Papers, Discussions and Reports given at the regular mid-Summer meeting of the Joint Board of Trustees of Michigan State Hospitals held at Kalamazoo State Hospital, July 15, 1920

Papers, Discussions and Reports given at the regular mid-Summer meeting of the Joint Board of Trustees of Michigan State Hospitals held at Kalamazoo State Hospital, July 15, 1920

Psychiatric hospitals.

Report includes a list of those in attendance; a memorial for Chauncey F. Cook, a trustee of the Kalamazoo State Hospital Board who died February 5, 1920; Reports of the finance committee; an address given by Dr. Frankwood E. Williams on "The State Hospital in Relation to Public Health"; two addresses on the solvency and therapeutic qualities of state hospital farms; and individual reports given by the superintendents of each institution.

Joint Board of Trustees of Michigan State Hospitals.

Original document held by Traverse Area District Library.

Lansing, Mich.: Wynkoop Hallenbeck Crawford Co., State Printers.

1921.

State of Michigan.

This document is in the public domain.

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

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English.

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Michigan, United States.

MICHIGAN DOC

PAPERS, DISCUSSIONS AND REPORTS
GIVEN AT THE

REGULAR MID-SUMMER MEETING
OF THE

JOINT BOARD OF TRUSTEES OF

MICHIGAN STATE HOSPITALS
HELD AT

KALAMAZOO STATE HOSPITAL

JULY 15, 1920

Lansing. Michigan
Wynkoop Hallenbeck Crawford Co.
State Printers

1921

LIST OF THOSE IN ATTENDANCE.
Hon. Albert E. Sleeper. Governor.
From the Pontiac State Hospital—Trustees John G. Clark, C. C. Yerkes, A. E. Stevenson, with Dr. E. A. Christian, Medical Superintendent.
From the Newberry State Hospital, Trustees Thomas Conlin, Fred S. Case, R. G.
Ferguson, with Dr. E. H. Campbell, Medical Superintendent.
From the Traverse City State Hospital—Trustees Dr. C. E. Miller, Dr. S. E. Neihardt,
A. Marshal!, J. M. Harris, with Dr. James D. Munson, Medical Superintendent.
From the Ionia State Hospital—Trustee E. W. Ranney, with Dr. Robert Haskell,
Medical Superintendent.
From the Eloise Hospital—Trustee O. B. Gulley, with Dr. J. J. Marker, Medical
Superintendent.
From the State Psychopathic Hospital—Director Dr. A. M. Barrett.
From the Michigan Home and Training School—Dr. Harley Haynes, Medical Superintendent.
From the Kalamazoo State Hospital—Trustees T. J. Cavanaugh, F. E. Pulte, A. A.
Anderson, John H. Ryan, Dr. E. P. Wilbur, with Dr. Herman Ostrander, Medical Superintendent.
There were also present, representing the Stewards Association, the following: Mr.
E. H. Halsey, of the Pontiac State Hospital; Mr. W. J. Garrett, of the Newberry State
Hospital; Mr. George B. Pike, of the Traverse City State Hospital; and Mr. Howard H.
Buckhout, of the Kalamazoo State Hospital; Frank E. Gorman, State Treasurer, Fred B.
Perry, Secretary of the Board of State Auditors, Terry Corliss, Superintendent of Publications, and Mr. Charles Foot, Budget Commissioner; C. D. Betts, State Purchasing
Agent; various members of the medical staff of the Kalamazoo State Hospital and other
employees of the same; Mrs. A. E. Sleeper, Miss Carrie Carr, Mrs. C. E. Miller, Mrs.
A. Marshall, Mrs. S. E. Neihardt, Mrs. Thomas Conlin, Miss Conlin, Mr. and Mrs.
Holmes, Miss Holmes. Mrs. E. A. Christian, Mrs. John G. Clark, Mrs. C. C. Yerkes, Edward Yerkes, Mrs. E. W. Ranney, Mrs. A. M. Barrett, Edward Barrett; Hon. A. J.
Mills, Mrs. A. J. Mills, Miss Helen Mills, Mrs. Dwight B. Waldo, Miss Wilhelmina De
Yoe, Mrs. Helen Statler, Mrs. J. A. Pitkin, Mrs. C. F. Cook, Miss Florentine Cook, Miss
Mary Isabel Wright, Mrs. E. H. Halsey, Mrs. George B. Pike, Mrs. C. D. Betts, Mrs.
Charles R. Foote, Mrs. Caroline Kleinstuck, Mrs. Hubbard Kleinstuck, Mrs. Helen Cobb,
Miss Tomlinson, Mrs. T. J. Cavanaugh, Mrs. A. A. Anderson, Mrs. John H. Ryan, Mr.
D. J. Buck, and Dr. Frankwood E. Williams, Associate Medical Director of the National
Committee for Mental Hygiene, New York City.

MEMORIAL SERVICES FOR THE HON. CHAUNCEY F. COOK, LATE TRUSTEE
OF THE KALAMAZOO STATE HOSPITAL BOARD.
ADDRESS BY HON. THOMAS .1. CAVANATJGH.

