opium treatment, although it is now thought that the bromide could be given along with the opium, and gradually be diminished as the opium is increased. Constipation occurred in only one case, and was easily overcome by the use of casoara sagrada. Examination of the notes of those oases that were treated with adonis vernalis, shows them to be negativa, or nearly so. A few other cases were tried, but with no more satisfactory results than are here recorded. As this article goes to the publisher, (August 17) Gr. 0. O., case No. 7 is still taking bromide of potassium, seven grammes daily, and is still free from convulsions. The following paper on the mechanical feeding of patients is contributed by Dr. R, Howell, of the medical staff. REFUSAL OF FOOD, AND MECHANICAL FEEDING. During the last biennial period there have been under treatment 22 patients that have refused food, some for a few days only, and others for weeks or months. We shall briefly consider some of these oases that required mechanical feeding, with especial reference to the delusions, illusions acd hallucinations that were the direct cause of refusal of food. It might be well to state that not all patients having delusions concerning their food refused to eat under conditions favorable to their own fancies; but the cases which we have here under consideration resisted all persuasive efforts until their failing physical condition made recourse to mechanical feeding imperative. �58 NORTHERN MICHIGAN ASYLUM. Of the 22 cases, 10 were males and 12 females, ease from which they suffered is as follows: The form of mental dis- Male. Dementia 3 1 1 1 Melancholia Senility Delusional 1 1 ... • Female. 4 Total. 2 2 1 7 3 1 2 1 1 1 1 2 3 10 12 22 a i i i Of the four female patients classed as Paranoia, three required mechanical feeding during the first few days of their residence in the institution, as they absolutely refused to eat. They had delusions in many respects similar; destroyed food because they feared it contained poison, and refused medicine for the same reason Two were hallucinated believing themselves to have held direct communication with God and each had attempted to take a child's life as an offering. They had refused food for some days previous to admission, and when received were noisy, resistive, constantly lamenting the sinful condition of others, and at times violent, one to such an extent as to require mechanical restraint and vigilant watching. One patient included in this classification refused food after being in the institution twenty days and having shown signs of physical improvement. She suddenly became the victim of religious delusions and of the idea of personal un worthiness, threw herself upon the floor and assumed the most uncomfortable attitudes. Her faoe wore an agonized expression, and she constantly bemoaned her sad condition and pleaded for deliverance. She resisted all necessary attentions, and was a reat care on account of her untidy habits and refusal of food. After eing fed mechanically for some weeks she consented to receive nourishment from a spoon. Another patient (Paranoia) was in a fair physical condition when admitted, but seemed to be completely under the control of delusions and hallucinations of a sexual nature. After two or three days' fasting, mechanical feeding became necessary and was accomplished without resistance. At first this procedure seemed to her novel and somewhat amusing, but in the course of a few days it became monotonous and she voluntarily took the nourishment in the normal way. Two of the male patients classed Paranoias, were in poor physical condition when admitted, much depressed mentally, resistive and apprehensive, and in many ways required much personal attention. One had been under treatment for seven years previous, and although he entertained delusions of poisoning and was much persecuted by almost everyone with whom he came in contact, he was a willing worker and took nourishment voluntarily until December last when he suddenly refused to eat, saying he would not do so until some woman came and prayed with him. He was inclined to remain in bed, although he had no physical ailment. Since that time he has absolutely refused to speak to anyone or to take nourishment in any form, thus necessitating mechanical feeding. t �REPORT OF THE MEDICAL SUPERINTENDENT. 59 He is perfectly aware of all that is going on about him, but offers no resistance whatever to feeding or necessary attentions. This patient has suffered from constipation, and often requires laxatives. The patients classed Dementia were in many respects similar in their manifestations of mental disturbance, All had delusions of poisoning; two entertained ideas of personal unworthiness, and one thought nothing good enough for her. Two were very apprehensive and believed that evil in almost every form would eventually befall them, and all were untidy in habits and resistive to attentions, In four of these cases there is a striking similarity with regard to the mental states which made mechanical feeding necessary, although the classifications are not the same. They were in a maniacal condition, much exhausted, sleepless and constantly occupied by hallucinations, which made it impossible to secure tbeir attention or confidence long enough at any time to administer nourishment or medicine. They believed everything contained poison, and looked with suspicion upon their attendants. It is a fact worthy of note that with but two exceptions all the patients herein considered were declining physically, and it is quite probable that their delusions or illusions were the result of some physical distress. Constipation was almost universal. Of those classed as General Paralysis and Organic Brain Disease two were blind and very feeble both physically and mentally, too much so, even, to successfully perform the act of mastication and deglutition. One developed delusions of poisoning after suffering from atrophic lesions in the feet and legs, became very much depressed and refused food, saying he had no stomach and therefore could not eat. After being fed mechanically for a while he himself would assist the process by passing the tube into his nostrils, protesting meanwhile that he had no stomach and could therefore derive no benefit from nourishment. Of the remaining cases we shall consider only the females classed hysteria. One seems entirely free from delusions or hallucinations, but at times loses self control, destroys furniture, and in many ways becomes very disagreeable. During her lucid intervals she expresses much sorrow because of her conduct while disturbed, and her refusal of food is prompted by the belief that she will thereby reduce her physical condition to such an extent as to be unable to do damage when she again has an outbreak of violence. The other patient remained at home for many years in a stuporous condition and possessed peculiar ideas about eating. For about a year since her admission to the institution it has been necessary to feed her mechanically She would lie in bed almost motionless, except when she thought she was not observed, apparently paying no attention to her surroundings. She did not resist feeding in any way, and was apparently unconscious of pain or physical suffering, However, while being fed one day she asked that her meals be served. Her request was granted, and since that time she has eaten well and improved physically, and her mental characteristics have also changed considerably. METHOD OF FEEDING. The method of mechanically feeding the insane is, with but few exoep tions, by means of the nasal tuba. A common soft rubber catheter, No, 12 to 16, American scale, and at least 18 inches in length, is used. This ia connected by means of a glass tube to another tube attached to a syringe . �60 NORTHERN MICHIGAN ASYLUM. Either a Fountain or Davidson syringe may be used successfully, but the syringe which we generally use and which we deem most desirable on account of the ease with which it can be cleansed, is Hall's health syringe. It consists of a glass jar with a metal cover and a metallic tube extending to the bottom of the jar; this cover is screwed on, making the jar air tight. By the use of a rubber bulb on the top of the cover and a bulblet beneath, the air is readily pumped into the jar, thus forcing the liquid up through the metallic tube to which is attached a rubbar tube connected by a glass tube to the catheter, which is forced into the oesophagus. The process of feeding is not very difficult unless there is resistance on the part of the patient. The tube is well lubricated with vaseline and passed into the nostril; then with a succession of short pushes it is passed beyond the epiglottis and time is given the patient to perform the act of deglutition, which generally results in passing the tube directly into the oesophagus. A short period should than elapse to ascertain if the patient can inflate the lungs, utter some sound, in order to be sure that the tube has not passed into the trachea. If respiration is free and the patient is able to speak in fairly distinct tone, the tube is pushed farther into the oesophagus and the feeding may proceed. However, the patient frequently offers much resistance, and this is best overcome by having sufficient help at hand to hold him securely. This is generally accomplished easily by placing the patient in a chair, taking cara that the hands and feet are well secured and napkins placed about the face for protection in case of vomiting or spitting. The physician should stand behind the patient, grasp the head firmly with his left arm, and manipulate the tube with the right hand. Where the resistance is great it is a very difficult task to insert the tube into the oesophagus, owing to the patient's incessant efforts to vomit, and the struggling, with the resulting forced inspiration, is very liable to carry the tube into the trachea. In such oases great care should be exercised and sufficient time should elapse after the tube has been inserted, to make certain that it has not passed into the trachea. Pneumonia almost invariably results from a mistake of this nature. The food generally used is milk and eggs, well mixed, to which any form of liquid medication may be added. In the acute, exhaustive oases, restless to an extreme, and suffering from constipation, a cathartic of 01. Kicini drams j and sulfonal grains xx or more is very effectual in producing refreshing sleep and free evacuation of the bowels. The results of mechanical feeding are as varied as the conditions which lead to it, Some patients require feeding for months, others for a few days only. Patients of the paranoiac class, having fixed ideas and governed by delusions of poisoning, generally require feeding for quite a length of time. The acute cases generally resume eating after the demands of the system have been supplied by nourishment mechanically administered and medication to relieve the toxic condition and secure much needed rest. Of course, in those suffering from organic dementia there is no hope of recovery or cessation of feeding, and they are almost invariably obliged to receive nourishment mechanically during the remainder of their existence. The following paper, the result of a study of 300 cases, was prepared by Dr. G. L, Noyes, a member of the medical staff. �61 REPORT OF THE MEDICAL SUPERINTENDENT. UR ANALYSIS. Epilepsy A. II, Delusional A. A. B. B O. C. C. O. I, Melancholia II, Dementia II, Organic II Senility I, Neurasthenia. ._ II, Periodical II, Paranoia Ill, Imbecility 38 2 9 5 6 30 13 5 6 7 74 8 203 910 1,256 1,147 1,150 1 220 574 1,054 1,087 986 300 1.69 2.03 2.35 1.31 2.2 2.35 2.14 1 93 2.5 1.86 1.74 2.16 4.93 7.33 6. 4.5 7.62 .93 1.33 1.04 .91 .93 10.72 15.66 15.83 8.83 12.75 12.83 15.42 5.1 1.02 59 1 1 1.07 15.92 1.13 12.78 16.66 7.42 7.38 6. 5.18 6.46 .97 1. .99 143 12. Glucose by weight. —Per cent. 47 3 12 6 8 49 21 10 13 9 107 15 Albumin by volume.— Per cent. 44.79 78.86 44.59 21.86 41.19 87.23 38.97 4903 30.45 46.75 35.75 41.35 Chlorides by volume.— Per cent. 1,335 1.443 1,071 Sulphates by volume.— Per cent. 6 Z Phosphates by volume. — Per cent. •4-1 O Urea by weight.— Per cent. V No. of cases. <a Average total solids for 24 hours.— Grammes. Form of insanity. Average quantity for 24 hours.— c. c. Inasmuch as it is essential in the quantitative determination of the constituents of the urine to have a sample of the 24 hours' product of the kidneys, it is very difficult in asylum practice to gain reliable statistical data from a large number of urinary analyses. With many patients it is almost impossible to procure a full 24 hours' sample because of their untidy habits, and advanced organic and senile cases so frequently void their urine in the bed that with them also many trials for an average sample are fruitless. The following summary has to do with the analysis of 300 samples of the urine of as many male inmates of this institution. All the figures included in the accompanying table were obtained from average samples of the 24 hours' urine, and in 203 cases it was possible to obtain the full product of the kidneys for that period. The figures relating to the average quantity and to the average of total solids are the result of the examination of the full 24 hours' specimens, only 203 in number, while those relating to the other constituents included in the table were obtained by the analysis of the whole number, or 300 samples. The clinical groups in the accompanying table have been made in accordance with the classification in use in this institnion, with the single exception of the epileptic froup in which all oases of epilepsy, regardless of etiologioal factors, ave been classified under the one head of epilepsy. 1.33 4 3.33 3 9 3 2. In all oases standard tests were used, and whenever possible an effort was made to reduce the results to a percentage basis. The means employed to gain this end in the determination of phosphates, sulphates, chlorides and albumin was the centrifugal machine. The urea tests were made with the Doremus ureometer. Haines' test was employed for the detection of sugar, and Purdy's titration method for its determination. The routine tests for albumin were made by Pnrdy's method, the ferrooyanide of potassium and acetic acid and the sulpho-salioylic acid tests �62 NORTHERN MICHIGAN ASYLUM. being used in confirmation of the routine teats. Repeated demonstration of the extreme delicacy of the sulpho salicylic acid solution as a test for albumin was made, and while it is not considered wholly reliable as a routine test because of its precipitation of another abnormal constituent of the urine, viz.: albumose, it is undoubtedly an agent of great value when used for negative purposes. The sulpho-salicylic acid may be used pure or in an aqueous solution varying in strength from 5 to 20 per cent, as individual preference may suggest. The 5 per cent solution in distilled water was found to answer every purpose admirably. The test with pure acid may be made in a very short time by dropping into a medium sized test tube one-third full of urine a grain or two of the acid. As the acid falls through the urine to the bottom of the tube it leaves behind it, if albumin be present, a tine opalescent line; then, if the urine in the tube be agitated, its whole volume is seen to become cloudy. A much more desirable way of applying the test is as follows: Pour the suspected urine into a test tube to the depth of about one inch, then carefully float upon it a layer of the acid solution about one-half as deep. If albumin be present, a pearly-white ring may be seen where the two fluids come in contact, the thickness of which varies with the amount of albumin present. The specific gravity of the acid solution is 1020; if the urine has a sp. gr. less than this, the test may be applied by floating the'urine on the acid solution with equally satisfactory results. If the tube and its contents be allowed to stand for a time after the test has been made, the ring falls of its own weight to the bottom, leaving a clear fluid above it. Experiments with this test show that if it be used with urine known to contain only .013 percent of albumin, and the tube allowed to stand for a few minutes, the ring can be plainly seen. Vas* used the test successfully with urine containing but .002 per cent of albumin. The amounts of phosphates, sulphates and chlorides were determined with the centrifuge. Taking 1020 as the standard sp, gr. or normal urine, only 7 per cent of those examined were found to be normal; 34 were above normal and 59 below. The highest sp, gr. noted was 1031, and the lowest 1000. It seems almost incredible that the specific gravity of the entire product of an apparently healthy man's kidneys should be so near that of water that no difference could be demonstrated even though the utmost care be taken in the use of the urinometer. Repeated trials gave no different result, the register never varying a degree. The condition is quite easily accounted for when the fact is taken into consideration that the patient from whom this sample was procured had not for six years tasted soup, fish, meat or eggs, but during that period refused all kinds of food except bread, crackers, potatoes, fresh vegetables and very small quantities of butter and milk. Authorities differ somewhat with regard to the quantity of urine excreted by the normal adult man. Fifteen hundred o. o. in 24 hours seems to be a fair estimate, and this has been accepted as a standard in the consideration of the samples examined. It can be seen by reference to the table that in no class of diseases included in it was the quantity equal in amount to that of the normal man. The same may be said of the total solids, with the single exception of the class A. I., hallucinatory, where the average solids were much in excess of the normal. However, in this regard it would be well to omit this class from our consideration, * {Centralblatt fttr Klinische Medecin, No. 48, 1892.) �REPORT OF THE MEDICAL SUPERINTENDENT. 63 since in only two oases was it possible to obtain a full 24 hours' supply. The difficulty in drawing conclusions from the figures here presented seems to be in the fact that it is hard to determine how many individual cases should be included in a series, the average of which is to be considered normal for the class of oases under consideration. As has been said, both the quantity and the total solids are markedly diminished, but there seems to be no direct ratio of reduction between the two. In the 74 cases of the paranoiac group there is a reduction of 41f per cent in the solids, while the quantity is reduced only 27| per cent. In the 38 oases of epilepsy there is a decrease in the solids of 27| per cent and of 11 per cent in the quantity. There is also a wide difference in the 30 cases of dementia, the solids showing a deficiency of 39 per cent and the quantity 23J per cent. The manner of living, as regards amount of exercise and diet, of an inmate of an asylum, as well as that of any other individual, has an important bearing on the character of his urine, and more especially on the amount of solids excreted. We conclude, therefore, that inasmuch as the majority of asylum inmates lead a more or less sedentary existence the solids should be greatly diminished, as is found to be the case. As might be inferred, the fluids are diminished, but the loss of fluids is comparatively small when the great deficiency of solids is considered. Is there not some physiological reason for the comparative preponderance of the fluid constituent of the urine over its solids? The urine of all men, sane or insane, must contain toxic material that contributes to the urine a toxioity, the intensity of which varies with the degree of concentration of the urine. Bouchard has shown that the urines of inactivity are more toxic than those excreted after muscular activity It would be reasonable to infer that the urine of a group of 300 insane men whose manner of living we accept as comparatively inactive, would be more toxic than the urine of a like number working at almost any trade for ten hours daily. Nature's safeguard against the deleterious effects of this poisonous material found in the urine is its power of diluting the toxic product until it becomes innoxious. Ordinarily the toxic product would be disposed of by oxidation resulting from muscular or mental activity, but in this class of individuals is it not probable that conservative nature comes to the rescue by diluting the product with this excess of fluid found to be present in. the specimens examined? The amount of urea found varied somewhat, the cases of delusional insanity, neurasthenia and dementia showing the greatest amounts. The least was shown to be present in the mania group, with the exception of the one case cited above in which the specific gravity was so very low. This specimen, though repeatedly examined, was always found to contain less than 0.1 per cent of urea. We are hardly justified, however, in considering the mania group for the determination of an average, since the cases were too few. The figures in regard to the amounts of phosphates, sulphates and chlorides are available in the table, and since they comprise the bulk of the total solids, further consideration of them is unnecessary. Albumin was detected in only three cases; in one, a case of acute mania, it lasted but a few days,but was accompanied by blood and epithelial casts in abundance. In the other two oases no kidney lesion could be determined by the microscope, these probably being cases of albuminuria �64 NORTHERN MICHIGAN ASYLUM. dependent upon some changes in the constitution of the blood which are often met with in enfeebled individuals.* Two cases of glyoosuria were found, one in an epileptic and another in a case of dementia. To these no particular clinical significance can be attached. It is remarkable that more oases of glyoosuria were not detected, since that condition may be expected in many pathological conditions involving the fourth ventricle and its vicinity. In fact, in making the analysis of the urine of the insane, after looking over the very small amount of available literature on the subject, one might expect to find wide-spread demonstrable kidney lesions and a preponderance of cases indicating serious difficulties in the urinary apparatus. This, however, has not been found to be true in the cases here presented, On the contrary, it seems that, inasmuch as only one per cent of the total number of oases suffered from albuminuria and 0.6 per cent from glycosuria, this great class of invalids is remarakbly free from diseases made manifest by abnormal conditions of the urine. * (Purely: " Practical Uranalysie.") TABLE IV.—Degree of Heredity. Paternal and maternal Paternal immediate Paternal remote Maternal immediate Maternal remote Brother and sister Dissolute parentage None UnascertainedTotal . - , _ __. For the biennial period. From the beginning. Males. Females . Total. Males. Females . Total. 2 5 11 17 9 13 11 1 17 11 29 10 3 22 22 46 19 19 61 43 81 43 13 69 29 105 48 32 130 72 186 91 65 91 13 7 63 34 26 18 128 125 70 30 263 675 82 31 291 318 152 61 554 993 224 185 409 986 2,271 1,285 �65 REPORT OF THE MEDICAL SUPERINTENDENT. TABLE V.—Occupation of those admitted. For the biennial period. From the beginning. Males. Females . Total. Males. Females . Total. Baker Blacksmith Butcher _ - . Cook 1 1 1 1 2 None. Painter Printer Photographer Policeman Railroad employ^ Sailor Saloon keeper 4 4 1 1 2 1 1 i 2 12 1 1 10 1 46 1 119 1 312 3 245 4 1 . _ _ . . 1 2 42 5 782 6 2 16 1 5 8 3 30 1 15 28 3 3 69 1 9 7 39 4 1 12 10 108 5 1 1 32 3 . 34 1 1 4 66 8 4 1 1 11 5 5 20 1 4 3 1 14 2 15 8 6 34 11 6 1 8 2 3 17 1 21 6 6 8 19 106 2 15 25 1 2 158 5 986 2,271 1 3 2 128 1 4 563 3 1 4 1 6 1 14 2 2 5 10 20 1 6 4 2 4 1 4 3 10 1 9 1 10 19 1 1 1 2 1 3 1 2 1 3 2 3 2 1 3 2 1 3 1 2 1 3 13 4 3 7 6 1 2 52 3 Surveyor . 1 1 2 1 7 2 9 2 7 1 11 2 18 1 224 185 409 5 57 3 2 1 42 1 219 3 1 3 1 40 1 88 1 8 1 33 1 1 557 7 1 1 1 1 Tailor Total 1 1 1 22 1 4 3 2 23 1 2 23 2 1 2 Unascertained Weaver . _ . . . 8 6 5 88 1 2 Shoemaker Telegrapher 4 2 5 8S 2 3 0 Minister 3 2 24 1 8 1 73 Miller 2 5 33 2 2 3 4 1 Florist Lumberman 3 1 12 1 1 3 1 Laborer 5 4 1 Editor 21 1,285 �66 NORTHERN MICHIGAN ASYLUM. TABLE VI.—Nativity of patient* admitted. Austria Belgium Canada For the biennial period. From the beginning. Males. Females. Total. Males. Females . Total. 1 . _ Denmark Delaware England France Finland Germany Holland Ireland Italy Indiana Illinois 1 _•_ New Hampshire Nova Scotia New Jersey. 1 34 1 29 85 2 98 5 91 194 1 21 1 7 1 11 77 7 13 6 7 52 2 16 6 18 129 9 29 12 2 3 1 5 3 1 1 1 15 8 13 12 1 7 1 4 1 is 1 2 1 2 2 19 1 51 1 100 6 5 11 203 1 1 27 1 1 3 3 20 43 127 . New York 25 1 64 4 62 109 U 2 ._ _ __ ._ 23 2 313 4 28 54 2 4 3 Maryland Michigan Minnesota.. Missouri Norway 5 1 134 3 14 27 1 3 H Kansas Kentucky Maine Massachusetts 18 1 179 1 It 27 1 1 23 10 7 •I 10 4 1 20 11 5 1 1 46 33 12 1 17 2 1 11 2 1 1 28 4 2 3 123 15 6 3 3 New Brunswick Ohio Poland Russia Scotland Switzerland _ Tennessee. Virginia Vermont West Virginia Wisconsin Wales Unascertained ._ 2 1 3 15 7 22 3 6 1 14 1 76 224 185 409 1,285 . Total 1 1 6 4 1 195 1 25 1 1 1 100 1 3 1 2 11 7 1 398 Z 1 52 1 3 4 1 227 56 21 7 2 1 102 54 19 85 10 8 1 3 208 25 14 1 2 8 1 15 44 5 U 2 29 1 120 986 2,271 RECAPITULATION. Foreign-born 199 188 22 Total 409 :::::::::: 913 1,238 120 2,271 �REPORT OF THE MEDICAL SUPERINTENDENT. 67 TABLE VIL—OUnieaJ groups. From the beginning. For the biennial period. Males. Females . Total. Males. Females. Total. 1 2 3 Brain disease 11 Congenital 10 5 12 4 16 12 14 9 99 43 6 39 20 1 27 74 20 29 100 70 80 59 Idiopathic 3 10 I 2 91 3 5 81 6 15 1 2 172 10 90 20 107 262 8 55 18 6 211 18 145 38 113 473 20 29 49 10 1 4 1 14 2 149 1 94 16 1 194 2 14 10 343 3 108 26 1 3 3 9 6 9 17 17 10 11 2 28 12 9 54 28 11 143 15 47 6 28 143 24 101 34 5 13 4 5 17 27 63 16 10 26 141 3 6 1 94 30 69 1 235 224 185 406 1,285 986 2,271 Adolescence. _. _ - - Neurotic Opium habit Paretic Phthisical Post-connubial -.. Post-febrile ._ . Puerperal Pubescence. Senile . Syphilitic . • „ .. _ Traumatic. Toxic __ Unclassified. Total , - .. . TABLE VIII.—Duration of disease previous to admission, For the biennial period. Males. Two months and under five Five months and under nineNine months and under twelve One year and under two Two years and under five Five years and under ten Ten years and under twenty... Twenty years and over . Unascertained , . Total ... .. __ Females . Total. From the beginning. Males. Females . Total. 36 27 16 3 26 41 19 12 5 11 77 46 28 8 37 210 129 80 20 153 161 95 67 21 86 371 224 147 41 239 34 10 20 11 41 35 12 16 9 25 69 22 36 20 66 220 119 122 51 181 174 124 123 53 82 394 243 245 104 263 224 185 409 1,285 986 2,271 �68 NORTHERN MICHIGAN ASYLUM. TABLE IX.—Civil condition of patients admitted. From the beginning. For the biennial period. Males. Females. Married Widowed Divorced Unascertained ,_ _ _ _ ._ Total _ _ Total. Males. Females. 98 107 10 4 5 114 44 20 5 2 212 151 30 9 1 491 666 224 185 409 Total. 11 54 669 198 95 19 5 1,160 864 154 34 59 1,285 986 2,271 TABLE X.—Age of patients admitted. For the biennial period. Males. Females. Total. From the beginning. Males. Females. 3 11 32 34 18 2 4 23 19 25 5 15 55 53 43 11 73 160 191 151 36 to 40._. 41 to 45 46 to 50.. . 51 to 55 34 17 16 16 36 21 10 13 70 38 26 29 56 to 60 61 to 70 70 and upwards Unascertained 10 16 11 6 11 9 7 5 224 185 16 to 21 to 26 to 31 to 20 25__ 30 35 Total .._._ _- _ _. Total. 6 45 96 142 141 17 118 256 333 292 175 135 75 65 148 108 89 57 323 243 164 122 21 25 18 11 48 72 32 97 40 55 16 43 88 127 48 140 409 1^285 986 2,271 • �69 REPORT OF THE MEDICAL SUPERINTENDENT. TABLE XI.—Probable exciting causes. For the biennial period. Males. Females. Business reverses. Climacteric. Disappointed affections _ _____ Epilepsy, Fever . 'Fright. Ill health Intemperance _._ La grippe Nostalgia Opium habit Puerperal i__ -_ _- 5 11 8 8 10 2 6 8 18 37 27 40 3 6 14 3 10 12 6 16 26 9 2 11 8 14 97 2 23 2 21 14 4 4 2 20 2 2 4 41 16 4 6 10 2 1 3 4 2 10 13 6 3 10 9 11 1 8 9 11 3 13 12 3 1 8 2 5 20 22 7 34 62 5 13 15 48 159 7 36 15 137 4 1 9 22 230 174 14 16 14 9 10 150 1 38 12 12 IBfr 3 4 11 14 14 4 12 14 17 8 23 22 15 1 1 20 48 25 9 4 45 57 4 5 42 28 402 136 38 4 273 12 80 32 675 148 1,285 986 2,271 10 12 Traumatism 10 6 42 14 32 2 18 6 74 16 224 185 409 Total 1 Total. 69 51 27 60 22 Religious excitementSyphilis Seduction Vicious habits Males. Females . 15 13 8 14 8 Prolonged lactation _ _ .. Phthisis Total. From the beginning. 93 no 13 7 1 24 3 2 5 51 14 �70 NORTHERN MICHIGAN ASYLUM. TABLE XII.—Residence of patients admitted. For the biennial period. Males. Females. 9 11 1 2 Alger Baraga . Benzie . Bay .... .. -_ .. - 4 Clare 1 Clinton . .. . Chippewa ... Delta Dicbinaon.. . .. Grand Traverse Gratiot _ .. Huron .. . Isle Royal Ionia . Kalkaska .. . ,.. Kent Lake Luce ._ Midland Otsego Roscomnioa _ -. _. .. St. Clair Schoolcraft Wayne No legal settlement. State Total... 1 1 2 9 2 From the beginning. Total. Males. Females . 4 4 1 3 13 15 2 5 41 28 7 5 1 3 1 3 1 2 5 1 7 1 11 6 3 3 1 16 6 19 3 4 8 8 26 15 23 21 24 1 20 19 6 2 10 1 4 2 6 4 5 9 7 14 4 9 7 5 1 16 21 9 1 44 49 97 2 6 3 6 5 12 4 11 15 19 23 2 10 4 2 1 3 1 7 2 2 8 6 2 1 1 1 4 7 9 3 1 3 12 11 36 9 2 9 9 4 5 6 3 6 2 4 2 15 5 15 11 8 7 87 17 46 88 17 13 8 1 6 1 14 2 66 2 7 5 1 1 3 6 2 1 1 10 4 5 17 9 6 1 3 8 3 1 1 1 2 1 1 2 4 4 12 13 224 1 2 4 2 2 1 12 185 1 4 8 6 2 13 25 409 34 28 5 9 1 5 11 1 18 9 1 25 7 15 8 19 1 21 34 43 60 1 1 18 16 Total. 75 56 12 14 1 1 16 17 1 37 25 13 1 51 22 38 29 43 2 41 3 11 78 92 157 1 1 37 39 2 13 15 5 8 1 1 15 15 3 1 13 28 15 16 1 2 25 34 5 1 24 64 57 13 35 31 29 10 1 55 2 144 30 81 119 46 23 1 121 4 73 24 23 9 7 27 8 4 3 75 33 24 6 6 33 5 148 57 47 15 13 60 13 4 5 6 3 5 10 8 1 10 19 2 2 20 24 6 79 16 1,285 2 1 2 7 24 2 14 12 986 11 3 1 4 27 48 8 93 28 2,271 �REPORT OF THE MEDICAL SUPERINTENDENT. 71 PLANS OF NEW LAUNDRY. As required by law, the plans of the new laundry were submitted to the State Board of Corrections and Charities, and the following is their report on the same: LANSING, August 17, 1895. JAMES D. MUNSON, M. D., Medical Superintendent Northern Michigan Asylum, Traverse City, Michigan: DEAK DOCTOR—The Board of Corrections and Charities, at a meeting held at your institution the 14th inst., examined the plans of laundry building for the asylum, provided for by act 212, laws of 1895. I am instructed to certify to you the approval of the board of such plan. By order of the board. L. C. STOKRS, Secretary. P. S. I have this day sent the necessary certificate to the Auditor General regarding the cost of such laundry, CHAPEL SERVICES. Chapel services have been regularly conducted by the Chaplain, Eev. D. Cooblin, assisted by Revs. A. E. Wells, G. S. Northrup, M. A. Kelsey and W. K. Wright. The chapel services, as in former years, have been largely attended and a source of much benefit and comfort to our people. ACKNOWLEDGMENTS. The institution returns thanks to the editors of the following papers for donations of their journals for the use of patients: Alpena Argus. Big Rapids Herald. Cheboygan Tribune. Church Helper. Deaf Mute Mirror. Grand Traverse Herald. Hemlandet. Index and Review. Michigan State Democrat. Native Copper Times. Pontiae Gazette. Practical Farmer and Fruit Grower. Traverse Bay Eagle. Transcript. Triumphs of Faith. We are also greatly indebted to C. L. Lockwood, Esq., Gen. Pass. Agt., G. R, & I. R. R. for regular donations of a large number of papers and journals. To all others who have in any way contributed to the comfort and pleasure of patients, I return most sincere thanks. The zeal with which the officers, chiefs of departments, and attendants, have discharged their duties has been highly commendable, and I extend my most sincere thanks to the members of the staff and to the steward for many personal kindnesses extended to me. I am under many obligations to the Board of Trustees for acts of kindness, and sincerely thank them for the great interest they have taken in the affairs of the instituiton and for the aid given to me in the discharge of my duties. The past two years have seen many advancements in the institution, and the outlook for the coming period promises to bring quite as many more. We hope that a fair measure of success may attend all our efforts for the coming period. Respectfully submitted, JAMES D. MUNSON, Traverse City, June 30, 1896. Medical Superintendent. �OFFIOEES AND EMPLOYES OF THE NORTHERN MICHIGAN ASYLUM, AND THE WAGES OR SALARIES PAID TO EACH, JUNE 30, 1896, AS REQUIRED BY SECTION 2, ACT 206, LAWS 1881. Rate. Service. Name. __. Medical superintendent Asst. medical superintended James D. Munson A. S. Rowley Robt. Howell E. L. Nii?kern U 41 it ' 11 Treasurer W L. Miller Engineer Chas. E. Kenyon C. R. Lackey Stenographer. _ C M. Prall S. G. Howard H. P. Lewis C. L Osborn T C Collins Storekeeper Assistant storekeeper _^___. __ „ Supervisor M. Geary ._ _ - _ - - __ {( 11 Attendant Grace E. Bul'as u u u u _ 11 11 u 11 N. Barber It . -- 11 u - 65 00 40 00 36 00 2000 26 00 53 65 12 12 12 u B. Gilbert __. 00 00 00 00 00 110 00 55 00 20 00 40 00 1,100 00 E C Kent LoraChaney 30 1,000 55 70 30 .._ _ -_ Baker May L. Botsford L. Bahlke A. Bahlke Clara Burgette $3,000 00 1,500 00 1,000 00 1,000 00 800 00 Per'annum. Resident, 80000 1,600 00 250 00 500 00 1,200 00 C. L. Whitney D. Cochlin J. T. Hannah T. H A. Tregea F M. Stehr Chas. H. King Time. „, 00 00 00 00 00 1200 15 00 20 00 12 '00 16 00 2400 14 00 13 00 21 00 30 00 23 22 20 16 14 00 00 00 00 00 N on -re si dent. Per month. Resident. Per annum. Non-resident. Per month. Resident. Non-resident. Resident. Per annum, Per month and meals. Resident. Non-resident, Resident. U (t Resident. K �OFFICERS AND EMPLOYES. OFFICERS AND EMPLOYES—CONTINUED. Service. Name. Attendant _- Ada G. Cole E. G. Cox Chas. Conkright J. M. Gates J. R. Gates F. A. Cross Myrtle Cox it K « , ' ' ' < lt Estella Daggett Eli Davis Vollie Brake i« » « " u A. Merton Eaves tt (( « it ti " u ElJa M. Faxon tt u „ G. W, Gibson Hattie Giddings F. M. Hale " H " u ,( • *4 i( I' " . tf (4 " it H. C. Haddow It (( Dennis W. Kelley Nellie Kreigh A. E. Knight A. C. McCarn Neil BlcLarty S. S. McGeachy Elsie Mid die ton U U U 22 22 22 12 14 00 00 00 00 00 H 00 16 00 20 00 22 00 26 00 22 22 22 16 22 00 00 00 00 00 32 20 12 30 22 00 00 00 00 00 U 22 18 14 28 00 00 00 00 00 18 30 22 22 13 00 00 00 00 00 22 12 18 18 12 00 00 00 00 00 21 00 30 00 20 00 13 00 24 00 Per month. Res dent. i ' 1 * ' ' . 14 I (1 ( ' ' * ' ' ; ' i ' ' ' ' t ' a " ( ' ' t i M " " (( a Non-resident. Resident. Non-resident, Resident. u u (I U " <•'• " " " " U (I " " it " " '•' a " « u " " t ' u * U it. (i U u a " "• 00 00 00 00 00 u 12 18 23 28 20 00 00 00 00 00 ; ' ' ' t " " " 1500 1400 2300 28 00 18 00 ' " " .1 . ' ' ' ' U ( " " " ' ' ' U I »« u *l ([ I* !( u It tf " l< (' 10 00 00 00 00 00 24 18 22 12 18 „ C H. Porter Victor Patrick Wm S. Purple Nellie Purple $13 15 21 25 30 Time. [( [( u « u u Eva McDonald EJthel A Malcolm F. G North Rate. 1800 28 00 32 00 14 00 32 00 t( " " " 1 1- * u" " u <(i �NORTHERN MICHIGAN ASYLUM. OFFICERS AND EMPLOYES-CONTINUED. Service. Name. E. Rose Edna Schug Wilson Shaw Chas. Stanfield A. S. Slaghuis F. R. Spears Matie Stewart Agnes J. Stone 'i " - . n I, it " " « u *i tl ii Blanche E. Smith l( It It Lou R. Taylor Pearl Tackaberry Laura Van Doren " 'I _. ___ I, Flora Watson "• ii Eunice Walsh " Hattie Walsh i( Jessie Way u. Frank Zimmerman Laundryman Wm. Weston Hugh Whitcomb _ _. Assistant laundryman. Laundry assistant Josephine Fuller . »< it Clara Seymour __ . _ . __ u u (1 U Mary Schmeising ___ Hannah Lebutske _ *; n Emily Arnold . _ _-. __ it ti Tony Yack it <l Anna Denki . _. Robt. Herkner Fred Hunter Assistant cook Kitchen assistant __ _ . t i < i J. R. Courtade E. J. Lavender. H. Carrier., Glen Parkes F. Wilhelm W. Veeder W. Donnelly Mary Lavender _ _ W. Travis Wm. Williamson .. __ H. P. Housler O. P. Stevens W. D. Clancy E, SilvernaiL. A. Armitage A. Ostrander F. J. Lillie. S. Whitcomb John Shea D. Patton i ' i Butcher Assistant baker Kitchen dining room Fireman u ,( Barnman i« „ Coachman Teamster a Rate. $38 28 22 15 23 00 00 00 00 00 24 24 28 IB 19 Time. Per month. Non-resident. Resident. u u u u 00 00 00 00 00 u u (t (1 u u u l( (i u 14 33 27 22 14 00 00 00 00 00 u 12 14 15 14 21 00 00 00 00 00 U [( « u u 11 u u .1 U 00 00 00 00 00 (( 22 00 U 12 18 23 20 20 13 13 13 13 13 00 00 00 00 00 13 12 12 37 20 00 00 00 50 00 U « u .' U (( U u u [( Non-resident. Resident. 35 00 18 00 14 00 14 00 u Non-resident, Resident. (i U U 11 9 U tt it U (I U u I. u tt u ii ti u it U U u u 4k it U 18 18 15 15 15 00 00 00 00 00 'I it U 15 18 15 40 18 00 00 00 00 00 « it it tt . t' . « 15 15 35 25 25 00 00 00 00 00 it «t it li it ii it it ii it 25 20 20 20 24 00 00 00 00 00 i U 1 t ' i tl 11 it tl 20 25 20 25 20 00 00 00 00 00 ii (t ti tt (t ii it tt [I K 11 it U (i U �75 OFFICERS AND EMPLOYES. OFFICERS AND EMPLOYES—CONCLUDED. Name. T. Dumbrille Andrew Young Frank Hartley Fred Bloeker W. Perry Teamster Laborer.. Blacksmith .Laborer S. H. McMichael Bert Wilhelm C. Getchell John King _ Carpenter Chas. Chadwick E. Davis S. B.Howard Laborer Painter _ A. E. Fox F. Rial W. H. Clark •J. Spedding J. Bilski J.Peterson C. H. Peterson P. Gillis 11 „ 11 11 1* . 11 Laborer ii (( u it u J. Quaife I. D. Hobbs Wm. Hollister u E. Bradley W. H. Kinch E. H. Wood Don Howard L. M. Tompkins W. W. Dean S. H. Toombs . _ . _ Laborer Carpenter Painter Mason Painter Laborer __ Laborer.. u u Team. ii u ii Time. $20 00 Per month. Resident. 1 25 Per day. Non-resident. 1 75 1 75 u u 1 50 11 M H. Mclntyre E. J. Mclntyre F. Nagle W. S. Maas P. A. Wright J. Blacken J. J. Shier 0. N. Tatman J. T. Schwass C. O. Blacken Eate. Service. . It It 2 50 1 75 1 50 2 00 2 00 11 11 11 11 11 It .1 11 U 11 1 75 2 00 2 00 2 00 2 00 11 11 11 11 11 U <1 11 11 11 2 00 2 00 2 00 3 00 3 00 II 11 3 00 3 00 3 00 3 00 2 50 11 2 25 2 00 1 25 1 25 1 50 u 11 11 It 11 11 U II 11 U 11 11 11 U II II 11 11 11 11 11 11 11 U II 11 II 1 25 1 25 1 25 1 25 1 50 II U 1 25 2 00 1 75 1 25 1 25 U 11 It 11 1 25 1 25 1 25 1 25 3 00 3 00 3 00 3 00 3 00 U II II 11 11 II I! II U II II II 11 11 u u 11 U U 11 II It II 11 u u 11 II 11 11 It 11 �LAWS GOVERNING THE ASYLUM. The act organizing the asylums of Michigan and providing for the admission, maintenance, and discharge of patients is known as Public Act 135, Laws of 1885. GOVERNMENT. SEC 10. Eacli board of trustees is hereby directed and empowered to establish such by-laws as it may deem necessary and expedient for regulating the appointment and duties of officers, attendants and assistants; for fixing the conditions of admission, support, and discharge of patients, and for conducting in a proper manner the business of the institution under its charge; also, to ordain and enforce a suitable system of rules and regulations for the internal government, discipline and management of the asylum. ADMISSION OF PATIENTS. The following by-laws govern the admission of patients: First, Indigent and pauper insane will be admitted upon orders granted by the propei.1 officeES, in accordance with the laws of the State, and no indigent or pauper insane persons shall be admitted without such authority; Second, Pay patients (or private patients) can only be admitted to the Asylum for care and treatment upon compliance with the following requirements: (a.) The certificates of two reputable plrysicians, under oath, appointed by the judge of Probate of the county wherethe alleged insane person resides, possessing the qualifications required by Section 22, Public Act No. 135, Laws of 1885, as amended by Act No. 220, Laws of 1889, and the certificate of the county clerk. (b.) A bond in the sum of one thousand dollars, duly executed by two persons of responsibility, to be approved by the Medical Superintendent, shall, be delivered to the Superintendent at the time of the admission of the patieut, obligating the bondsman to pay all the patient's expenses while in the Asylum. (c.) An order from the Judge of Probate of the county of the patient's residence, committing him (or her) to the Asylum as a private patient. (d.) Pay for thirteen weeks' board and treatment must be made in advance of the admission of the patient. No patient shall be detained in the Asylum after the medical superintendent shall determine that he is of sane mind. Indigent insane persons are admitted on the orders of judges of probate, in accordance with the provisions of the following section: SEC. 23. When a jjerson in indigent circumstances and not a pauper becomes insane, application may be made in his behalf to the judge of probate of the county where he resides; and said judge of probate shall immediately notify such alleged insane person of such application, and of the time -and place of hear- �LAWS GOVERNING THE ASYLUM. 