Report of the Board of Trustees or the Northern Michigan Asylum at Traverse City June 30, 1896.

Report of the Board of Trustees or the Northern Michigan Asylum at Traverse City June 30, 1896.

Asylums--Michigan--Traverse City--History.

Psychiatric hospitals.

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.

Board of Trustees or the Northern Michigan Asylum at Traverse City.

Original document held by Traverse Area District Library.

Lansing: Robert Smith Printing Co., State Printers and Binders.

30 June 1896

State of Michigan.

This document is in the public domain.

See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection.

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English.

Document.

TCSH0018

Traverse City, Grand Traverse County, Michigan.

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,

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C. R. Cloak, Roorrv.
D.R.I. Distributing Room.
D.R. Jurying ROOJIV.
E.R.£fi.fjine Room-.

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Washers.
TunM&r.
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SMrtlroner1.

S.R. Stave Room.
S.M.Ri. Soap Malting Room/.
S.fi.X. SterilizingROOTTIJ.
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Collar- Cuff Ir oner,
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5
6

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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.

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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

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ii
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Time.

$20 00 Per month. Resident.
1 25 Per day. Non-resident.
1 75
1 75
u
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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

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11

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1 75
2 00
2 00
2 00
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2 00
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2 25
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1 25
1 25
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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