Ladies and Gentlemen: We have gathered here today, my friends, to pay a tribute
of respect and appreciation to one of our former associates.
Chauncey F. Cook, was born in the city of Hillsdale, March 9, 1857, and died in the
same city February 5, 1920.
Chauncey F. Cook's first educational training was in the public schools of the city of
his birth. Afterwards he attended Hillsdale College for awhile, and then entered the
literary department of the University of Michigan, graduating therefrom in 1879, and in
1882, he graduated from the law department of the same University. After this, he gave
his attention to the law and was in a law office in Toledo a short time, returning to Hillsdale where he opened an office on his own account. The legal profession however, did
not appeal to him, and in 1884 he organized the Hillsdale Savings Bank, entering the banking business with fixed principles of sound and conservative banking. He was elected its
first cashier and later, on the death of his father, he was made president, which position
he held until his death.
During his life, Mr. Cook was actively interested in public affairs, and a leader in
civic development. He took a prominent part in all matters that related to the civic and
intellectual development of his community. He was a member of the Board of Education
for a long period, and a trustee of Hillsdale College for a number of years, and because of
his unusual knowledge and grasp of public problems, together with his rare administrative
ability was an influential and valued member of both boards.
Long before the question of municipal ownership of public utilities became an economic problem in this country and when he was but 28 years of age, he advocated municipal
ownership of water works for the city of Hillsdale, and was elected Mayor of the city on
that issue and during the first of his administration the present water works system of
Hillsdale was installed and as a municipally owned and operated utility was and is a success.
For many years he served as a member of the Board of Public Works and has given
freely of his time to administering Hillsdale's public utilities.
Politically he was a Democrat and in 1891, he was appointed a trustee of this institution now the Kalamazoo State Hospital by Governor Winans, for a period of six years,
and thereafter, at the expiration of each succeeding term, without regard to which party
was in power, he was reappointed so that at the time of his death, he had served continuously for a period of 29 years.
He acquainted himself with all the details of the institution and was intensely interested in the care of the inmates thereof, advocating such improvements, diversions and attractions as would add to their comfort and the satisfaction of their friends and relatives.
He always took a prominent part in the discussions at joint board meetings and was
instrumental in suggesting and recommending legislation for the betterment of the hospitals
for the insane throughout the state.
He served as chairman of the Board in charge of the Psychopathic hospital at the
University of Michigan from the time of its establishment.
He held many other positions of trust which he filled with the same sound business
skill that obtained in his own business affairs.
In 1891 Mr. Cook was married to Miss Louise Stock. To this union were born one
son, Chauncey F. Cook, Jr., and one daughter, Florentine W. Cook. To these and their
bereaved mother, his death is indeed a calamity.
He entered upon his career possessed of a robust intellect, great energy, rugged honesty, and a worthy ambition. Everything was to him important. His strict honesty in
business, his loyalty to his friends, his faithfulness to every obligation and undertaking
were valuable assets during his whole life, which entitle him to be remembered as an ideal
citizen. Thus it may be said of him, he was true to his friends, faithful to his business,
and business associates, true to every problem of life that he undertook to solve—a man
of just and high ideals and one whom we might well hold up as an example for our young
men to follow.
It has been said that God erects men. Time destroys them, mouldering everything

6

MEETING OF JOINT BOARD OF TRUSTEES.

from the monuments raised to perpetuate the memory of the patriot to the garland laid
by the hands of love on the tomb of the peasant and watered by the tears of sorrow. At
our birth, instead of beginning to enjoy the temporary pleasures of this life, we are merely
preparing to die, decaying, withering the moment we begin to exist—no place or condition
of life free—the sage and philosopher meditating over musty tombs until every medium
of thought is a living, sparkling gem, are chilled by the icy touch of death and the vaulting
ambition of a future filled with splendor wanes and passes down the slope of the eternal
in company with that of the ignorant barbarian and village peasant.
Cut off by grim death in the prime of life, full of promise, when the sun of mature manhood was shining bright—thus is the instability of human life evinced. Well may the
poet exclaim:
' 'Oh why should the spirit of mortal be proud!
Like a swift fleeting meteor, a fast flying cloud
A flash of lightning, a break of the wave
Man passes from life to his rest in the grave.
The leaves of the oak and the willow shall fade,
Be scattered around and together be laid,
And the young and the old, the low and the high
Shall moulder to dust and together shall lie.''
But though he be ashes and dust, in the years to come CHAUNCEY F. COOK will
live in our memory as a wise and good man, and Michigan's history will recite his name
among its valued pioneers.
REMARKS BY HON. FRED S. CASE OF THE NEWBEHRY STATE HOSPITAL BOARD.

Ladies and Gentlemen: I served with Mr. Cook on the Psychopathic Hospital Board
for about 15 years, and I am very glad that I knew him. I know he was my friend. I
never met him with his cherry, kindly greeting that I did not feel better. The last time
I saw him was at Ann Arbor, last fall, and after the meeting, he said to me "Case, come
over to the Martha Cook Building, with me. and I will show you the dormitory.'' On
the way he showed me half a dozen houses, and said ' 'I bought them for Will. He wants
to build a dormitory for the boys," and I remember the pleasure he had in doing that work.
He said "let's step over to see Butts of the Engineering Department. We went in and I
remember their greeting. Butts said, ' 'Cook, it is a mighty fine thing, what Will is doing
for the University." Mr. Cook replied that he does not look at it that way; that he feels
that everything he is, and all that he has worldly, is due to the University of Michigan,
and he is just paying part of the debt.'' It was a beautiful thing, and when I was at Ann
Arbor, and learned of his death, I thought that Ann Arbor had lost in him one of the best
friends the University of Michigan ever had. I had visited with him many times and
knew of his deep interest. It seemed to me that his name represented unselfish service.
Today his memory should remind vis of our public duties. He never said ' 'Let George
do it", but he met every problem frankly and fearlessly as though it was a pleasure and
his memory ought to inspire every one of a higher public service and more affection for his
fellow men.
REMARKS BY DR. WALTER HUME SAWYER, OF HILLSDALB.