77 ing to be held thereon and in the discretion of the judge of probate any relative or other person having said alleged insane person in charge or custody, shall likewise be notified of said time and place of hearing; and shall also call two legally qualified physicians and other credible witnesses and also immediately notify the prosecuting attorney of his county, and the supervisor of the township or the supervisor or alderman of the ward in which said insane person resides, of the time and place of such hearing, whose duty it shall be to attend the examination and act in behalf of said county; and said judge of probate shall fully investigate the facts in the case, and either with or without the verdict of a jury at his discretion, as to the question of insanity, sliall decide the case as to his indigence, but this decision as to indigence shall not be conclusive; and if the judge of probate certifies that satisfactory proof has been adduced, showing him to be insane and his estate insufficient to support him and his family or, if he has no family, himself, under the visitation of insanity, on his certificate under the seal of the probate court of said county, he shall be admitted into the asylum, and supported there at the expense of the county to which he belongs, until he shall be restored to soundness of mind, if effected in two years, and until otherwise ordered; and the judge of probate shall in no case grant such certificate until fully satisfied of the indigence of such insane person. The judge of probate in such case shall have power to compel the attendance of witnesses and jurors, and shall file the certificates of the physicians taken under oath, and other papers in his office, and enter the proper order in the journal of the probate court in his office; and he may appoint a proper person or persons to conduct such insane person to> the asylum, who shall receive pay for expenses and services, in the discretion of said judge, the same as any other officer. The judge of probate shall report the result of his proceedings to the supervisor of his county, whose duty it sliall be, at the next annual meeting thereafter, to raise money requisite to meet the expenses of support accordingly. The provisions of this section secure the benefits of the Institution to a class by far more numerous than any other in this State, who, though possessed of some property, find it insufficient to meet the expenses of treatment and the support of the family at the same time. The form of order arranged in accordance with the requirements of this section, copies of which may be procured at the Asylum, is as follows: STATE or MICHIGAN, County <f f ss' At a session of the probate court for the county of holden at the probate office in the of on the day of in the year one thousand eight hundred and Present , Judije of Probate. In the matter of , an indigent insane person; This day having been assigned for hearing the petition, now on file in this court, of alleging that , a resident of in said county. is insane, and praying that said may be admitted to the Northern Michigan Asylum at Traverse City, there to be supported at the expense of the county of , and having duly notified the said , also relative..of the said , also prosecuting attorney for said county, and supervisor of in which said insane person resides, of the time and place of hearing said petition, and having filed the certificates, taken under oath, of. and two legally qualified physicians, and having taken the testimony of credible witness.... and having inquired into h. . .settlement, and having fully investigated the facts in the case with. .. .the verdict of a jury as to the question of insanity and indigence, I, the judge of probate, in and for said county, do find that said is in indigent circumstances, and certify that satisfactory proof has been adduced showing the said to be �78 NORTHERN MICHIGAN ASYLUM. insane; that he has. ..acquired a legal settlement m sard county of and that h . . . estate is insufficient to support h . . . and h . . . family under the visitation of insanity. And it appearing to the court that said under and according to the provisions of Sec. 23 of Public Act 135, laws of 1885, is entitled to admission into the Northern Michigan Asylum, at Traverse City. It is ordered that the said be supported in said Asylum at the expense of the county of until restored to soundness of mind, if effected within two years, and until otherwise ordered. Jiidge nf Probate. STATE OF MICHIGAN, County, I hereby certify that the foregoing is a true copy of the original order and' certificate made by me. In testimony whereof, I have hereunto set my hand and affixed the seal of the Prcbate Court, at .................................... . . . this ................... day of .................................................................. ., A. D_ 18 ...... I hereby appoint, and direct said Judge of Probate. to conduct to the Northern Michigan Asylum. of Probate. Indigent insane patients, having no legal settlement in any county of the State of Michigan, can be committed to the Asylum, as non-resident State patients, in accordance with the provisions of Sec. 25, Act No. 135, Laws of 1885, as amended by Act No. 62, Laws of 1887. Dependent or pauper insane persons are admitted on orders of judges of probate granted in accordance with the following section: SEC. 26. The county superintendents of the poor of any county, or any supervisor of any city or town, to which a person who shall' become insane may be chargeable by reason of being a paupor, shall make application to the probate judge of said county, who shall proceed to inquire into the question of the insanity of said person, and for the purpose of such inquiry shall call upon and may compel the attendance of one or more legally qualified physicians, and such other witnesses as he may deem necessary, and if satisfied of the insanity of said person, said probate judge shall make the samel certificate and order for itaiission into the insane asylum, and the same record and report as are required' to be made, by section twenty-three of this act, in the case of ail insane person, in. indigent circumstances. The form of order is the same as prescribed for indigent patients under Section 23. Pay patients (or private patients) are admitted in accordance with the following sections of Act 135, Laws of 1885, as amended by Act 220, Laws of 1889, and Act. No. 204, Laws of 1895: SEC. 21. No person who is a resident of this State shall be held" as a private patient in any asylum, public or private, or in any institution, home or retreat, for the care or treatment of the insane, except upon the certificates of two reputable physicians under oath appointed by the Judge of probate of the county where such alleged insane person resides to conduct an examination, and an order from said judge of probate setting forth that the said person is insane and directing his removal to an asylum or institution for the care of the insane. When the relatives or friends of any insane person shall make application in his behalf for an order admitting him to any asylum, public or private, or to any institution, home or retreat for the care or treatment of the insane to the juttgt* of probate of the county where he resides, the judge of probate shall institute an inquest ami take proofs as to the alleged insanity before granting such order, and' shall inline- �LAWS GOVERNING THE ASYLUM. 79 diately notify such alleged insane person of such application and of the time and place of hearing to be held therein, and any relative or other person having such alleged insane person in charge or custody shall likewise be notified of said time and place of hearing, and the judge of probate may appoint a guardian ad litem to represent such insane person upon such hearing and shall fully investigate the facts, and if the judge of probate shall deem it necessary, or if such alleged insane person shall so demand, a jury of twelve freeholders, having the Qualifications required of juors in courts of record, shall be summoned to determine the question of insanity, and the said judge of probate pending such proceedings, if it shall appear to be necessary and essential so to do, such alleged insane person may be placed in the custody of some suitable person, or may be moved to the asylum of the district in which said insane person resides, or to any hospital, home or retreat, to be detained until such application can be heard and determined: Provided, however, That the period of such temporary detention shall not exceed in all fourteen days, and all the expenses thereof shall be paid by the petitioner or out of the estate of said alleged insane" person. Such alleged insane person shall have the right to be present at such hearing, unless it shall be made to appear to the judge of probate either by certificate of the medical superintendent of the asylum or the officers in charge of such hospital, home or retreat, to which he may have been temporarily committed or by the certificates of two reputable physicians that his condition is such as to render his removal from the institution for that purpose or his appearing at such hearing improper and unsafe. The said judge of probate shall, if satisfactory evidence is adduced, showing the alleged insane person to be of unsound mind and in need of care or treatment in an asylum, home or retreat, grant an order for the commitment of such insane person to such institution, there to be supported as a private patient. Before making his order committing an insane person as a private patient to any of the public asylums supported by this State, the judge of probate shall require the petitioner or friends of. such insane person to enter into such bond for the support of such insane person thereat as may be provided by the by-laws thereof and to pay such sum to the medical superintendent or treasure!- thereof as an advance payment towards his support as such by-laws may require, which bond shall be signed by at least two sureties who shall justify their responsibility on oath before such judge of probate, and said judge of probate at the request of the medical superintendent of the asylum in which any insane person may be committed as a private patient, may require such sureties to justify their responsibility anew or order that a new bond be filed in the place and stead thereof. SEC. 22. It shall not be lawful for any physician to certify to the insanity of any person for the purpose of securing his admission to an asylum, unless said physician be of reputable character, a graduate of some incorporated medical college, a permanent resident of the State, registered according to law, not related by blood or marriage to the alleged insane person nor to the person applying for such certificate, and shall have been in the actual practice of his profession for at least three years; and such qualifications shall be certified to by the clerk of the county in which sucli physician resides. No certificate of insanity shall be made except after a personal examination of the party alleged to be insane; and it shall not be lawful for any physician to certify to the insanity of any person for the purpose of committing him to any asylum of which the said physician is either a trustee, the superintendent, proprietor and officer, or a regular professional attendant. The county clerk's certificate of qualification, of which there shall be one for each certifying physician, shall be in the following form: STATE OF MICHIGAN, / County of ........ ..... ( bo I hereby certify that .......... of ........ , is personally known to me as a reputable physician, and is possessed of the qualifications required by section 22 of Act No. 135 of the Session Laws of 1885, as amended and now in force, and that, as appears by his oath on file in my office he is a graduate of .......... medical college, and that he has been in the practice of medicine for a period of ...... years, and is registered according to law. Comity Cleric. The following blanks have been adopted for the admission of private patients : �80 NORTHERN MICHIGAN ASYLUM. JUDGE OF PROBATE'S ORDER. STATE OF MICHIGAN, ) County of , $**• At a session of the Probate Court for the County of holden at the probate office in the of , on the day of , in th3 year one thousand eight hundred and Present Judge of Probate. In the matter of an alleged insane person. To the Medical Superintendent of the Northern Michigan Asylum: Having received the certificates of and duly qualified medical examiners in insanity, appointed by this Court, by whom of an alleged insane person, was personally visited and examined, and after notifying the said of the proceedings to be taken in h . . . case, and having taken the testimony of credible witnesses, and having fully investigated the facts in the case with... .the verdict of a jury, as to the question of insanity, I, the Judge of Probate in and for said county, do find that the said is insane and a fit person for care and treatment in the Northern Michigan Asylum. It is therefore ordered that the said be removed to the Northern Michigan Asylum, there to be supported as a private patient. Judge of Probate. STATE OF MICHIGAN, ) County, P I HEREBY CEKTIFY, Ttst the foregoing is a true copy of the original order and certificate made by said Court. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of the Probate Court at this day of Judye of Probate. APPLICATION FOR ADMISSION. To Hon County of The application of Judge of Probate for the in the State of Michigan: of the of in said county, respectfully shows that who is a resident of the of in said county, is insane and in need of asylum treatment: That said petitioner will furnish a bond with sufficient sureties to the Treasurer of the Northern Michigan Asylum at Traverse City, to guarantee payment of the expense of the maintenance and care of the said in said asylum. That the petitioner is and is well acquainted with the pecuniary circumstances of said and makes this application in behalf of said that he may be admitted, on the certificate of said Judge of Probate, in the Northern Michigan Asylum, and there supported at private expense, according to the provisions of Act No. 220 of the Laws of 1889. Dated .............................. 18. ... STATE OF MICHIGAN, ) County of ___________ , j .......................................... . ......... the above named applicant, being duly sworn, says that the above application by him signed, is true, as he verily believes. Subscribed and sworn to before me this [ . ....... _ .......... _ ............ _ . . day of ) ........ _. ............... _____ A. D. 18.. ) Judge of Probate. �LAWS GOVEBNING THE ASYLUM. 81 APPOINTMENT OF MEDICAL EXAMINERS. STATE OF MICHIGAN, ) oc — >• oo. County of . At a session of the Probate Court for said County of held at the probate office in the of , on the day of , in the year one thousand eight hundred and Present, ,' Judge of Probate. In the matter of an alleged insane person. • Application having been made to this Court for an order for the admission of said alleged insane person to the Northern Michigan Asylum as a private patient, and two reputable physicians, qualified medical examiners in insanity, are hereby appointed to examine said alleged insane person, as to such alleged insanity. Judge of Probate. BOND. Know all Men by These Presents, That we and in the county of , are held and firmly bound unto treasurer of the Northern Michigan Asylum, at Traverse City, and his successors in office, in the sum of one thousand dolla.rs, for the payment of which we jointly and severally bind ourselves, our heirs, executors and administrators by these presents. WHEREAS, of the of , in the county of , an insane person, has been admitted as a patient into the Northern Michigan Asylum, at Traverse City, Now, therefore, the condition of this obligation is that if the said obligors shall pay the treasurer of said Asylum, the sum of dollars and cents per week, for the care and board of said insane person so long as. .. .shall continue in said Asylum, with such extra charges as may be occasioned by. .. .requiring more than ordinary care and attention, and also provide with suitable clothing. and pa.y for all such necessary articles of clothing as shall be purchased for by the steward of the Asylum, a statement of which, by the steward, shall be taken as conclusive, and is hereby agreed to by the undersigned, and remove whenever the room occupied by shall be required for a class of patients having preference by law, and also pay for all damages that may do to the furniture or other property of said Asylum, and for reasonable charges in case of elopement, and funeral charges in case of death; such payments for board and clothing to be made quarterly, and at the time of removal, then this obligation to become void, otherwise to remain in force. Sealed with our seals and dated the day of in the year 18. .. IL. s.] [i.. s.] Signed aad sealed in the presence of I HEBEBY CERTIFY, That I a.m personally acquainted with and signers of the atove bond, and consider either of them fully responsible for the prompt discharge of its obligations. PHYSICIAN'S CERTIFICATE. In the Probate Court f°r said County. } S" In the matter of the application of ............................................ in behalf of ....................................................... an alleged insane person, praying that he may be admitted into the NORTHERN MICHIGAN ASYLUM. I, .................................. a permanent resident of .................. in the County aforesaid, being a graduate of ................................ and having practiced as a Physician. ..... years, hereby certify under oath, that on the .......... day of ....................... , 18. . . ., acting under the direction and by the appointment of the HOII ................. Judge of Probate for the County of 11 �82 NORTHERN MICHIGAN ASYLUM. , I personally visited and examined of al aged... .years, by occupation a and 2 , and that the said . is insane, and a proper person for care and treatment, under the provisions of Section 21, of Act No. 135, of the Session Laws of 1885, and acts amendatory thereto. I further certify, That 1 have formed this opinion upon the following grounds, viz: [Here insert delusions, insane conduct or other evidences of insanity.] And I further certify and declare, That I am not related by blood or marriage to said insane person, or to the person applying for this Certificate, and that I am not a trustee, the superintendent, proprietor and officer, or a regular professional attendant of the Northern Michigan Asylum, and that my qualifications as a Medical Examiner in Insanity1 have been duly attested and certified by Clerk of County. (Signed) , M. D. Sworn to and subscribed before me, this day of , 18.. 1 8 Male or Female. Married, single, widowed or divorced. Judge of Probate. COUNTY CLERK'S CERTIFICATE OF QUALIFICATION*. STATE OF MICHIGAN, County of , I hereby certify, That of is personally known to me as a reputable physician, and is possessed of the qualifications required by Section 22 of Act No. 135, of the Session r/aws of 1885, as amended and now in force, and that, as appears by his oath on file in my office, he is a graduate of Medical College, and that he has been in the practice of medicine for a period of years, and is registered according to law. County Clerk. Patients are transferred from private to county charge in compliance with the provisions of the following section: SBC. 24. When an insane person in indigent circumstances shall have been maintained by his friends in the asylum as a private patient, for three months, and the superintendent of the asylum shall certify that he is insane and requires further treatment, the Judge of probate, on application by the friends of such patient, shall determine the question of such indigence, according to the provisions of the preceding section, with or without further evidence of the insanity, as in his discretion lie may think best, and if the indigence be established, he shall make a certificate authorizing the admission of said patient into the asylum as a county charge, and the report to the supervisors required by the preceding section; and the said patient, as in other cases of indigence, shall be supported at the asylum at the expense of the county until restored or for a period not exceeding two years. Insane members of the Michigan Soldiers' Home can be committed to the insane asylums according to the provisions of Act No. 47, Laws of 1895. * SueflPublic Act No. 220, Lawn of11S89." �LAWS GOVERNING THE ASYLUM. 83 Indigent patients can be committed to private asylums within the State in accordance with the provisions, Sec. 1945d, of 3d HowelPs Annotated Statutes of Michigan, as amended by Sec. 4, Public Acts No. 84. Laws of 1895. THE REMOVAL OF PATIENTS TO THE ASYLUM. In conveying a patient to the Asylum do not deceive him. Truth should not be compromised by professing a visit to the Institution, and, on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to come and "stay a few days to see how they like it," under the impression that they can leave at pleasure. This course not only destroys confidence in friends, but also in the officers of the Asylum by giving patients an impression that they are parties to the deception. Removal to the Asylum should never lie attempted when the patient is much prostrated or laboring under severe bodily illness, and care should be taken that the excitement attending acute mental ct/isease be not mistaken for physical strength. The attention of county officers is particularly directed to the requirements of the following section in reference to a female attendant, clothing, etc.: SEC. 35. All town and county officers sending a patient to the asylum, shall, before sending him, see that he is in a state of perfect bodily cleanliness, and is comfortably clothed and provided with suitable changes of raiment as prescribed in the by-laws of the asylum, and shall provide a female attendant, of reputable character and mature age, for a female patient or patients, unless accompanied by her husband, father, brother or son. Any person or officer who shall bring a female patient to the asylum in violation of the last preceding provision of this section or who shall under the provisions of law, or otherwise, bring or accompany a,ny patient to the asylum, and not in due time deliver him into the lawful care and custody of the proper officer of the asylum, taking his receipt therefore, provided lie be admitted, or who shall wilfully leave, abandon, neglect, or abuse such patient, either in going to or returning from the asylum, shall be deemed guilty of a misdemeanor, and on conviction shall be liable to a fine not exceeding two hundred and fifty dollars, or to imprisonment not exceeding one year, or to both in the discretion of the court before which the conviction shall be had. REMOVAL OF TJNRECOVERED PATIENTS. An unrecovered patient may be removed from the Asylum in accordance with the following by-law adopted by the Board of Trustees, Jan. 18,1888: An unrecovered patient supported at private or county expense may be allowed to leave the Asylum on trial, with the approval of the Medical Superintendent, under the charge of a guardian, relative or friends, and may be received back without the formality of a new bond or order, provided, that the period of absence be not longer than six months. �84 NORTHERN MICHIGAN ASYLUM. CLOTHING. As friends of patients are often in doubt as to what articles of clothing it is necessary to provide, the following suggestions are made: Male patients require 3 new shirts, 1 new and substantial coat and rest, 2 pairs pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair shoes or boots, 1 pair slippers, 1 overcoat. Female patients should have 3 calico dresses, 3 chemises, 3 pairs drawers, 4 pairs hose, 3 night dresses, 3 cotton flannel skirts, 6 handkerchiefs, 4 collars, 1 pair shoes, 1 pair slippers, 1 shaw! or cloak, 1 hat, hood or nubia, 4 aprons. The outfit should be liberal when circumstances permit. As nearly all the patients go regularly into the open air each day it is desirable that they be furnished with clothing of a character to enable them to go comfortably in all weather, and also to appear at little social gatherings. When desired, articles of clothing, etc., will be furnished at the Institution. Jewelry should not be brought with patients. If such articles are left in their possession the Asylum cannot be responsible for their safe keeping. I , CORRESPONDENCE. All letters concerning patients, from individuals having the right to make inquiry, will be answered at once; and friends are promptly advised of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are recorded, to whom such communications are sent. Letters are frequently received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will often save them disappointment and the Asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at the written request of friends. MEDICAL HISTORY. Application for admission should be made before the patient is brought to the Asylum, and the following facts should be furnished when possible, in reference to his case: 1. Please state the name, residence, age, nativity, civil condition, occupation, education and religion. 2. Give facts pertaining to family history. 3. Speak of any physical peculiarities or defects, of the habits as M child,and later as an adult;state the temperament, disposition and tastes: the success in business; if addicted to the use of n iquor, opium or tobacco; if the patient has any vicious habits. 4. State if the patient has ever had convulsions, or any previous attack of insanity, the age at time of attack, its character, duration and the treatment employed; if sent to an asylum, state where, and the result of treatment. Give the particulars of subsequent attacks. 5. State the supposed cause or causes of the attack, also any facts that will throw light upon the case. �LAWS GOVERNING THE ASYLUM. 85 6. State the date of the first indication of any change in the usual condition, habits, disposition, or temper of the patient. What was the change? What was the physical condition? Give the subsequent history of the attack, and the treatment employed. 7. Give full particulars of every attempt to injure self or others; whether in any way destructive, or careless and uncleanly in habits. 8. If it has been necessary to use restraint or confinement, state in what form and for how long a time. 9. Give present condition. Physically—whether in usual health, or feeble and emaciated; pulse, respiration, appearance of pupils, whether equally dilated. Voice, whether natural, or if there is any unnatural hesitancy or stammering while speaking; appetite, sleep, digestion, hearing, sight; if there is any evidence of paralysis, or loss of power or of control of muscles. Mentally—if excited or quiet, pleasant or moody and irritable, the character of the delusions, how occupied during the day. 10. Give name and address of attending physician. If the case will admit of delay, blanks for this history will be furnished on application. Idiots are especially excepted ~by law -from the benefits of the Asylum and cannot under any circumstances 6e received. All correspondence in reference to patients may be addressed to Dr. James D. Munson, Northern Michigan Asylum, Traverse City. �INDEX. Account*, classification of Accounts, current : Acknowledgments Admission of private patients .' Admission of indigent and pauper patients Admissions and discharges _ Age,of patients. Table Appendix Admission of non-resident patients Cost of maintenance Civil conditions. Table Clinical groups. Table. Classification Confusional insanity Divine service Duration of disease. Table Deaths, causes, etc Exciting causes. Table Farm and garden products Farm and garden Form of disease. Table Government of the asylum Heredity. Table Hysterical insanity Improvements Inventory, summary of Movement of population. Table Nativity of patients. Table Names of officers and employes Occupations. Table Report of trustees Report of treasurer Report of medical superintendent Report of steward Report of auditing committee Report of State Board of Charities and Corrections Roofs Receipts and disbursements ; Residence of patients. Table Special appropriations Support of patients by counties Mechanical feeding of the insane Opium bromide treatment of epilepsy Uranalyses _ ._ _ . .' 2B 17 Tl 78 76 _ 33 68 76 78 7 68 67 41 42 71 67 34 69 29 12,28 41 76 64 48 9 32 33 66 73 1. 65 _. 5 17 33 25 24 71 11 15 70 10,11,12 6 57 52 81 � https://localhistory.tadl.org/files/original/0cb746c9de17ff779f599e0555d9df27.pdf c72a6012e872137dcb635b677dc8170e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Sixth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1918 Subject The topic of the resource Psychiatric hospitals. Description An account of the resource Fifth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1916. Delivered to the State Legislature. Trustees again brought to the attention of the Legislature the inadequate facilities provided for the work of the hospital, in both size and arrangement of buildings. Due to the First World War, a cooperative agreement with the Surgeon General of the Army led to the instruction of officers of the Medical Corps of the Army beginning in June 1917. An additional cooperative agreement with the State Board of Health led to the extension of the out-patient ward, to examine women for mental disorders who might come under the care of the State Board for the spread of venereal diseases. Reports by the medical director and treasurer included. Creator An entity primarily responsible for making the resource Board of Trustees, State Psychopathic Hospital at the University of Michigan. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Fort Wayne, IN: Fort Wayne Printing Company, Contractors for Michigan State Printing and Binding. Date A point or period of time associated with an event in the lifecycle of the resource 1919 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees at various institutions in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context MSH0005 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Ann Arbor, Washtenaw County, Michigan PDF Text Text capture metadata for PDF documents Text SIXTH BIENNIAL REPORT OF THE BOARD OF TRUSTEES OF THE State Psychopathic Hospital AT THE UNIVERSITY OF MICHIGAN FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1918. BY AUTHORITY FORT WAYNE PRINTING COMPANY CONTRACTORS FOR MICHIGAN STATE PRINTING AND BINDING FORT WAYNE, INDIANA 1919 ��OFFICERS OF THE STATE PSYCHOPATHIC HOSPITAL. TRUSTEES. Chauncey F. Cook Fred S. Case Dr. Walter H. Sawyer Wm. L. Clements Benjamin S. Hanchett Frank B. Leland Albert C. Stevenson William Lloyd Hillsdale -. . . Sault Ste. Marie Hillsdale Bay City Grand Rapids Detroit Port Huron Manistee OFFICERS. Albert M. Barrett, A. B., M. D Arnold L. Jacoby (absent on leave) Bertrand L. Jones, A. M., M. D Raymond F. .Wafer, M. D James M. Stanton, M. D Robert G. Greve Adeline E. Gurd, M. D Sobei Ide, M. D Agnes Tennant, R. N Medical Director First Assistant Physician Acting First Assistant Physician Second Assistant Physician Resident Physician Business Officer Pathologist Serologist Head Nurse �REPORT OF TRUSTEES. To ilie Legislature of the State of Michigan: The Board of Trustees of the State Psychopathic Hospital at the University of Michigan has the honor of submitting the following report. The membership of the Board continues the same excepting that M. F. Quaintance, member from the Board of Trustees of the Traverse City State Hospital, has been succeeded by William Lloyd, from the same Board, and Albert E. Stevenson has succeeded Dr. Stewart Galbraith from the Board of Trustees of the Pontiac State Hospital. Meetings of the Board of Trustees have been held at intervals at the Hospital and the Trustees have maintained an active interest in the work of the institution. Detailed statements of the medical work of the hospital and its business administration are given in accompanying reports of the Medical Director, the Business Officer and the Treasurer of the Hospital. The number of patients treated during the period was 538 as against 510 of the previous period. There continues, as in other years, a greater demand for the admission of patients than the capacity of the hospital can accommodate. The Board of Trustees must again bring to the attention of the Legislature the inadequate facilities, both in size and arrangements that have been provided for the hospital. Many patients for whom the Hospital might do much by treatment must be refused admission. The progressive development of the medical, research, and teaching work of the hospital has reached a point where no further extensions are possible, until more space is provided. The pressing needs of the Hospital can only be met by the erection of a new building. It is hoped that the public may become more familiar with the important service the Hospital is giving to the State and that adequate provision for the work will be made at an early date. The average per capita cost for the maintenance of patients during the period was $1.34 per diem. The per diem cost for the entire hospital administration, including salaries, current expenses of the laboratory and repairs and improvements was $2.16. The increase of the per diem costs over that of previous years is accounted for by the increased cost of supplies and extensions of the medical work of the hospital. The out-patient services of the hospital located in Detroit and Ann Arbor have become most important features of the work of the hospital. During the past period they have treated a far larger number of patients than in previous years, and through these agencies the influence of the hospital throughout the State has been greatly extended. �6 STATE OF MICHIGAN. In cooperation with the State Board of Health, the trustees have approved an extension of the out-patient ward of the hospital to aid in the examinations for mental disorders of women who might come under their care in connection with the efforts of the Board of Health against the spread of venereal diseases. The War has presented to the Psychopathic Hospital opportunities for helpful service to the Government. At the request of the Surgeon General of the Army the trustees have gladly offered the facilities of the hospital for instruction of officers of the Medical Corps of the Army who were to be assigned to the care of mental and nervous disorders in the Army. Courses of instruction began in June 1917 and have continued through the period. Signed: CHAUNCEY F. COOK, WALTER H. SAWYER, FRED S. CASE, WM. L. CLEMENTS, BENJ. S. HANCHETT, FRANK B. LELAND, ALBERT C. STEVENSON, WILLIAM LLOYD. �PSYCHOPATHIC HOSPITAL. ORGANIZATION. The State Psychopathic Hospital of the University of Michigan was established in 1901. Its purposes are defined by legislative statutes of 1907, as follows: Act 278, Public Acts 1907, Sec. 15—Patients admitted to the Psychopathic Hospital are divided into two classes: First: Public patients are such as are kept and maintained by the State. Second: Private patients are such as are kept and maintained without expense to the State. Sec. 17.—Patients may be admitted to the Psychopathic Hospital at the University of Michigan in accordance with the following provisions : First: Persons adjudged insane according to the provisions of act two hundred seventeen, sections fifteen and sixteen, public acts of nineteen hundred three, may be committed to the Psychopathic Hospital at the University of Michigan, whenever, in the opinion of the judge of probate, it may be deemed advisable: Provided, That before such patient be sent to said hospital, he shall obtain the approval of the director of the Psychopathic Hospital for such action. But, if an insane patient committed to the Psychopathic Hospital cannot be received because of lack of room, he shall be committed to the proper asylum in the district in which he resides and receive treatment until there is room for him at the Psychopathic Hospital, and if it appears in the course of his treatment in such asylum that he would not probably be benefited by treatment at the Psychopathic Hospital, he shall remain at said asylum. In all orders made by the judge of probate for the admission of an insane person to the Psychopathic Hospital at the University of Michigan, it shall be specified that in case such patient shall not recover after a satisfactory period of observation and treatment, or whenever, in the opinion of the director of the Psychopathic Hospital at the University of Michigan, further residence in said hospital is inadvisable, such patient shall be transferred to the asylum in the district of which said patient was a legal resident or to such other asylum as the judge of probate may designate in such order of committal: Provided, That whenever an insane person is to be so transferred, due notice of such transfer shall be given to the judge of probate and the person making application for such admission and to the superintendent of the asylum to which such patient is to be transferred. Second: When, in accordance with section sixteen, act two hundred seventeen, public acts of nineteen hundred three, in the hearing as to the insanity of a person, it may seem advisable to the court, that on account of doubt as to the sanity or insanity of a person, or if in the opinion of the court, a permanent order of insanity is inadvisable, or if in the opinion of the court and examining physicians, the case presents complicating diseases which may be treated by the clinical physicians �8 STATE'OP MICHIGAN. in the general hospital of the University, and by such treatment their mental or nervous disability be cured or benefited, the court may continue said hearing in said court not to exceed thirty-five days, and direct that such person shall be sent to the Psychopathic Hospital at the University of Michigan, as a public or private patient, as a person afflicted with some nervous or mental disease and that said person be there confined, observed and treated for a period not longer than thirty-five days. Before the expiration of this period the director of the Psychopathic Hospital shall return to the judge of probate the results of his observation and treatment of said patient, and an opinion stating whether said patient, is insane or sane. If observation has shown that the patient is insane, then the court shall notify said patient, the relatives and the person making the application for said admission to the asylum, and may pass judgment of insanity and order that said person to be confined as an insane patient in the Psychopathic Hospital at the University of Michigan, or in the State asylum for the insane in the district of which said patient is a legal resident, or in such other asylum for the insane in the State of Michigan as may seem advisable; and it sha'l thereupon be further ordered that said patient be transferred to the State asylum for the insane of the district of which said patient was a legal resident, or to such asylum as said judge of probate may designate, when in the opinion of the director of the Psychopathic Hospital further residence in said hospital would not result in recovery or would be inadvisable: Provided, That whenever an insane patient is to be transferred to an asylum in accordance with such provision, due notice of the intention of such transfer shall be given to the judge of probate, the person making application for the admission of said patient into an asylum, and the superintendent of the State asylum for the insane, to which said patient is to be transferred. If the results of the observation of said person show that, in the opinion of the director of the Psychopathic Hospital, said person is not insane, then the order for confinement, observation and treatment shall be vacated and the patient discharged from the Psychopathic Hospital. Third: Persons who are residents of the State of Michigan, who are afflicted mentally, or with serious nervous disorder, but who are not insane, nor been legally adjudged insane, may be admitted to the Psychopathic Hospital at the University of Michigan as voluntary patients, either at the discretion of the director of said hospital, or in accordance with the statutes providing for the admission of voluntary patients to the Michigan State Asylums for the insane. Such voluntary patients, when so received, shall be subject to the general rules and regulations of the Psychopathic Hospital. All voluntary patients shall be supported without expense to the State, and the amount agreed upon for the maintenance of such voluntary patients in the Psychopathic Hospital shall be secured by a properly executed bond to be approved by the medical director, and there shall be made such advance payments as may be required by the action of the board of trustees of the Psychopathic Hospital at the University of Michigan, and bills for their maintenance shall be collected monthly. Voluntary patients so received may be discharged at any time by the medical director, and in case any voluntary patient in the Psychopathic Hospital at the University of Michigan is believed to be insane, the proceedings shall be carried out as provided for such contingency by act two hundred seventeen, section twentynine, public acts of nineteen hundred three; �PSYCHOPATHIC HOSPITAL. 9 Fourth: In case the superintendent of any one of the asylums for the insane in the State of Michigan shall be of the opinion that the condition of mind of any person who is confined in such asylum may be benefited by residence and treatment at the Psychopathic Hospital at the University of Michigan, he may cause said patient to be conveyed to said hospital, and, in case said patient, while there confined, shall be restored to sanity, such patient shall be discharged; but, in case such patient shall be found incurable, such patient may be returned to the asylum from which said patient was received, or may be discharged or paroled from the Psychopathic Hospital by its director, with the consent of the superintendent of the asylum from which such patient was received. Whenever, in accordance with the above provisions, a patient shall be transferred from any asylum to the Psychopathic Hospital, the superintendent of such asylum shall notify the guardian, if any, of such patient and the judge of probate of the county of which such patient was a resident, and when said patient is discharged, paroled or returned to the asylum from which said patient was received, the director of the Psychopathic Hospital shall inform said guardian, if any, and the judge of probate, before taking such action. Voluntary patients may be admitted at public expense in accordance with Public Acts 1915, Act 27. The hospital may admit any resident of this State who is desirous of submitting himself to treatment as a patient, and who makes written application therefor, and whose mental condition is such as to render him competent to make such application: Provided, The approval of the judge of probate of the country in which such person resides shall be obtained in writing and such person shall not be detained for more than three days after having given notice in writing of his intention or desire to leave such institution. The rate of charge for insane patients, and the rules for admission of insane patients so far as not inconsistent, shall apply to such voluntary patients. Section 21. Par 2, Any insane patient of the Psychopathic Hospital may be transferred to the State Asylum for the Insane in the district of which said patient was a legal resident, or to such asylum as the judge of probate may' designate in his order of admission, whenever, after a satisfactory period of observation and treatment, it is found that said patient is incurable, or that further confinement in the Psychopathic Hospital at the University of Michigan is inadvisable: Provided, That whenever an insane person is to be transferred, due notice of such transfer shall be given to the judge of probate, and to the person making the application for the admission of said patient to an asylum, and to the superintendent of the asylum to which patient is to be transferred. �10 STATE OF MICHIGAN. REPORT OF THE MEDICAL DIRECTOR. In accordance with the statutes of this State, I have the honor of submitting to the legislature of the State of Michigan my report as Medical Director of the State Psychopathic Hospital covering its sixth Biennial Period. During this period the general policy of the operation of the hospital has continued along much the same lines as previously. In common with all institutions the hospital has felt the influence of the situation brought about by the war. The problem of maintaining former standards has been difficult. In addition to this the hospital was called upon to do special work in connection with the instruction of medical officers of the army. The hospital has treated a somewhat larger number of patients than in any previous period. It is not to be expected that any marked increase in the number treated can occur until the capacity of the hospital is increased. Under present conditions there is always a waiting list of patients desiring admission as soon as vacancies occur. It would be possible to increase the admissions if it were possible to make transfers of patients, whose problems are custodial, more rapidly to the State Hospitals. The greater number of admissions are from the eastern part of the State and the present crowded condition of the Pontiac State Hospital offers far fewer opportunities for transfer than could be utilized. In spite of the clear definition in the statutes of the State, as to the field of work of this hospital, it is found difficult to adhere to these owing to the great pressure that is continually present for the admission of patients. Friends of patients and committing authorities are not able or willing to recognize the unsuitability of many patients for admission to this hospital. The desire to keep the hospital filled to its capacity and to be of as much service to the State as possible results in the admission of many patients quite unsuited to the purposes and facilities of the hospital. CLINICAL AND LABORATORY WORK. A detailed account of the clinical work is given in another section. The foundation of the clinical work is the routine intensive study of each patient's personal history and the clinical manifestations of his disorder. The results of these are presented at frequent conferences of the medical staff. The activities of the laboratory have chiefly been centered in the intensive study of the nervous system of patients, whose clinical course has been well studied. A tabulation of this work is given in another section. �PSYCHOPATHIC HOSPITAL. 11 SOCIAL SERVICE. During the period the hospital added to its staff a worker trained in the social aspects of mental disorders. It thus became possible to undertake a more thorough study of the social relations of patients in their pre-institutional life, and to keep in touch with their progress after discharge. A systematic study was made of the after life of a large number of patients who had been discharged from the hospital in the earlier, years of its existence. The results of this will be published during the coming year. MEDICAL INSTKUCTION. In this work the hospital has one of its most interesting and usefu activities. The instruction of former years has already shown results among medical practitioners, especially those who have gone out from the Medical School of the University within recent years. There is a more widespread interest in psychiatry and the standards of medical examinations for hospital commitment have improved. At the present time students of the fourth year medical class receive 45 hours of clinical lectures on psychiatric medicine and 16 hours of practical work at the bedside. MILITARY MEDICAL WORK. Soon after the beginning of the war the Surgeon General of the Army requested that certain hospitals devoted to mental and nervous disorders should arrange courses of instruction in neuro-psychiatry. To these would be assigned- for intensive training medical officers, who would later on be given charge of the care and treatment of mental and nervous disorders in the medical organization of the army. The hospitals so selected to do this were: The Henry Phipps Psychiatric Clinic at Baltimore, The Government Hospital for the Insane at Washington, The New York Neurological Institute, The Philadelphia General Hospital, and the Psychopathic Hospital at Ann Arbor. The Medical Director of this hospital was appointed Military Director of the hospital and in cooperation with Professor Camp of the Department of Nervous Diseases of-the University, Professor Slocum of the Department of Ophthalmology, and Dr. Furstenberg of the Department of Otology, a course of instruction was conducted. This work has continued through the last year of the period. In all 79 officers have been in attendance remaining for instruction from 4 to 6 weeks. OUT-PATIENT SERVICES. This work which had its beginning during the preceding period has been greatly extended during this. The hospital now conducts two services for out-patients. One, locally in connection with the medical work of the General Hospital of the University, examined during the period 407 patients; and one in Detroit examined and gave advice to 978 �12 STATE OF MICHIGAN. patients during the period. This latter service known as the Wayne County Psychopathic Clinic, Wayne County Out-Patient Service of the State Psychopathic Hospital, was organized in 1916. This service is located in rooms in the Wayne County Juvenile Court Building in Detroit. Its work is conducted by a trained psychologist and a social service worker. It is supervised by the State Psychopathic Hospital. At intervals a physician of this hospital attends the clinic and gives advice to such cases as have been referred from the regular routine work of the clinic. The financial support of the clinic is provided in part by Wayne County public funds and in part by ph lanthropic individuals of Detroit. Since the beginning of the war the Michigan State Board of Health has been active in systematic efforts to prevent the spread of venereal diseases among the soldiers in mobilization camps. In carrying this out, women who were found to be infected were interned in hospitals for treatment. As it has long been appreciated that women of this class were frequently mentally deficient or disordered, it was felt that the present occasion offered an unusual opportunity for studying this problem. It was also believed that the results of such studies would be a great aid in determining the after-care of those who were treated. The Psychopathic Hospital was requested to supervise an organization that would make systematic mental examinations of these individuals. A group of trained workers were provided by the Board of Health and the Work placed under the direct supervision of the Detroit Out-Patient Service of this hospital. Detailed reports of the work of the various out-patient services is given in another section. RELATIONS WITH THE STATE HOSPITALS. There continues the same cooperation of the State Hospitals treating mental disorders and the Psychopathic Hospital in the investigation of problems common to their work. This cooperation has resulted in decided advances in medical standards in the State Hospitals and the maintenance of a live interest in clinical problems of mental disorders. Extensions of the work of former years has not been advisable owing to the depleted personnel of the medical staff of the hospitals and the difficulties of administration incident to war conditions. FUTURE DEVELOPMENTS. The Psychopathic Hospital is in urgent need of a new building for its work that will be adequate in size and arrangements. Anyone who is familiar with the construction and arrangements of the present building must realize how poorly it is adapted to the treatment of patients with mental disorders and how unsuited it is to carry on its purposes of investigation and teaching. Those who are interested in the administration of the hospital urgently request that at some early date the legislature make provision for a building better adapted in size and plans for its needs. It is planned to further extend the out-patient services to other cities convenient to access to Ann Arbor as soon as arrangements can be made. �PSYCHOPATHIC HOSPITAL. 13 OFFICIAL CHANGES. The following changes in the Medical Staff have occured during the period. Dr. Arnold L. Jacoby, first assistant physician, was granted leave of absence in April 1917 in order to enter the medical service of the navy. Dr. Earl Palmer was appointed acting first assistant physician in May 1917. Dr. Harold S. Hulburt resigned as second assistant physician in January 1917. He was succeeded by Dr. Raymond F. Wafer, appointed in July 1917. Dr. W. I. Lillie resigned as resident physician in July 1916 and was succeeded by Dr. Robert Hale, who served until July 1917, leaving to enter military service. Dr. Bertrand L. Jones was appointed resident physician in July 1917, serving in this capacity until May 191-8 when he succeeded to the position of acting first assistant physician. Respectfully submitted, ALBERT M. BARRETT, Medical Director. �14 STATE OF MICHIGAN. CLINICAL REPORT. Information regarding the medical work of the hospital is considered in two sections. The first of these consists of a tabulation of the admission and discharges considered from various aspects of social, causative and treatment relations. The second is a detailed analysis of the more important clinical groups. GENERAL STATISTICAL TABLES, Information given in these tables may be compared with similar tabulations made by other State Hospitals for the Insane, but in doing so the peculiar relations under which the State Psychopathic Hospital operates should be given consideration. This hospital receives patients from the entire State of Michigan, rather than from any one section of the State. The small capacity of the hospital and its special field of work require that admission should as far. as possible be restricted to mental disorders in their earlier stages and to functional nervous abnormalities which are not regarded as commitable to the larger State Hospitals. A constantly pressing demand for the admission of patients necessitates a somewhat rapid change of patients and this results in a far shorter period of treatment for most individuals than in the larger State Hospitals for the Insane. TABLE No. 1.—Showing the number of patients admitted and discharged and remaining June SO, 1918. Year ending June 30, 1917. Year ending June 30, 1918. Total since beginning. M. M. M. • Admission by court commitment. Public maintenance Admission voluntary Transferred from State Hospitals State maintenance Total number admitted Patients in hospital at beginning of year Discharged With psychosis Died . - Without psychosis Died F. F. T. F. T. 71 6 89 160 10 55 76 10 131 13 3 30 42 6 72 0 33 4 46 1 0 1 1 0 0 2 0 1 2 1 0 ] 0 112 139 251 94 139 233 1,147 1,194 2,341 26 138 28 167 54 305 26 120 28 167 54 287 16 38 44 7 7 61 54 5 23 99 98 12 9 34 37 5 14 44 58 7 23 78 95 12 154 371 498 52 1 4 2 0 0 4 7 1 1 8 9 1 1 3 7 0 1 0 6 0 2 3 13 0 2 7 39 0 139 251 96 130 24 37 112 Patients in hospital at close of period . . T. 4 79 701 103 3 299 303 10 602 3 3 0 11 8 22 8 4 15 19 12 37 755 1 , 456 102 205 159 313 397 768 522 1,020 44 96 1 4 29 1 3 11 68 1 226 1,123 1,157 2,280 61 �PSYCHOPATHIC HOSPITAL. 15 The above table shows the number and legal relations of those admitted during the biennial period, and from the beginning of the work in this hospital. It also shows the results of treatment of those who were discharged. The total number of admissions is about six percent larger than in the previous period. The number of those entering the hospital as voluntary patients was considerably larger than in any previous period. Since 1915 it has been possible for patients to be admitted as voluntary public charges. This provision is not yet as widely known throughout the State as is desirable. In the present period 10 patients of this class were admitted. Voluntary admissions form 33 percent of all admissions to the hospital. One-third of all admissions are maintained privately. The comparative increase of admissions each year since the opening of the hospital is as follows: 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. 27 Female 39 40 48 59 78 26 70 89 92 96 96 118 101 109 88 117 104 94 114 126 126 112 139 94 139 53 79 107 148 181 192 219 197 221 208 252 251 233 The admission for the period by months has been: July 1, 1916 to June 30, 1917. Male Female 7. 8. 9. 7 14 10 13 11 13 21 23 24 11. 12. 1. 2. 3. 4. 5. 6 Total 10 8 13 15 13 10 7 9 7 7 10 17 7 11 6 11 11 11 112 139 18 28 23 16 14 27 18 17 22 251 10. July 1, 1917 to June 30, 1918. Female 7. 8. 9. 10. 11. 7 11 7 10 6 13 6 12 9 9 18 17 19 18 18 1. 2. 3. 4. 5. 0. Total 7 9 7 15 10 12 9 10 11 10 8 17 7 11 94 139 16 22 22 19 21 25 18 233 12. The average monthly admissions was 20. The largest number admitted in any one month was 28. The variety of clinical forms given in the following table is about as in former years. By far the most frequent form of psychoses are those belonging in the manic depressive group. The relative frequency of disorders that remained undiagnosed was 2.5 per cent of admissions. �16 STATE OF MICHIGAN. TABLE No. II.—Showing the forms of insanity in patients admitted and discharged during the biennial period. Year ending June 30, 1917. Admitted. M. Traumatic Psychoses: 1 Traumatic delirium . Senile Psychoses: 1 Presbyophrenic type Psychoses with cerebral arterio5 sclerosis General Paralysis: Demented type 14 1 Expansive type Agitated type 1 1 Juvenile type Psychoses with Cerebral Syphilis. . Vascular type 0 Meningitic type 0 Psychoses with Brain Tumor 3 Psychoses with other Brain or Nervous diseases: Multiple sclerosis 0 Multiple neuritis 0 1 Meningeal hemorrhage Tabes 0 Alcoholic Psychoses : Pathological intoxication 0 1 Korsakow's psychosis Chronic paranoid type 4 Psychoses due to drugs and other exogenous toxins: Opium intoxication 3 Chloral intoxication 0 Veronal intoxication 0 Psychoses with pellagra 0 Psychoses with other somatic diseases : Delirium with septicaemia 0 Delirium typhoid fever 0 Exhaustion delirium 0 1 Delirium with uraemia Delirium of unknown origin. . . . 2 Psychoses with Basedow's disease 0 Psychoses with rheumatism. . . . 1 Psychoses with pernicious 0 anaemia 0 Psychoses with tetany 0 Psychoses with Glaucoma Manic Depressive Psychoses: 8 Manic type 17 0 Mixed type 1 Dementia Praecox 0 3 12 Hebephrenic type 4 Year ending June 30, 1918. Discharged. Admitted. Discharged. M. F. T. M. F. T. 1 1 13 1 1 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 5 0 0 0 18 2 0 0 4 1 1 0 1 2 0 0 5 3 1 0 6 2 2 1 1 2 0 0 7. 4 2 1 1 1 1 1 0 1 1 1 3 2 0 0 4 1 2 1 2 1 1 1 1 1 3 0 0 0 1 0 O 1 1 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 1 2 0 0 1 2 0 0 0 1 4 0 0 0 0 1 4 0 4 1 0 0 0 1 0 4 0 2 1 0 0 0 0 2 4 0 1 0 2 0 0 1 0 1 0 1 3 0 1 1 0 0 0 0 1 0 0 0 1 0 1 1 0 0 1 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 1 0 1 1 1 0 0 0 2 0 4 0 0 0 10 28 1 0 4 7 14 1 F. T M. F. 0 0 6 1 1 11 1 1 8 0 0 5 5 0 0 0 19 1 1 1 13 2 0 0 2 1 2 2 1 5 0 0 2 2 0 1 0 1 0 1 1 1 0 0 1 0 0 0 0 0 1 4 0 1 0 1 1 1 0 0 0 0 3 1 T 1 0 2 0 3 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 18 45 1 1 8 18 0 1 32 1 0 11 19 50 1 1 6 14 1 0 15 28 1 9 21 42 2 9 4 10 26 5 1 2 12 4 5 7 12 2 6 9 24 6 4 5 8 4 7 8 6 2 11 13 14 6 1 0 1 1 1 0 0 0 1 0 0 0 1 0 1 1 1 0 0 0 2 1 2 2 1 1 2 0 1 0 1 1 0 1 0 2 0 0 1 2 0 0 1 6 12 10 26 1 0 0 5 3 6 6 4 5 8 8 0 1 3 1 3 0 1 1 18 36 1 5 8 14 14 4 �PSYCHOPATHIC HOSPITAL. 17 TABLE No. II—Continued. Year ending June 30, 1917. Discharged. Admitted. M. Paranoia and Paranoiac Conditions : Paranoia Paraplirenia systematica Presenile paranoiac condition. . . Paranoiac condition with impaired hearing ' Undiflerentiated paranoiac conditions Epileptic Psychoses Neuroses and Psychoneuroses : Hysterical type Psychasthenic type Neurasthenic type Anxiety neurosis Compulsion neurosis Psychoses with Constitutional Psychopathic Inferiority . . . . Psychoses with Mental Deficiency Undiagnosed Psychoses Not Insane: Epilepsy without psychosis . . . . Drug addiction without psychosis Constitutional psychopathic inferiority without psychosis Mental deficiencywithout psychosis Subnormal Feebleminded Idiot Constitutional syphilis without psychosis Total P. Year ending June 30, 1918. T. 1 1 0 0 0 7 1 3 1 2 4 1 0 0 M. 2 2 0 7 4 1 1 0 0 5 9 0 0 1 9 10 1 0 1 0 2 0 0 0 6 6 2 1 0 0 F. T. Admitted. Discharged. M. F. T. M. 1 2 0 0 3 4 2 1 0 0 3 1 1 5 1 1 2 2 1 4 2 0 3 0 0 4 1 0 7 1 0 0 0 1 1 1 1 4 1 5 0 6 3 2 5 5 7 0 0 1 11 9 1 0 1 2 1 0 2 0 7 6 0 0 0 9 7 0 2 0 F. T. 1 1 2 5 2 6 2 0 7 7 0 0 0 9 8 0 2 0 5 8 13 3 11 14 6 8 14 8 9 17 0 1 2 6 2 7 0 1 1 4 1 5 1 0 2 5 3 5 1 0 3 7 4 7 0 0 0 0 0 0 2 0 2 2 0 2 1 0 1 1 0 1 1 1 2 1 1 2 5 6 11 6 6 12 5 5 10 5 4 9 0 0 0 5 0 0 0 0 6 0 5 6 0 5 4 1 4 5 0 4 2 3 0 3 7 1 5 2 1 0 3 0 3 5 1 3 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 1 0 0 1 0 1 112 139 251 113 138 251 94 139 233 95 131 226 Some information regarding the family constitution was obtained in 89 percent of all admissions. In all cases in which information was available influences regarded as of significance in their relation to insanity among descendants were present among 68.2 per cent. These occurred among the parents in 57.8 per cent of instances; among the grandparents in 9.2; among collateral lines in 17.7 per cent and among the brothers and sisters in 15.3 per cent. The following table shows the hereditary factors in patients admitted: �TABLE No. III.—Showing the occurrence of hereditary factors in patients admitted. Period ending June 30, 1918. - Direct. M. F. Insanity Apoplexy and paralysis . Psychopathic conditions Alcoholism 23 10 14 19 45 11 30 18 Atavistic. Collateral. Brothers and Sisters. Total since beginning. Total. Direct. Atavistic. Collateral. Brothers and Sisters. Total. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. 68 21 44 37 334 7 4 1 2 6 13 12 30 42 12 14 26 54 3 7 1 4 5 1 1 2 16 0 1 3 1 4 7 6 13 25 4 6 0 1 1 1 3 4 22 95 149 19 35 37 62 48 66 126 164 290 45 39 84 101 126 227 62 76 138 78 61 139 30 37 67 7 10 17 10 8 18 46 78 124 8 3 11 16 11 27 17 29 46 66 53 119 8 8 16 5 4 9 9 6 15 125 87 88 F. 405 116 121 71 T. 739 241 208 159 50 H [> 1-3 H <-, Total heredity 66 104 170 14 13 27 16 36 52 21 24 45 117 177 294 316 356 672 91 87 178 129 151 280 98 119 217 634 713 1,347 g h-1 0 Negative Unknown 66 71 137 23 30 53 318 . .195 Total 89 101 190 1.147 1,194 2,341 330 151 648 346 3 3 �PSYCHOPATHIC HOSPITAL. 19 TABLE No. IV.—Showing the age of patients admitted. Year ending June 30, 1917. M. From 0 to 4 years From From From From From From From From 10 to 15 to 20 to 25 to 30 to 35 to 40 to 45 to 14 years 19 years 24 years 29 years 34 years 39 years 44 years 49 years From 55 to 59 years From 60 to 64 years From 65 to 69 years From 70 to 74 years From 75 to 79 years From 80 to 84 years Age unknown ... .. .. Total F. Year ending June 30, 1918. T. 0 1 0 0 0 0 5 14 15 12 22 23 17 13 8 6 0 2 1 1 0 0 0 0 7 23 29 25 35 44 30 19 14 12 6 4 1 2 0 0 112 139 251 0 0 2 9 14 13 13 21 13 6 6 6 6 2 M. F. M. F. 1 8 ' 27 84 131 0 2 13 99 131 131 165 170 153 121 83 57 27 7 7 3 1 24 1 10 40 183 262 279 295 318 263 233 161 136 66 25 17 9 2 41 233 1,147 1,194 2,341 T. 0 0 1 0 2 2 9 9 13 21 14 15 13 23 13 ' 25 14 9 17 9 4 8 2 2 2 3 1 1 1 0 0 0 0 0 0 0 89 139 Total since beginning 0 1 4 18 34 29 36 38 23 26 12 4 5 2 1 0 0 0 148 130 148 110 112 78 79 39 18 10 6 17 T. From this table we see that the largest number of admissions occurred between the ages of 30 and 40. TABLE No. V.—Showing civil condition of patients admitted. Year ending June 30, 1917. M. Single Widowed . . Total . .. F. T. Year ending June 30, 1918. M. F. 44 68 0 0 0 49 79 7 1 3 93 147 7 1 3 49 41 2 1 1 54 76 5 2 2 112 139 251 94 139 Total since beginning T. M. F. 103 117 7 3 3 501 574 35 33 4 413 663 79 32 7 914 1,237 114 65 11 233 1,147 1,194 2,341 T. �STATE OF MICHIGAN. 20 TABLE No. VI.—Showing degree of education of patients admitted. Year ending June 30, 1917. M. Illiterate Common school College Unascertained Total F. Year ending June 30, 1918. T. M. F. 1 8 65 19 9 10 1 5 87 32 7 7 2 13 152 51 16 17 ' 2 4 46 20 14 8 1 1 81 43 5 8 112 139 251 94 139 Total since beginning T. M. F. T. 3 5 127 63 19 16 17 82 688 201 100 59 3 54 766 263 51 57 20 136 1,454 464 151 116 233 1,147 1,194 2,341 TABLE No. VII.—Showing the occupation of those admitted during the current period and from beginning. Year ending June 30, 1917. M. Professional Mercantile and trading Personal service, police and military Laboring and servants Manufacturing and mechanical industry Agriculture, transportation and other outdoor Student No occupation Total 15 18 2 1 F. T. 26 31 2 1 0 , 29 15 24 0 3 1 4 11 13 0 0 0 12 0 0 85 8 5 5 15 24 112 139 Year ending June 30, 1918. M. 85 11 6 9 13 16 0 5 1 2 14 3 1 0 0 10 0 0 88 7 9 7 251 94 139 0 41 21 10 1 3 1 21 F. T. 35 13 2 3 1 31 13 16 88 12 10 9 Total since beginning M. F. 112 99 112 40 81 64 9 4 18 196 140 325 0 107 12 0 46 41 18 233 1,147 T. 0 782 40 75 20 193 163 121 44 18 303 152 325 782 86 116 38 1,194 2,341 �21 PSYCHOPATHIC HOSPITAL. TABLE No. VIII.—Showing the nativity of patients admitted. Year ending June 30, 1917. Total admissions Total born in Michigan Total born in United States. Unascertained Armenia Austria . . . , Bohemia Canada . . . England .. ... Germany Holland Hungary Italy Poland M. F. T. 112 70 139 78 104 27 8 0 0 1 0 0 15 1 0 2 2 1 0 1 0 1 0 1 0 1 1 251 148 188 48 15 0 0 3 0 0 22 1 3 4 3 1 0 1 0 2 0 3 2 1 1 0 0 0 8 0 1 0 15 84 21 7 0 0 2 0 0 7 0 3 2 1 0 0 0 0 1 .. 0 2 2 0 0 0 1 0 Scotland Sweden Syria. Wales West Indies . Year ending June 30, 1918. 7 M. 94 59 74 14 6 2 0 0 0 0 3 0 2 3 0 0 0 0 0 0 0 1 1 0 0 0 0 0 fi Total since beginning M. F. F. T. 139 86 109 16 14 0 0 0 0 0 7 0 3 0 1 233 1,147 1,194 685 741 145 183 920 956 187 30 170 20 57 51 2 3 0 1 0 0 4 4 0 0 2 0 1 0 0 10 55 76 1 0 2 24 5 15 3 32 40 1 10 8 2 0 6 1 0 0 2 2 1 1 0 0 3 6 0 1 0 0 11 9 2 2 8 5 0 4 7 1 1 2 1 0 0 2 0 0 1 0 0 25 28 20 0 0 1 0 0 0 1 1 1 0 0 0 0 14 T. 2,341 1,426 1,876 357 108 3 1 8 2 1 131 3 39 72 18 8 1 4 1 9 1 20 13 11 3 1 2 1 53 The above table shows that the number of foreign-born patients was much larger than in any previous period. Foreign born formed 21 per cent of admissions. TABLE No. IX.—Showing the natimtlj of parents. Year ending June 30, 1917. Year ending June 30, 1918. Total since beginning •' M. One foreign born, one One foreign born, one One native born, one Unascertained Total F. T. 44 38 10 3 2 15 51 50 21 4 6 7 95 88 31 7 112 139 M. F. 8 22 28 38 7 2 5 14 40 57 21 2 3 16 251 94 139 T. 68 95 28 4 8 30 M. F. 365 508 127 9 404 769 494 1,002 163 290 11 20 18 28 104 232 10 128 T. 233 1,147 1,194 2,341 From the above table it is seen that patients whose parents were foreign born almost equal those of native-born parents among the admissions, �22 STATE OF MICHIGAN. TABLE No. X.—Showing counties from which patients have been received. Year ending June 30, 1918. Year ending June 30, 1917. M. 0 0 1 0 0 0 0 0 2 0 Alpena Bay Benzie 0 2 2 0 0 Cass Cheboygan Clare Clinton Delta Eaton Emmet Gladwin Gogebic Gratiot Hillsdale 0 0 0 0 0 .... .... . losco Iron . .... 1 0 2 0 3 1 0 0 0 2 1 0 7 1 0 0 1 e i Kent Lake Lena wee Luce . Menominee. . . . Monroe 0 3 0 0 4 0 2 0 0 0 0 1 0 0 1 0 0 1 0 2 0 F. 0 0 0 0 0 1 1 0 0 0 0 2 1 0 1 1 0 0 1 1 1 0 5 1 5 0 0 0 3 1 1 0 3 2 0 0 1 11 1 0 10 0 1 3 0 1 2 0 0 0 0 0 0 0 0 0 0 1 2 1 F. M. T. 0 0 1 0 0 1 1 0 2 0 0 4 3 0 1 1 0 0 1 1 2 0 7 1 8 1 0 0 3 3 2 0 10 3 0 0 2 13 2 0 13 0 1 7 0 3 2 0 0 0 1 0 0 1 0 0 1 1 4 1 0 1 4 0 0 0 0 0 3 1 0 0 1 0 0 0 1 0 2 0 0 0 3 1 3 0 0 1 1 1 1 3 4 0 0 0 0 2 0 0 5 0 2 1 0 1 1 0 0 2 0 0 0 0 0 0 0 1 0 0 Total since beginning. M. T. 1 0 0 0 1 1 0 1 1 1 1 0 4 1 0 0 0 0 0 0 1 0 3 0 9 0 0 1 2 2 1 2 5 0 0 0 0 9 2 0 2 0 1 1 1 1 2 0 0 3 1 0 0 0 0 0 0 2 3 1 1 1 4 0 1 1 0 1 4 ' 2 1 0 5 1 0 7 2 17 9 0 4 0 3 31 2 5 21 18 2 5 0 1 0 2 0 1 0 6 1 12 10 2 0 10 3 1 1 17 3 38 2 1 2 19 32 6 6 33 18 5 0 5 30 9 0 73 0 4 13 0 23 16 0 1 10 5 3 12 5 2 2 1 22 18 0 0 0 2 3 3 2 5 9 0 0 0 0 11 2 0 7 0 3 2 1 2 3 0 0 5 1 0 0 0 0 0 0 3 3 1 F. 4 0 10 3 5 3 1 6 22 1 6 9 25 4 2 9 0 3 7 3 3 0 26 8 57 2 0 2 22 28 8 5 44 15 4 0 8 57 6 0 69 1 2 18 2 18 19 2 0 15 3 2 9 0 1 0 1 14 20 2 T. 11 2 27 12 5 7 1 9 53 3 11 30 43 6 7 19 2 3 17 6 4 1 43 11 95 4 1 4 41 60 14 11 77 33 9 0 13 87 15 0 142 1 6 31 2 41 35 2 1 25 8 5 21 5 3 2 2 36 38 2 �PSYCHOPATHIC HOSPITAL. 23 TABLE No. X.—Concluded. Year ending June 30, 1917. M. Muskegon Oakland F. Year ending June 30, 1918. M. T. T. 4 0 1 1 0 13 1 14 1 0 10 2 17 3 2 23 3 31 4 2 2 0 0 2 0 0 0 0 5 0 2 0 0 7 1 6 0 1 40 0 9 0 1 50 1 15 0 2 90 11 2 0 0 0 1 1 0 1 0 2 0 0 1 0 3 1 0 3 2 53 11 0 1 2 62 9 1 4 4 115 20 1, 2 2 1 1 0 6 4 3 1 1 2 1 1 0 1 5 2 1 0 1 7 3 2 0 2 21 19 9 2 14 25 21 7 3 5 46 40 16 5 19 13 35 0 0 11 39 0 2 24 74 0 2 9 24 1 1 8 41 2 0 17 65 3 1 147 190 5 5 128 215 3 2 275 405 8 7 112 139 251 94 139 7 0 3 0 0 0 0 0 0 3 1 0 0 0 4 Presque Isle. ... Saginaw Schoolcraft .... 0 0 5 1 0 0 0 6 1 0 St Glair Tuscola 4 2 2 0 1 Total F. 3 0 0 1 0 3 0 3 0 0 Washtenaw . . . . M. T. 1 0 1 0 0 0 4 0 0 0 0 1 0 0 0 1 Ontonagon Oscoda F. Total since beginning. 0 0 233 1,147 1,194 2,341 This hospital is open to patients from any county of Michigan. Patients not resident in Michigan are not received. During this period 71 of the 83 counties of the State sent patients for treatment. �STATE OF MICHIGAN. TABLE No. XI.—Showing the form of insanity of patients discharged and the results of treatment. Period ending June 30, 1918. • Recovered. Traumatic psychoses: Traumatic delirium Senile psychoses : Presbyophrenic type Psychoses with cerebral arterioGeneral paralysis: Psychoses with cerebral syphilis: Psychoses with brain 'tumor Psychoses with other brain or nervous diseases: Multiple neuritis Tabes Alcoholic psychoses: Psychoses due to drugs and other exogenous toxins: Chloral intoxication Veronal intoxication Psychoses with pellagra Psychoses with other somatic diseases: Delirium with septicaemia Delirium with typhoid fever . . . Delirium of unknown origin. . . . Psychoses with Basedow's Psychoses with rheumatism . . . . Psychoses with pernicious Psychoses with glaucoma Manic-depressive psychoses : Manic type Mixed type Dementia praecox: Simple type Paranoia and paranoiac conditions Presenile paranoiac conditions. Paranoiac conditions with impaired hearing Undifferentiated paranoiac con Epileptic psychoses Neuroses and psychoneuroses : Improved. Unimproved. Died. M. F. T. M. F. T. M. F. T. M. F. T. 2 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 5 1 0 0 2 0 0 0 7 1 0 0 14 2 18 4 2 1 0 0 0 0 0 2 1 4 2 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 2 0 0 0 2 0 2 1 1 0 4 0 0 0 0 1 0 0 0 0 2 0 5 0 2 7 0 0 0 0 1 0 0 0 0 3 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 1 0 1 0 0 3 0 0 0 0 0 3 0 0 2 0 0 0 0 0 2 1 2 0 0 0 1 0 0 0 0 0 1 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 0 0 0 2 0 2 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 2 8 1 0 0 0 0 0 1 0 1 0 0 1 0 1 2 0 0 0 1 0 2 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 5 8 0 0 4 3 0 2 9 11 0 2 5 13 0 1 6 29 1 0 11 42 1 1 4 3 1 0 12 22 0 3 16 25 1 3 0 4 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 5 8 2 4 3 9 0 5 8 17 2 3 3 10 6 5 10 11 2 8 13 21 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 2 0 1 2 1 3 0 1 5 1 2 8 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 3 1 1 1 4 2 0 2 1 1 3 2 0 0 0 4 2 0 0 0 7 3 1 2 0 7 0 0 0 1 14 9 1 2 1 0 0 0 0 0 2 6 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 4 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4 7 0 0 0 2 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 �PETCHOPATHIC HOSPITAL. 25 TABLE No. XI—Concluded. Period ending June 30, 1918. Recovered. Psychoses with constitutional Psychoses with mental deficiency Undiagnosed psychoses Not insane: Epilepsy without psychosis . . . . Drug addiction without psychosis Constitutional psychopathic inferiority without psychosis . Mental deficiency without psyIdiot * Constitutional syphilis without psychosis Total Improved. Unimproved. Died. M. F. T. M. F. T. M. F. T. M. 1 0 0 0 0 0 0 5 0 0 13 2 3 18 2 3 5 1 1 6 2 7 11 3 8 0 0 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 1 0 0 0 3 0 0 0 0 0 0 27 22 49 2 0 0 0 0 0 1 F. T. 7 5 12 4 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0 0 8 0 7 0 10 1 7 0 0 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 2 0 0 0 90 125 215 12 13 25 79 109 188 1 0 1 1 0 1 0 0 0 0 0 0 In Table XI are given results of treatment in all patients discharged according to their various clinical disorders. Patients are regarded as recovered when they are in their normal mental condition at discharge; as improved when their mental condition at discharge is more or less improved over that at admission; as unimproved when their mental condition has not changed for the better. According to these standards 10.3 per cent were discharged as recovered; 39.4 per cent as improved; 45.0 per cent as unimproved, and 5.2 per cent died. �26 STATE OP MICHIGAN. TABLE No. XII.—Showing duration of residence in months of all cases discharged. Recovered. M. F. Improved. Unimproved. Died. Total. T. M. F. T. M. F. T. M. F. T. M. F. 0 0 1 2 6 1 0 3 7 14 1 2 3 15 26 0 1 7 7 31 1 3 10 22 57 5 5 7 8 20 11 4 9 15 32 16 9 16 23 52 3 1 2 1 2 1 2 3 3 1 4 3 5 4 3 10 8 14 29 56 12 22 7 15 20 34 27 56 70 126 0 1 1 0 0 0 0 10 2 0 1 0 0 0 0 0 16 5 0 2 1 0 0 0 0 5 7 8 2 3 3 1 1 0 20 16 7 7 3 0 2 2 2 25 23 15 9 6 3 3 3 2 14 7 12 3 1 0 2 0 0 17 13 8 7 3 1 2 1 1 31 20 20 10 4 1 4 1 1 1 1 1 0 0 0 0 0 0 2 0 0 0 0 0 0 3 1 1 0 0 0 1 0 0 26 18 21 6 5 3 3 1 0 49 31 15 15 6 1 5 3 3 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 2 2 0 0 3 3 0 0 2 2 1 1 0 1 0 0 2 3 1 1 0 0 0 0 0 0 0 0 0 0 0 0 3 .3 1 1 2 3 0 0 Total. . . 27 22 49 90 125 215 12 1 week or less . . . 1 2 weeks 0 2 5 8 2 months 6 4 months 5 months . . .3 7 months 9 months 10 months 11 months .... 12 months 14 months 18 months 24 months 79 109 188 1 0 13 T. 75 49 • 36 21 11 4 8 4 3 5 6 1 1 25 208 269 477 TABLE No. XIII.—Showing age of patients discharged recovered. Period ending June 30, 1918. - / From 20 to 24 years From 35 to 39 years . Total .. Total from beginning .... ... M. F. T. M. F. T. 0 0 1 1 4 3 1 5 1 1 8 4 4 9 0 13 13 15 16 25 3 16 22 27 16 22 3 29 35 42 32 47 3 2 4 2 0 0 4 0 1 0 0 0 7 2 5 2 0 0 21 14 12 6 1 2 19 10 6 2 1 0 40 24 18 8 2 2 27 23 50 156 161 317 4 1 3 4 �PSYCHOPATHIC HOSPITAL. 27 TABLE No. XIV.—Showing the causes of death. Biennial period. M. F. Total since beginning. T. M. 2 1 1 0 1 0 4 1 0 1 1 6 2 1 1 5 3 3 0 2 1 4 1 1 0 6 4 1 2 1 0 1 1 1 0 1 0 0 2 1 1 1 1 3 1 2 0 1 2 1 2 1 0 0 2 4 1 1 2 2 1 2 0 0 1 1 1 1 3 2 2 3 1 4 3 0 0 0 4 1 2 1 1 0 4 2 1 1 4 1 1 1 0 A m'n ' 'r'miQ ' ' ' ' Ttrnnrhn TiTipiirnnnia ^ptlpral Tiaralvsis Cystitis . . 0 1 0 1 1 1 0 1 0 1 0 1 1 1 0 1 1 1 0 1 1 0 p .' lv • r»nn i ilofmiV ' ' ' 0 1 0 0 Tetany 1 4 1 1 1 . 1 0 1 1 1 0 0 1 1 0 1 2 2 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 3 0 0 0 7 3 1 3 1 7 6 13 25 52 45 0 2 .... i 3 T. 1 1 0 I Total 1 F. 12 1 3 1 0 3 97 �28 STATE OF MICHIGAN. TABLE No. XV.—Showing the age of patients who Year ending June 30, 1917. M. From 10 to 14 years F. Year ending June 30, 1918. T. M. F. Total since beginning. T. M. F. T. 1 0 1 0 0 0 0 2 5 2 1 0 3 5 2 0 0 1 1 1 1 0 1 1 34 years 39 years 44 years 49 years 54 years 1 0 0 2 0 1 2 0 1 1 2 2 1 2 1 1 0 1 1 1 2 0 2 3 2 3 0 4 6 5 5 8 2 1 9 11 3 6 7 14 16 11 From 55 to 59 years From 60 to 64 years From 65 to 69 years 1 1 2 1 0 0 2 1 2 0 0 0 0 1 0 0 1 0 4 8 6 0 1 2 5 4 1 1 0 0 9 12 7 1 1 2 7 6 13 5 7 12 51 46 From 20 to 24 years From 25 to 29 years From From From From From 30 to 35 to 40 to 45 to 50 to From 75 to 79 years Unascertained Total 97 TABLE No. XVI.—Showing the number of patients transferred between the State Psychopathic Hospital and other State Institutions. Transferred to. Received from. Biennial Period. M. F. Pontiac State Hospital Kalamazoo State Hospital 1 1 0 0 Michigan Farm Colony for Epileptics . . . Michigan Home and Training 1 0 Total 3 0 Biennial Period. From Beginning. From beginning . M. F. T. M. F. T. 1 1 18 18 2 0 11 8 0 1 29 26 2 1 20 10 5 0 0 25 7 5 1 0 45 140 148 288 17 101 87 188 10 49 41 90 1 5 5 10 0 G 7 13 1 1 0 1 1 0 T. 3 39 20 59 36 38 1 M. F. T. 2 0 2 0 1 1 74 303 289 592 Thus it is seen that of all patients discharged, 15.5 per cent were transferred directly to one of the other State Hospitals. OUT-PATIENT SERVICE. The Psychopathic Hospital operates two services for patients who do not enter the hospital for treatment. One of these is a local service in connection with the admission service of the General Hospital of the University of Michigan. The other is located in Detroit and operates as a mental clinic in connection with the Wayne County Juvenile Court and the Associated Charities of Detroit. �29 PSYCHOPATHIC HOSPITAL. TABLE No. I.—Showing Diagnoses made in Psychiatric Out-Patient Service of the General Hospital. Traumatic delirium Pre-senile depression . Migraine . . . ... . Alcoholic hallucinosis . . Drug addiction, morphine Pernicious anemia . . . Deliria of unknown origin . No diagnosis made Total ... ... ... Paranoiac conditions Epilepsy . . Neurosis and psychoneurosis : Neurasthenic type .... ... . . . . Year ending June 30, 1918. M. T. M. P. T. 0 1 2 2 2 0 1 3 12 12 0 2 0 0 1 1 5 0 3 10 2 0 0 1 0 6 0 0 1 1 2 0 0 0 0 3 1 1 0 0 2 1 1 0 3 1 1 1 1 3 0 3 9 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 5 0 0 0 1 1 0 1 6 1 0 0 2 0 0 0 0 0 1 3 16 11 0 7 1 10 3 2 3 4 26 14 2 10 9 3 1 2 1 2 11 8 0 3 0 2 0 1 3 20 11 1 5 8 8 3 3 24 11 0 3 32 19 3 6 13 5 11 8 13 10 1 4 2 10 1 4 13 7 3 1 4 5 9 13 2 8 18 3 10 0 11 15 1 5 0 2 11 26 15 12 12 4 15 0 13 26 123 93 216 114 77 191 0 0 1 10 10 4 0 0 0 1 1 0 0 1 ., Cerebro-spinal syphilis . Tabes Multiple sclerosis. . . ... Year ending June 30, 1917. F. 1 �30 STATE OF MICHIGAN. TABLE No. II.—Showing the number and source of out-patients. July, 1, 1916 to June 30, 1917. General hospital clinic of neurology General hospital clinic of surgery General hospital clinic of gynecology General hospital clinic of genito-urinary surgery . . . General hospital clinic of orthopedic surgery General hospital clinic of contagious diseases University students' health service Miscellaneous sources Total July 1, 1917 to June 30, 1918. M. F. T. M. F. T. 10 28 16 6 7 2 21 17 5 5 12 49 33 11 12 26 20 28 2 4 12 18 11 3 3 38 38 39 5 7 6 3 0 1 4 3 1 6 5 2 9 4 6 6 6 5 5 0 2 3 4 3 11 1 1 9 8 11 3 4 0 0 0 12 21 9 2 1 1 0 13 9 2 1 1 12 34 18 2 0 0 10 1 .6 0 3 0 0 2 5 2 3 0 -10 3 11 123 93 216 114 77 191 �PSYCHOPATHIC HOSPITAL. 31 WAYNE COUNTY OUT-PATIENT SERVICE OF THE STATE PSYCHOPATHIC HOSPITAL. RESIDENT OFFICERS. Nellie L. Perkins, Ph. D., Psychologist. Margaret Wylie, A. B., Assistant Psychologist. Ethel Plumb, A. B., Registrar and Chief of Social Service. Sarah Dunlap, A. B., Field Worker. This Branch of the Out-Patient Service has now been open nearly three years. From the first, the work has been of the most practical nature, namely, an attempt to solve the problems of maladjustment arising in the community served by the clinic. This was necessarily the case as the funds for maintaining the resident staff were subscribed by individuals, and the real worth of a work of this kind had to be demonstrated before provisions for a permanent organization would be made. The results have been gratifying, and already the value of the work done has been recognized and appreciated to the extent that the County is willing to contribute toward the support and holds out the hope that eventually it will take over the entire organization, making it part of the Court system. A review of the types of cases handled and organizations served shows a steady growth of the work with an ever-increasing active part in the social service carried on in Wayne County. The function of the clinic seemed to have been definitely indicated after a short period of practice. From the beginning, it has been used as a center for advice in the handling of problems in social adjustment. Whenever an organization found a case that did not improve under the usual methods of relief, especially if there were several organizations working with the family group, it was referred to the clinic for study and advice, the purpose being to determine whether mental defect or abnormality were responsible for the existing conditions. It is of interest to note that about 80% of the problem cases which have been troublesome for years were found to be distinctly in need of study in a clinic of this kind. Among the cases referred, there was a large group of feebleminded, a surprising number of definite psychoses and the ever present borderline cases made up of psychopaths that are not so easily classified as either of the other groups, but frequently more difficult relative to diagnosis, prognosis and care. Where the examination did not show the presence of a psychiatric condition, very often the study led to the discovery of peculiar temperaments or unusual attitudes which, when understood, made social service possible where it had not been before. Considerable assistance of this kind has been given with fairly satisfactory results in many cases. The main interest however, has been placed in detecting abnormal mental conditions with a view to ridding the community of this group in order that the reconstruction attempted by social agencies would not be lost. The examinations have led to many commitments to institutions, and have already relieved conditions somewhat. Advice �32 STATE OF MICHIGAN. given in cases where custodial or hospital care was not necessary, but where much depended upon a better understanding of the individual temperament, has in many instances materially changed the methods of handling certain groups with the result that some of the problem cases are no longer giving trouble. As the workers become acquainted with our methods and learn how to handle cases under direct:ons, the clinic can serve a larger group and the work of the social agencies will also be more effective. Not only have the efforts led to educating the community to a more intelligent understanding of a social behavior, but it has also meant closer cooperation between social agencies, and less duplication of work, all of which makes necessary more careful planning of case work. Perhaps the change in the point of view, due to the recognition of the fact that there is a certain group of individuals that cannot be helped and must be regarded as social waste, has been as valuable as some of the more positive results, in that it has re-directed efforts which were practically lost. This has been one of the most difficult tasks, due to the old sentimental approach and lack of scientific backing for case work. �PSYCHOPATHIC HOSPITAL. 