For thirty-five years I knew Chauncey F. Cook. He never avoided a responsibility
or forsook a friend. In private life and public duty, he was true to himself, and being true
to himself, was never false to any man. Painstaking and conscientious in every task, he
brought to the cause in which he was enlisted, rare good sense and sound judgment. Having
determined for himself what was right and best, he never faltered or allowed himself to
be influenced from his course. With undaunted courage and energy, he strove for his
goal. With such characteristics, he could not have been other than a marked man and
a great public servant. His service to Society and to his State was invaluable, and his
contribution to general betterment will live to bless his name and his people.
"Oh, well for him whose will is strong!
He suffers, but he will not suffer long;
He suffers, but he cannot suffer wrong;
For him nor moves the loud world's random mock,
Nor all Calamity's hugest waves confound.
He seems a promontory of rock,
That compassed round with turbulent sound,
In middle ocean meets the surging shock,
Tempest-buffeted, citadel-crown'd.''

6

MEETING OF JOINT BOARD OF TRUSTEES.

from the monuments raised to perpetuate the memory of the patriot to the garland laid
by the hands of love on the tomb of the peasant and watered by the tears of sorrow. At
our birth, instead of beginning to enjoy the temporary pleasures of this life, we are merely
preparing to die, decaying, withering the moment we begin to exist—no place or condition
of life free—the sage and philosopher meditating over musty tombs until every medium
of thought is a living, sparkling gem, are chilled by the icy touch of death and the vaulting
ambition of a future filled with splendor wanes and passes down the slope of the eternal
in company with that of the ignorant barbarian and village peasant.
Cut off by grim death in the prime of life, full of promise, when the sun of mature manhood was shining bright—thus is the instability of human life evinced. Well may the
poet exclaim:
' 'Oh why should the spirit of mortal be proud!
Like a swift fleeting meteor, a fast flying cloud
A flash of lightning, a break of the wave
Man passes from life to his rest in the grave.
The leaves of the oak and the willow shall fade,
Be scattered around and together be laid,
And the young and the old, the low and the high
Shall moulder to dust and together shall lie.''
But though he bo ashes and dust, in the years to come CHAUNCEY F. COOK will
live in our memory as a wise and good man, and Michigan's history will recite his name
among its valued pioneers,
REMARKS BT HON. FRED S. CASE OF THE NEWBERHY STATE HOSPITAL BOARD.

Ladies and Gentlemen: I served with Mr. Cook on the Psychopathic Hospital Board
for about 1.5 years, and I am very glad that I knew him. I know he was my friend. I
never met him with his cherry, kindly greeting that I did not feel better. The last time
I saw him was at Ann Arbor, last fall, and after the meeting, he said to me ' 'Case, come
over to the Martha Cook Building, with me, and I will show you the dormitory." On
the way he showed me half a dozen houses, and said ' 'I bought them for Will. He wants
to build a dormitory for the boys," and I remember the pleasure he had in doing that work.
He said ' 'let's step over to see Butts of the Engineering Department. We went in and I
remember their greeting. Butts said, ' 'Cook, it is a mighty fine thing, what Will is doing
for the University." Mr. Cook replied that he does not look at it that way; that he feels
that everything he is, and all that he has worldly, is due to the University of Michigan,
and he is just paying part of the debt.'' It was a beautiful thing, and when I was at Ann
Arbor, and learned of his death, I thought that Ann Arbor had lost in him one of the best
friends the University of Michigan ever had. I had visited with him many times and
knew of his deep interest. It seemed to me that his name represented unselfish service.
Today his memory should remind us of our public duties. He never said "Let George
do it", but he met every problem frankly and fearlessly as though it was a pleasure and
his memory ought to inspire every one of a higher public service and more affection for his
fellow men.
REMARKS BY DR. WALTER HUME SAWYER, OF HILLSDALE.

For thirty-five years I knew Chauncey F. Cook. He never avoided a responsibility
or forsook a friend. In private life and public duty, he was true to himself, and being true
to himself, was never false to any man. Painstaking and conscientious in every task, he
brought to the cause in which he was enlisted, rare good sense and sound judgment. Having
determined for himself what was right and best, he never faltered or allowed himself to
be influenced from his course. With undaunted courage and energy, he strove for his
goal. With such characteristics, he could not have been other than a marked man and
a great public servant. His service to Society and to his State was invaluable, and his
contribution to general betterment will live to bless his name and his people.
"Oh, well for him whose will is strong!
He suffers, but he will not suffer long;
He suffers, but he cannot suffer wrong;
For him nor moves the loud world's random mock,
Nor all Calamity's hugest waves confound.
He seems a promontory of rock,
That compassed round with turbulent sound,
In middle ocean meets the surging shock,
Tempest-buffeted, citadel-crown'd.''

STATE HOSPITALS OF MICHIGAN.

7

REMARKS BY DR. ROBERT HASKELL, MEDICAL SUPERINTENDENT OF THE IONIA STATE HOSPITAL.

My knowledge of the relations that Chauncey Cook had to the early history of the
Ionia State Hospital is not sufficiently detailed to warrant dilating on that theme.
I do however feel under great personal obligation to Chauncey Cook and his teachings.
My acquaintance with him was quite different from that of you gentlemen who were associated with him so long as members of this Joint Board and as Superintendents of the
Hospitals for the civil insane and was practically limited to seeing him as a regular attendant
and guiding spirit at Board meetings at the Psychopathic Hospital. His encyclopaedic
knowledge of state hospital affairs was stimulating to me, a mere tyro, even many times
to the point of alarming. There never seemed to come up a question of policy or procedure that he couldn't settle right off the reel, and authoritatively. He took special
pride in the confidence that the people of Hillsdale County and the neighboring couifties
had in him as a surety for the welfare of their friends in the Kalamazoo Hospital and at
Ann Arbor; in fact he used to almost exult as he would tell me often that most of these
people would rather have his report about the progress of their sick ones than that of the
Doctors.
The one characteristic that made the deepest impression on me in those formative days
of hospital work was his feeling of personal responsibility to the people of the State of
Michigan for his Trusteeship and I am not certain that that characteristic was not the
crowning feature of his most honorable career. I can remember well in this connecton
the statement made to me by a member of the legislature which well illustrates this point
as he said, ' 'When Chauncey Cook comes over here with a proposition concerning the insane hospitals, you may know it's all right; if he isn't along, I don't mean to say the proposition isn't all right, mind you, but if he is there you may bank on it.'' This has helped
me many a time while pondering over some administrative difficulty as it would recur in
the query, "I wonder what Chauncey Cook would think of that."
I shall ever treasure it as a great privilege to have come even so remotely under his
influence.
REMARKS BY HON. A. J. MILLS, OF KALAMAZOO.

Mr Chairman; Ladies and Gentlemen: It is a sad pleasure to be able to be present
and to pay tribute to the life and memory of one of the best and dearest friends I ever had.
I became acquainted with Mr. Cook in February, 1893, when I was appointed to
membership- on this Board, and I served with him for nearly twenty years. He was appointed in 1891 by Governor Winans, who seemed to have a very keen insight into the
selection of men to serve on the State Boards. He appointed no man on any of these
boards for mere political reasons. They were selected because of their fitness for that
place, and when Governor Winans selected Mr. Cook, he made no mistake.
With Mr. Cook, was appointed Henry M. Fletcher, one of the ablest lawyers and one
of the best business men of Michigan. This institution was opened in 1859, and these
gentlemen came to membership on this board at a critical time. The institutions were
beginning to modernize. Dr. Van Deusen had been the superintendent here for a great
many years, and had been succeeded by one of his staff, and he was about to leave to take
up other work. The Trustees selected Dr. Edwards, and it was a very happy selection.
From that time this institution and the institutions caring for the insane in this state, began
to take on modern methods, and to become, as they are today, the equals of any similar
institutions in the world.
It was my pleasure, with Dr. Edwards, largely at the suggestion of Mr. Cook, to visit
many of the institutions in this State, and many of them abroad, and I am safe in saying
that Michigan's institutions are the equals of any anywhere.
Mr._ Cook's brain helped, however, to substantiate every reform, every work that was
carried on here for the long period of twenty-nine years. When he took office, the institution was certainly ' 'down at the heels.'' The buildings were out of repair; the furnishings
about the halls were meagre, and there was nothing about the asylum to suggest the place
of comfort it became in later years.
When Mr. Cook and Mr. Fletcher started on their work, there were two steam plants,
one at the female department, and one at the male department. They planned the present
central plant, which has been a suggestion to several other institutions in the State. They
planned this building in which we meet. Mr. Cook planned every building, every structure
connected with this institution, with the exception of the male department and the female
department. Mr. Cook's handiwork is shown in the beautiful grounds which surround
this institution. Mr. Cook took part in preparing the law under which the State Hospitals
are governed. There is no activity connected with the institutions with which he did not
have a large part from the time of establishment of the joint board down to the time of
his death.

8

MEETING OF JOINT BOARD OF TRUSTEES.'