33 NUMBER OF PATIENTS EXAMINED, AGENCIES REFERRING THEM AND REASONS FOR REQUESTING A PSYCHIATRIC EXAMINATION. COURTS. JUVENILE COURT: Feebleminded Subnormal Retarded Feebleminded and epileptic Epileptic Psychopathic personality Neurasthenia Hysteria Anxiety neurosis Symptomatic mental state Pathological irritability. . : Unclassified insane Manic depressive Dementia praecox Supernormal No psychiatric condition No diagnosis made Deferred 157 80 5 2 4 17 2 17 1 1 1 4 3 1 1 76 5 22 399 JUVENILE DIVISION OF POLICE: Feebleminded Subnormal Psychopathic personality No psychiatric condition 5 3 1 2 MOTHEE'S PENSION AND NEGLECT: Feebleminded Subnormal Epileptic Psychopathic personality Hysteria Anxiety neurosis Unclassified insane General paralysis No psychiatric conditionDeferred No diagnoses made 31 12 1 2 2 1 3 1 8 5 1 11 67 POLICE, CIRCUIT AND RECOKDEB'S COUKTS: No diagnosis made 2 COUNTY AGENT: Psychopathic personality No diagnosis made 1 1 o o PROBATE COURT, INSANE DIVISION: Feebleminded Subnormal Feebleminded and epileptic Psychopathic personality Unclassified insane Dementia praecox No psychiatric condition Deferred No diagnosis made ' : 11 1 1 2 3 3 5 1 2 29 510 �34 STATE OF MICHIGAN. While all the cases referred have in some way shown atypical behavior, those sent by the courts, with the exception of the Mother's Pension and Neglect groups, have been the more serious offenders, and their conduct has been sufficiently anti-social to have brought them into conflict with the law. In many of these individuals the defect is quite apparent and they are referred for examination without Court hearing. Upon receipt of a positive diagnosis, the charges are withdrawn, it being the opinion of the Court that it is useless to prefer charges against a feebleminded or insane individual, and the case is often referred to the Insane Division of the Probate Court for hearing for commitment to the proper institution. A second large group referred by the Juvenile Court is composed of those cases whose offense is serious enough to warrant commitment to the Industrial Schools. To be effective, these Institutions must work with reformable types, those capable of receiving training. The Court therefore does not wish to flood them with the mentally abnormal or definitely defective, so that all questionable cases are examined before commitment and the disposition depends upon the diagnosis. The group sent by the Mother's Pension Department is particularly interesting, not so much because of their troubling others, as themselves. These cases are generally reported because they are unsuccessful, even with the financial aid and supervision of the Court, and do not use to advantage what is given them. They fall into two groups; those who spend funds unwisely, and those whose conduct is questionable, the result of poor judgment and general lack of ability to live up to certain standards insisted upon by the Court. This type of relief provides not only financial aid, but attempts supervision in the more difficult cases. The visiting housekeepers are called in to supervise the family budget and give concrete lessons in management; the pension officers advise and look after the conduct of the various members of the family. In case of failure to meet the requirements, the pension may be revoked. Before the establishment of the clinic, the giving of a pension was a matter of experiment, and in many cases proved expensive and unreliable. Now whenever it is felt that the applicant is mentally incompetent, the case is referred for examination, and whether a pension is granted depends upon the findings and recommendation. There will always be some borderline cases where experiment is the only possible fair test, but after an examination the court worker has the benefit of the study, and can handle the case more intelligently because of suggestions which are possible only after an investigation of this type. The results seem to indicate that many of these families have succeeded with a pension because of the special provisions made to meet their requirements, whereas they might have failed if left to themselves as formerly. The per cent of feeblemindedness and insanity runs very high in this group. This is also true of those referred by the Neglect Division of the Juvenile Court, as is shown by the table. Work with these groups is the most difficult and often the least successful because ths problem is always complicated by so many social conditions, over which we have little control, but we hope to change some of this when we have passed over the experimental stage and are better acquainted with the possibilities at our disposal. The records show a marked increase in the number of cases referred by the Insane Division of the Probate Court. This is due to the fact �PSYCHOPATHIC HOSPITAL. 35 that the Judges are using the clinic more frequently in those cases o conflicting or indefinite diagnosis where it is a question of commitment to the State Hospitals. Cases are referred whenever there is any disagreement on the part of the certifying physicians, especially if it is a question of commitment to the State Psychopathic Hospital. There is a hesitancy on the part of the general practitioner to recommend the State Hospitals especially if he is not certain of the diagnosis or if the family objects. An observation order for the Psychopathic Hospital is frequently used as a simple way out of the difficulty because it not only relieves him of the responsibility of a correct diagnosis, but also shifts the family's disfavor. This is not always a wise disposition of the case as many of them have old psychoses and are distinctly custodial types. They could be committed directly to Pontiac and save the unnecessary expense and extra time by going directly to the State Hospital, thus leaving the Psychopathic Hospital for those cases with borderline conditions or psychoses of more recent onset. The clinic, situated as it is and because of its relation to the Court, has the opportunity to select cases and tries to direct types to Ann Arbor which will be of some value in demonstration teaching, and while it is not always possible to do this because of the existing conditions, among them public opinion and certain legal and medical obstacles, there have been occasions when we could serve in this capacity. In time we hope to develop this side of the work. DEPARTMENT OF EDUCATION. BOABD OF EDUCATION, CHILD STUDY DEPARTMENT: Feebleminded Subnormal Supernormal Feebleminded and epileptic Psychopathic personality Hysteria Dementia praecox No psychiatric condition Deferred TRUANCY DEPARTMENT: Feebleminded Subnormal No psychiatric condition 1 4 3 1 3 2 1 4 4 23 2 1 1 RECREATION COMMISSION: Feebleminded.. 1 1 28 The Detroit schools have an exceptionally good Child Study Department but so far most of the emphasis has been put on the feebleminded and subnormal child, with no provision for those who are not feebleminded but a-typical, due to emotional and volitional peculiarities. Neither has anything been done with the High School groups. These two classes are now being referred to this clinic as the Board of Education appreciates that work with types of this kind is essential, but as yet they are not equipped to handle it. We have found a surprising number of psychopathic children, several of whom made interesting studies. : The Board of Education has offered this clinic the use of their Special rooms for borderline mental defectiveness, speech classes, fresh air rooms for tubercular children, and classes for crippled children, making it �36 STATE OF MICHIGAN. possible for us to care for many of the children in their homes where social nursing, rather than Institutional care would be more effective provided that they could receive the advantages of special educational methods so essential in their training. CHARITABLE ORGANIZATIONS. CHILD CAKING AGENCIES. CHILDREN'S AID SOCIETY: Feebleminded ....................................................... Subnormal .......................................................... Retarded .................. . ...................................... Epileptic . . . : ....................................................... Psychopathic personality ............................................. Hysteria ........................................................... Unclassified insane ..................................... .. ............. Manic-depressive .................................................... Deferred ........................................................... No psychiatric condition ............................... .............. No diagnosis made .................................................. ST. VINCENT DE PAUL SOCIETY: Feebleminded ....................................................... Subnormal ..................................................... Retarded ........................................................... Feebleminded and epileptic ........................................... Pathological irritability .............................................. Unclassified insane ................................................... Dementia praecox .............................................. Deferred ........................................................... No psychiatric condition ............................................. PROTESTANT ORPHAN ASYLUM: Subnormal NEIGHBORHOOD HOUSE: No psychiatric condition ......................................................... ............................................. 26 28 3 1 2 I 3 1 10 35 1 - Ill 22 .... 12 2 1 1 2 ..... 1 1 6 - 48 1 1 1 161 These agencies place children in boarding homes or for adoption and in either case a mental examination is quite essential, especially if there is any question of abnormality or defect because such a child is not suitable for adoption, and as the State provides Institutional care for them at a much lower cost than is possible in an ordinary boarding home, the agencies encourage commitment of Institutional types. It not only costs more to care for these children, but it is the exceptional woman who can manage them with no more than the ordinary equipment found in an average home. The schools frequently expel them and they are sent home for indefinite periods which necessitates providing daily occupation and amusements. They get into mischief and often become neighborhood nuisances. This leads to changing them from boarding home to boarding home, which neither solves the difficulty nor is fair to the patient. It has been found that the wiser plan was to have an examination made, and then provide special boarding homes for the a-typical children. Temporary provisions have now been made. The children are kept in little colonies until there are vacancies for them in the State Institution. The length of stay varies somewhat,' and may be^as long as eighteen months or two years, depending upon the waiting list, but these provisions have proved much more satisfactory than the old system of random placing which amounted to long drawn out and ill-controlled experiments which seldom succeeded. �PSYCHOPATHIC HOSPITAL. 37 AGENCIES PROVIDING MATERIAL RELIEF. ASSOCIATED CHARITIES: Feebleminded Subnormal Compulsion neurosis Deferred No psychiatric condition . 4 2 1 2 1 VISITING HOUSEKEEPER'S ASSOCIATION: Feebleminded 1 POOH COMMISSION: Feebleminded Subnormal Psychopathic personality Unclassified insane Alcoholic dementia General paralysis No psychiatric condition 1 2 1 1 1 1 1 10 j 8 UNITED JEWISH CHARITIES: Feebleminded Subnormal Psychopathic personality Hysteria Unclassified insane General paralysis Manic-depressive No psychiatric condition 6 2 1 3 2 1 1 1 ———~ 17 AMERICAN RED CROSS CIVILIAN RELIEF: Feebleminded 1 1 37 These organizations supplement the work done by the Mother's Pension and Neglect divisions of the Juvenile Court, and provide for those cases which do not come under any of the headings of the Mother's Pension law and therefore cannot receive aid from the Court. As would be expected, they closely resemble in type the cases discussed under the Pension group. They too have failed to make the required social adjustment and many of them are incapable of competing with others. Examination shows many of them to be low grade feebleminded, and for the most part, distinctly Institutional types. Some are recommended for commitment to the State School, but more often not because of the difficulty of having them committed when it means provision for a large family of children. We have instances where the mother and several of all of the children were found to be feebleminded, and the entire family is now at Lapeer, but the solution is seldom so simple. �38 STATE OP MICHIGAN. AGENCIES CARING FOR GIRLS AND YOUNG WOMEN. GIRL'S PROTECTIVE LEAGUE: Feebleminded Subnormal Feebleminded and epileptic Epileptic Psychopathic personality Hysteria Anxiety neurosis Psychaesthenia Insane Deferred ..' 6 1 1 1 3 6 I 1 1 1 22 B U R E A U OF CATHOLIC CHARITIES: Feebleminded Subnormal No psychiatric condition Deferred 2 1 2 1 FLORENCE CRITTENDEN HOME: Feebleminded Subnormal Psychopathic personality Manic-depressive No psychiatric condition Deferred ST. AGNES HOME: Feebleminded Subnormal Retarded Dementia praecox 3 1 1 1 1 1 2 3 1 1 43 By far the most interesting group of cases are those referred by this group. These organizations provide for girls 17 years of age or older, or that group just beyond the jurisdiction of the Juvenile Court, and while the main purpose is not the solution of problems of delinquency but is rather protective, there are a large number of young women who have offended against the law and these are referred by the Police Courts to these agencies, so that the delinquent also is prominent in this group. The reasons for referring some of them to the clinic are much the same as in other cases, namely, the ordinary way of providing for them is not successful, or they persist in their anti-social reactions apparently in spite of themselves and the efforts of the Protective League. For the most part, these have proved to be psychoneurotic individuals, with a few definite psychoses. The Florence Crittenden and Salvation Army Homes have arrived at a practical, even if not always accurate criterion to warrant requesting a psychiatric examination, namely, two or more illegitimate pregnancies. It is of interest to note that in practically every case referred for this reason, the patient was found to be either feebleminded or insane. �PSYCHOPATHIC HOSPITAL. 39 MEDICAL GROUP. HARPER HOSPITAL: Feebleminded Subnormal Retarded Hysteria Insane No psychiatric condition '. 4 7 1 1 1 5 "WOMAN'S HOSPITAL: Feebleminded Subnormal Psychopathic personality Insane No psychiatric condition 6 2 1 1 1- GRACE HOSPITAL: Hysteria 1 1g 11 CHILDREN S FKEE HOSPITAL: Subnormal Epileptic Deferred : 1 1 1 FORD HOSPITAL: Hysteria 1 CITY BOARD OF HEALTH: Feebleminded Subnormal Feebleminded and epileptic Psychopathic personality Deferred 7 1 1 1 1 11 VISITING NURSES ASSOCIATION: Feebleminded Subnormal Epileptic .' Psychopathic personality Hysteria Unclassified insane Dementia praecox No psychiatric condition BABIES MILK F U N D : Feebleminded 4 1 2 1 1 4 1 1 , 1 PRIVATE PHYSICIAN AND F A M I L Y : Feebleminded Subnormal Psychopathic personality Hysteria Unclassified insane Dementia praecox Manic-depressive No psychiatric condition Deferred 7 2 1 3 3 1 3 3 1 24 86 �40 STATE OF MICHIGAN. STATE BOARD OF HEALTH. Feebleminded Subnormal Retarded Feebleminded and epileptic Epileptic Psychopathic personality Dementia praecox Manic-depressive No psychiatric condition 35 27 5 1 1 7 1 1 12 90 176 As there are no clinics in any of the hospitals for the diagnosis or treatment of mental cases, most of these are referred to this clinic. Work with the medical group has been particularly satisfactory, and has led to many interesting consultations in case work. The physicians make physical examinations, X-Rays, etc., and the hospitals have opened their clinics and given hospital care to bed patients referred from this clinic. The Visiting Nurses have done unusually good social nursing on cases returned to their homes where special care was needed. Private physicians frequently refer cases, sometimes with the request that we diagnose and report back to them, but more often release the cases to us, largely because with the numerous demands made upon them they have little time to devote to the endless petty details of having a patient committed to a State Institution, and they know that the clinic is equipped to handle this part of the work. Some time ago we found that we obtained better results with little effort to ourselves, and much less inconvenience to the patient's family, if we took charge of the preliminary work in connection with commitments. In March, 1918, the clinic was asked by the State Board of Health to make mental examinations of all cases interned for venereal disease in Detroit hospitals. This request came at the suggestion of the Social Workers who were handling the follow-up work in an attempt to rehabilitate the patients when released, as it was apparent that constructive work was out of the question with many of them as they were definitely defective and incapable of self-support under ordinary conditions of employment. While mental defects and abnormalities were not altogether responsible for the failures in adjustment, they occurred in sufficient numbers to make practical a systematic examination of all patients with a view to segregating the a-typical as a group which could then be dealt with accordingly and not allowed to hamper the work and confuse results. We expected to find mental disabilities among this group, but the number found far exceeds any of our early estimates. Feeblemindedness is the most frequent condition. �PSYCHOPATHIC HOSPITAL. 41 INDUSTRIAL GROUP. FORD MOTOR COMPANY: Feebleminded Neurasthenia Unclassified insane Dementia praecox Manic-depressive No psychiatric condition Deferred No diagnosis made DODGE BROTHERS: Compulsion neurosis Dementia praecpx General paralysis 1 1 5 2 1 2 1 2 15 2 1 1 SOLVAY PROCESS COMPANY: Epileptic j. L. HUDSON COMPANY: Anxiety neurosis 2 1 2 1 UNION TRUST COMPANY: Psychopathic personality 1 1 23 Among the more recent developments is the use of the clinic made by the Welfare Departments of the industries. The types referred vary in age and condition because the Welfare Departments look after the entire family, as well as the employees, probably the father or older brother. This leads to the discovery of many feebleminded and epileptic children who are being cared for at home to the neglect of the others. Insane and feebleminded wives are also frequently the cause of inability to meet the requirements' laid down by the factory for employees. Of all cases referred these have the promptest and most thorough after-care. All recommendations are acted upon without question. Whether it is because the industries want immediate relief from the disturbing factors for economic reasons, or it is simply another instance of their prompt and efficient methods which is part of their routine, the fact remains that their social supervisors carry out all directions immediately upon recommendation, and the case is not closed unt 1 advice is carried out or the employee in whose interest the case was taken up leaves the factory. �42 STATE OF MICHIGAN. SUMMARY. DIAGNOSIS: Feebleminded Subnormal Retarded Feebleminded and epileptic Epileptic Psychopathic personality Hysteria Psychoneuroses other than hysteria Unclassified insane Dementia praecox Manic-depressive Paranoia General paralysis Alcoholic dementia Symptomatic mental state Deferred No psychiatric condition No diagnoses made 347 198 20 8 13 49 36 12 33 13 11 1 4 1 1 50 167 14 978 RECOMMENDATIONS. INSTITUTIONS HOSPITALS: Lapeer Wahjamega Pontiac Eloise State Psychopathic Hospital St. Joseph's Retreat 258 6 39 10 52 1 366 INSTITUTIONS, CORRECTIONAL: House of Good Shepherd Adrian Lansing Ford Republic House of correction 9 7 15 19 3 CO EDUCATION: Special room Public schools School for crippled children Fresh air school Private schools 16 2 1 1 3 COURT CARE: Mother's pension Remove from home Remove the children Release to parents Release from House Good Shepherd Release from Ford Republic Probation Parole 6 16 3 1 6 1 121 2 SOCIAL CARE: Supervision and social nursing Deport Bay Court Florence Crittenden Home 220 17 1 1 MEDICAL CARE: Harper Hospital University of Michigan Hospital Receiving hospital RETURN TO PSYCHOPATHIC CLINIC: NO ADVICE GIVEN: 1 5 1 83 51 978 23 156 239 �PSYCHOPATHIC HOSPITAL. 43 This table gives an idea of the type of after-care recommended. The proportion of Institutional cases is high, as would be expected, but the more interesting fact brought out is, that while many of them do not require custodial care,, very few can manage for themselves unless conditions can be specialized for them, and some sort of social service is necessary if they are to succeed. The table would indicate that very little medical work was done, but this is the fault of the method of compiling the statistics. The medical care recorded in the table refers only to those cases where the problem was purely medical and not psychiatric. All other cases are lost because the clinical picture is dominated by the mental condition, rather than the physical, as is shown by the recommendations. WAYNE COUNTY PSYCHOPATHIC CLINIC BY NELLIE L. PERKINS. Psychologist. December 1, 1918. �44 STATE OF MICHIGAN. REPORT OF THE CLINICAL GROUPS. MANIC-DEPRESSIVE INSANITY. During this biennial period there were admitted 139 cases of manicdepressive insanity of which number 47 were males and 92 females. The following table shows the frequency of this form of disorder among the admissions to this hospital. Male. Female Total No. Per cent. No. Per cent. No. Per cent. 206 47 22's 278 92 '33'i' ' 484 139 ' '28'7' ' There are considered among those under treatment during this period five males and fourteen females who were admitted during the previous period but were discharged in this. In all 158 cases of manic depressive insanity were under treatment. There was a relative increase of 3.3% in the number of admissions with this disorder over that of the previous period. This increase was almost wholly distributed among the female cases. The following table shows the relative frequency of the several forms of this disease. The diagnosis was determined from the course of the disease of each case during the residence of the patient in the hospital. Female. Male. Mixed Total. No. Per cent. No. Per cent. No. 14 31 1 1 29.1 66.0 2.5 2.5 25 56 2 9 27.6 60.8 2. 1 9.5 39 87 3 10 Per cent. 28.8 62.5 2. 6.7 Except in the so-called "circular group," it was the phase of the disorder present at the time of admission which determined the diagnosis. It will be seen from the above table that the depressive phase was the most frequent. Both the manic and the depressive phase are more frequent in the male sex; while the circular is more frequent in the female. In the previous period the depressive phase was more frequent among females. �PSYCHOPATHIC HOSPITAL. 45 The three following tables show the number of patients who have had at least one attack other than the one at present; the form of the first attack in those having more than one attack, and the form of the first attack in all cases admitted. Male. Female. 20 27 40 52 Total. 60 79 The form of the first attack in those patients having more than one attack is shown in the following table. Male. 4 Mixed . . . . 13 1 1 1 Female. 12 22 0 0 6 Total. 16 35 1 1 7 The form of the first attack in all cases of manic-depressive insanity admitted was as follows: Manic Mixed. . . . Male. Female. 11 25 53 2 6 32 2 1 1 47 Q 92 Total. 36 85 4 7 7 139 These tables show that a previous attack had occurred in 42.5% of all male and 43.4% of all female cases of this disorder. These percentages are almost identical with those of the previous period. In the group as a whole, previous attacks had occurred in 43.1% of all cases admitted. In eleven, or approximately 8% of the cases, the first attack presented a phase different from the one of this admission. The form of the first attack in all cases admitted was manic in 25.9%; depressive in 56.1%; mixed in 2.8%; circular in 5%, and unknown in 5%. The following table shows the age of patients at the time of the first attack and the age of patients at the time of their admission. �Admission. First attack. Depressive. Manic. M. 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 . . Total .... F. Mixed. T. M. F. T. M. F. T. 0 0 1 1 0 0 F. T. M. F. T. M. Mixed. T. M. F. T. M. 1 0 2 5 14 13 15 15 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 1 9 0 1 3 3 1 3 0 2 0 0 3 7 1 4 2 2 2 2 0 4 10 4 5 5 2 4 2 0 0 1 0 0 0 0 1 4 1 1 1 0 0 1 2 3 4 8 4 2 1 0 1 3 11 9 7 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 2 0 0 0 1 0 2 0 0 0 2 4 1 0 0 0 5 1 1 0 0 0 7 5 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2 3 1 9 10 14 25 39 31 56 87 1 1 6 6 4 6 2 2 0 1 1 7 10 8 6 5 2 1 1 0 0 2 5 7 4 4 5 0 1 2 3 5 14 6 5 5 5 1 2 5 10 21 10 9 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 3 1 1 0 0 0 2 1 0 0 0 2 5 2 1 0 0 2 0 0 0 0 0 0 13 30 43 32 51 83 1 1 1 1 Oil culai F. 0 0 1 0 4 0 1 0 0 1 1 0 0 0 0 • 0 1 0 0 1 4 4 0 3 0 1 0 1 M. Depressive. Manic. Circular. 1 1 0 1 1 1 F. 0 1 3 1 1 2 0 0 0 1 T. �PSYCHOPATHIC HOSPITAL. 47 From the above table it is evident that, where the first attack was manic in character, 41.8% occurred under the twenty-fifth year. Where the first attack was depressive in character, only 9.6% occurred under the twenty-fifth year. This is less than half the number in the previous period. In all cases admitted, the first attack occurred before the twentyfifth year in 23.8% and before the fiftieth year in 85.6%. There is one group of the depressive cases which calls for separate consideration, those in which there seems to be some connection with the involution period. There were five cases admitted in the period, or 3.6% of all cases admitted. Four of the five cases were females, and their ages were respectively 46, 48, 49 and 54. The one male was 55. Four of the five had had no definite previous attack. All were apprehensive, and agitated. Three of the five died apparently from exhaustion and starvation. Mechanical feeding was necessary in four of these cases. There is also a group of six cases, or 4.3% in which there was a strong paranoid tendency; of these, five were females, and all occurred between the 34th and 53rd year. One other group of manic-depressive cases should be noted at this point; namely, those with unmistakable evidences of mental deficiency. Two such cases were admitted during the period. Both were mild manic cases, the so-called "hypomanic" phase, and are not inciuded in the table on page 74, under the group headed "Psychosis with Mental Deficiency". The reason for not including these two cases under this last named group is that both came into the hospital primarily because of manic excitement and manic tendencies. One was a male age 48; he had shown a change of character and temperament for a year precedingadmission, and was regarded as improved when discharged. The other was a female age 23, and had had a sub-acute course dating back for a period of nearly three years. The male showed, by psychometric test, a mental age of 9 years, and the female a mental age of 9.16 years. Both individuals judged by economic and social, as well as educational criteria, had a history that confirmed the results of psychometry. HEREDITY. Information concerning the occurrence of nervous and mental disorders in the families of the patient with this disorder was obtained in 129 of the 139 cases admitted. The nature of the distribution of these are shown in the following table. In 72% of the families where information was available, there were instances of mental abnormalities other than those of the patient. In the families of the 93 cases showing abnormalities of the family and antecedents, there were 34 in which there was one other instance of abnormality. There were 31 families with two, fifteen with three, six with four, six with five, two with six, two with seven, and two with eleven instances of abnormalities. In the 93 families, there were 318 abnormal individuals. �STATE OF MICHIGAN. 48 Direct. Atavistic. Collateral. Brothers and Sisters. Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Psychopathic Inferiority Total heredity . 8 20 28 3 7 10 1 10 11 3 2 5 2 1 1 1 2 0 0 0 4 5 15 20 5 1 1 1 2 0 1 0 0 0 0 1 0 1 1 0 5 10 20 42 62 0 0 5 8 13 0 0 2 10 12 0 0 4 3 7 15 39 54 5 2 7 5 10 31 63 94 6 17 23 5 14 22 36 Unknown 2 Total . . . . ... 7 9 47 92 139 ETIOLOGY. Of the 139 patients admitted, eighteen were reported by the informants as having peculiarities of personality preceding the acute outbreak. In 107 cases there were experiences closely associated with the onset of the disorder, which were regarded by their friends as of causative importance. Many of these experiences may be better regarded as precipitating factors than as true etiological factors. They seem to appear at a time when the individual is under stress which, either because of his make-up or because of his physical condition, he is not able to meet. In ten cases the onset was associated with the puerperium. In three instances the attack appeared to be influenced by the appearance of the menses or associated with menstrual disorders. In 18 instances financial or occupational difficulties seemed to precipitate the attack. Physical illness or surgical treatment was given in 17 instances. Illness or death in the family occurred in sixteen cases. Conjugal troubles including quarrels, desertion, divorce, etc. were assigned as causes in eight instances. Insanity in the family was thought to precipitate in three instances; enlistment of a son or husband in five instances; religion was held as responsible in three cases; disappointment in love in five, and the menopause in one. Wassermann examinations of the blood serum were made in 135 of the 139 cases admitted. It was found strongly positive in one case only. Three cases gave a doubtful reaction on the first examination, but all of these were returned as negative on subsequent examination. One male shows a cell count of six cells in the spinal fluid. In none of these doubtful cases was there a history or clinical evidence of a luetic infection. The one case in which the blood Wassermann was strongly positive, was a wonian, twenty years of age. Her family history was bad, her mother being a neurotic; her father suicidal, one sister mentally deficient, one brother insane and two paternal uncles alcoholic. She was of limited education. She was of an excitable temperament, em . tionally unstable, �PSYCHOPATHIC HOSPITAL. 49 and even before her attack always seemed to do things as if under high tension. She married at seventeen. She had no previous attacks. The present trouble dated one month previous to admission. She suddenly became elated following child birth. Physical and neurological examinations negative. Blood Wassermann + + + +. 6 cells. Nonne-Apelt, phase one, two dilutions doubtful. Gold sol, almost a flat curve, 00011000000. She entertained delusions of reference. The predominating mental symptoms were those of a manic excitement: she was resistive, irritable, exhibited a pressure of speech, was profane, destructive, and had to be tube fed. She also had auditory and visual hallucinations. EESULTS OF TREATMENTS. The following table shows the condition of the cases of manic-depressive insanity at the time of discharge from the hospital. There are considered here the cases admitted during this period and 19 cases of this disorder remaining over from the previous period. The average duration of treatment for males was 77 days, for females, 103 days; for both sexes, 94.3 days. All the patients were discharged to their homes, except nine who died, and sixteen who were transferred to the various State Hospitals. Manic. Depressive. Mixed. Circular. Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Unimproved Died Remaining - 5 4 9 8 3 11 5 6 11 13 29 42 4 12 16 2 23 25 0 1 1 4 4 8 1 4 5 7 10 17 0 0 0 0 0 1 1 1 1 0 1 0 0 0 0 0 0 1 1 0 2 0 3 0 4 2 13 9 22 1 19 36 55 3 7 38 45 0 4 5 9 4 8 19 27 It may be seen from this table that of the 130 patients discharged, 16.9% were discharged recovered; 42.3% improved; 34.6% unimproved; and 6.9% died. Of the 37 cases of the manic phase, 24.3% were discharged recovered, and 30% improved. Of the 86 depressive cases, 12.7% were discharged recovered, and 48.8% improved. Grouping the recoveries and improvements together we find from this table that 65.7% of the manic cases and 56.9% of the depressive cases were benefited by their hospital treatment. Nine patients died from inter current disorders. It was possible to make a laboratory study of the central nervous system in one of these. Case 1945—Manic-depressive, depressed phase. Male, age 55. Stationary Engineer, One sister insane. Always a hard and conscientious worker, particular about details, and of good habits. No previous attacks. Present trouble sub-acute, and of about' one year's duration previous to admission. Financial losses due to playing margins in the stock market seem*i'o have been the precipitating situation. Physical �STATE OF MICHIGAN. 50 examination showed little except a general adenopathy, a scaphoid abdomen, and blood pressure, systolic, 150. Neurological examination also showed little except a slight oedema of the nerve head and the retina with slight arteriosclerotic changes. Serological examinations negative except for a count of six cells in the C. S. F. His sleep was extremely disturbed. He lost 18 pounds in weight during his residence here of 18 days. He expressed delusions of selfaccusation, and was deeply depressed, and agitated. Mechanical feeding became necessary. Autopsy was performed 1J^ hours after death. In the gross, the brain appeared normal, but small. It weighed 1190 grams. No pathology in the chest organs. Stomach greatly contracted, and its mucosa much congested. Capsules of both kidneys adherent. Adrenals hypertrophied and very firm. All the muscular tissues deeply colored, probably the result of starvation. No gross cause of death was found. Histological examination of the cortex showed nothing distinctly pathological except an excess of fatty pigments in the pia and in the endothelia of all blood vessels, even to the finest capillaries, and in the glia cells. The left adrenal showed irregular light-colored patches in which the cell nuclei were much reduced in number and the cell bodies large and pale. Many small hemorrhages and a general venous congestion were also seen. DEMENTIA PRAECOX. There were admitted 89 patients whose mental disorder was diagnosed as Dementia Praecox. This number formed 18.4% of all patients admitted. Per cent. No. Dementia praecox 206 40 Total. Female. Male. • 19.4 No. Per cent. No. Per cent. 17.6 484 89 18.4 ' 278 49 The 40 male cases formed 19.4% of all males admitted and the 49 female cases 17.6% of all females admitted. The 89 cases occurred in the following clinical forms: Female. Male. Paranoid type Hebephrenic type Simple type Total No. Per cent. 4 8 20 8 10 20 50 20 40 No. Per cent. No. Per cent. 20.4 32.6 40.8 6.1 15 23 40 11 16.8 25.8 44.9 12.4 11 15 20 3 49 Total. f 89 �51 PSYCHOPATHIC HOSPITAL. AGE. The following table shows that the onset of the mental disorder occurred before the 25th year in 48.6% of the male cases and 34.8% of the females or 40.8% of all cases of Dementia Praecox admitted. The youngest age of onset was 12 and the oldest 43. Admission Onset. F. M. 10-14 15-19 20-24 25-29. . . 30-34 35-39. . 40-44. . 45-49 50-54 . 55-59 . . . . 9 11 6 1 2 3 11 8 10 10 4 10 20 19 16 11 6 11 8 8 1 2 3 2 . . . .... 3 3 F. M. T. T. 2 2 10 10 11 13 2 16 21 19 21 6 1 1 2 1 1 0 0 1 1 4 6 The relative frequency of occurrence before the 25th year of the various clinical types was: Per cent. Paranoid type Catatonic t y p e . . . . Hebephrenic type. Simple type 20.0 43.4 37.5 63.6 Information regarding hereditary influences was obtained in 80 cases. Among these there were 54 or 67.5% in the families of which there was a history of insanity or some other predisposing factor. In these 54 families there were 163 individuals who were mentally or nervously disordered. The following table gives the details: Direct. M. Apoplexy or Psychopathic. . . . 7 2 3 2 Total heredity . . . 14 Unknown Total . Atavistic. T. M. F. 7 14 1 7 10 4 6 19 33 2 1 0 3 3 6 3 9 F. Brothers and sisters. Collateral. Total. T. M. F. T. M. F. T. M. F. 1 3 2 4 6 2 1 3 2 3 1 2 3 13 3 2 4 6 3 3 6 4 2 22 15 3 13 3 9 7 32 11 6 26 6 13 9 54 26 9 40 49 89 T. �52 STATE OF MICHIGAN. ETIOLOGY. Information regarding the personal constitution of the patient was obtained in 61 cases. In 35 instances there were abnormalities of personality that had attracted the attention of others. The most frequently observed peculiarities were unusual reticence or seclusiveness, various oddities of character, and indefinite nervous manifestations. In 29 instances there were quite definite precipitating causes. These were reactions to experiences of strong emotional quality or in relation with some physical disorder or accident. In 4 instances the acute attack occurred after confinement. RESULTS OF TREATMENT. The results of treatment are given in the following table. Among these are included 10 cases remaining over from the previous period. M. 0 16 22 0 7 Died F. 2 1G 28 1 7 T. 2 32 50 1 14 Per cent. 23 37.6 58 8 1.1 Of those discharged 53 returned to their families and 31 were transferred to one of the larger State Hospitals for the Insane. PARANOID TYPES. There were admitted 15 patients that belonged to this group, of these were males and 11 were females. The ages at onset and at admission were:— \dmission Onset. M. 20-24 25-29 30-34 35-39 2 1 0 1 F. T. 1 3 5 2 Four 3 4 5 3 M. F. 1 0 T. 1 3 7 4 0 3 5 3 2 1 Hereditary predisposition was present in 10 of 13 cases regarding whom information was available. The results of treatment were:— M. Unimproved. 0 1 3 1 F. T. 1 4 5 2 1 5 8 3 �PSYCHOPATHIC HOSPITAL. 53 CATATONIC TYPE. There were admitted 23 cases belonging in this group. Eight of these were males and 15 were females, as may be seen in the following table: Admission Onset. M. 0 1 10 14 15-19 20-24 25-29 30-34 35-39 40-44 2 4 0 o 1 o P. T. M. 1 1 2 4 2 2 3 I 1 2 6 6 2 I 2 F. T. 1 2 6 2 2 8 5 3 3 2 1 o 3 1 0 1 3 1 2 Hereditary factors were present in the families of 68.4% of cases. The results of treatment are given in the following table: This includes two patients remaining over from the previous period. M. Recovered Died . 