He was largely instrumental in the establishment of the Psychopathic Hospital, and
I well remember the day when he was selected as one of the Trustees of that institution, a
position he held until his death. He wag a man who never hesitated to speak out, when
he thought it was proper and necessary to do so. He was open, and frank, and vigorous.
He called a spade, a spade. He respected the opinions of others, and his conduct compelled others to respect him. He was no policy man. He marked out a course for himself,
and he hewed straight to the line.
Some people sometimes thought that Mr. Cook was desirous of having his own way,
and that he thought his own way was the best way. It was not so. Mr. Cook had his
own ideas, and he advocated them, and he was mighty glad when he found a man who had
the manhood and the strength to stand up and combat them, and many a time, when Mr.
Cook has met with defeat, he has gone to the man who has opposed the ideas he was presenting with the most vigor, and congratulated him, and thanked him for having held his
own ideas so well.
There was, in Mr. Cook's make-up, nothing but sincerety. He was always kind and
generous and capable. He did more for the insane and for the State Institutions in Michigan than any ten men in my judgment, that ever attempted such work, and he did it as
a labor of love.
Some of the older members of the joint boards particularly will remember the graveness and the skill with which he presented the financial problems of the Institutions at
the joint Board meetings. He was an encyclopedia of the affairs of these institutions.
As a Mathematician, I never met his equal. It seemed to me, sometimes, if he could have
a mouthful of figures, he enjoyed it better than the best meal that was ever set before him.
We used to meet at the July meeting to settle the rate of maintenance, and you would
find the Governor and one or two of the other Trustees at work until the middle of the
night, and very frequently until early morning, carefully going over the figures, and working out .the problems, and when they came down to breakfast next morning, we would
laugh at them about it, and they would tell us that Chauncey Cook had convinced them:
he had the whole matter ' 'right down pat,'' and he was never vanquished in any task of
that kind.
I could say a great many things of a personal nature with reference to Mr. Cook,
that I do not feel equal to saying at this time, because the departure of Mr. Cook to me
was a great personal loss. I have had some friends in this life, and I have a few left, but
I don't think I ever had a friend whose friendship. I prized as much as I did the friendship,
and as dear the memory of that man.
When he died, and the gates of Heaven opened to him, as they surely did, he was met
with this enconium:
"Well done, good and faithful servant. Enter thou into the joy of thy Lord."
The Hon. Harry C. Davis, of Traverse City, being unable to be present, forwarded
the following letter:
' 'I regret that I shall not be able to attend the meeting of the Joint Board of Trustees
on the 15th inst. I am sorry, but matters have intervened making it impossible.
The State, in the passing of Mr. Cook, lost a good man, but the results of his many
good deeds will continue. Mr. Cook, Mr. C. L. Whitney and myself were appointed on
our respective boards at the same time, nearly thirty years ago. My acquaintance with
Mr. Cook dates from that time, and I have met him frequently on the Joint Board, but
oftener on the Psychopathic Board. He was deeply interested in the management of our
State Hospitals and the welfare of the patients. He seemed to have and did have an abiding faith in the purposes, the success and the necessity of the Psychopathic Hospital. He
might, with propriety, be called the father of that institution. While I would not minimize his labor on the Kalamazoo Board, or the Joint Board, his heart and energy seemed
centered in the Psychopathic Hospital. In speaking of his characteristics, as they impressed me, I would say he was genial, purposeful, alert, positive and frank. It is refreshing always to come in contact with a positive character. Mr. Cooks firmness however
was not stubbornness, but a constancy born of deep conviction. We valued him as a
friend and a good citizen.''
Yours sincerely,
H. C. DAVIS.

STATE HOSPITALS OP MICHIGAN.

REPORT OF THE FINANCE COMMITTEE.
July 15, 1920.
To the Joint Board of State Hospitals, Kalamazoo, Michigan:
Your committee would recommend for the consideration of the Board of State Auditors, a per diem rate of $1.00 for Traverse City State Hospital and Newberry State Hospital for the ensuing year, and $1.05 for Pontiac State Hospital, and $1.10 for Kalamazoo
State Hospital for the same period.
We also recommend for the consideration of the various Boards of Trustees, composing
this Joint Board, the following appropriation for officers' salaries, to be effective from July
1, 1920, these several amounts to be the total maximum salaries to be paid the officers of
the several institutions. Increases in the present salaries paid to the officers are to be
effective only when in the discretion of the Board it is necessary to make such a change.
Newberry State Hospital
Kalamazoo State Hospital
Pontiac State Hospital
Traverse City State Hospital

$15,730
29,720
21,870
23,920

00
00
00
00

Moved by Trustee Anderson and supported by Trustee Clark that the following resolutions be adopted:
RESOLUTION.

Resolved, That the report of the Finance Committee be accepted and that the rate of
maintenance for the Kalamazoo State Hospital be fixed at $1.10 per patient per day; that
the Pontiac State Hospital be fixed at $1.05 per patient per day; that the Traverse City
State Hospital be fixed at $1.00 per patient per day; and that the Newberry State Hospital
be fixed at $1.00 per patient per day; for the fiscal year beginning July 1, 1920; that in
addition to the above mentioned per diem allowances the cost of clothing, elopement expenses and cost of returning patients to their homes be reimbursed by the State.
(Adopted.)
2

10

MEETING OF JOINT BOARD OP TRUSTEES.

THE STATE HOSPITAL IN RELATION TO PUBLIC HEALTH.
ADDRESS BY FRANKWOOD E. WILLIAMS, M. D., ASSOCIATE MEDICAL DIRECTOR, THE NATIONAL
COMMITTEE FOR MENTAL HYGIENE.

Overwearied as we may be from the hot enthusiasms and the sharp idealisms of the
war period, and deep as we may be in the depressive spiritual reaction from those days,
yet are we aware that a new spirit has come into the world. This spirit may be difficult
of definition, but we are made conscious of it in many ways and by activities in various
fields of human endeavor. It has something in it of aggressiveness, of the consciousness
of power that is born of success, of fearlessness in facing problems, of a keener sensitiveness to injustices and unfairnesses, whether in the political, the economic, or the social
field, a greater awareness and intolerance of needless evils. And to the elements of this
spirit may be added what to psychiatrists must give satisfaction, a desire to investigate,
to know facts, to be guided by facts, and to meet issues squarely.
A few years ago our good friend and onetime chief, Dr. E. E. Southard, from whom
we gained much inspiration, read a paper in which he discussed what he called the Kingdoms of Evil. Dr. Southard's contention was that the evils in the world are not numberless, as appears on a casual survey; that the myriad forms of evil that confuse and discourage us are but symptoms and signs; that when these are grouped and classified, a
number, not discouragingly large, of major evils will be found; that it were better for the
right-minded to save their energies in attacking numberless symptoms of evil in numberless ways and places and to turn the energies thus fruitlessly expended into carefully classifying the major groups; that once the major groups are identified it will be the prime business of all to make a concerted attack upon them. Toward this end Dr. Southard himself attempted a classification of the Kingdoms of Evil. In this classification he was not
concerned, of course, with the old chameleonlike moralities, but with the larger aspects of
evil.
In Dr. Southard's classification of evils one is not surprised to find sickness. Obviously it belongs there. But the world has not long realized that it belonged there. Sickness
has not been an evil in the minds of people. From being a punishment and scourge it had
come to be a thing to be expected and to be endured as the necessary part of the end of
man. But while the human machine must in time wear out, it need not be consumed by
conflagration. Sickness is an evil and men are fast coming to realize it and to organize
their forces on that basis.
Many lines of thought from various fields of human effort have contributed to the
development of this point of view, and some have been from fields far apart from medicine. Medicine, however, as it has become more socially conscious has been gradually
working in this direction. The treatment of disease is a negative social contribution—important to be sure, but negative and humanitarian. Thus to link the humanitarian with
the negative is not to underestimate his contribution, but it is to assay him critically, better, to estimate or revalue his worth, a proper psychiatric function. No one knows better
than the psychiatrist the significance of humanitarianism. Humanitarianism surely is
not the opus magnum of human evolution, with its leached instincts and sublimations—•
good in the sense that it is better than bad, but bad in the sense that it represents the defeat of better.
Socially conscious medical men could not long tolerate such a negative position once
an opportunity for greater positive contribution were presented. This opportunity came
with preventive medicine, and into the field of preventive medicine entered men of vision
whose instincts needed not so much sublimation as wider outlet. The prevention of disease represents a greater positive social contribution, but it is not free of negativism and
it was not to be expected that medicine with its great potential for positive good would
rest here. Medicine is preparing for another move forward. One observes in medical
literature, discussion, programs, and health campaigns a new note—not alone that the ill
shall be made well, that the well shall be prevented from becoming ill, but that the energies
of medicine shall be given to extending the power and happiness of man through developing to their maximum his physical and mental abilities. The campaign in social hygiene
is no longer for the prevention of venereal disease alone, but for an intelligent understanding of sex; the anti-tuberculosis campaign is not alone for more sanitaria for the tuberculous or a direct attack upon the incidence of tuberculosis, but for better health in general;

STATE HOSPITALS OF MICHIGAN.

11

school physicians, while still performing the important function of inspecting adenoids
and tonsils, are giving their larger energies toward developing among children proper habits of health and hygiene; the attack upon infectious disease is continued with even greater
zeal, but attacks are also led against diseases of deterioration through campaigns for better health and more hygienic living in general. These endeavors represent positive social
contributions as opposed to the purely negative contributions of the past. Medicine has
therefore progressed from empiricism to scientific treatment, to prevention and, finally,
if you will, to productive medicine.
Has psychiatry any such positive contribution to make? Is psychiatry prepared to'
make such possible contribution? One cannot doubt the ultimate answer to these questions, but the immediate answer will depend upon how far psychiatry has advanced in
the preliminary steps of this evolution from empiricism through the negative aspects of
medicine—treatment and prevention.
As you are not unaware, the first hospitals for mental disease opened in this country
were as free of access as any other hospital. A patient with a sick mind could come as
freely to such hospitals as his brother with a broken hip could enter a hospital of another
kind. For some fifteen or twenty years this freedom continued. Gradually, for one reason
or another, fairly or unfairly, doubt and misunderstanding arose in the minds of the public;
the hopes with which these hospitals were built were disappointed, and from being the
' 'state's greatest charity'' the hospitals frequently became, with warrant or without warrant, the state's greatest source of scandal. In bitterness, disappointment and distrust,
legislatures built a legal stockade about the hospitals until prisons were more accessible
than hospitals, in fact procedure was much the same in both cases, with leniency in favor
of the jail. Hospitals became isolated, socially and medically. For almost forty years
hospitals have been endeavoring to free themselves from this tremenduous handicap and
have now largely succeeded. Laws permitting voluntary admission, temporary care, and
observation have been passed in many states, and again the psychiatric skill of the community is becoming accessible to those who need it.
Originally the institutions for the insane were called asylums, a beautiful name with
a beautiful meaning—a place of refuge. But unhappy connotations came to be built up
around the term asylum, and legislatures have seen fit to change the name to hospital.
But asylums cannot be changed into hospitals through legislative enactment. A building,
a physician, a nurse, and a patient do not make a hospital. Even less do a thousand patients, three physicians, and a few poorly trained attendants make a hospital. Are our
hospitals in name hospitals in fact? As one surveys the situation generally throughout
the country, one is convinced that there are many'excellent hospitals, that there are still
too many which have only good housekeeping and a low per capita to recommend them—
asylums in the proper sense—and that there are some that are but inferior jails. Putting
it in another way, one may say that most state hospitals are rendering a humanitarian
service, some are rendering a medical and scientific service, while still too few are rendering
a positive social service in spite of the fact that-they contain possibly the greatest potential for social service of any organized medical group.
The right of any state to call its institutions hospitals can properly be questioned, and
least of all can a superintendent or a board of trustees take pride in an institution as a hospital, unless such institution has met the requirements that experience has shown to be
needed in such institutions. These requirements are familiar to you, but they may be
briefly enumerated:
A reception or acute service.
Facility for proper classification and segregation of patients.
Facilities for active treatment, such as hydrotherapy and occupational therapy, and
these in the hands of competent persons.
Properly equipped and staffed laboratories.
An adequate medical and nursing staff with a training school for nurses.
Frequent and regular staff meetings.
A system of adequate case records.
A parole system.
Social service.
The number of hospitals in this country that maintain such a standard is not inconsiderable and the number becomes larger each year. Asylums are not made into hospitals
easily. AVhen made the transition has come through years of hard work and against many
obstacles by earnest superintendents who have given to it the best years of their lives.
There are hospitals in this country that stand as monuments to men who won them, not
in a moment of exalted heroism as is so frequently the case with our better known awards
of merit, but by courage sustained through long periods, through sweat and toil and sacrifice, and without the stimulus that comes from crowd action.