0 5 3 0 1 F. 1 3 10 1 1 T. 1 8 13 1 2 One patient with acute catatonic stupor died. This was F. D. 2185, a young woman aged 21 at her admission to the hospital. Her father for several years showed marked psychopathic traits, became addicted to the use of chloroform and died from heart disorder. She was born at a difficult instrumental labor. In childhood she was delicate, suffered much from gastro-intestinal disorder, and required for a long time a carefully regulated diet. Temperamentally she was rather serious and was always regarded as being a nervous child. She did well in school and had completed two years in college when she developed mental peculiarities. On account of straightened family circumstances she was obliged to work while attending college. She at times showed unhappiness over her situation, and complained of being tired and unable to do her work as well as formerly. Her mood became continuously mildly depressed. She withdrew from companionship of others and about a week before her admission suddenly broke into tears. When given a hypodermic she became greatly agitated, asserting that it would cause her to fall asleep and she would not awake. For a few days she became more normal in her behavior, then she began to make a peculiar humming noise with her mouth and smack her lips. This persisted for some days. She no longer showed her usual interest in things around her. This attitude lead to her admission here. The physical examination showed the following: Good development and nutrition, muscles in general are moderately spastic. The heart rapid and at times arrhythmic. Respirations increased in frequency �54 STATE OF MICHIGAN. and shallow. Her behavior was unusual, she held herself in a rather stiff attitude, her pupils were widely dilated and she usually would keep her gaze away from the one talking with her. Her motor reactions soon took on a stereotyped character. She stood in strange attitudes. She kept up a peculiar rhythmic noise and for a long time continuously smacked her lips. Finally she resisted whatever was done for her and refused to talk or eat. The first few days she would at times give attention to questions, but usually she was quite out of touch with things around her. When she would attend her comprehension was clear. Her stream of thought was hesitating and interrupted by frequent blocking. Her productions of thought were few, they largely concerned her family and were at times expression of fear of harm coming to herself or mother. There were frequent instances of ambivalent thought. Three days after her admission her attitude was extremely negativistic. She refused to talk or do anything for herself. Her facial expression was one of troubled perplexity. Her physical failure was rapid. In spite of artificial feeding and saline infusions her nutrition failed. Her hands and feet became cyanotic, the surface of her body was cool and moist. Her heart was rapid and shallow. There was no rise in temperature. Death occurred 11 days after admission. The autopsy showed no gross pathological changes in the body organs. There was no gross change in the thyroid or thymus glands. The brain appeared under tension and somewhat more voluminous than usual. It weighed 1350 grams. The membrane was clear. The veins of the pia mater were slightly filled. The brain substance was excessively moist, but not softened. The histological studies of the brain showed very marked pathological conditions among nerve cells and glia, and blood vessels. The nerve cells especially in the second and third layers of the cortex were excessively filled with fat, and many showed granular degeneration. The nucleus was frequently folded and of irregular outline. The glia in the molecular layer was increased. Many abnormal glia cells were present in all layers. There were many of the ameboid type. Endothelium of the blood vessels was frequently observed in a state of proliferation, many of the nuclei showed mitoses. The changes present in this case agree with those that have previously been observed in rare instances of sudden death in dementia praecox, and show definitely that at least in some cases of this disease there is associated a definite structural disorder of the brain. �PSYCHOPATHIC HOSPITAL. 55 HEBEPHBBNIC TYPE. There were admitted 40 cases whose mental disorder was of this type. The cases were equally divided between the two sexes. The ages at onset and admission were: Admission Onset. F. M. 15-19 20-24 25-29 30-34 35-39 40-44 45-49 T. I F. M. T. 4 6 5 4 4 3 3 5 10 8 7 3 7 5 3 0 3 5 4 3 10 10 7 0 0 7 1 7 1 2 1 1 6 1 1 8 1 1 2 0 0 Hereditary factors were present in 63 per cent of the cases, regarding which information was available. The results of treatment are shown in the following table; this includes four patients admitted in the previous period. M. Recovered F. 8 10 4 Died T. 9 11 17 21 2 6 SIMPLE TYPE. Eleven of the cases admitted belonged in this group. Eight of these were males and three were females. The ages at onset of the disorder and at admission were: \dmission Onset. M. 10-14 15-19 20-24 25-29 30-34 35-39 50-54 . . 55-59 F. M. T. F. T. 2 1 1 1 0 2 3 1 3 2 I 1 1 3 2 2 0 2 2 0 2 1 1 1 1 0 0 2 1 1 2 0 2 �56 STATE OF MICHIGAN. Hereditary factors were present in 63% of the cases. The results of treatment are shown in the following table: This includes two patients remaining from the previous period. M. Recovered Unimproved Died Remaining • ... T. F. 2 6 0 2 2 8 1 2 3 PARANOIA AND PARANOIAC CONDITIONS. Under this heading are placed a number of cases in which the mental symptoms were of a paranoiac type, but in which the clinical course was different from that of the paranoid form of dementia praecox and it did not seem possible to find a relationship with any specific cause. Some of these cases in their clinical course correspond to the group which Kraepelin has described and defined as paraphrenia systematica; some show distinct presenile features; some are associated with impaired hearing; and some are less clear in their clinical position and as a consequence are grouped together as a general group of undifferentiated paranoid conditions. The following shows the total number of such conditions admitted during the period. Nine are males, and fourteen are females, or 4.7% of all admissions. Female. Male. 1 4 0 0 4 Paranoiac conditions with impaired Undifferentiated paranoiac conditions Total Paranoiac conditions including Total. 1 7 2 2 11 2 1 7 1 3 9 23 14 No. Per cent. No. 206 9 4.3 278 14 Per cent. 5 No. Per cent. 484 23 4.7 It is interesting to note that but two cases of true paranoia were admitted during the period, or .4 of one per cent. Of paranoid cases associated with impaired hearing there was but one, or .2 of one per cent. Presenile paranoiac conditions number the same as those of paranoia. �PSYCHOPATHIC HOSPITAL. 57 PAEAPHRENIA SYSTEMATICA. Eleven cases admitted during the period were grouped under this heading, four of them males, and seven females; in all they make 2.2% of the total admissions. Male. No. Total. Female. Per cent. 206 4 2 No. Per cent. No. Per cent. 278 7 2.5 484 11 2.2 The following table is interesting in that it shows the onset in 63.7% of the eleven cases of paraphrenia sytesmatica occurred before the thirtieth year, and 100% before the 45th year. Onset. M. 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 19 24 29 34 39 44 49 54 59 F. M. T. 1 0 0 2 2 Total \dmission . 1 F. T. 0 2 1 0 0 0 1 0 1 3 0 3 1 1 3 2 0 0 0 0 1 0 0 0 1 1 0 0 2 1 0 0 7 11 4 7 11 2 0 0 2 2 0 4 0 0 0 0 2 0 0 4 2 0 Hereditary factors were present among the ancestry in five instances, or 46.5% of the cases. RESULTS OF TREATMENT (PARAPHRENIA SYSTEMATICA). The following table shows the results of treatment in the cases of paraphrenia systematica discharged during the period. One case improved. This stands in contrast to eight discharged as unimproved. It is needless to say that the prognosis in this condition is bad. M. Improved Unimproved Died Total . ... . . . . . . . F. T 0 1 3 0 0 0 5 0 0 1 8 0 4 5 9 �58 STATE OF MICHIGAN. Of those discharged seven were returned to their families and two were transferred to some one of the State Hospitals. PARANOIAC CONDITIONS UNDIFFERENTIATED. There were admitted during the period a number of individuals whose mental disorder was characterized by more or less elaborated delusions, and which showed symptoms and course different from the paranoid conditions grouped elsewhere. There were seven of these cases, four males, and three females, in all forming 1.4% of all admissions. PARANOID DISORDERS UNDIFFERENTIATED. Male. No. Hospital admissions Paranoid disorders, (undifferentiated 206 4 Female. Per cent. 2 No. 278 3 Total. Per cent. 1 No. Per cent. 484 7 1.4 The ages at onset and admission are shown in the following table: \dmission Onset. M. 25 30 35 40 45 to to to to to 29 34 39 44 49 50 to 54 55 to 59 60 to 64 Unknown Total F. M. T. F. T. 1 1 0 0 1 1 1 0 1 0 2 2 0 1 1 1 1 0 0 1 0 1 1 1 0 2 1 1 1 0 o 0 I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 4 3 4 3 7 1 1 1 Hereditary factors were present among the antecedents in five instances, three of these being in the direct line. The results of treatment are given in the following table: M. Unimproved 1 0 2 1 F. T. 0 2 2 0 1 2 4 1 All of the above cases were returned to their families, some against advice, and one, by escape. �PSYCHOPATHIC HOSPITAL. 59 The following tables show at a glance the heredity in all of the twenty three cases of the entire group of paranoia and paranoiac conditions. The first table shows the number of separate instances in each of the different sub-groups. Forty-seven per cent of the cases show that hereditary factors were denied or unknown. The positive instances are almost equally distributed between paraphrenia systematica and the undifferentiated cases. The second table shows the different forms of hereditary taint in the twenty-three cases. Apoplexy and paralysis lead with 33|%; and insanity and alcohol each with 25% of the total instances with positive heredity. • M. Paranoia Paraphrenia Systematica. . . . Presenile condition Deaf. . Unclassified 0 1 0 0 Total heredity 2 Denied M. F. T. M. F. T. M. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 2 0 2 1. 1 3 1 0 0 0 1 0 1 0 0 1 5 7 0 0 0 1 1 2 2 F. 0 1 1 1 1 . . Total . .... T. .. . Direct. Total T. M. F. 0 1 0 0 0 0 2 0 0 1 0 2 0 0 3 0 3 1 1 2 0 5 1 1 5 1 3 5 7 12 4 0 5 2 9 2 9 14 23 F. . . .. Atavistic. Brothers and sisters. Collateral. T. Total. T. T. M. F. T. M. P. T. M. F. T. M. F. 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 1 0 1 0 2 3 3 0 1 4 0 3 1 1 0 1 1 2 1 3 0 2 4 2 3 5 7 12 4 0 5 2 9 2 9 14 23 Total heredity Denied Unknown Total. F. M. Insanity Apoplexy or paralysis Psychopathic. . . . Alcoholism Brothers and sisters. Collateral. Atavistic. Direct. .... 2 �60 STATE OF MICHIGAN. RESULTS OF TREATMENT. Results of treatment in the cases of paraphrenia and the undifferentiated cases have already been noted. The following table shows the results for the entire group of paranoia and the paranoiac conditions. Of the 21 cases discharged, 15 were regarded as unimproved, or 71.4%. Only 1 case recovered, and that was an undifferentiated case, a male of 60, who had delusions of marital infidelity. He entered the hospital physically under-nourished: As he gained in weight and as his sleep became more regular, his mental condition improved and at the end of a month's treatment he was discharged as recovered. M. Recovered Improved Unimproved F. T. 1 1 6 0 2 2 1 5 15 4 4 Q Of the 21 cases discharged, 17 were returned to their respective families, and 4 were transferred to the State Hospital. MENTAL DISORDERS DUE TO SYPHILIS. During the biennial period, 39* cases were admitted in which the mental disease was due to syphilitic involvement of the central nervous system. Clinically these cases were classified as follows: F. M. 8 23 1 0 Tabes FREQUENCY OF SYPHILIS AMONG CASES T. 31 7 1 6 1 ADMITTED. Of the 484 patients admitted during the period, 433 had the Wassermann test made on their blood, and of these 93 had the Wassermann test made on their cerebrospinal fluid. The results of these tests were as follows: Blood. Positive Cerebrospinal fluid. M. F. T. 27 168 21 217 48 385 M. 24 25 F. 16 28 T. 40 53 *Two cases, 1 male and 1 female, with constitutional syphilis but not insane were admitted for examination. �PSYCHOPATHIC HOSPITAL. 61 Of the total admissions, 48 or about 9.92% had syphilis. Deducting 39 cases whose mental disease was directly due to syphilis and 2 cases of constitution syphilis not insane, leaves 7 cases, or 1.45%, who had syphilis but whose mental disturbance was of a non-syphilitic type. Distinguishing between the sexes, 27 cases, or 13.05 % of males admitted and 21 cases or 7.55% of females admitted gave positive Wassermann test. It is interesting to note that of the 7 cases classified as cerebrospinal syphilis, 6 were females while only 8 of the 31 cases of general paralysis were women. FAMILIAL SYPHILIS. For several years it has been the practice of this hospital, whenever possible, to examine for the presence of syphilis, members of the family of patients who have had syphilitic forms of mental disease. Difierent members of the family are examined neurologically and a Wassermann is made on their blood. When this is found strongly positive, they are usually advised to enter the hospital for a lumbar puncture and for further treatment. During the present period Wassermann tests were made upon the blood of the wives in seventeen cases of male general paralytics. The result of this showed that eight wives exhibited the presence of syphilis, or a percentage of forty-seven. Tests made upon the blood of the husbands of six women, who had general paralysis, showed that five of these had syphilis, a percentage of 83.3. There were six cases of wives who had cerebro-spinal syphilis; the husbands of five of these showed the presence of syphilis, a percentage of 83.3. In twenty-nine cases of mental disorder due to syphilis in which members of the family were examined, the mate showed the evidence of syphilis in eighteen instances, or a peicentage of 62. Examination of the blood of sixteen children distributed through these cases gave only one positive Wassermann reaction. In one case of juvenile paresis, the blood of the parents was positive. GENERAL PARALYSIS. During the biennial period, 23 male and 8 female, or a total of 31 cases of general paralysis were admitted. The ratios and percentages as related to total admissions were as follows: Male. General paralysis Female. Total. No. Per cent. No. Per cent. No. Per cent. 206 23 'ii'ie' ' 278 8 ' '2\87' ' 484 31 6.40 �62 STATE OF MICHIGAN. CLINICAL FOKMS. The majority of the cases were of the demented type. In one case of juvenile paralysis, both parents were luetic. Two cases of the demented and 1 of the expansive types also had the Lissauer syndrome. The cases were classified as follows: M. Demented Agitated Delirious F. 16 4 2 0 1 T. 6 2 0 0 0 22 6 2 0 1 AGE. Leaving out 1 case of juvenile paralysis aged 13 years, the average age at time of admission for males was 36.1 and for females 36.5. The following table shows the age at the time of onset of the disease and age at time of admission of patients to the hospital: Admission. Onset. Age. M. F. 1 0 10-14 . 20-24 25-29 30-34 35-39. . 40-44 45-49 4 11 5 0 M. 1 1 3 4 14 7 1 0 1 1 0 3 2 1 2 , T. F. 1 0 2 4 11 5 0 T. 1 1 3 4 14 7 1 0 1 1 0 3 2 1 HEREDITY. Hereditary factors were found in 19 of the 31 cases admitted, or 61.22% of cases in which information was obtained. 10 cases gave negative histories for instances of hereditary factors. Among the antecedent and collateral relatives of the 31 cases of general naralysis, there were 61 instances of mental abnormalities. Direct. Insanity Apoplexy or paralysis Psychopathic. . . . Alcholic Total heredity . . . Total Brothers and sisters. Collateral Atavistic Total M. F. T. M. F. T. M. F. T. M. F. T. M. F. 2 1 2 2 1 0 0 0 3 1 2 2 2 0 0 0 1 0 0 0 3 0 0 0 0 0 0 0 2 2 0 0 2 2 0 0 1 0 0 1 0 0 1 2 0 1 1 5 2 5 2 0 1 10 3 3 3 11 10 2 8 0 0 19 1O 2 23 8 31 1 3 T. �PSYCHOPATHIC HOSPITAL. 63 PRODROMAL PERIOD. The approximate date of syphilitic imection was obtained in 21 of the 31 cases. The average interval between the date of infection and onset of mental symptoms was 11.95 years. Time in years 5 7 8 9 10 11 12 13 14 15 16 24 1 1 1 1 5 2 1 3 2 1 2 1 NEUROLOGICAL DISTURBANCES. No. of cases. Per cent. Pupil 23 20 17 70.97 70.97 41.93 51.61 25.81 22 58 58 06 83 87 6 45 74 19 64.52 54 84 10 32.26 22 Unequal . Reaction sluggish 22 13 16 8 7 18 26 2 Both Apoplectiform or epileptiform In 6 cases the pupillary reflex to light was absent on 1 side only, but in each of these cases the light reflex was sluggish on the opposite side. Tabetic symptoms were present in 10 cases, all of which showed disturbance in locomotion. SEROLOGICAL CONDITIONS. Wassermann test on the blood of the 31 cases showed a strong positive reaction in 27 cases, + in 1 case, and + + in three cases. The Wassermann test on the cerebro-spinal fluid showed a strongly positive reaction in 30 cases. In one case, the fluid was not examined. The number of cells per cu. mm. in the cerebrospinal fluid in 29 cases examined was as follows: No. of cells per cu. mm No of cases 5 to 11 to 16 to 21 to 31 to 41 to 60 100 61 to Over 1 5 7 3 4 6 2 1 10 15 20 30 40 100 �64 STATE OF MICHIGAN. In all except 3 cases, the albumen content of the cerebrospinal fluid was greatly increased. In 5 cases, the Nonne-Apelt (Phase I) test was positive in 5 dilutions of the fluid; in 19 cases, the fluid showed positive test in 10 dilutions; and in 3 cases was positive in 15 dilutions. Quantitative test by the Nissl-Esbach method gave the following results in 29 cases examined: Per cent, albumen No of cases . 03 + 04 + 05 + 06 + 1 0 0 6 07 + .08 + .09 + .10 + 2 10 5 5 The Colloidal gold test was made on 28 cases with the characteristic curve of general paralysis in 26 cases and with the curve of cerebrospinal syphilis in 2 cases, 1 of which later gave the typical curve of general paralysis. RESULTS OF TREATMENT. Energetic anti-syphilitic treatment of general paralysis, by known methods, appears to be of benefit only to cases in which the disease has made slight progress. In favorable cases, the progress of the disease appears to be arrested and notable improvement has been observed. Our methods of treatment have been varied from time to time with hope of finding some manner of treatment which would give more encouraging results than methods used up to the present have given. Salvarsan or closely related substitutes have been given intravenously in all cases treated. In addition mercurial inunctions and periodical withdrawal of varying amounts of cerebrospinal fluid and the introduction of from 0.3 mg. to 1.2 mg. of Salvarsan into the spinal canal have been resorted to. In only 1 instance of a series of about 9 cases which received energetic treatment were the results satisfactory. This case (No. 2009) was admitted to the hospital, February 2, 1917. Primary infection occurred 5 years prior to onset of mental symptoms. At the time of admission to the hospital, the abnormal mental condition was indicated by the patient's euphoric mood, mildly grandiose ideas, overactivity, unreliability, irritability, defective memory, and disturbance of attention. Neurological examination showed deafness in left ear, sluggish and irregular pupils, exaggerated knee and tendo-achilles reflexes, tremors of the tongue and fingers. Laboratory examination of the blood and cerebrospinal fluid showed: Blood-Wassermann + + + +, Cerebrospinalfluid-Wassermann+ + + +, cells in csf. 157 per cu.mm., pressure greatly increased (Nonne-Apelt test 10 dil. + ), (Nissl-Esbach Method 0.09%.)' Collodial-gold curve 55555542000. This patient received 17 intravenous and 24 intraspinal injections of Salvarsan at intervals of 1 week each. He remained in the hospital 40 days after first admission and then returned every week for treatment. The amount of cerebrospinal fluid withdrawn each week varied from 15 c.c. to 70 c.c. and at no time was there serious reaction following the withdrawal of the fluid. The fluid was withdrawn as soon as possible following the intravenous injection of Salvarsan. The dosage of Sal- �PSYCHOPATHIC HOSPITAL. 65 varsan was usually 0.6 gm. The dosage of Salvarsan injected intradurally immediately following withdrawal of the fluid was 0.3 mg. increased gradually to 1.2 mg. Examination after treatments were discontinued, showed neurological conditions unchanged. Wassermann test on the blood was ±. Wassermann test on the cerebrospinal fluid showed 0.10 c.c. = + + + +. 0.08 c.c. = _ + +, 0.05 c.c. = ±. Other fluid findings were: Color = clear, pressure increased, cells = 8 per cu. mm., Nonne-Apelt = 2 dil. + , 5 dil. ±, Nissl-Esbach .026 per cent albumen. The patient has continued at work but has shown minor irregularities of conduct which are gradually interfering with his domestic and business relations. Of 14 cases of general paralysis receiving various degrees of treatment, 6 showed improvement and 5 of these returned to their homes. Only 1 untreated case showed improvement. 1 treated case with extensive focal lesion and Lissauer's syndrome died. The following table shows the condition of patients discharged. Four male patients admitted in the previous biennial period are included. Re covered. Improved. Unimproved. Died. General paralysis. M. Demented Expansive .... P. T. M. P. 5 1 2 0 T 7 1 M. 14 P T 2 2 4 2 0 18 4 2 1 0 1 M 1 P 0 T 1 Of 34 patients discharged, 19 were transferred to one of the State Hospitals and 14 returned to their homes. The average period of residence of patients of this group was 104.2 days. Case H. M. 2144. A male aged 36 at admission. Temperamentally he was neurotic, emotional and unstable. At 24 probably luetic infection. No serious after -effects were noted. Nine months before admission there developed an unusual irritability, and unreasonableness. There was a tendency to sleep during the day. These symptoms gradually increased. Six months after the first symptoms there occurred a convulsion followed by unconsciousness. From this there was seemingly good recovery. Two weeks later another attack of unconsciousness lasting a number of hours. During the next week there were a number of similar attacks. After this period he showed marked mental change. He had a profound memory disturbance for retention and recall of names. There was a marked paraphasia with inability to name many objects or call them by their proper name. His mood was expansive, and he expressed numerous grandiose ideas. On admission to this hospital he showed no serious condition of the body organs, but there were numerous and severe neurological disturbances. The pupils were dilated, irregular in outline, and reacted sluggishly to light. All tendon reflexes were much increased. There was a severe dysarthria and paraphasia with amnesia for names. Mentally he was euphoric and �66 STATE OF MICHIGAN. showed a rather characteristic mental state of paresis. Focal disturbances were always prominent. At one time there was a transitory paralysis of the tongue, and the aphasic condition did not improve. About 5 weeks after admission the knee jerks disappeared and he developed a marked ataxia in gait and arm movements. From this time on there was retention of urine. The neurological findings were as follows. The blood always gave a strongly positive Wassermann reaction. Six examinations of the spinal fluid all showed increase of cells, varying between 14 and 41. The albumen was usually increased about twice over normal. The colloidal gold reaction was always that of a typical paretic process. The Wassermann reaction was always strongly positive. Death occurred from cystitis and infection from a deep decubitus about 4 months after admission. The study of the nervous system gave the following results. The brain at autopsy weighed 1310 grams. Characteristic histological changes of general paralysis were present throughout the cortex, but varied greatly in intensity in different regions. The pia was slightly thickened and in only isolated places were plasma cells present. There was a moderate purulent meningitis present in all regions. In the left frontal and left temporal regions the changes were of extreme severity. Here there was marked distortion of the normal architecture and vessel infiltrations were intense. Nerve cell degenerations were severe and rod cells numerous. In other regions the changes were extremely slight. The spinal cord showed a characteristic tabetic type of dorsal column degeneration. The distribution of the changes in the brain is of much interest in view of the clinical symptoms. CEEBBROSPINAL SYPHILIS. Seven cases, admitted during this biennial period, were classified as syphilis of the central nervous system of the non-parenchymatous form. It is interesting to note that, of these 7 cases, six were females and 1 case remaining from the proceeding period was a female. The relation of these to total admissions was: Male. Female. Total. No. Per cent. No. Per cent. No. Per cent. 206 1 ' '6'4s' ' 278 6 ' ' z.ih' ' 484 7 ' ' i '. 45 �67 PSYCHOPATHIC HOSPITAL. AGE. The average age at time of onset of the disease for the females was 39.7 years. Age. Admission. Onset. M. 30-34 . . 40-44 F. 1 M. T. 2 4 1 3 4 T. F. 3 2 4 4 PRODRO-MAL PERIOD. In 2 of the 7 cases admitted the date of primary infection was not known. Of the other 5 cases the interval between date of infection and onset of symptoms was given as 3, 5, 10, 8 and 9 years. HEREDITY. Of the 7 cases admitted, 4 gave negative histories of hereditary factors among antecedents or collaterals; two gave instances of insanity of direct antecedents and 1 gave a history of apoplexy in a female collateral relative. CLINICAL. In 3 cases of this group, the symptoms were mostly due to vascular involvement and in 4 cases the symptoms were of the meningeal type. NEUROLOGICAL CONDITIONS. Pupil. [Irregular Unequal Reaction sluggish [Reaction absent Knee reflex 5 4 5 » 2 (Absent.. . •! Unequal. . I Increased. Speech defect 6 Babinski on both sides. 1 Tremor.. Hands Tongue Both.. Apoplectiform or epileptiform attacks 6 5 . 5 2 One case had the knee reflex absent on one side and increased on the opposite side. The same case had absent pupillary reflex on the right side and sluggish on the left. �68 STATE OP MICHIGAN. SEROLOGICAL TESTS. Colloidal gold curve. Wassermann Cells Number C.S.P. 2014. . 2027 2036 . . . 2294 2320 2324 2330 .... ++ 1 |j "" Esbach Before treatin't After treatment. + + ++ I 1 1 1 1 1 _|_ _|_ _| [_ + 1 Apelt O.S.F. Blood. 1 _j | I + ++ + .06 10 .09 04 11122100000 45553321000 11232220000 01223210000 11122210000 22343300000 00133321000 00122100000 5+ 08 5+ .06 .08 11223332000 12234321000 00000000000 11233100000 11233210000 00122100000 2 25 18 2 2+ 10 + 2+ 2+ 94 31 21 2+ Case 2330 gave a negative Wassermann test after a course of treatment. RESULTS OF TREATMENT. Of 4 cases discharged, including 1 case remaining from the preceding biennial period, all showed great improvement except 1, and all were returned to their homes. The treatment of cases of cerebrospinal syphilis was essentially the same as for general paralysis. Experience has shown that energetic treatment of cerebrospinal syphilis gives much better results than treatment of general paralysis from which fact the conclusion has been derived that the tissues affected in the non-parenchymatous type of syphilis are much more accessible to medication than in the parenchymatous type. The average period of residence of patients of this group was 152 days. TABES WITH PSYCHOSIS. One case of Tabes with mental symptoms was admitted. The mental symptoms were those of hysteria with anxiety attacks. This patient would not remain for a sufficient period of treatment and was discharged against advice as unimproved. This was the patient's second admission because of hysterical symptoms. ALCOHOLIC MENTAL DISORDERS. Ten patients, all males, whose mental disorders were attributed to the excessive use of alcohol, were admitted during this period. This is only 55.5% of the number of cases, classified in the same group, admitted in the preceding period and was only 4.85% of the total male admissions and 2% of total admission of both sexes. This is a decrease of 1.9% in the admission rate of this class of mental disorder as compared to the preceding period and practically the same decrease as shown in the preceding period. �PSYCHOPATHIC HOSPITAL. 69 CLINICAL GROUPING. F. M. Acute alcoholism Delirium tremens Korsakow's psychosis . Chronic alcoholism . 1 0 1 8 . Two cases had had previous attacks and 2 cases had had previous institutional treatment for alcoholic mental disorders. Wassermann tests on the blood of all cases were negative. HEREDITY. Atavistic. Direct. M. P. T. Insanity Apoplexy 1 0 1 Psychopathic . . . Alcoholic 3 0 3 M. F. Brothers and sisters. Collateral. T M. F T - Total heredity Negative . . Unknown Total . . . M. F T Total. T 0 1 3 0 ' '3 4 0 4 3 3 0 0 3 3 10 0 10 No. of cases. 6 Unequal 0 5 2 0 Pupils: Unequal 2 0 2 0 Achilles-tendon reflex : T 1 N E U R O L O G I C A L CONDITIONS. Conditions. F 1 1 0 �STATE OF MICHIGAN. 70 RESULTS. Recovered. Acute alcholism 1 Chronic alcoholism . . . 2 Improved. 3 Unimproved. 3 Died. 1 Total. 1 1 8 The average period of residence for cases of this group was 48.6 days. Six of these patients returned home and 2 were transferred to one of the State Hospitals. The clinical and laboratory report o'n the case that died is as follows: Case W. S., 1887, male aged 59 at admission to this hospital. His father had been insane and a sister was mentally and physically defective. In early life was an excessive user of alcohol. He married and had six normal children. At the age of 49 he showed evidences of cardiac disease. These were not very troublesome until the age of 57 when he had periods of dyspnoea and cyanosis. Under rest his condition improved. Three months before admission the cardiac symptoms were severe. At all times he showed a slight degree of memory impairment and there were episodic occurrences of confusion. These led to his admission to this hospital. The examinations then showed marked cardiac hypertrophy with dilatation, aortic regurgitation, and arrhythmia. Mentally he had a clear comprehension but there was an extreme retentive memory disorder. He was unable to learn the names of his physicians or nurses. He had a tendency towards spontaneous confabulations and made up fanciful accounts of recent experiences. While usually good humored, he became irritable when opposed. There were from time to time acute attacks of heart failure in one of which he died 4 months after admission. The autopsy showed the following:—Cardiac hypertrophy. Weight 880 grams, ascites, mitral insufficiency, aortic stenosis, passive congestion of the lungs, liver and kidneys. The brain weighed 1465 grams. Its consistency was much softened from a general oedema. The large arterial trunks were severely sclerotic. Histological studies of the cortex showed: hyperplasia of the connective tissue of the pia mater, with moderate infiltration of phagocytic cells. The medium sized and smaller vessels showed sclerotic changes. The nerve cells in general showed but slight changes, but there were isolated cells showing very severe alterations. These were sclerosed and showed the axonal type of toxic reaction. The glia, both fibrous and cellular, was increased and always of a regressive type. There were rather numerous ameboid glia cells lying throughout the nerve cell layers. The changes in the nervous system were indicative of a chronic toxic process. They agree with changes not uncommonly met with in chronic alcoholism. �PSYCHOPATHIC HOSPITAL. DRUG INTOXICATIONS. There were admitted 9 patients who were addicted to the use of narcotic drugs. Six of these presented mental symptoms of a fairly definite psychosis. Three patients showed little beyond the weakness of will and character deterioration, commonly present in chronic users of drugs. Seven cases were due to the chronic use of morphine; 1 to the use of veronal, and 1 of chloral. Cases of drug addiction formed 1.8% of all admissions: Males. Drug intoxications Females. No. Per cent. No. 206 5 2.4 278 4 Total. Per cent. 1.4 No. Per cent. 484 9 1.8 Seven patients used opium in some form. Five used morphine hypodermatically. The maximum quantity taken by any of these patients was 16 grams daily. One patient had for some time been taking 8 to 10 ounces of paregoric daily, and another 3 drams of the tincture of opium each day. The beginning of the habit with 4 patients was for relief from discomforts incidental to some physical or nervous disorder. Results of treatment: M. Recovered Improved Unimproved . Died Remaining T. P. 3 1 2 1 1 0 0 1 5 2 1 1 The average duration of treament in the cases discharged as recovered was 7 weeks The abstract and anatomical findings in the case that died are here given: Case A. D., 1954, a man aged 35, whose sister had epilepsy, was admitted to the hospital by reason of addiction to morphine. At the age of 18 he contracted gonorrhoea. Treatment over a period of 7 years did not bring a cure. Cystitis developed and an operation at the age of 25 brought little improvement. At this time he began the use of morphine for relief of pain. At the end of a few months he was taking 4 grains daily. This was gradually increased and for a long period he took 25 grains each day. For several years he had been a heavy drinker. At his admission he was stuporous, and seemingly under the influence of alcohol. He was restless and uneasy, movements were accompanied by marked tremor and there was general muscular weakness. His �72 STATE OF MICHIGAN. attention was distractible.. His comprehension was for the most part clear, but on fatigue he soon became confused. He was unable to sleep. The second morning he showed extreme apprehension. He was afraid of the nurses or physicians. At times he was unclear and hallucinated. He saw bats and flying creatures around him. There was extreme physical prostration. Then he developed vomiting and a severe diarrhoea. There rapidly developed a cardiac weakness, and death occurred on the third day after admission. The autopsy showed myocarditis, cardiac dilation, fatty degeneration of the liver, passive congestion of the kidneys, acute dilation of the stomach. The brain showed oedema of the membranes. The brain substance was soft and wet, but otherwise showed no gross pathology Histological studies of the brain showed hyperplasia of the connective tissue of the pia-arachnoid without infiltration. The nerve cells were not definitely altered from normal and the neuroglia was not pathological. The pituitary body showed several relatively large cysts with colloid contents lying between the nervous and glandular portions. EPILEPSY. Fourteen cases of epilepsy were admitted during the period. Twelve of these were males and 2 were females. The entire number formed 2.8% of all admissions. In their clinical form 10 showed typical epileptic convulsions with mental deterioration. Two of these were in etiological relation to head injuries, both showing convulsions of a Jacksonian type. Two cases were admitted in a state of mental unclearness. Both had at times typical epileptic convulsions. Two cases had characteristic convulsions without the existence of any definite psychic disturbance in the intervals between attacks. Hereditary factors were present in two-thirds of the cases. The ages of onset and admission were as follows: Onset. M. 0- 4 5-9 10-14 15-19. . 20 24 25-29 30-34 35-39 . . . . . . . . 40-44 45-49 . . . 50-54. . 54-59 60-64. . 65-69 Admissions. T. P. M. F. T. 1 0 1 2 3 0 0 2 3 1 2 0 0 1 2 3 1 0 0 3 2 1 2 2 2 0 1 1 1 1 0 0 2 0 0 0 0 2 2 1 0 1 2 1 1 0 2 1 1 1 1 �PSYCHOPATHIC HOSPITAL. 73 Included among results of treatment is 1 case admitted in a previous period: M. Unimproved Died 3 8 1 I F. 1 1 0 0 T. 4 9 I 1 An abstract of the case that died is here given: Case R. H., 2238, Family History: Desertion by father during infancy. Mother was nervous in disposition. As a child he was backward in learning to walk. At the age of two he fell about 6 feet and was supposed to have injured his spine. He stuttered for many years. In school from the age of 6 to 12. He was extremely backward and at leaving had only reached the third grade. At the age of 12 a trephine was made in the right parietal bone for the purpose of relieving a supposed pressure. Following this he appeared brighter and his speech defect was less marked. From 15 to 27 he was profitably employed as an industrial laborer. He then developed attacks of unconsciousness and periods of confusion in which he would wander off. In January 1916 another trephine operation was made, removing a button of bone from the left parietal bone. Three days later there developed a paralysis of the right hand and face with motor aphasia. After a week the aphasia and paralysis disappeared, but from then on he was subject to attacks of Jacksonian epilepsy involving the right arm and face and sometimes the right leg. Then he developed mental deterioration with depression and irritability. This lead to his admission to this hospital. The chief points of interest concerned the neurological feature of the case. There was present a tactile agnosia of the right hand without motor paralysis. While there was considerable loss of the appreciation of light touch in this hand, there was a total inability to name any object placed in the hand. When the same object was placed in the left hand it was at once correctly named. At times he complained of paraesthesia of the right hand. There were subjective feelings of numbness and cold localized in a narrow band extending vertically through the right face over the vertex and down the right half of the back. Both knee jerks were increased and there was a Babinski reflex in the right foot. The Wassermann reaction on the spinal fluid and blood was negative. Attacks of a Jacksonian type were frequent. At times there were periods of confusion, and when at his best there was a characteristic epileptic type of mental deterioration. Death occurred about three weeks after admission during a series of convulsions. The examination of the brain showed a defect caused by the second trephine operation involving the middle portion of the left post central convolution, and leaving the anterior central convolution intact. The brain tissue in this place was broken down and adherent to the overlying dura. Histological examination of this region showed the reactions characteristic of softening with hyperplastic changes in the pia-arachnoid and dura. Nerve cells had largely disappeared and the glia showed marked proliferative changes. �STATE OF MICHIGAN. 74 Several regions of the cortex away from the focal injury were studied. In none of these were there normal relations. Nerve cells generally showed changes of a toxic type. These varied from cells with slight granular degeneration to others showing severe disintegration. Many cells presented the changes characteristic of fibre injury. The protoplasmatic glia was present in excess and in all sections there were many amoeboid forms of glia. PSYCHOSES WITH MENTAL DEFICIENCY. This series of cases, five in number, are grouped separately, because the psychotic features are not so pronounced as the features of mental deficiency. Otherwise they could have been included under the various psychoses without mental deficiency. In other words the psychotic picture in each case is that of a brief or an episodic attack, and while this attack may have been the factor that induced the relatives to bring the patient to the hospital, yet during the patient's residence here, the most pronounced feature was that of subnormal intellectuality or "hypophrenia." The following table shows the form, and frequency relative to the total hospital admissions for the period. The percentage of all cases is approximately 1%. Male. , With hypomanic features With epileptiform features With hysterical features No. 0 1 0 206 Total. Female. Per cent. 0 4 0 No. 2 0 2 278 Per cent. 7 0 7 No. 2 1 2 Per cent. 4 2 4 484 Hereditary factors were reported in 4 of the 5 individuals, 3 in the direct line; 1 showing insanity in the ancestry, and 2 showing hysteria. Results of treatment, of course, have reference to the psychotic symptoms, and not to the mental deficiency. Two were discharged as improved, and 2 as unimproved. One remained; none were removed to State Hospitals. �PSYCHOPATHIC HOSPITAL. 75 MENTAL DEFICIENCY WITHOUT PSYCHOSES. This group of cases, 10 in all being admitted during the period, includes 1 subnormal individual, and 9 definitely feebleminded. No idiots were admitted. As mental deficiency is so manifestly in each case a restive matter, and a matter of degree, no attempt is made to classify them as "imbeciles," morons, "high,"-and "low-grade" "feebleminded," etc., etc. Social, economic, pedagogic, and physical factors all play so large a part and in such complicated relationships, that the simplest grouping possible seems to be the most helpful. The mental ages varied from 8.5 to 13.5. For statistical purposes they are grouped together in the following table. MENTAL DEFICIENCY Male. Per cent. No. Mental deficiency , . . 206 3 ... Total. Female. 1.4 No. Per cent. No. Per cent. 278 7 2.8 484 10 2 In all they make up 2% of all admissions. Four are adults, and 6 are juveniles. The youngest age was 15, and the. oldest 41. Of the juveniles, all except 2 were guilty of some delinquency; 3 females were sexually del nquent. Hereditary factors were present among 7 (63.6%) of all cases, and in 90% of all cases in which information was available. The following tables show how the heredity is distributed: Direct. Atavistic. Brothers and sisters. Collateral. Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. Subnormal Feebleminded. . . . Idiot . . 0 1 0 0 4 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 2 0 0 5 0 0 7 0 Total heredity 1 4 5 0 0 0 0 1 1 1 0 1 2 5 7 1 0 1 1 2 1 3 7 10 Denied Total T. �STATE OF MICHIGAN. 76 Direct. Atavistic. Brothers and sisters. Collateral. Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. 