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MEETING OF JOINT BOARD OF TRUSTEES.

But no organization can live by maintaining past or even present excellencies. What
was excellent yesterday is mediocre today and retrogressive tomorrow. Hospitals for
mental disease have sat by the side of the road and performed their humanitarian service,
binding up the wounds, as it were, of the generations that have crowded past them. In
no generation have they been a vital dynamic part of the community life. And yet they
contain within their walls a potential force of unlimited value.
Once psychiatrists left their places by the road, took off their robes of negative humanitarianism, and put on the armor of the crusader. It was at a time when the best that
was in men was challenged. At first the change from robe to armor was not organized
and those about smiled and dubed these psychiatric officers "nut-doctors," and "nutdoctors' ' they would have remained to the end had their services been limited to the negative one of caring for the insane, valuable as a such a service would have been. But
these men soon became a dynamic force in the life of the army. Their contribution was a
positive one, and with it came the respect of their brother medical officers and line officers
alike. The handling of the problem of the war neuroses is familiar to you and need not be
elaborated in this connection except to point out that the problem of the war neuroses is
the problem of the civil neuroses. Two contributions not so well understood may be
mentioned briefly.
When the United States entered the war an official request was sent from Washington
to the commandant of the United States Disciplinary Barracks at Fort Leavenworth requesting an estimate on the increased provision it would be necessary to make in order to
take care of the prisoners to be expected from .an army of 3,000,000 men. After a study
of the figures of the Civil War, the Spanish-American War, and the operations on the Mexican Border, the commandant replied that it would be necessary to provide for 50,000
prisoners. As a matter of fact, the Disciplinary Barracks, including the two branches,
received approximately 5,000 prisoners; in other words, 10 per cent of the estimated number, based on previous experiences. This can be explained on only three grounds: (1)
the enforcement of prohibition in the army in general and especially in cantonments and
their neighborhood, (2) the activities of the War Camp Community Service in furnishing
recreation for men in their leisure, (3) the elimination by the psychiatric officers of the
potential delinquents of the army—the mental defectives, the insane, the psychopaths.
The effect of the work of the neuropsychiatric officers in eliminating these potential delinquents was clearly shown when a survey of the prisoners at the Fort Leavcnworth Disciplinary Barracks disclosed that the distribution of intelligence among them was practically that of the ordinary division of troops. Adler in his report of the survey points
put that ' 'there was an absence of the high proportion of defectives and psychopaths found
in nearly all of our civil prisons. Instead of the 30 or 40 per cent of feebleminded and
psychopaths found in the latter institutions, between 10 and 12 per cent were found among
the prison population at Fort Leavenworth."*
With men far away from home, living under unusually trying conditions, frequently
homesick and depressed, and with the means of suicide about them on all sides, it would
not have been surprising had the suicide rate in the A. E. F. been high. However, it was
strikingly low. The number of suicides in the A. E. F. was 94, representing an annual
rate of 4.7 per hundred thousand. The rate in the Regular Army in 1915 was 53 per hundred thousand, twice that of the adult male population of New York State. Had the same
rate existed in the A. E. F. as for the adult male population of New York State, there would
have been 1,060 suicides. One of the causes of the small number of suicides in the A. E. F.
was the extensive provision for the early care of mental cases, but probably more important was the elimination of the psychopathic material in the examinations in the United
States."**
These days are over, but from them have' come a multiplicity of complex problems.
The world is milling. The issues are considerably clouded by the dust that arises from the
process and there are earnest people who are conscientously analyzing the dust. Leaders
in various fields, however—the economist, the sociologist, the jurist, the statesman,—
have pushed through the dust screen and are making earnest efforts to find fundamental
causes of the disturbance. Some weak-hearted have returned in a state of panic. There
was another similar time. When thousands of men began to pour out of the trenches
blind, deaf, and paralyzed, and to stream back upon the hospitals, general medical men
who could find no organic lesions were puzzled and at their wits end what to do. But the
psychiatrist was not puzzled and, free of any feeling of panic, proceeded in a matter of fact
way to readjust these individuals and to return them to the line of duty. The present
situation is but slightly different. If there is any group that should be panic proof in the
*Discij>linary Problems of the Army. By Herman M. Adler, M. D. MENTAL HYGIENE, Vol. Ill, No.
4, October 1919.
**Address by Dr. Thomas W. Salmon at the meeting of the Military Training Camps Association, Hotel Knickerbocker, January 17, 1920.