0 0 0 2 0 2 0 2 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 3 0 2 0 3 0 3 1 2 5 7 Unknown 1 0 1 1 2 1 Total 3 7 10 Insanity Apoplexy or paralysis Psychopathic. . . . Alcoholism 1 1 0 • Total heredity T. RESULTS OF TREATMENT. The following table shows the results of treatment; as would be expected none improved or recovered. What benefit might come from M. 0 0 1 Died 0 2 F. T. 0 0 7 1 0 0 0 8 1 2 hospital residence must necessarily be in regulated habits, and consequent physical improvement. Of those discharged, 5 returned to their families, 1 was transferred to a State Hospital, 2 to the custody of the court, and 1 died. The case which died showed the following clinical history and pathology. Case 1900. Female, age 15. Father and paternal grandfather both insane. Mother feebleminded. Seven siblings of the patient all subnormal. The patient was slow in development during childhood, and did not talk until 4 years old. In spite of this she was the main support of the family at time of admission. Physical stigmata: absent nipples. Developed Pott's disease during residence in hospital. Blood Wassermann negative. Wassermann on fluid negative. Gold sol. curve, 11110000000. Mental examination negative except for definite evidence of mental deficiency. Mental age 8 years + . Died three weeks after admission of an intercurrent tubercular meningitis. Autopsy showed, in gross findings, the following: Apex of left lung firmly adherent. Abdominal organs negative except spleen which was large and adherent to stomach and mesentery, at lower pole and around the hilus. Brain removed—. Calvarium rather thin, otherwise negative. �PSYCHOPATHIC HOSPITAL. 77 Histological examination of brain and cord showed: Process in the cord is characteristic of a severe tubercular compression myelitis, with the associated tubercular pachymengitis. The pia-arachnoid over the cortex shows the beginning of meningitis, undoubtedly of tubercular origin. Nothing of importance relative to the mental subnormality was observed unless it was the difference in the thickness of the two hemispheres, the left measuring 11 c.m., the right 10 c.m. PSYCHONEUROSES. There were admitted 39 patients whose mental disorder belonged in the group of neuroses and psychoneuroses. Of these eleven were males and 28 females. This number formed: Female. Male. ' Per cent. No. 206 11 5.3 Total. No. Per cent. No. Per cent. 278 28 ' 'io'i' ' 484 39 8.0 These cases were distributed among the various clinical types of these disorders as follows: * M. F. 1 2 6 2 0 T. 1 0 0 12 15 1 2 18 17 1 Information concerning hereditary influences was obtained in 71 instances. In 23 families of this group there were 40 individuals who had shown mental or nervous abnormalities. The following table gives details. Direct. Apoplexy and Psychopathic. . . . Total heredity Total Atavistic. M. F. T. M. F. T. 0 3 3 0 1 2 1 2 2 1 1 4 5 3 1 4 1 7 2 4 8 12 4 8 12 1 1 4 Brothers and sisters. Collateral. 5 M. 1 1 I F. 1 1 1 T. 2 2 2 Total. M. F. T. 0 2 2 ' '6' 0 M. F. T. 7 7 1 6 3 2 10 1 1 i i 1 4 1 4 4 6 17 23 3 2 9 2 12 4 11 28 39 4 4 4 �78 STATE OF MICHIGAN. The ages at the onset of the nervous symptoms and at admission of the cases of this group as a whole were: Admission. Onset. M. F. 1 0 5 1 0 2 0 2 0 10-14 15-19 20-24 25-29 30-34 35-39. . 40-44 45-49 Unknown T. 6 3 3 4 4 2 2 1 3 M. 7 3 8 5 4 4 2 3 3 HYSTERIA. F. 0 0 4 3 0 1 0 3 T. 3 3 5 3 3 7 3 1 3 3 9 6 3 8 3 4 _ The clinical course of 18 cases was that of various hysterical manifestations largely of a conversion character. Four of these cases had convulsions at some time during thair course. Seven showed episodes of unclearness. Two of these had fugues lasting from a few hours to several weeks. Two cases were of a traumatic type, the symptoms developing immediately following an accident. PSYCHASTHENIC TYPE (Anxiety Hysteria). Seventeen cases belonged in this group. In all there were noted either frank attacks of anxiety, or various mental or nervous manifestations that at some time or other had relations to anxiety episodes. HESULTS OF TREATMENT. Recovered. M. Total F Improved. Unimproved. Remaining. T. M. F. T. M. F. T. M. F. 7 3 0 2 1 7 6 1 0 0 14 9 1 2 1 0 0 2 6 2 6 0 0 1 2 1 2 27 0 8 8 0 3 3 1 0 3 2 4 2 1 5 G 13 14 T. �PSYCHOPATHIC HOSPITAL. 79 PSYCHOPATHIC INFERIORITY. In 48 patients there was present a constitutional state of mental instability that had resulted in failures to meet successfully common experiences in life or to adapt themselves to social regulations. These failures were not'due to intellectual deficiency nor to the presence of one of the principal psychoses. They resulted rather from an inherent weakness of character, to lack of emotional control or to more or less well defined paranoid traits. Male. No. Psychopathic inferiority 206 21 Female. Total. Per cent. No. Per cent. No. Per cent. 10.2 278 27 9.7 484 48 ''gig In 27 of these, 11 males and 16 females, the mental reactions of the individual at the time of his admission were of such a character as to indicate the existence of a more or less well-defined psychotic disorder. In most instances these were transitory in their occurrence, and manifested themselves as outbursts of emotional excitement with disorderly behavior, or unusual behavior with paranoid traits. These cases were in the general statistical tables of this report, considered as belonging among the group of psychoses. Among those showing psychopathic inferiority there were 21 patients in whom the mental abnormalities, manifested previous to admission and while under treatment, were more those of their inherent consitutional peculiarities rather than an acute psychotic episode. The larger number of these were under 25 years of age. In most instances these had come into conflict with home discipli ne or had been involved in various criminal delinquencies. A considerable number of this type had entered the hospital from its out-patient services. AGE AT ADMISSION. With psychoses M. 10-14. . 15-19 20-24 25-29 30-34 35-39 40-44. . 45-49 50-54 55-59 60-64 . . 1 1 1 0 0 2 3 0 0 2 1 F. 1 1 3 2 2 1 1 4 1 0 0 Without psychoses T. 2 2 4 2 2 3 4 4 1 2 1 M. F. T. 1 1 7 0 1 6 1 2 13 1 0 0 0 1 3 1 1 3 �80 STATE OF MICHIGAN. Hereditary nervous or mental factors were present in 73.3% of these cases regarding which information was known. Direct. Atavistic. Brothers and sisters. Collateral. Total. M. F. T. M. F. T. M. F. T. M. F. T. Insanity Apoplexy and paralysis . . Psychopathic. . . . Alcoholism . 2 1 2 3 3 0 2 6 5 1 4 9 1 1 0 0 1 1 4 5 9 0 1 1 1 0 1 Total heredity 8 11 19 3 0 3 M. F. T. 7 9 2 2 4 0 2 7 16 2 4 11 15 18 33 Unknown 6 0 6 3 12 3 Total 21 27 48 4 5 9 1 0 1 The results of treatment in the two groups of patients were: Psychoses with Psychopathic Inferiority: M. Recovered Unimproved . . Died Remaining . 1 . 5 5 0 F. T. 1 18 0 13 6 1 n 1 Psychopathic Inferiority without Psychoses: M. Recovered Unimproved Died 7 4 F. T. 5 5 12 9 1 1 Of those discharged, 11 were returned to their homes and 10 passed into efficient custody. �PSYCHOPATHIC HOSPITAL. 81 PSYCHOSES WITH SOMATIC DISEASES. In this group are placed 19 cases in which the mental disorder was in close etiological relation with some somatic disease. In the larger number of instances this disorder was of an infectious or exhaustion type. In 18 cases the etiological factors were fairly definite. In 4 cases the symptoms and course were those of a toxic disorder but the nature of the process could not be determined. This group formed 3.9% of all patients admitted. Male. No. Hospital admissions Psychoses with somatic diseases 206 7 Female. Total. Per cent. No. Per cent. No. Per cent. ' s'i' 278 12 4.3 484 19 3.9 M. F. The etiological relationships were as follows: Psychosis with pellagra . . . . 1 1 0 0 1 0 0 1 0 2 T. 0 1 5 2 1 0 1 0 0 1 6 2 1 1 1 1 1 1 4 2 AGE OF ADMISSION: M. 20-24 25-29 30 34 35-39 40-44 45-49 50 54 . . .. . . . ... . . . . T. 1 0 1 0 2 1 3 3 3 1 4 3 0 3 0 0 3 1 4 1 . F. 4 �STATE OF MICHIGAN. 82 Hereditary factors were present in 52% of cases in this group. In 10 families there were 27 individuals who had shown some nervous or mental abnormality. 1 Atavistic. Direct. M. Apoplexy and Psychopathic. . . . 1 1 Total heredity Total F. T. 1 1 2 1 1 1 0 3 0 1 4 1 4 4 8 3 6 9 6 10 13 M. F. Brothers and sisters. Collateral. T. M. F. T. 0 2 2 0 0 2 2 M. F. Total. T. M. F. 1 1 1 1 3 0 3 0 4 1 4 6 10 3 6 9 7 12 19 2 2 T. 4 1 RESULTS OF TREATMENT. M. 3 4 1 2 0 Died F. T. 4 3 2 2 1 7 7 3 4 1 In this group there was a relatively larger number that died than in any other group. PSYCHOSIS WITH PELLAGRA. Case S. G., 1835, Male aged 68. Unknown family history, foundry worker by occupation. At the age of 66 he had several operations for hemorrhoids and following these a gradual physical decline. It was observed that he looked yellow and waxen and that the skin of his hands was dry. Several months after his admission to this hospital in May 1916 there were symptoms of mental disorder. His thought at times was incoherent. His memory was severly impaired and finally he became unable to properly care for himself. He entered the Dermatological Clinic of the University. At that time he showed a dermatitis of both hands, diarrhoea and advanced mental deterioration. A diagnosis was made of pellagra with mental disorder. He was transferred to the Psychiatric Clinic. The �PSYCHOPATHIC HOSPITAL. 83 skin on the hands, feet and face was deeply fissured and pigmented, and the skin over his body was of an appearance resembling ichthyosis. Bowel movements were frequent and often bloody. The Wassermann reaction on the blood was negative. The cerebrospinal fluid showed no increase of cells or albumen. The Wassermann reaction on the spinal fluid was negative. The blood and urine were not pathological. Mentally he was unclear in comprehension, at times much disturbed by visual hallucinations, marked disorientation. Generally he was dull and mildly stuporous. At times he was for brief periods somewhat more alert and would respond to questions, his replies showing an unclear comprehension and disorientation. His physical failure was progressive. The skin condition became somewhat improved, but his general strength was weakened. About 3 weeks after his admission he developed coarse tremors, especially marked on fatigue. Often there were choreiform movements of the arms and hands. Failure was continuous and death occurred five months after his admission. The nervous system presented the following changes: The brain showed no gross abnormalities. In microscopical studies the pia was slightly thickened and showed many small endothelial thickenings on its free surface. The lymph spaces of the pia-arachnoid contained many small lymphocytes and similar cells were rather numerous in the adventitial spaces of the small cortical vessels, especially in the medullary portion of the convolution. Isolated plasma cells were present in the pia-arachnoid and there were large numbers of medium sized phagocytic cells and a few megaloblasts. The nerve cells of the cortex were generally more pale and more homogenous in structure than under usual conditions. An occasional cell showed a characteristic axonal type of reaction. The glia in the molecular layer of the cortex, both fibrous and cellular, was considerably increased and showed regressive changes. The protoplasmatic glia was much increased in the medullar part of the convolutions especially in the cerebellum and around the blood vessels. The spinal cord showed large numbers of corpora amylacea, chiefly in the dorsal columns. In these regions there was an increase in the fibre-bearing glia cells. . The histological changes in the central nervous system were those of a parenchymatous degeneration of a toxic type, and infiltration and hyperplastic changes of a subacute inflammatory reaction in the interstitial tissues. PSYCHOSIS WITH TETANY. Case G. C., 2274, a man.aged 46 at his admission to this hospital. In disposition he was good-natured, abstinent from alcohol and was never regarded as nervous or mentally ill until recently. At the ages of 31 and 34 he had a Neisser infection and a luetic infection at the age of 42. At the age of 42 he had a sharp pain below the right knee cap. Soon afterwards as he walked his right foot dragged and the muscles of the leg "knotted up." The muscles of the right leg gradually became stiff, and later the leg became similarly affected. This condition grew progressively worse until about two years before admission, when his eyesight began to fail. At times he would have attacks of sudden contractions in the leg muscles that caused him to fall to the ground. In some of these the entire body was involved; his legs and arms would be �84 STATE OF MICHIGAN. flexed on his trunk and his back bent forward. In the following months he progressively lost more control of his muscles. Tetanoid attacks were frequent. About six months before admission he had a sudden attack of confusion in which he was extremely unclear and unable to help himself. At times he was agitated and expressed an apprehensive content of thought. This condition continued for several weeks, when there were at intervals periods of clearness and later he was continuously clear, but there persisted an impaired memory The tetanoid contractures gradually became more general and severe. He became quite helpless and was brought to the General Hospital of the University. Soon after his admission there he became unclear and finally he passed into a stupor in which condition he entered this hospital. The physical examinations showed him to be moderately well nourished with a general hypertonicity of the muscles of the body. The skin over the back and hands was atrophic with beginning trophic erosions over the shoulders and back. The gums of the lower jaw were ulcerated, moderate inguinal and cervical adenitis. Heart and lungs were not abnormal. Blood pressure was 130 systolic and 90 diastolic. Moderate leucocytosis. The blood gave a negative Wassermann reaction. The cerebrospinal fluid showed no pathological changes. The urine contained many hyaline casts, but no albumen. The neurological abnormalities were: irregular pupils, arteriosclerotic changes of the fundus of the eyes, sluggish pupillary reactions, tremors of the lids, tongue, lips and extremities, marked dysarthria, extreme hypertonicity of all muscles, increased tendon reflexes, Babinski's sign in the right foot. Three days later all tendon reflexes were greatly decreased. There was almost constant twitching of the muscles of the hands, arms and face. At brief irregular intervals there were tonic contractions of the muscles of the body and extremities. These could sometimes be elicited by tapping the muscles. There was no control of the sphincters. Mentally he was always unclear and usually deeply stuporous. At times he was extremely apprehensive. The stupor deepened and death occurred 1 week after admission. • DELIRIUM OF UNKNOWN ORIGIN. Case F. K., 2310, a woman aged 31 at her admission. So far as known her family and early personal history showed nothing notable. She was married at 18 and owing to the conduct of her husband was soon divorced. Two months after this she remarried and.by this marriage had one miscarriage, and had one living normal child. Temperamentally she was always impulsive, easily angered and difficult to get along with. Aside from occasional episodes of temper and irritability there were no pronounced mental difficulties until about a month before her admission. She then became over-active and talkative. She at times complained of headache and sometimes appeared confused and unclear as to her surroundings. Showed an extreme jealousy of her husband and developed a paranoid content of thought. These centered about her husband, with ideas of poisoning and hypnotism. She refused food. She could not sleep and was given rather frequent and heavy doses of chlorotone. At her admission she .was deeply stuporous and quite helpless. The physical examination showed that she was well nourished. The pulse �PSYCHOPATHIC HOSPITAL. 85 was always rapid and weak, varying between 120 and 160. The blood count showed 12,695 leucocytes with 74% polynuclears. The urea content was a little increased, 0.58. The Wassermann reaction was negative. The urine showed an excessive amount of indican and acetone. Blood cultures were negative. The cerebrospinal fluid was not pathological. The fundus examination showed neuro-retinitis of both eyes and a slight swelling of the left nerve head. The knee jerks were about normal until a few hours before death when they could not be obtained. There was double ankle clonus. The pupils varied in width at first were almost pinhead in size, and later they dilated widely and remained so with only slight reaction to light. The last few days of her illness showed a slight internal strabismus. On a few occasions there were slight haemorrhages from the bowels. A week after her admission there was a sudden rise of temperature to 103.4 and a fall to normal the next day, and never again rising. A few weeks later she developed an acute otitis media. This seemed to be entirely localized in the ear and yielded well to treatment. Mentally she continued in deep stupor. Only on a few occasions when irritated did she show any spontaneous talk or interest and then only for a brief period. She was during her entire residence fed mechanically. There was a progressive physical failure and death occurred 25 days after her admission. The autopsy showed the following: A few scattered small pus cavities in the right lung. The heart was not pathological. The liver showed many small pin-head sized whitish areas scattered through its substances. Otherwise the body organs showed no gross pathology. The brain weighed 1190 grams. In appearance and topographical relations it showed no gross abnormalities. Histological studies showed extreme changes in nerve cells of all regions. These were swollen and their granular contents were pale and atrophic. The glia cells were increased in number around the smaller blood vessels and many had undergone retrograde changes. The changes as a whole were such as are occasionally met with in toxic disorders affecting the nervous system. The liver showed a most extreme degree of fatty degeneration. This affected the parenchymal cells in all parts of the lobules. To a lesser degree the kidney parenchymal cells showed the same changes. While the etiological agent in this case was unknown, the changes within the nervous system and body organs were definitely toxic in character. Case M.M., 1991, age 22 at admission. She was backward in childhood development, not talking till the age of four. In school she showed mental retardation and at the age of 17 she had only advanced to the fifth grade. After school life she remained at home; there was regarded as "odd, a poor eater, and unusually dependent on others." Three weeks before admission she became irritable and over-active. She talked much, spoke of hearing voices. This condition brought about her admission to the hospital. The examinations showed her to be poorly developed physically and showing a number of stigmata of deviation. The teeth were badly decayed and the lips and tongue covered with sores. The skin over the body showed an erythematous blush. ' The thyroid was much enlarged. There was a loud systolic heart murmur. The urine showed a trace of albumen and many hyaline and a few granular casts. The blood at the �86 STATE OF MICHIGAN. early examinations showed a slight leucocytosis. Later on this was more pronounced. The Wassermann reaction was negative. The spinal fluid showed four cells and a slightly increased albumen content. The tendon reflexes were greatly increased. There was double ankle clonus and a frequent fibrillary contraction of the muscles of the trunk and extremities. During the first few days she was clear in comprehension and her distractibility and over-activity suggested a manic excitement. Later she progressively became more unclear and her condition was that of a delirium. With this unclearness there occurred a slight rise in temperature, leucocytosis and albuminuria. At no time during the course did the temperature exceed 99.4 degrees. At times there were evidences of cortical irritation such as muscular twitchings and choreiform movements, and a general increase in muscular tonus. There was progressive physical failure and death occurred three weeks after admission. The autopsy showed: chronic vegetative endocarditis of the mitral valve, cystic degeneration of the thyroid gland. The brain weighed 1180 grams. The pia-arachnoid showed a number of haemorrhagic effusions. The longitudinal sinus of the dura showed a large thrombus in its posterior portion with extensions into the confluent veins and into the right lateral sinus and right internal jugular. Histological studies of the internal organs showed a chronic fibrous thickening of the edge of the mitral valve, multiple small haemorrhages in the liver, and an occluding septic thrombus of the longitudinal sinus of the dura. The nerve cells of the cortex as a whole were fairly normal. Some cells showed acute swelling and a few showed severe disintegrative changes of the cell granules. The chief interest lay in the condition t>f the blood vessels. The larger veins of the pia were completely closed by thrombi, some advanced in process of organization. There was in many vessels of the pia a marked proliferation of the fibroblasts in their walls. The connective tissue of the pia showed very marked proliferative changes. The reactions in the brain were probably all secondary to the vascular disturbance. PSYCHOSES WITH BRAIN TUMOR. There were admitted 7 cases of brain tumor with mental disorder during this period. Four of these were males and 3 were females. This number included 1.4% of all cases admitted. Four cases were discharged unimproved and 3 died. Brief abstracts of the clinical course and pathological findings are here given: Glioma of left posterior frontal region: Case M. B., a woman aged 60 at her admission. Six weeks previous to this she had a sudden attack of confusion with almost total motor aphasia. She could only repeat "yes" or "no." Her confusion soon passed away but the aphasia persisted. At her admission there were few notable abnormalities of the body organs. The heart was a little enlarged to the left. The blood pressure was 140 systolic and 80 diastolic. The blood on two occasions showed a moderate leucocytosis. Wassermann's reaction on the blood was negative. The neurological disturbances were: residuals. of a slight right hemiplegia, weakness in muscular power of right hand and leg, �PSYCHOPATHIC HOSPITAL. 87 increased right knee jerks, Babinski's reflex was present in the left foot but not the right. There was almost a total motor aphasia. She could repeat a few monosyllables and familiar words. Usually she would repeat part of the question, but beyond this there was little spontaneous speech. She understood many simple questions, recognized familiar objects, but could not name them. She could not read nor write. Most of the time she was dull and stuporous. The right hand became completely helpless. She gradually became comatose and died three weeks after admission. The autopsy showed a gliomatous tumor of large size involving the foot of the left third frontal convolution, the operculum and the region up to the left lenticular nucleus. Histological studies showed the tumor to be composed of closely packed glia cells with larger numbers of intermixed glia fibres. In places the cells had broken through the margins of the cortex and extended out into the arachnoid lymph spaces. In many places the tumor had undergone regressive changes with formation of small cystic cavities with colloid contents. The nerve cells of the cortex away from the region of the tumor were oedematous and showed considerable fatty degeneration. Glioma of frontal lobes: Case A. 0., 2309., a male aged 44 at his admission. Six months earlier he developed severe headaches which became so severe as to force him to give up his work. He showed at about the same time a definite mental change. He became more dull and often fell asleep in his chair. He expressed delusions of suspicion and feared that he was being harmed and pursued. At times he would show brief episodes of confusion and unclear comprehension. At his admission the chief physical disorders were residuals of an old fracture of the left leg and a mitral insufficiency. The neurological abnormalities were: headaches, choked discs with haemorrhages of the retina in both eyes, evenly contracted visual fields, tremors of the hands, hypotonus of muscles of arms and legs, normal tendon reflexes, at times loss of bladder and bowel control. No disordered sensibility. His attitude and behavior was of one physically weak. His comprehension varied. During the first few weeks it was generally clear but at intervals there were brief episodes of inability to understand questions on his situation. Towards the last he gradually became more dull and stuporous, finally becoming comatose. The stream of thought was slow and at times somewhat rambling. Memory was inaccurate for both recent and remote experiences. The content of thought was generally fairly normal in its relation to his situation, and at other times showed a marked paranoid trend with fairly well elaborated delusions of suspicion. This mood was usually good humored, often jocose. At other times he was dull and apathetic. As there was definite evidence of intracranial pressure, two decompression operations were done.. These were followed by a slight improvement in the fundus changes, but mentally he became more dull and finally deeply stuporous. Towards the last .he developed a severe and continuous hiccoughing. Death occurred following several days of coma. The autopsy showed a large gliomatous tumor involving the septum and anterior region of the fornix and extending out into the central substance of the right and left frontal regions and into the lateral ventri- �88 STATE OF MICHIGAN. cal cavities. The tumor in places showed many small cavities filled with a colloid like substance and a few with recent haemorrhages. The cavity of the acqueduct was entirely occluded by proliferation of the neuroglia. Histological studies of the tumor showed it to be a glioma with two quite different methods of growth, one very slow in its development in which enormous masses of fibres are present. These in places had undergone degeneration, with haemorrhages and softening, which has lead to the production of large amounts of connective tissue. The other type of growth is a very rapid proliferation of neuroglia cells with practically no glia fibres or connective tissue formation. The cortex in the regions of decompression showed severe changes. The pia was packed with infiltrating cells, mostly small lymphocytes. All the vessels adjacent to the area of injury showed proliferative changes of their endothelial cells. The nerve cells were seriously altered from normal. Many have degenerated and disappeared. The neuroglia cells were increased in size and numbers. Large numbers of rod cells were scattered through the cortex. The cortex aside from the areas affected by the decompression operation showed a pia mater comparatively normal in thickness, but with spots where the endothelium was in early stages of proliferation. The nerve cells were all pale and oedematous. Glioma of the right occipital lobe: Case A. H., 1917, a man aged 54 at his admission to this hospital. Nervous or mental abnormalities do not appear to have been present until the age of 53, when, following what was called an attack of influenza he developed herpes zoster. The pain from this was intense and he lost much in weight. He was admitted to the University Hospital where a diagnosis of multiple neuritis was made. The skin condition seems to have improved but there developed severe headaches and a failing of vision. There gradually progressed a motor weakness and loss of sensation in the left arm. Later this involved the left leg and foot. Three weeks before his admission to this hospital he became greatly depressed and threatened suicide. His memory became poor and his comprehension slowed and at times unclear. The physical examination at his admission showed him to be much under-nourished. There was a leucoderma involving the skin over the greater part of the body. The skin over the backs of the hands was atrophic. The scars from the previous herpetic eruption extended around the right side between the 9th to 12th ribs. Heart and lungs were normal. Blood pressure was 135 systolic and 90 diastolic. Urine, and blood Wassermann were negative. Neurological abnormalities were striking. There were Romberg's symptoms. The gait was ataxic. Both legs were somewhat spastic and the left leg was weak in its motor force. At rest the right leg was kept flexed on the body. The arm and knee jerks were increased and somewhat more on the right than the left side. The left Achilles jerk was absent. There was no definite Babinski's sign. On the left side of the body from the neck to the anterior part of the sole of the foot there was complete loss of touch sensibility. Pain appreciation was absent over the anterior and outer surfaces of the left upper arms. Astereognosia of the left hand. No sense of position of upper or lower extremities. Both fundi showed swelling of the dies and there was left homonomous hemianopsia. �PSYCHOPATHIC HOSPITAL. 89 Mental symptoms consisted chiefly of a mild depression and a tendency towards stupor. He gradually became more dull and died after several days in coma. The autopsy showed a large brain weighing 1560 grams. There was a larger area of tumor substance filling in the central part of the right occipital lobe. While the posterior limb of the capsule seemed uninvaded by the tumor its position was so close to the position of the sensory radiations that they might well have been injured by the growth. Posteriorly and externally the tumor extended into the surface of the cortex. In consistency the tumor was firm. In many places it showed small cysts of degenerations and scattered haemorrhages. Histological studies showed the tumor to be a rapidly growing glioma. It was composed of thickly packed glia cells of every size and shape. Mitoses were numerous. PSYCHOSES WITH CEREBRAL ARTERIOSCLEROSIS. In 11 patients admitted tthis mental disorder was due to structural changes in the brain associated with arteriosclerosis of its blood vessels. Five of these were males and 6 were females. These cases formed 2.3% of all admissions. Male. Female. Total. No. Per cent. No. Per cent. No. Per cent. 206 5 • '2' 4' ' 278 6 2.2 484 11 2.3 Hereditary factors were present in 7 of 8 cases in which information was obtained. These all occurred in the parents or brothers and sisters of the patient. In these seven families there were 23 abnormal individuals. The earliest age of onset was between the years 30 and 34. Two-thirds of the cases developed between the 45th and 60th year. In 7 cases the patients had at one time or another attacks of an apoplectiform or epileptiform type. Heart murmurs were present in 6 cases. Increased systolic blood pressure was present in 9 cases. In 3 cases the pressure ranged between 110 and 150. In 5 between 160 and 200, and in 3 between 210 and 240. In 8 cases arteriosclerotic changes were present in the vessels of the fundus of the eye. In 8 cases the cerebrospinal fluid was examined. The cells in these ranged in numbers between 2 and 8. All had negative Wassermarm reactions. RESULTS OF TREATMENT. Recovered . . . . Died M. F. 1 5 1 T. 6 8 �90 STATE OF MICHIGAN. Included among these are 3 cases admitted in the previous period. Five of these cases were transferred to one of the other State Hospitals. SENILE DEMENTIA. There were admitted two men whose mental disorder was due to senile brain atrophy. The ages of onset were 64 and 73, respectively. Both were discharged in an unimproved condition. TRAUMATIC PSYCHOSES There were admitted 2 men in delirium that had its development following injury to the head. At their admission they were unclear, hallucinated, and confused in their thinking. Both cases made a complete recovery, 1 after 2 weeks treatment and 1 after 4 weeks. MULTIPLE NEURITIS. Two women were under treatment with a mental disorder showing unclearness, marked disturbance of retentive memory, and the neurological disorder of multiple neuritis. In neither case was the etiology clear. Neither had used alcohol nor had they been exposed to any toxic agent commonly producing multiple neuritis. One woman was somewhat improved at her discharge, the other was unchanged. UNDIAGNOSED PSYCHOSES. There were under treatment 12 cases of mental disorder that could not be definitely diagnosed. The reasons for this were largely too short a period of observation, or lack of information regarding the early development of the disorder. The number of this group admitted during the period formed 2.5% of all admissions. Male. - Total. Female. No. Per cent. No. Per cent. No. Per cent. 206 1 ' 'b'.b' ' 278 11 ' '4^9' 484 12 2.5 All of these cases were discharged in the period, three as improved, 8 as unimproved, and 1 died. REPORT OF THE PATHOLOGICAL LABORATORY. The laboratory of the State Psychopathic Hospital operates as a central laboratory for all Michigan Hospitals for the Insane. Its problems have been largely centered in the study of the nervous system of such cases of mental disorder, as have been adequately studied during life, �PSYCHOPATHIC HOSPITAL. 91 These studies have in many instances made it possible to have a clearer understanding of the pathology associated with mental disorders, and in their cumulative results will contribute much to the field of psychiatry. The results of material sent from the State Hospitals are communicated to the institutions interested and by this their medical standards are improved. The hospital makes Wassermann Examinations for all of the State Hospitals and for the General Hospital of the University. The number examined for the various State Hospitals is given in accompanying tables. •* TABLE No. I.—Number of cases received between July 1, 1916 and June 30, 1918 and sources. Year ending Year ending June 30, 1917. June 30, 1918. Pontiac State Hospital Traverse City State Hospital Michigan Home and Training School Lapeer University of Michigan Hospital 56 21 16 7 1 8 Total for period 49 28 1 105 49 16 8 11 2 7 11 3 15 Total from Michigan State Hospitals . . Outside sources 109 1 98 1 207 2 Total number received 110 99 209 �STATE OF MICHIGAN. TABLE No. II.—Clinical Diagnosis of cases studied in Laboratory. Year Year Total ending ending June 30, for June 30, 1918. Period. 1917. Alcoholic mental disorder, chronic Alcoholic mental disorder, Korsakow's psychosis Alzheimer's disease Amaurotic idiocy Cerebral arteriosclerosis Dementia praecox Drug addiction Epilepsy Involution melancholia Imbecility Manic-depressive insanity Myelitis, tubercular Meningitis, purulent Meningitis, tubercular Non-psychotic, traumatic Not insane Paralysis agitans Pernicious anemia Pellagra Senile dementia .' Syphilis, central nervous system, general paralysis Syphilis, central nervous system, meningo-vascular Syphilis, central nervous system, vascular Syphilis, tabo-paresis Traumatic psychosis Toxic psychosis, undiflerentiated .-. Toxic psychosis, endocarditis Tumor, central nervous system Tetany Material unstudied or undiagnosed Cases diagnosed under two or more heads: Arteriosclerosis and senile dementia Arteriosclerosis and multiple softenings Arteriosclerosis and brain tumor Arteriosclerosis and syphilis Alcoholic insanity and acute meningitis Alcoholic insanity, chronic, and senile dementia Alcoholic insanity, chronic and cerebral syphilis Dementia, organic and trumatic epilepsy Dementia praecox and multiple melanotic sarcomata Huntington's chorea and tabes dorsalis Senile dementia and epilepsy Syphilis, general paralysis and acute meningitis Syphilis, central nervous system, meningo-vascular, gummatous Syphillis, central nervous system, vascular and general paralysis Syphilis and tuberculosis Total 2 0 2 •0 11 5 1 6 1 0 3 1 2 1 1 1 0 2 1 3 9 5 0 0 1 o 1 3 0 39 1 0 1 9 6 0 0 0 0 2 1 0 2 4 4 0 1 3 0 1 0 5 1 30 1 1 1 0 1 1 1 o 0 1 1 1 o 0 0 110 99 TABLE No. III.—Number of cases reported to the State Hospitals during the period. This includes 54 cases received during previous periods but reported in this. Kalamazoo State Hospital Pontiac State Hospital Traverse City State Hospital Newberry State Hospital Michigan Home and Training School, Lapeer. Total number reported. �Number of Wassermann Tests made between July 1, 1916 to June 30, 1918. Year ending June 30, 1918. Year ending June 30, 1917. C. S. P. Blood. Kalamazoo State Hospital . . . Traverse City State Hospital Newberry State Hospital State Psychopathic Hospital Ionia State Hospital Wayne County Hospital Michigan Home and Training School. . . .. ' Blood. 1,840 452 389 346 367 17 305 94 233 228 915 190 30 78 175 35 0 8 2 0 3,617 755 590 555 694 135 529 289 1,408 433 4,532 945 620 633 869 170 529 297 1,410 433 IK Kl O 3,512 4,271 1,433 9,005 10,438 Q 1,485 13,942 15,427 2,918 22 , 947 25,865 O. S. F. Blood. 1,327 355 362 299 304 13 305 86 233 228 2,290 400 228 256 390 2692 493 231 287 502 31 0 0 2 0 122 224 203 1,175 205 153 224 203 1,177 205 513 97 27 47 63 4 0 8 0 0 674 5,493 6,167 759 Total. C. S. F. Total. 402 93 3 31 112 Total for period. Total. 679 6,901 7,580 706 7,041 7,747 1,353 12,394 13 , 747 1,465 10,553 12,018 td o hj w O 02 �94 STATE OF MICHIGAN. REPORT OF THE SECRETARY AND BUSINESS OFFICER. Ann Arbor, Mich., June 30, 1918. To the Board of Trustees: Gentlemen—I have the honor to present the report of the business transactions of the hospital for the biennial, period ending June 30, 1918. During this period the expenses of running the Hospital have been considerably higher than they were for the two years just preceding. By referring to the following tables it can easily be seen that this was due almost entirely to the increased cost of food supplies and of hospital help covered by the classification of the Medical Department. Both of these increases were due to the conditions brought upon us by the war. A small building was built for the housing of animals for the laboratory at a cost of $773.90 but aside from that only the necessary repairs on the building were made. Our total number of patient days for the two years amounted to 41,634. The average daily cost to the State per patient per day was $1.341, the highest rate for any one month being $1.45 and the lowest rate $1.25. DISBURSEMENTS. ON ACCOUNT OF CURRENT EXPENSES. July 1, 1916 to June 30,. 1918. Food Clothing Laundry Expenses Heating and Light Medical Department Office, Stationery, Etc " Amusement and Instruction Furniture and Household Supplies Improvements and Repairs Miscellaneous Expenses Refunds '. Total for Biennial Period. $27,701 193 2,635 3,670 15,550 2,369 319 6,442 3,385 839 1,339 24 81 08 14 61 33 05 90 20 29 48 $64,446 13 �PSYCHOPATHIC HOSPITAL. 95 DISBURSEMENTS. ON ACCOUNT OP CLINICAL LABORATORY. July 1, 1916 to June 30, 1918. Officers' Salaries Animal Food Heating and Light Medical Department Amusement and Instruction Office, Stationery, Etc Improvements and Repairs $17,680 02 328 19 71 76 6,700 16 11 17 1,732 38 801 32 Forward $27,325 00 Brought Forward Clothing Farm, Garden and Stock Miscellaneous Expenses $27,325 00 8 82 34 00 486 07 Total for Biennial Period $27,853 89 RECEIPTS. ON ACCOUNT OF CURRENT EXPENSES. July 1, 1916 to June 30, 1918. From From From From From From State for County Patients State for State Patients Private Patients Interest Accounts Refund on Pay Roll Miscellaneous Sales Total for Biennial Period $44,630 48 961 03 22,006 39 1,478 41 40 78 112 47 $69,229 56 �96 STATE OF MICHIGAN. RECEIPTS. ON ACCOUNT OF CLINICAL LABORATORY. July 1, 1917 to June 30, 1918. Special Appropriation Wassermann Tests From Miscellaneous Sales.. $27,000 00 1,261 00 391 89 Total for Biennial Period $28,652 89 Table showing the number of hospital days and the daily per capita costs by months from July, 1916 to June 30, 1918. Patient hospital days. From July 1, 1916 to June 30, 1918: July, 1916 August, 1916 September, 1916 October November, 1916 December, 1916. . January, 1917 February, 1917 March, 1917 April, 1917 May June, 1917 July, 1917 August, 1917 September, 1917 October, 1917 November, 1917 December, 1917 January, 1918 February, 1918 March, 1918 April, 1918 May, 1918 June, 1918 1,712 1,846 1,800 1,800 1,651 1,667 1,701 1,595 1,729 1,806 1,701 1,539 1,727 1,768 1,718 1,814 1,752 1,724 1,764 1,614 1,877 1,737 1,781 1,813 . . Daily per capita cost to state. $1 26 1 25 1 25 125 1 25 126 1 28 1 3O 1 30 1 30 130 134 1 36 1 36 1 41 141 136 1 43 1 40 1 45 142 1 43 1 38 1 43 SUMMARY OF INVENTORY, JUNE 30, 1918. Hospital buildings Furniture Fixtures Apparatus Books Supplies Total $2 ,990 676 5,837 1,202 6,608 99 00 11 58 19 $79,043 13 17,314 87 $96,35800 Respectfully submitted, ROBERT G. GREVE, Secretary. �PSYCHOPATHIC HOSPITAL. 97 REPORT OF TREASURER. July 1, 1918. To the Board of Trustees of the State Psychopathic Hospital: Gentlemen—Herewith I hand you report of the State Psychopathic Hospital for the biennial period ending June 30, 1918. RECEIPTS. Balance in the Treasury July 1, 1916 By cash from State Treasurer, annual appropriation laboratory (Sec. 28 Act 278, Public Acts 1907) By cash from State Treasurer (Support of State Patients'). . By cash from State Treasurer (Support of County Patients) By cash from Private Patients By cash from Earnings Institution (Interest, etc.) $21,704 44 27,000 961 44,510 22,137 3,274 00 03 05 02 35 $119,586 89 DISBURSEMENTS. Clinical Laboratory Accounts Current Expenses (Running Account) Balance June 30, 1918 $27,853 89 64,446 13 27,286 87 '$119,586 89 Very respectfully submitted, R. A. CAMPBELL, Treasurer. � asylums https://localhistory.tadl.org/files/original/eba7d02e3ea16ffa142c794038c2bac7.pdf 6cdb9d9c60632294725ae1c5d4361cac Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Traverse City State Hospital Board of Trustees Reports Subject The topic of the resource State hospitals Psychiatric hospitals Description An account of the resource Items within this collection pertain to the Traverse City State Hospital, also known as the Northern Michigan Asylum for the Insane and the Traverse City Regional Psychiatric Hospital. Creator An entity primarily responsible for making the resource Amy Barritt, 1984- Source A related resource from which the described resource is derived Original documents held by the Traverse Area District Library. Publisher An entity responsible for making the resource available Various. Date A point or period of time associated with an event in the lifecycle of the resource 1885-1989 Contributor An entity responsible for making contributions to the resource Board of Trustees for the Traverse City State Hospital. Various. Rights Information about rights held in and over the resource Content in this collection may be protected by copyright law. Contact the Traverse Area District Library for permission to reproduce, display or transmit this image. Relation A related resource Various. Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context 2028.13 TCSH-xxxx. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. Document A resource containing textual data. Note that facsimiles or images of texts are still of the genre text. Text Any textual data included in the document. Text embedded in record from PDF Extractor. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Paper booklet. Physical Location Physical location of item itself. Traverse Area District Library, Local History Collection, Main Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Specifications, conditions of contract, proposals and guarantee for heating and plumbing the Northern Asylum for the insane at Traverse City, Michigan, in accordance with plans prepared by C. M. Wells, Superintendent, and adopted by the Board of Commissioners. Subject The topic of the resource Asylums--Michigan--Traverse City--History. Psychiatric hospitals. Description An account of the resource Advertisement for proposals for the heating and plumbing contract for the Northern Asylum for the insane at Traverse City, Michigan. This advertisement includes the instructions and conditions of the heating and plumbing contract. Creator An entity primarily responsible for making the resource Board of Commissioners of the Northern Asylum for the insane. Source A related resource from which the described resource is derived Original document held by Traverse Area District Library. Publisher An entity responsible for making the resource available Traverse City: Herald Job Printing Office. Date A point or period of time associated with an event in the lifecycle of the resource 29 April 1885 Contributor An entity responsible for making contributions to the resource State of Michigan. Rights Information about rights held in and over the resource This document is in the public domain. Relation A related resource See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection. Format The file format, physical medium, or dimensions of the resource PDF. Language A language of the resource English. Type The nature or genre of the resource Document. Identifier An unambiguous reference to the resource within a given context TCSH0022 2018.13 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Traverse City, Grand Traverse County, Michigan. PDF Text Text capture metadata for PDF documents Text SPECIFICATIONS, CONDITIONS OF CONTRACT, PROPOSALS AND GUARANTEE -FOE- HEATING ANDPLUMBING THB- NORTHERN ASYLUM FOR THE INSANE AT TRAYERSE CITY, MICHIGAN, IN ACCORDANCE WITH PLANS PREPARED BY C. M. "Wells, Superintendent, AND ADOPTED BY THE BOARD OF COMMISSIONERS. PEEEY HANNAH, E. H. VAN DEUSEN, M. D., ALEXANDEE CHAPOTON, SB., BOARD OF COMMISSIONERS. HENET H. EILEY, MILTON H. BUTLEE. TRAVERSE CITT: EZJIALJ) JOB PBiNTrae OFFICE. 1885. �[ADVERTISEMENT.] Proposals Wanted. Sealed proposals will be received at Traverse City, Michigan, by the Board of Commissioners of the Northern Asylum for the insane, until 10 a. m. of Thursday, June 4, 1885, at which time said ^proposals will be opened, for all labor and materials required for the HEATING AND PLUMBING, either or both, of the Northern Asylum for the insane, at Traverse City, Michigan, including radiators, steam distribution, hot and cold water distribution, hot water boilers, tanks, pumps, bath room, lavatory and closet fixtures, etc., in accordance with plans and specifications adopted by said Board. Said plans and specifications can be examined at the office of the Superintendent, at the Northern Asylum, Traverse City, Michigan, on and after May llth. For further information relative to the plans or conditions, address April 29. 1885. C. M. WELLS, Superintendent, TEAVEBSE CITY, MICHIGAN. By order of the Board of Commissioners. �Instructions to Bidders AND Conditions of Contract. These Instructions and Conditions shall apply equally to both heating and plumbing contracts if the two are divided. Bidders are invited to be present at the opening of proposals, at the office of the Superintendent, Traverse City, Michigan, at 10 a. m. of Thursday, June 4, 1885. No proposals will be received after the time above named. No proposals will be considered unless accompanied by a bidding bond or guarantee, a form of which is hereto attached, in the sum of five thousand dollars, signed by the bidders and by two acceptable sureties, residents of the State of Michigan, or in lieu of the sureties, a certified check in the sum of five thousand dollars may be deposited with the Treasurer of the Board. The successful bidder must give a bond in the full penal sum named in hip contract for the full and faithful performance of all the provisions of his contract, said bond to be signed by the bidder, and by two sureties, residents of the State of Michigan, and to hold gocd until all the provisions of the contract have been executed. �6 A bond, in amount and sureties to be approved by the Board, will also be required in accordance with the provisions of the law therefor, for the payment by the contractor and all sub-contractors for all labor performed or materials furnished in the execution of the work under contract. No bids will be considered unless accompanied by a full, itemized and fair schedule of prices and quantities of all labor and materials to be used in the work tendered for, which schedule when footed, must be the same amount as named in the proposal. The proposals, instructions, conditions of contract, plans and specifications will be made a part of the contract, and be signed both by the Board and by the contractor. A form of proposal is hereto attached ; the blanks therein must be all tilled. These specifications, the proposal and the bidding bond must be together inclosed in a sealed envelope, endorsed "Proposals for Heating and Plumbing Northern Asylum," and addressed to C. M. Wells, Superintendent, Traverse City, Michigan. Proposals will be received for both Heating and Plumbing, or for either alone. The bidding bond for either portion of the work to be the same as for the entire work; and the Board hereby reserves the right to accept in a proposal for the whole work, the tender for the heating and to reject the tender for the plumbing, or vice versa. The right is especially reserved to accept any proposal or to reject all as the Board shall deem for the best interest of the State. �7 Work shall be prosecuted under the direction of the Superintendent, in such order and places as he may direct. His decision on all points of construction, and as to the acceptance or rejection of any materials offered, or work performed, shall be binding. Any points not covered by the plans or by these specifications, or questions arising in regard to the plans and specifications, shall be referred to the Superintendent, and his decision thereon shall be binding. An appeal from the decision of the Superintendent may be made in writing to the Board of Commissioners, and the decision of the Board shall be final. In case the contractor neglects or refuses to purchase materials in time, or of the proper quality, or to perform any work as directed, or to execute any of the provisions of the contract, the Board shall have power to purchase such materials, or employ labor to execute such work, and to i charge the expense therefor and all attendant exoenses to the contractor, to be considered as a payment of like amount on the contract, and in the final payment deducted therefrom, or held against the bond, if in excess of the contract price. In any case where the quality of the materials or the method to be taken to execute any work is not shown or specified, or is indefinite under the plans and specifications, the contractor herein agrees that the contract shall be construed to call for the best materials in every case rather than the poorest. Where the positions of pipes and fixtures are shown by the plans these positions shall be considered approximate �8 and may be varied in order to attain the best results; and no claim of extra or deduction shall be based on such change. The general methods for accomplishing results are either stated in these specifications, or shown on the plans. In each and every case where tne general methods do not fully apply so as to attain the best results, the work must be done under the direction of the Superintendent. All material shall be of the very best in the market of the kind and class called for, and all work shall be executed by skilled mechanics in the very best workman-like manner. All pipes shall be run parallel and perpendicular to the walls, be thoroughly and satisfactorily supported and secured. Offsets, if made, shall be with true curves. All holes in walls must be drilled, and, after the pipe is in position, filled in tight with mortar work, rat proof. All damage or marring of wood work, walls, plaster, paint, varnish, glass, or any other part of the building, must be repaired and made sound and perfect by the contractor. Any man employed by the contractor may be discharged by the Superintendent for incompetency, misconduct, smoking within the building, or carelessness in the use of greasy waste or charcoal furnaces whereby the building may be endangered. The Board of Commissioners and the Superintendent shall have the right to fully examine or test, at any time, by expert or otherwise, any work or material, and for such examinations or tests, the contractor shall furnish all necessary facilities, labor and appliances. Any work, which, at any time before the final release of �9 the bond, shall be found to be imperfect in any respect, shall be at once removed, and perfect work substituted therefor? and rejected material shall be at once removed from the Asylum farm. In every case where a special or a patented article is called for, it shall be held to mean that article, or other equally good to be approved by the Board, and in the case of patents, the contractor must satisfy the Board that he has the right to use the proposed patented improvement. All work either shown on the plans or called for by the specifications, either or both, shall be fully executed, and if the plans and specifications disagree, the option shall be with the Board; and any pipe, valves, fittings, or appliances of any nature, necessary for the full and perfect operation of any portion of the heating or plumbing work, according'^to the intent and scope of the plans and specifications, shall be furnished by the contractor under the contract price, whether the same is specially shown or called for or not. Bidders are expected to verify and fully examine the various places and positions in which work is to be done' and will be supposed to know all the difficulties to be surmounted in the execution of the work. Work shall be commenced as soon as is possible, prosecuted with vigor and all be fully completed not later than October 1st, 1885. PAYMENTS. Payments will be made monthly, about the first of each month, to include all materials delivered and accepted and all labor satisfactorily completed during the preceding month, reserving twenty-five per cent of each estimate until the final �10 and satisfactory completion of all work called for by the plans and specifications and its acceptance by the Board. Payments will be based on the schedule prices furnished by the contractor, and the contractor shall not be entitled to payment for any material or labor for which a price is not named in the schedule until the final completion of the work. Quantities shall be determined by the Superintendent, based upon the actual amount of material delivered, and labor fully completed since the preceding payment. In case the amount of material named in the schedule is insufficient to complete the work, the contractor shall make such deficiency good without payment at the time, and in any case without payment in excess of the contract price. There shall be no extra payments for furnishing all materials and labor required to thoroughly and completely accomplish all designed to be covered by these specifications, i. e. no claim for extras will be considered, based on the quality of materials furnished, or the manner or method taken to execute any work, or for any work or materials required to fully accomplish and perfect all parts of the work called for under the contract. The Board shall have the right to add materials and labor, when not called for by the plans and specifications, at the prices named therefor in the schedule, or to omit any portion of the work at schedule rates, and any change thus made shall not invalidate in any degree the contract or bond. �11 Specifications for Heating Apparatus. THE BOILERS. The boiiers, viz: two tubular boilers for power, each sixteen feet long, and six feet diameter, and two fire box, drop, return-flue boilers for heating, each twenty-six feet and four inches long and eight feet diameter, will be furnished to the contractor, delivered on board cars at the Traverse City station. The contracLor will move, place and connect the boilers, taking all responsibility of damage to the boilers by accident or otherwise. The necessary nozzles will be furnished, riveted in place, but the flanges not drilled. The domes of the power boilers wiU be furnished, riveted to the twelve-inch connecting nozzles, but the nozzles not riveted to the shell. The necessary holes will be drilled and the rivets furnished, and the contractor will rivet the domes to the shell after the boilers are in place. Grate bars for the heating boilers only will be furnished by the Asylum. The contractor will furnish all labor and material not excepted above for setting the boilers, or necessary for their full and pei'fect opei'ation for all intended uses. �12 SUPPORTING HEATING BOILERS. Under the saddles which support the boilers, prepare a bed of concrete, six inches thick, made of coarse screened gravel three parts, coarse sand two parts, and fresh Milwaukee or other approved cement one part. On each bed of concrete place a dimension stone six inches thick, two feet wide, and six feet long, the exposed surfaces dressed and the margins tooled. On each dimension stone, bed in fine mortar a cast iron plate one inch thick, sixteen inches wide, and forty-two inches long, the top surface made a smooth plane. Support each boiler, bedded in putty, on five cast iron saddles, as shown, the top and bottom plates, ribs and webs to be not less than one inch thickness of metal, the bottom of the lower web made a smooth plane, and between each saddle and the iron plate below, place four steel rollers, one and one half inches in diameter, the leugth of the saddle. FOUNDATIONS FOR POWER BOILERS. Build foundations, as shown, of coursed, flat bedded rubble masonry, laid in the best manner in mortar composed of one half fresh, approved water lime, and one half quick lime, with the proper proportion of sand. BRICK WORK OF POWER BOILERS. Lay all exterior or exposed surfaces with best pressed brick, with tooled joint, as in front of Asylum building. Lay all flame exposed surfaces with one course of best Jackson or U. S. Fire Clay Co. fire brick at the option of the Board, with heading courses, all laid tight in finely pulverized �13 fire clay, all as shown or directed, using arch and special brick where necessary. Furnish for the piers forming the bridge wall, solid pieces made of fire clay of the dimensions and form shown in the drawings, and set these together with tight joints. Lay all other brick work in best selected sound common brick, in quick lime mortar, laid with air spaces as shown or directed. Pave ash-pits with brick on edge, bedded in rich concrete, and grouted with cement mortar to make the pits water tight. Furnish and place a coping of sand stone, rubbed smooth, for power boiler exterior walls, one foot and eight inches wide and six inches thick. Build the lower portion of smoke flues for heating boilers of rubble stone, and brick work above, all as before specified and shown. COVERING HEATING BOILERS. Cover the shells with pure asbestos paper, three thicknesses one thirty-second of an inch each; then two layers of one half inch best hair felt, separated by thick manila paper, and outside of all, heavy Russia sheet iron, made smooth and neat in every particular. Put the covering on each boiler in six rings, in sections to admit of removal in parts, and band the joining of the sections and the ends of the boilers with finished brass bands three inches by one-sixteentli inch, arranged with screws to draw each band tight into position. Finish the covering at the front with cast iron moulding, resting on and fastened to the boiler. At the rear of boilers turn the Eussia iron down on to the shell. �14 COVERING THE POWER BOILERS. Similarly cover the domes or drums of the power boilers. Cover the tops of the power boilers with three thicknesses of one-eighth inch pure asbestos paper built into the side brick walls four inches, then fill in to four inches above the top of the boilers with wood ashes, on top of which place a two-inch coating of pipe-covering cement. Build into the side walls two-inch pine plank above the covering, sufficient for walks to reach all valves, manholes, etc. SUPPORTING POWER BOILERS. For each boiler lug, furnish and build within the wall, in accurate line and level, a cast iron standard frame four feet long, and one inch thickness of metal. Face the upper surface of the standard, and between this faced surface and the lug, place a roller carriage, made of three steel rollers one and one-quarter inches in diameter, connected to act as one, all as per drawings therefor. BOILER FRONTS. Furnish a d place fronts, for the power boilers, a design for which is shown, and the dimensions of which must be followed, but some other design, if satisfactory to the Superintendent may be substituted therefor. The seatings of the fire and ash-doors must be tight, and the doors must be provided with proper baffle plates and registers. GRATE BARS. Furnish for the power boilers Page's or Hall's shaking grate bars, at the option of the Board, in six feet lengths, arranged complete. �15 OTHER IRON WORK FOR POWER BOILERS. Furnish for each boiler a dead plate, bearer bars, arch and check plates, rods for anchoring the front, all necessary bolts, etc., also back arch frames to support the brick covering arch at rear of the boilers. Rivet to^the rear of each boiler an angle iron to support the ends of the ribs and between the ribs and the angle iron place a round steel roller one and one-quarter inch in diameter. Also for each power and heating boiler furnish an ash door, about sixteen inches by twenty inches, made heavy in two thicknesses, the outer thickness to fit tightly the planed surfaces of a frame set into the wall. BOILER TRIMMINGS. Supply each boiler with one water gauge, the gauge barrel to be ornamental, hexagon, finished brass, twenty-eight inches long, connected top and bottom with boiler with one and one quarter inch brass heavy pipe, and having three threequarter inch compression gauge-cocks with wood handles and stuffing boxes, and three-quarter inch brass pipe and cock from bottom to ash pit for blowing off. Also furnish a threequarter inch Scotch glass tube eighteen inches long, with top and bottom valves and boUom waste. Furnish for each power boiler a Crosby improved, or other approved steam gauge, having brass case and ring, nickel-plated ten-inch dial, one inch brass connections, registering two hundred pounds and connected with a syphon. For the heating boilers furnish and connect gauges as above, but for low pressure, to register ten pounds in quarter pounds. �16 Furnish for each power boiler an improved five-inch Case and Bailey safety valve, and for heating boilers each a fiveinch safety valve, as above, all brass mounted and gun metal seats. SMOKE FLUES. Make the smoke flues in sizes and positions as shown by dotted lines on the drawings of number sixteen iron, thoroughly riveted and made tight, let into the brick joints four inches, lapping on to boilers six inches, and made tight to boilers and boiler fronts. Support the round flue with one and one-half inch pipe rests from the central boiler wall, and the square flue with three-quarter inch pipe brackets let into the wall of the boiler room. Arrange a heavy and substantial damper for each boiler, in positions as shown, so as to be operated by rods, sheaves and brass pull from the front of the boilers. HEATING BOILER CONNECTIONS. Supply steam from each boiler to the drum of the steam main, through eight-inch wrought pipe with angle valve. Connect the two boilers at top with six inch wrought pipe, and in the connection put a straight way six inch valve. Return condensed water to each boiler from five-inch return main through four-inch wrought pipe with angle valve. Feed through one and one-half inch pipe with one and one quarter inch branches with valve to each boiler into the four inch return pipe between the return valve and the boiler, and put in Crane's improved check valves. �17 Blow off from extreme end of return main through two and one-half inch galvanized pipe with cock, the pipe continued outside the boiler room wall to the sewer. POWER BOILER CONNECTIONS. Feed through one and one-half inch pipe along front of the boilers with one and one-quarter inch connections and valves into the boilers, and put in Crane's improved check valves. This feed may be a continuation of the feed pipe of the heating boilers, and it is to be extended beyond the power boilers with stop cock to the connection with the sewer, to be used for a surface blow off. Blow off through two-inch extra strong pipe, connected with stop cock into bottom of boiler at front, and carried to the sewer connection. All pipe, valves and fittings exposed to view along front of the boilers will be of best finished seamless-drawn brass. Connect with five-inch pipe and angle valves, the drums on the boilers with a common steam drum of eight-inch wrought pipe, extending over both boilers, and from this drum supply steam through pipe of proper size branching to the engines, which will aggregate about one hundred horse power, to the steam fire pump two and one-half inch, to the deep well pump, so far as the outside of the boiler room, two and one half inch, to the boiler feed pump, one inch, to the laundry, three inch, so far as the inside of the laundry room, to the hot water heaters two inch, and to the kitchen one and one-quarter inch so far as the inside of the kitchen room. The sizes above given are to be considered approximate, as portions of the work are not yet determined, and may be varied to meet the requirements of the work as it progresses. �18 BOILER PUMP. Furnish and place a No. 4 Knowles heavy pressure pump for hot water, bolted to foundation stone slab six inches thick, of proper length and breadth, bush hammered surfaces and margin drove edges, this stone resting on substantial rubble stone foundation built as directed. Connect this pump, in steam to high pressure steam pipe, with one-inch pipe, in exhaust with one and one quarter inch pipe to the common exhaust leading to the hot water boilers, in suction with the soft water cistern with two inch pipe, with the discharge pipe from hot water boilers with one and one half inch pipe, and with the hot water condense tank with twoinch pipe, and in delivering to the boilers as before specified with one and one-half inch pipe. Furnish for the foregoing connectious all the necessary valves, throughway where angle valves cannot be used, for full operation including strainer and foot valve placed within one foot of the bottom of the soft water cistern. CONDENSED WATER TANK. Furnish a tank three feet in diameter, and six feet ex- . treme length, heads braced to stand seventy pounds cold water pressure, at which pressure the tank shall be tight, made of one quarter inch 0. H. number one boiler plate, heads five-sixteenths inch flange plate, and furnished with one-inch Scotch water gauge two feet, six inches long, with guards and with upper and lower one and one-quarter inch valves with blow off cock. Support the tank on iron saddles resting on three-inch stone flag placed within a niche in the boiler-room wall above �19 the level of the boiler pump, the niche to be cut out and lined with brick so as to be substantial and neat in appearance. Provide inlet one and one-quarter inch at bottom of tank with steam trap, Walworths number Two, and branch the inlet to reach the kitchen with one-inch pipe, the laundry coils with one and one-quarter inch pipe, and the hot water boilers with one and one-quarter inch pipe, and in each branch put in either an angle or a gate valve. Also connect the inlet pipe on the tank side of the steam trap with the return main on the sewer side of the five-inch gate valve, with one-inch pipe and valve, so as to either fill the tank from the main, or blow off through the main. In like manner connect with the hot water boilers with one and one-quarter inch pipe for service when exhaust steam is used in the hot-water boilers, all valves to be either angle or gate valves. Also connect the tank with the boiler pump as before specified, and put in one-inch vapor and air pipe with valves extending to the open air. THE STEAM MAINS. Make the steam mains throughout of wrought iron, perfect pipe, of sizes and in positions as marked on the plans. The twelve-inch main will start at the boiler room from the center of a twelve-inch wrought iron steam drum, having blank flanges at the ends, and extending over both heating boilers. Within the plenums, in a few places, the mains will cut through or above brick arches, which cutting is not indicated on the plans. Put an angle valve in each nine-inch main branch leading from the basement of the administration building to each wing. �20 Pitch the mains in the direction of the flow of the steam, not less than three inches per hundred feet. Carry the mains as near the ceiling as possible, raising by special fittings to a higher level, whenever the down pitch makes it desirable. Take all branches from T's looking up, and. no branch except from an appropriate fitting. To reduce the number of fittings on pipe six inches and larger, branches not exceeding six in number, where near together, may be taken from a single T, through appropriate sized pipe, providing that in this case, as in all others, expansion and contraction be amply provided for by return bends, swing joints, or other appropriate method, all to be subject to approval. At two points in the length of the twelve-inch main, at each reduction of size of the mains, and at each change of direction, if directed, drip the steam mains by bottom outlets to the return mains, using one and one-quarter inch pipe for mains five inches and larger, and one-inch pipe for mains smaller than five inches. Also continue the end of each main full size into the return main. SUPPORTING STEAM MAINS. Support the twelve-inch main and drum in the boiler room, from single standard of four-inch wrought iron pipe, the upper end screwed into a cast iron saddle with convex upper surface, and the lower end screwed into a cast iron plate with convex bearing surface to provide for expansion in the main. Support the lower plate from dimension stone two feet six inches by two feet six inches by six inches, on six inches of concrete. Tie the ends of drum to vertical steam main by using three-quarter inch rods with turn-buckles for adjustment. �21 Truss the steam main between the shop and chapel buildings, using two one and one-quarter inch rods, having turnbuckles for adjustment, and collars at the ends securely clasping the main. Screw the two center struts into a cast iron saddle supporting the main, and into a cast plate with grooves on the under side to receive the rods. Similarly truss the main in crossing the engine room. Where the steam main crosses the walls of the shop building, and the outside wall of the chapel building, bed in putty on top of a stone the width of the wall, two feet long and five inches thick, a cast iron plate twelve inches by twelve inches by one inch, and place a cast iron concave roller between each plate and the main. At all other crossing of walls by the twelve inch main use similar rollers and iron plates, the latter bedded in mortar on the brick work of the wall. Through the chapel building, the main will be sufficiently supported by the walls as above. Through the connecting corridor, at,d within the base" rnents, for all mains larger than five inches, use wrought iron adjustable hangers with concave cast iron rollers to slide on their axles sufficiently to provide for movement perpendicular to the main. Support the adjustable bolt of the hanger from a cast iron knee bolted to the side of the joist, one every eight feet for twelve-inch pipe, every ten feet for ten-inch and nineinch pipe, and every twelve feet for pipe less than nine inches. All steam mains five inches and under, and all other steam connecting pipe for both direct and indirect radiation, may be supported every twelve feet, with adjustable pipe hangers screwed into the joists, or with looped, bright chain made adjustable, or by special device where necessary for expansion and contraction. �22 THE RETURN MAINS. The sizes and positions of the return mains are shown on the plan s. They will be laid in exact grade, pitching toward the boilers only sufficiently to empty the pipes if desired. SUPPORTING THE RETURN MAINS. Hang all return mains, except the five-inch, from the pipe brackets on which the indirect radiators rest, by means of bright chain of appropriate size, made adjustable in its connection with the radiator bracket, or use pipe hangers. Where the distance between the stacks of radiators exceeds twelve feet, the mains can be similarly suspended from the same height from one-half inch pipe, bent to a right angle, one end sulphured into drilled holes in the wall, aud the other having a foot plate resting on the concrete floor. Support the five-inch main every ten feet through the pipe duct, on three-quarter inch pipe bent to a right angle, let into the wall and resting on the floor as above, running the horizontal portion of the pipe through a cast iron concave roller on which the return main will rest. Within the boiler room, support the main on one-inch pipe rollers laid on the flagging floor. At the entrance to the boiler room, put a throughway valve in the main, and continue the main full size under both boilers. INDIRECT RADIATION. Furnish, place, and connect for indirect radiation, cast iron, extended surface, pin radiators of the Gold patent, center, planed surface connections and couple-bolted, all in strict accordance with the sizes, places, and square feet of radiating �23 surface marked on the plans, the surface to be counted at eight and one-half square feet of surface per section. A sample section can be seen at the asylum, and in weight, strength, finish, number and length of the pins, this section will be made the standard. Join the sections together with paper gaskets, using a thin mixture of red lead and oil. Supply each stack of radiators with the Davis, finished, automatic air valve properly connected and placed in accessible position. Support each stack of radiators at uniform height on two three-quarter inch pipe brackets, each bracket made of one piece of pipe neatly bent to an uniform angle of sixty degrees, the ends let into drilled holes in the wall, not less than eight inches deep, and sulphured in. So far as practicable, the different stacks of radiators in tbe same line will be brought out to an uniform distance from the wall, the space between the back of the smaller stacks and the wall being filled in with galvanized iron laid on the brackets. ENCLOSING THE RADIATORS. To enclose the radiators use best twenty-ounce duck, hung from the plenum ceiling, as per detail, extending six inches below the bottom of the radiators, and painted on the radiator side with one heavy coat of silicate paint. The duck will be tacked to a dressed pine strip, three and one-half inches by seven-eighths inch, the strip nailed to two-inch by one-inch strips in turn nailed through the plastering to the ceiling joists. At the angle between the three and one-half inch strip and tbe ceiling, use one-inch fillet, and cover the duck where �24 tacked, with one and one-quarter inch moulding. The duck, similarly, will be tacked to vertical strips nailed to the brick wall, and made air tight, the joint and tacking hidden by fillet as above. Make the curtain in two pieces with neatly sewed vertical joint at one exterior corner, and turn wide hem at the bottom. Keep the duck from coming in contact with the radiators by using wire screen guard of number fourteen wire, two-inch rnesh, eight inches wide, extending from wall to wall along the ends and front of the radiators. A piece of duck as a standard can be seen at the office of the Superintendent. Paint with silicate paint, two coats, the plastered ceiling above the radiators. Where connecting pipes and air valve pipes pass through the duck, cut away to give a margin of one inch around the pipe, and neatly and sufficiently rivet to the <iuck a collar of heavy spun tin or galvanized iron, with hole in the center the diameter of the entering pipe. All the foregoing enclosing and placing of radiators must be done in general as shown and specified, but in detail as directed, so as to make a substantial, neat and workmanlike appearance. Paint neatly on the duck the story and hall heated by the enclosed stack. The radiation shown on the kitchen floor of the chapel building and in the basement of the administration building, will be indirect, as before specified, supported as in the plenums, with the top of the radiator one foot below the ceiling. Enclose each of the foregoing stacks with number twenty-six refined, galvanized iron, extending from eight inches below the ceiling to within ten inches of the floor, riveted and �25 made tight, the iron receding from the face of the radiator at its lower front edge at an angle of forty-five degrees to within six inches of the wall, from which point it will drop vertically to within ten inches of the floor, forming there an opening six inches by the length of the radiator for the admission of air. CONNECTIONS TO INDIRECT RADIATORS. The general method is shown, the steam taken from the top of the main and entering the front section, using three elbows and an angle valve for each stack. The return, leaving the rear section and entering the top of the return main, using one elbow and one angle valve. Modifications of this general method may be necessary to meet peculiar situations, or to provide for sufficient expansion and contraction. Generally, also, the sizes of the connections are marked on the plans. Where not so marked, follow the table hereinafter given, or in special cases with long connecting pipes, make the sizes as directed. AIR SUPPLY. Construct boxes of number twenty-six, refined, galvanized iron, riveted and made tight for suDplying fresh air to the plenums, wherever such are marked on the plans. These boxes will start with the area of the outside window, which will be hinged at the bottom, so as to either close the window, or form part of the boxing, and the boxes will take the sizes at the ceiling and beyond as marked. Control the entering air supply at the inside of the plen. um wall with wooden slide doors. All brick work must be cut and repaired by the contractor. �'26 TIN AiR FLUES. Nine flues leading from the basement of the administration building to rear rooms, will require each a tin hot air flue, each twelve inches by twelve inches, and not more than four feet long, to cross the closets near the ceiling at the rear of the rooms; the tin to be X bright tin. DIRECT RADIATION. Furnish and place for the shop building, for the chapel building, except the kitchen story, for the fourth story of the administration building, and for the bath rooms where required by the plans, cast iron, vertical loop, direct radiators, made by the Detroit Steam Kadiator Co., all in accordance with the distribution and amounts of heating surface shown by the plans, each loop thirty-six inches in height to be counted as four square feet of heating surface. Furnish with the radiators for the fourth story, and the bath rooms open, iron, ornamental tops, bolting the tops to the radiators, and securely fastening the radiators to the walls in the bath rooms of the wards. The shop and chapel radiators will be without tops. For the chapel room, use the Walworth, vertical, fourpipe radiator, with open base and ornamental top, in sizes and positions as marked. Enclose these radiators at the ends, and for six inches from the ends along the front, from the floor to the top of the radiator, with Russia sheet iron, made tight to the wainscot ing with nickel, large headed screws, and held to each radiator at top and bottom with one and one-quarter inch brass band, passing from wall to wall over the front and ends of the radiator. Also cover over the space between the back of each ra- �27 diator and its top with Russia iron, and cover the wainscoting at the back of the radiators with bright tin. For each chapel room radiator, cut through the outside wall just above the shoe of the wainscoting, and put in galvanized iron flues twelve inches by eight inches, turned to form an opening twelve inches by six inches, looking down on the outside of the wall. At the interior opening of each flue, place a tightly fitting register with valves, arranged with rod and nickel plated cap, to be opened from the chapel room above the radiators. Furnish for each direct radiator an all-brass, nickel-plated, wood-handled radiator air valve. Also, furnish for each radiator a steam and return angle valve of the size required by the connecting pipe. STEAM DISTRIBUTION. So far as is practicable, the sizes and positions of risers and branches are marked on the plans. Where not so marked, follow the general scdle hereinafter given, except that for a long single connection, the pipe may be increased one size at the option of the Superintendent For all except the first story of the shops and the bath rooms, the distribution is generally on the ceiling below the radiators to be supplied. Dotted lines on the first story of the shop and chapel buildings, indicate that the return pipes are carried below the flagging or other floor. For this purpose prepare a trench in concrete of suitable size, and re-cover so as to give ready access to the pipe. Drip each steam riser at its foot with three-quarter inch pipe for one and one-quarter inch riser, and one-inch pipe for �28 risers larger than one and one-quarter inches, and carry the drip into the return main, or into the return riser below the water-line of the boiler, except that a short connection supplying a single radiator need not be dripped. For all steam and return pipes, risers, and mains, which pass through ceilings, floors, or stud partitions, use Wall worth's fire-proof floor packing, having frame, ceiling, and floor plates, and asbestos packing complete. Off-sets may be made by bending the pipe, but the bending must be done uniformly or symmetrically in both directions so as to present a neat appearance. AIR CURTAINS. After the pipes are all in place and covered, make a tight partition in the pipe duct on the boiler room side at the point where the duct enters the air tower, by using for the partition two thicknesses of twenty-ounce duck, painted each thickness with one coat of silicate paint, the pipes passing through the curtain partition, which will be made tight around each pipe by flanging out the holes in the curtain, and using a gathering string, so as to allow travel in the pipes. At the entrance from the fan tower to each air duct, hang on rollers, curtains of twenty-ounce duck, unpainted, having a three-inch round stick in the bottom of each curtain, and arranged with pulleys and cords for raising and lowering, all to be neat and workmanlike and to serve the intended purpose. VALVES. For all angle valves, use the Jenkins patent disc throughout, and in each case where an angle valve cannot be properly placed, use Ludlow's best, throughway, single-gate valve. �Valves two and one-half inches and above are to be iron bodies, brass mounted, with gun metal seats, and swivel discs. Valves two inches and under to be of gun metal. As a standard the Walworth best valves are named. The five, six, and eight-inch valves in the boiler room to have finished flanges to be provided with yokes, and to be in all respects subject to approval. The direct radiator valves, and the indirect radiator valves of the administration building, basement and kitchen to have rough bodies, nickel plated and rosewood handles. All valves in the boiler and engine rooms two inches and under, will have rough bodies, nickel-plated and wood handles. GENERAL PROVISIONS. In all piping, both horizontal and vertical, the evil effect of expansion and contraction must be sufficiently guarded against by methods satisfactory to the Superintendent. All pipes and mains except risers must drip in the direction of the flow of the steam or water, be placed in exact line, and to an uniform grade, and with equal bearing on the supports. No steam or return pipe must in any case corne in contact with wood, or vegetable fibre of any kind. All pipe unless excepted will be of best and perfect, standard wrought iron, the size named by its internal diameter, pipe one and one-half inch and larger lap-welded, one and one-quarter inch and below butt-welded. All fittings to be best, heavy cast iron of good finish, the threads clean cut, tapering and uniform, and heavily beaded. As a standard the Walworth fittings are named. Black all radiators and connecting branches, risers, etc., the boiler fronts, and all other pipes not to be covered, with �30 black baking Japan varnish, and in addition, ornament the radiators of the chapel room with gold bronze in approved designs, all to be done after the work is in place. No rubber packing will be used For flanged joints use Sander's metalic, corrugated packing. Use flanged unions wherever the necessities of the work require. The whole heating system must be constructed so as to work noiselessly, without snapping or concussion in the pipes. Test the whole system for tightness and expansion with thirty pounds of steam pressure maintained at the boilers, each valve to be tested separately for tightness. Follow primarily the sizes of pipe as marked. When not marked the following tables will be the guide. To supply 40 square feet of surface or less, 1 inch pipe. 62 do do do do 1J 92 do do do H do do do do 2 do do 170 272 do do OX do do 424 do do 3 do do do do 637 928 do do do 1215 1630 do do do 31 4 41 do do do do 2650 do 4077 do do do do do do do do 6016 8586 11920 16166 21500 do do do do do do do do do do do do 2 5 6 7 8 9 10 11 12 do do do do do do do do do do �31 To d r a i n 40 square feet of surface or less, f inch pipe. do 77 do do 1 do do do 127 do do 1* do 222 do do do 1* do 494 do do 2 do do 981 do do do 2* do 1875 do do 3 do do 3176 do do do 3* do 5850 do do 4 do do 12485 do do do 41 do 21500 do do 5 do Plumbing Specifications. COLD WATER TANKS. Furnish and place with all connections, valves, etc., complete, four tanks in the attics of wings, in accordance with the plans, each tank twelve feet in diameter, and nine feet six inches high, made with flanged bottom and top, and vertical seams on sides, of steel tank plate, one-eighth of an inch full thickness, riveted with three-eighths inch rivets, one and onequarter inches from centers, tightly calked, and made perfectly tight when overflowing, the tanks all placed on exactly the same level. Also in closet of fourth story of administration building, place a tank as per the foregoing specifications, but four feet diameter, and nine feet six inches high. �32 Overflow each tank through three-inch wrought iron pipes passing through the roof, having elbow above and close to the roof, and short piece of pipe beyond the elbow looking down the roof, and provided at the end with a wire screen guard. Above the roof fit the overflow pipe with a galvanized collar, running up the pipe under the elbow, and worked into the slating to insure tightness. Provide for each tank a three-inch inlet, four inches above the bottom of tank, with valve, and beyond this valve join fire service two and one-half inch pipe to the inlet pipe. From the bottom of each tank take with valve one inch waste pipe, discharging into the gutter at the eaves. Provide each service pipe, the sizes of which are marked, with a valve and a suitable copper strainer. Make all inlets aud outlets through cast iron saddles riveted on. Make a manhole fifteen inches by eighteen inches into top of each tank, with cast iron saddle, riveted to the tank, the seating surfaces of the saddle and cover to be planed, and the cover firmly secured with bolts and nuts. Support the ward tanks from the walls now built for that purpose, each on seven, seven-inch, wrought iron rolled beams, each fourteen feet long, the ends resting on four-inch by sixteen-inch solid oak planks bedded in mortar the full length of the brick work forming the tank foundation. Similarly support the tank in administration building, on three five-inch beams, each six feet long. On the floor under each tank, place a drip pan of number twenty, best, refined, galvanized iron, riveted, soldered, and made tight, with the sides turned up six inches, so as to receive all the condensed moisture from the tank; and from �33 the drip pan carry one-inch lead waste pipe, delivering with twelve-inch water seal into the nearest pipe shaft or gutter. Paint the tanks inside and out, the drip pans both sides and the beams, each with two heavy coats of iron clad, mineral paint. Arrange two wooden signal dials, to indicate the depth of water in the tanks, operated by the means of wire cord passing over pulleys down through the overflow pipe, or stand pipe to wooden floats within the tanks, the dials to be seen at points outside the building as directed, one each side of the administration building. SINKS. Furnish, place and connect, as shown by the plans, best cast iron, painted sinks, without backs, supported on brackets and having an opening made through the top of the rim to the patent overflow, so that the overflow passage can be cleaned out. No wood work of any description will be required, except that necessary to bring the brackets out, so as to leave an open space between the sinks and the wall. The numbers and sizes are as follows: '25 sinks, 2 feet 6 inches by 20 inches by 6 inches 2 " 2 " 0 " " 18 " " 6 " 3 •• 5 •' 0 " ' " 28 " " 10 " 1 » 3 " 0 " " 22 " " 7 " SLOP SINKS. Furnish and put up with all connections complete sixteen best, cast-iron, painted slop sinks, one for each bath room of the wards except two, furnished with strainer and outlet one and one-half inches, supported on sink brackets clear of the wall. �34 BATH TUBS. Furnish and place complete for the bath rooms of the wards, eighteen cast-iron, best and perfect, painted, sixty-six inch bath tubs, and for the bath rooms of the chapel building, two bath tubs as above, each tapped with bottom inlets for three-quarters inch pipe, and connected for one and onehalf inch waste. Tap through the rims over the patent overflows, to make openings the full size of the overflow for cleaning out. Furnish, place and connect for the bath rooms of the administration building, two of Mott's porcelain-lined, sixtv-six inch, French, bath tubs, with supply fixtures and McFarland's waste and overflow, and hard wood rims, all complete as per plate 20 D of Mott's 1884 sheet. WASH BOWLS. Furnish, place and connect for all the lavatories of the wards, as shown, cast iron, enameled, sectional, slabs and bowls complete, as per Mott's plate 96, with brackets built into the wall, brackets drilled for six screws each, the backs of the sinks secured to the wall, and all made very firm and secure. There are eighteen lavatories which will require sixteen double sections, and two single sections, the single bowls to go in the corners if required. Furnish as above single wash bowls, two for the general kitchen floor, and three for the shop building, located as shown. Furnish, place and connect, for the administration building, as shown, Mott's best, oval, English, marbled, earthenware washbowls, with Italian marble, countersunk and �35 moulded tops, two feet four inches by one foot eight inches by one and one-quarter inches, and Italian marble, moulded backs eight inches high, and seven-eighths of an inch thick, the backs secured with large headed, nickel plated screws, and the bowls ground to the slabs to make a watertight joint, and secured by set screws through metai lugs on the bowls. Support the stands on wood legs with four-inch, moulded and beaded wood rim under the edge of the slabs, the woodwork black walnut, perfect and highly finished. Furnish for each bowl, best rubber stopper and chain, the chain extra heavy for the wards. WATER CLOSETS. For the wards furnish, place and connect, complete in every respect, forty-two of Mott's straight back, iron, enameled, flushing rim hoppers, page-39-B., having two and onequarter inch outlets, and furnished with wooden rim, selfraising seats, with chain, weights etc., page 78-B., all located as shown by the plans. With each hopper use Mott's No. 11, after-wash cistern, except that the cistern must be made of wood, dovetailed at corners, lined throughout with four-pound lead, the lead not strained or thinned at the corners. Connect cisterns with the hoppers with one and one-quarter inch lead pipe, and put one half inch valve in each supply pipe for shutting off. Make the lever extra long to allow the weight and the chain and pulley connection between the hoppers and cisterns, to pass either back of the brick wall, or inside a painted and finished boxing on the wall, so that the chain and weight shall be inaccessible. �36 Bolt each hopper securely to a short, flanged, floor connection, made of cast iron, and connecting with the soil pipe with calked, lead joints. Furnish for the shop and chapel buildings four of Mott's short, flushing rim, best, English, earthenware, ventilated hoppers, and ventilated, earthenware traps, with enameled slop safe and hard-wood seat, all complete, as per plate 80B., except that the cistern shall be wood, lead lined, with .lead one and one-quarter inch connections, all as specified for the wards. Make the connection between the trap and the soil pipe as specified for the ward hoppers. Furnish for the administration building, five of Mott's plate 90-B. Inodora. best, English, all earthenware water-closets, with seat and trap ventilation, brass couplings, and percelain slop safes, and flanged floor connections, which may be either brass or iron, bolted to the flange of the closets. Furnish with each closet as above a No. 10 ready supply cistern with lead one and one-quarter inch service pipe and lead one-half inch supply pipe with valves, all as shown by the plate before named, except that the cisterns shall be wood, lead lined as before specified. Or, at the option of the Board, furnish for the administration building Waring's Dececo, all earthenware closets, to be operated by the MeyerSniffen Co. Em Ess cisterns, otherwise as before specified. Furnish for each closet of the administration building, sn ornamental, heavy, black walnut, finished and moulded, hinged seat, without cover, resting on approved legs and frame. In general, the wood-work of the cisterns, seats, etc., must be highly finished, and all lead pipes, or brackets of cisterns �37 must be securely fastened to hard wood, moulded, wide strips, black walnut for the administration building, ash elsewhere, secured to the walls, and in the wards the cisterns must be placed near the ceiling. URINALS. For the wards, use as required by the plans, fourteen iron, enameled, lipped urinals, flat or corner, with ventilating hood, flushing rim, brass fan, three-fourths inch supply, and one-inch waste couplings complete. For the administration, shop and chapel buildings, use, as required by the plans, six Armstrong's, best, English, earthenware, small, lipped, automatic, syphoning urinals, corner or flat, as necessitated by the position ; or, at the option of the Board, use as above any wash-out, hooded and ventilated urinal called for. For each urinal throughout, use the Kelly tank and stop and waste cock complete, the cock nickel plated, with lead or galvanized iron three-fourths inch connections, arranged with large platform neatly set in the floor, connected in best manner to fill and discharge the tank. In ihe wards conceal the operating chain and cock back of the wall, or in boxing on the wall, and throughout cover the platforms with four-pound sheet lead, beaten neatly over moulded strips on the outside upper surface of the platforms. For wood backing of brackets, lead pipes, etc., apply the provisions relating to water closets. FAUCETS, COCKS, ETC. All urinal and water closet cistern supplies to be shut off with brass cocks, nickel plated. �38 Furnish all sinks, slop sinks and wash bowls, with Zane's self-closing faucets, plain, five-eighth inch for hot and cold water for the sinks and slop sinks, except that the third and fourth story and kitchen sink and slop sink faucets will be three-quarter inch, and for the wash bowls, nickel plated, one-half inch throughout, in cold water only for the ward bowls, in both hot and cold water elsewhere. Place faucets for hot and cold water in the basement of the connecting corridor for drawing water as shown. Furnish each hot and cold water faucet of first story and basement, with a neat and suitable air chamber. Use for painted bath-tub inlets, throughout, the Fuller three-quarter inch cock, in straight run of iron or lead pipe for hot and cold water, and for the wards provide each inlet with lock shield and socket key. COLD WATER DISTRIBUTION. Except for the chapel and shop buildings, the cold water supply will be distributed from the tanks with valve in iron pipes, the sizes of which are marked generally through the attics. The branches will reach the sinks three-quarters inch, the slop sinks three-quarters inch, the wash bowls one-half inch, the water closets and urinals as before specified or required by the cisterns, the bath tubs three-quarters inch, except for the third story one inch. In every case not marked or specified, the pipe must be put in as directed, proportioned amply in size in accordance with the size last shown, and the sizes at the fixtures. The lavatories and sinks of the wards will be supplied with down pipes from the attics, outside the walls, the down- �39 falls one and one-quarter inches for third story, one inch for second story, and three-quarters inch for first story. The bath, water closet, slop sink and urinal supplies for the wards will pass down the pipe shafts, one and one-half inches for third story, one and one-quarter inches for second story, and one inch for first story, except for the pipe shafts in divisions A. and No. 1., in which the pipes shall be increased one size for each story. Make the sink downfalls of the administration building one and one-quarter inches for the fourth and third stories, one inch for the second and first stories, and three-quarters inch after last branching in the basement. Make the bath room downfall in the pipe shaft of the administration building as above, but three-quarters inch for the first story. Make the water closet downfall within the pipe shaft of administration building, one inch for fourth, third and second stories, three-quarters inch for first story, and continued three-quarters inch to dispensary. Take from the water main in the duct a two inch branch with valve, as hereinafter described, and from this branch, which must be carried full size to the inside of the laundry room, supply the bowls, hoppers, urinals and hot water boilers of the shops in sizes as directed. Also take from the water main in the pipe duct as above, with valve, a branch one and one-half inches for supplying the general kitchen floor, branching to baths, hoppers, urinal and sinks as shown or directed. COLD WATER MAINS. Make the cold water main, starting outside the foundation wall of boiler room, nearest the deep well, and con. �40 tinued through the pipe duct, branching at center basement, with valves in the branches, to risers which supply thb first wing tanks, of four-inch, cast iron, socket pipe, three-eighths of an inch thick, to weigh not less than one hundred and ninety-eight pounds pel twelve-foot length, hubs included. Beyond the first wing tanks, and for risers to all the tanks, use three-inch, cast iron pipe as above, weighing not less than one hundred and sixty-two pounds per twelve-foot length, with valves at the tanks. Support the pipe through the pipe duct and basement in the manner described for the return steam mains, making the grade the same. Connect at the boiler room, the water main with the fire main, and put a valve in the connection. Take no branchas from the main except a branch to supply the shop building, and a branch to supply the chapel building, both as before specified. These branches, after leaving the pipe duct, will each discharge into the bottom of a length of wrought iron, eight-inch pipe, in vertical position on the walls as marked, to serve as air chambers, and the discharge will be taken from the same blank flange on the bottom of the eight-inch pipe through which the supply enters. F I R E PUMP. Furnish, place and connect complete, except steam supply, best, Knowles' fire pump, in which the following requirements are specially named; steam cylinder eighteen-inch, water cylinder ten-inch, stroke twenty-four inch, suction eight inches, made with the very greatest care, with planed joints, finished flanges, and fine finish throughout. Steam cylinder handsomely lagged with black walnut and brass bands, hammered copper air chamber, bronze bushing in water cylinder, �41 and drawn composition rod, the pump made double cap, and in.every particular very strong. In all points not specially named the pump must follow the requirements of Knowles' fire pumps. Or, at the option of the contractor, furnish the Smith, Vaile & Co- fire pump, ail as above, except the water cylinder to be removable, porcelain-lined, and the water piston rod to be brass covered, and in all other points to follow the requirements as for Knowles' fire pump. Set the pump on a rubble stone foundation, laid in water lime mortar, battered from firm ground up to level of engineroom floor. Above the noor lay two six-inch courses of rockfaced, jointed sand stone, carefully laid, with one and oneball' inch margins at the corners, and cap with two sand or lime stone blocks, one for each cylinder, each six inches thick, with fine bush hammered surfaces and margin-drove edges. The bolts which fasten the pump to the foundation must be securely anchored near the bottom of the foundation, and pass through holes in the cap stone larger than the bolts. Connect the pump with eight-inch, cast iron suction pipe leading, below frost, to the bottom of the soft water cistern, or an equivalent distance at the option of the Board, and put in best, approved foot-valve and strainer. Also connect with the six-inch fire main with valve, and cross connect between the fire main and the four-inch cold water main with valve as before named, so that the deep well pump and the fire pump can work together or singly for either fire or tank service. Also connect with boiler feed pipe with valve to feed boilers in case of necessity. Carry exhaust pipe through roof to the open air. Attach to one outlet of pump a two-way hose connection. �42 FIRE MAINS AND RISERS. From the fire pump carry not less than six-inch, cast iron socket pipe through the pipe duct, supported on pipe brackets as before described, to the basement of the administration building, from which point, branch with four-inch socket pipe through basements, and outside to reach each hydrant as located on the plans. Make the six-inch pipe full five-eights of an inch thick, weighing not less than five hundred and te« pounds per twelve-foot length, and the four-inch pipe one-half inch thick, weighing with the hubs two hundred and seventy-six pounds per twelve-foot length. Where one-eighth curves cannot be used, increase the elbow or T. one size in the sizes smaller than six inches, this to hold good at the joining of the mains with the risers. From the main as before described, take two and onehalf inch, wrought iron continuations to the extremes of the basement as shown, a riser to each of the five, tanks, one riser each in divisions, A., No. 1., F. and No. 6., and two in the chapel building. Connect each tank riser with supply pipe to tank as before described, and close other risers at top with a plug. From each riser to tanks and elsewhere, take connections with two-inch, best, approved hose valves, to each story of the wards, administration and chapel buildings, to the basement of the administration building, and one connection to attic of chapel building, making thirty for the wards, five for the administration building, and seven for the chapel building. Between the upper hose valve and the tank, put in each �43 tank riser a Crane, best, patent check-valve, to prevent discharge into tanks daring fire service. Portions of the mains in the basement shown dotted, must go under the basement floor, encased in one and onehalf inch of Portland cement, surrounded with three inches of good concrete. Dig trenches for pipe outside the building to even grade, and in refilling thoroughly ram and compact the earth. HYDRANTS. Place and connect as shown, seven Geo. C. Morgan's patent hydrants, with jackets, brass valve and seal, to bury four and one-half feet, having two two and one-half inch discharge nozzles each. HOSE. Furnish and connect to the hose valves, two-inch, rubber-lined, three-ply, cotton, Baker fabric, fire hose, with automatic couplings, and twenty-inch brass pipes with cocks. These to be divided between the outlets as directed, an average of sixty feet of hose for each outlet. Furnish, with automatic couplings, four hundred feet of two and one-half inch, four ply, fire hose of the novelty brand, made by the Gutta percha and Rubber Manufacturing Co., or other approved brand, and two brass thirty-inch pipes with swivel handles. WASTE AND VENTILATING PIPES AND TRAPS. Use throughout, unless excepted, best, extra heavy soil pipe and fittings, sound, smooth, of uniform thickness, of a quality that can be readily cut, and to weigh per foot not less than as follows: Two-inch pipe two and one-half �44 pounds, three-inch pipe nine and one-half pounds, four-inch pipe thirteen pounds, five-inch pipe seventeen pounds, and six-inch pipe twenty pounds, all to be asphaltuin coated. All waste pipes will be continued two feet beyond the outside wall, or to the sewer head or grease trap where the waste enters such. To provide against breakage from settlement of the building, leave a clear space between the top of the pipes and the outside walls through which they pass, and a clear space under the pipes next the outside walls, by laying in rough walls of brick. The waste pipes will run without the walls, sink, lavatory and urinal wastes generally falling directly to the basement ceiling before entering the main soil pipe. The main soil pipes and the urinal wastes will generally be located in the pipe shafts, the latter entering the soil pipe near the bottom of the shaft. All waste pipe running horizontally in the basements will be kept above the floor, fastened to the side walls or ceilings, where such position is possible. Waste pipes, which must be placed beneath the basement floor, after having been tested, will be surrounded with one-half inch of Portland cement, then with three inches of good concrete, and t l- e floor left in its original condition. Leave fittings as directed for future connections with kitchen and laundry wastes. The general system adopted is that of trap ventilation, the waste pipes continued up through the roof, and having no traps at the bottoms, the ventilating1 pipes carried through the roof, all with as few bends or angles as possible. Make soil pipes and ventilating pipes of soil-pipes, four inches, the ventilating pipe starting from the bottom of the �45 shaft as shown. Into this four-inch ventilating pipe carry two-inch, trap ventilating pipes from the water-closets; and from the bath tubs, the urinals, the slop sinks, or other fixtures that may be near the soil pipes, carry ventilating pipes as above the full size of the trap used. Make generally other vertical waste and ventilating pipes two inches, and carry from each trap a ventilating connection to the ventilating pipe, the full size of the trap used. Make urinal wastes one-inch, either of lead or galvanized iron. Make outlets and traps from the various fixtures, each and every outlet trapped as near the fixture as possible, in sizes as follow: Water closets of wards, three inches. Other water closets four inches, or by using a reducer may be three inches. Bath tub outlets 1^ inches trap Ijinch. Sink outlets 1£ " " 1J " Slop sink outlets 1^ " " 1J " Wash bowl 1£ " " 1 " Urinal 1 " 1 " The connecting pipe between the fixture and the waste pipe, except for water closets, the trap and the ventilating connections to ventilating pipe, may be of lead extra heavy and strong, the manner of connection to be approved. Each trap must be furnished with a brass trap screw for cleaning out, and every joint between lead and iron pipe must be made by a brass ferrule soldered to the lead and calked into the iron. Each vertical pipe, in addition to its attachment to the walls, must have a positive, permanent, approved support at its foot. �46 Wherever the plans call for ventilating pipe outside the walls, put in four inch, standard, wrought iron pipe, galvanized, painted two coats as for tanks, joined at foot with the underground sewer, and extending through the cornice and ten feet up and along the roof with wire basket at top. Into these ventilating pipes, connect the ventilating branches from traps of sinks and wash bowl in front part of administration basement, from traps of all fixtures in chapel building, the connection in sizes as before specified. Ventilate sinks of special kitchen and wash bowl in steward's room, back to the ventilating pipe in the pantry. Continue soil pipe past water closets in the shops full size up and through the roof, and into these pipes ventilate the traps of closets, urinals and wash bowls, except that the ventilating pipe of wash bowl in boiler room can be carried simply through the outside wall. HOPPER AND HOOD VENTILATION. For every tier of urinals throughout in the wards, put up in the pipe shaft nearest thereto a four-inch, patent, spiral seam, riveted pipe, made from No. Twenty-six, Birmingham wire gauge, galvanized sheet iron, together with the fittings therefor, carried above the roof to the outer air, and connect the urinal hoods thereto with like pipe of the size required by the urinal vent. In each administration building pipe shaft, put a similar four-inch pipe, and similarly connect thereto the ventilating hood of the urinals, and the hopper ventilation of the water closets. The closets and urinals of the shop and chapel buildings will have similar hood and hopper ventilation, but carried in- �47 to a near chimney flue as directed instead of up through the roof. Solder all joints and make the work as tight as possible. HOT WATER BOILERS. Furnish, place and connect, complete in every respect, so as to use one or both with either live or exhaust steam, two boilers for heating water for domestic purposes, located in the engine room. Make the shell ot each four feet in diameter with right angle at the center, seventeen feet iong measured around the exterior angle, and nine feet long measured along the interior angle, of five-sixteeuths inch C. H., No. 1 iron. Make the tube heads aud exterior heads of best flange iron, one-half inch thick, so as to give a steam chamber at each end six inches deep, and put in seven-eighths inch stay bolts, as directed, between the heads, screwed and riveted. Put into each boiler, with four-inch centers each way, twenty-five two-inch best, seamlees, brass tubes, iron pipe size, weighing three and three-quarters pounds per foot, the center tube to be twelve feet long, the tubes to be expanded into the heads, so as to make a shoulder or groove on the inside of the heads, and beaded outside. Near the angle, opposite the horizontal center tube, put a manhole, having heavy cast iron, faced seating riveted to the boiler, and heavy faced cover bolted thereto, aud opposite the center vertical tube, put a hand-hole. Single rivet the boiler throughout with bast quality rivets, in size and spacing standard for the thicknesses of iron used, and neatly, without scarring the boilers, and tightly calk with concave tool �48 On upper and lower heads place a man-hole as before described, and through the center of each take the eight-inch exhaust steam connections, using a flange union, so that the cover can readily be removed. Take all other connections with the boiler through castiron saddles riveted thereto. The boilers must be tested and be tight and perfect at one hundred pounds cold water pressure per square inch, both the water space and the stearn space. Jacket the boilers, complete, in the manner described for the heating boilers. Support each boiler, one end looking up, one foot from the floor, on three neat, heavy, cast iron, approved saddles, having foundations prepared therefor. CONNECTIONS TO THE BOILERS. The connections will be a two and one-half inch feed pipe near the bottom, a three-inch hot water pipe near the top, a one and one-quarter inch condense water pipe leading to condense tank, a two-inch surface blow-off at the top, a two-inch sediment blow-off at the bottom, the blow-offs connected and leading to the sewer, and the entering and leaving exhaust steam connections as before named, each with necessary valves or cocks. Into the exhaust pipes between the valve and the boiler, connect a two-inch live steam pipe with valve. Into the two and one-half inch supply pipe connect as above the return two and one-half inch pipe. Collect the exhausts from the engines, about one hundred horse power, the deep well pump four inches, from the outside of the boiler room, the boiler pump, one and one- �49 quarter inches, all into one eight-inch pipe, branching with valves to the bottom inlet of each boiler, and continued in single pipe from the top of each boiler in eight inch pipe with valves to the twelve-inch steam main. Arrange so that the engines and boiler pump can exhaust to the open air at will. This does not include the exhaust from the deep well pump. On the one and one-quarter inch condense pipe leading to the tank, between the tank and the steam trap, put a vertical glass cylinder three feet long and six inches diameter, with brass, ornamental top and bottom, hell thereto by brass clamp rods. Through this cylinder, both entering and leaving the bottom, take all the condense water from the hot water boilers. Arrange to shut it off, and empty it from onehalf inch pipe in bottom with stop cock. HOT WATER DISTRIBUTION. Supply each sink, slop sink and bath tub throughout, and each wash bowl, except for the wards, with hot water through outlets in sizes as required for like cold water service, and having faucets in size, kind and quality as specified for the accompanying cold water supply. Carry one and one-half-inch branch to inside of laundry room, and leave fittings as directed for general and special kitchen future connections. The hot water mains will start from near top of boiler three and one-half inches, follow the twelve-inch steam main, suspended thereto, to the inside of the chapel building, thence pass direct to, and through the attic of chapel, crossing from the roof of chapel to the administration building, supported in the crossing by rods or struts from the walls �50 as directed, thence branch with valves to the ward attics, and branch to the various fixtures. The trunk ventilating flues in the attics must not be cut, the pipes passing over or around each flue. At every point where a syphoa is formed, either long or short, in which air can collect, a one-half inch air pipe must be carried high above the top of the tanks. Each main branch, except for the shop service, shall be carried into a return pipe in the basements, passing back through the pipe duct two and one-half inch, supported as for steam return pipe, to the cold water inlet as before specified. So far as practicable the sizes of both main, return and branches are marked; in othe^ cases follow directions in accordance with the general scale. GENERAL PROVISIONS. Use throughout, wherever an angle valve cannot be used, the best, Ludlow, single gate, throughway valves, in brass, iron and composition as specified for steam valves. Support and fasten all pipe securely and satisfactorily, with pipe-hooks, or pipe rests to the walls or ceilings, using ceiling and floor flanges, and in the wards hard-wood finished strips on the walls, with neat bands over the pipes fastened thereto. Enlarge the upper length of all soil and ventilating pipe which passes through the roof, and on the extreme end put a wire basket guard. Every precaution must be taken to thoroughly pour full, and calk thoroughly with oakum and pure lead, all socket joints in the very best manner. �51 All lead work must be put up in the very best manner, with wiped joints and cleats, so as to be substantial, straight and neat. No putty joints will be tolerated. All pipes which show within rooms must be neatly blacked. All cast iron pipes must be made from best, soft, grey iron, free from sand holes, of uniform thickness, and to have a bath of coal tar and asphaltum. All traps, valves, etc., must be put in so as to be readily accessible for repairs, work under floors to have a portion of the floor neatly cut out, and fastened with screws. Wherever practicable make all junctures with Y branches, and use one-eighth curves rather than elbows. The waste and ventilating pipe system throughout must be tested, and must be absolutely tight when full of water, from the lowest outlet to the highest outlet. Test the cold and hot water mains and returns to eighty pounds pressure at the pump. Test the fire mains throughout with the full pressure of the fire pump at eighty pounds steam pressure. �Accesibilitj of work Additions Advertisement Air chamber Air curtains Air flues tin Air supply Air valves Appeal Bath tubs Blacking pipes, radiators, etc Boilers Boiler fronts Boiler covering, Heating Boiler covering, Power Boiler connections, Heating Boiler connections, Power Boilers, Heating, support of Boilers, Power, foundations of Boilers, Power, brick work of Boilers, Power, iron work of Boilers, Power, supporting Boiler trimmings Bond Brackets for radiators Branches from mains Calking pipes Ceiling plates Completion of work Conditions of contract Coping of sandstone Curves one-eighth inch Damage to building Dampers , , 50 10 3 38 28 26 25 22-27 7 34 29-51 11 14 13 14 16 17 12 12 12 15 14 15 5-6 23 20 50 27 9 5 13 51 8 16 �54 PAGE. Deduction Discharging workmen Drip pan Drip pipes Exhaust pipes Expansion.... Faucets, cocks, etc Fire brick Fittings, quality of Fixtures, positions of Flanged unions Floor-packing Floor packing Floor-plates Galvanized pipe Gauges, steam Gauges, water General provisions Grate bars Hangers.... Holes in walls Hose Hose valves Hot-water boilers Hot-water boiler connections Hydrants Instructions to bidders Lead pipe Lead work Lettering Mains, cold water Mains, Mains, return Mains, return, support of Materials, quality of Noise in pipes Offsets Oil-catcher Packing Painting fire . 10 8 32 20-27-29 48-49 29 37 12 29 7 30 27 27 27 46 15 15 29 14 21 8 43 42 47-48 48 43 5 45 51 24 39-40 42 22 22 7-8 30 8 49 30 23 �55 PA&E. Patented articles Payments Pipe, brass Pipes, positions of. . Pipe, quality of Pipes, tables of sizes of Piping Proposals Pump for Boilers Pump, fire Putty joints Radiation, direct. Radiation, indirect Radiation, enclosing of Radiators for chapel Radiators, indirect, connections to Rejected work Risers, fire Rollers Schedule Signal dials Sinks Slop-sinks Smoke flues Spiral pipe.... Steam distribution Steam drum, support of Steam-mains Steam-mains, support of . Steam traps Supporting pipes Tanks, cold water Tank, condensed water Tanks, condensed water, connections to Tanks, painting of Testing fire-mains , Testing steam system Testing waste pipes Testing water distribution Testing work , . 9 9-10 17 7 29-51 30 8 6 18 40-41 51 26 22-24 23-24 26 25 9 42 21 6-10 33 33 33 16 46 27 20 19 20 18 50 31 18 19 33 51 30 51 51 8 �56 PAGE. Traps Trusses of steam main Urinals Valves Valves safety Ventilating pipe Ventilation of hoppers Ventilation of traps Ventilation of urinals Wash bowls Waste pipes Waste pipes, positions of Water closets Water distribution cold Water distribution hot Wire baskets Wire guards Y. Branches . 43-45 20 37 28-29-50 16 43-46 46 44-45 46 34 43 44 35-36 38 49-50 .... 46 23 51 �PROPOSALS. Town, County anil State.) 1885. jp0 fejerefrij propose, to furnish all the labor and materials of every kind reguiredfor Heating and Plumbing the Northern Asylum for the Insane, at Traverse City, Michigan, all in strict accordance with Conditions and Specifications for doing said work, adopted by the Board of Commissioners, a copy of which Conditions and Specifications is hereto attached, and in strict accordance with the plans for doing said work, on file in the office of the Board of Commissioners, and in accordance with the schedule of prices accompanying this proposal. The_Eeating for the sum of DOLLARS. The Plumbing for the sum of DOLLARS. &nd .pledge to enter into a written contract with the people of the State of Michigan, with good and approved securities, within ten days after being notified that. "bid has been accepted. To C. M. WELLS, Building Superintendent. Traverse City, Michigan. �GUARANTEE. KNOW ALL MEN BY THESE PRESENTS, That we,... of the County of. and State of Michigan, are held and firmly bound unto the people of the State of Michigan, in the penal sum. of five thousand dollars, lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators and assigns, jointly and severally, firmly by these presents. Sealed with our seals and dated this ' day of, XL. D. 1885. The Condition of tfc above obligation is such, that, whereas, the Board of Commissioners of the Northern. Asylum for the Insane for the State of Michigan, has advertised for bids or proposals for Heating and Plumbing the slsylum Buildings at Traverse City, State of Michigan, in accordance with said advertisement, and with the plans and specifications prepared for the same, and on file in the office of said Board of Commissioners, and whereas, ha by bid or proposal made subject to the condition of the advertisement inviting the same} agreed to abide by, execute, carry out and perform all the provisions, conditions and requirements in said plans and specifications and advertisement contained for an amount of money specified in said bid or proposal. NOW THEREFORE, If the said in case such bid or proposal shall be accepted, and the, contract for said Heating and Plumbing, or for either Heating or Plumbing, be awarded to by said Commissioners, shall, within ten days after the acceptance of such bid or proposal by said Commissioners, enter into an agreement or contract, in writing, with the People of the State of Michigan, and deliver the same to the said Commissioners, to perform and execute the said work of Heating or Plumbing, or of both Heating and Plumbing, and to furnish and deliver all the materials therefor, required by the plans and specifications for the price mentioned in bid or proposal, and according to plans and specifications, and also in penal bond, in the sum named contract, with good and sufficient sureties, to be approved by the said Commission- ers, binding firmly to carry out said contract or agreement in manner contemplated and for the amount of money mentioned in said bid or proposal, to be paid in the manner therein stipulated; then this obligation to be null and void, otherwise to be and remain in full force and effect- [SEAL] [SEAL] [SEAL] [SEAL] �