STATE HOSPITALS OF MICHIGAN.

13

face of restlessness, discontent, suspicion, jealously, cries of treachery, robbery and murder,
it is the psychiatrist, who at least has some insight into problems of human behavior.
In one respect, however, the situation is different. Many psychiatrists have removed
their crusading armor and have returned to their humanitarian robes. The civil line
officers—the state officials, the jurists, the educators—are left without special advice or
counsel. At another time in another difficult situation one of the most useful officers was
the division psychiatrist. The division psychiatrist was responsible for the mental health
of the men in his division. He was a constant advisor of his superiors, both of the line and
of the medical corps. It was his business to know his men, their weakness and their strength.
It was he who supervised the examination of the men in his division in the elimination of
the unfit. Through his assistants he was in constant touch with the morale of his organization. His constant inspection revealed weak spots as men began to break. Perplexing problems of discipline were brought to him for solution. With action imminent he
forestalled panic by plucking out those likely to precipitate panic. With his troop in
action he was immediately behind them with his special hospitals organized to take care
promptly of those who would find the task too difficiilt. Every officer and man had access
to him and to his trained advice and counsel as personal crises approached. He was a
dynamic force in his combat community. No one will gainsay the importance of such
an officer. But where is his counterpart in civil life?
Such force, such leadership is just as much needed today in every state and in every
hospital district in the country as it was two years ago on the division battlefields of France.
There is but one immediate source for such leadership and that is the state hospital. Most
states are divided into definite hospital districts. A hospital receives 'its patients from a
particular district. This is a definitely limited district usually not over large. The superintendent of the hospital may easily be familiar with every city, town, hamlet, and county
in the district. All about him in this district are earnest people struggling with perplexing problems—industrial, educational, correctional, charitable. He is not apart from this
community, but an integral portion of it. These problems are his problems and the problems of his staff, as much as they are any citizens problems. He observes his fellow citizens struggling with what he all too frequently considers their professional problems, and
as time goes on he receives into his refuge the by-product and sometimes the direct product
of the prodigious labors of his friends. He calls it waste, damnable, needless waste, and
yet the key to the solution of many of these problems remains locked in his own institution.
From 1915 to 1918, inclusive, the Michigan State Hospitals received some 6,700 new
patients, approximately 1,700 patients each twelve months. There will be a new 1,700 in
the next twelve months. Where are these individuals and who are they? They are not
a mysterious group that will descend upon the state like a plague from some far off place
and from some unexpected direction. They are our neighbors, our friends, and their
children. They are not a group peculiar to New York or California or Texas, but citizens
and children of Kalamazoo, of Grand Rapids, of Ann Arbor, of Pontiac, and of Traverse
City. Their course is about run and they will soon be with us. But in the offing there
is another 1,700 and as far as we can see yet another and another. It is a veritable army
of living, breathing, unhappy individuals—1,700 within one year of us; 3,400 within two
years; 5,100 within three years; 6,800 within four years; 8,500 within five years; 17,000
within ten years.
Some that we can'see just over the horizon are mere toddlers who are today having
their first brush with what is to them a surprisingly unfriendly environment and reacting
to it badly and in a manner that is significant; nearer is the boy or girl just beginning to
edge away from the crowd; the boy who has just found the false way around an obstacle;
the lad who is beginning to doubt himself, but who is finding an explanation of his failure
in the unfairness and unfriendliness of others; the boy or girl who today has just dropped
his or her head in-unhappy recognition of his or her inferiority, or the other fellow in the
group who has just thrown up his head, frightened at the inadequacy he has found within
himself, but who has buckled on an armor of self-defense, stands breathing defiance and
ready to challenge authority. With increased puzzlement and confusion, misery and unhappiness, pitiful and tragic, these boys and girls will be moved along toward us year by
year. Inefficiency, failure and humiliation will be heaped upon them. As without understanding and without guidance they are pushed forward by the crowd about them, it
will be but an accident whether some first reach us or the prisons. But in the years that
are to intervene parents will labor with them, the schools will work with them, the judges
of the juvenile court and the probation officers will do the best they can with some and with
some the higher courts, reformatories, and prisons will have to take a hand. Energy and
money will be expended upon them without avail. But whatever the intervening steps,
the end is failure. How difficult of readjustment they will be when once they reach the
reformatory or finally find a refuge with us. And yet, pliable as they are today, how simple
in many cases would the readjustment be now—how simple the psychiatrist who met yet

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MEETING OF JOINT BOARD OP TRUSTEES.

more difficult problems of readjustment in the army know, and Campbell and Richards
in Baltimore, Glueok and Brown in New York, Healy and Bronner in Boston, who in school
or court have worked with these children, have pointed out. We are inclined to think of
these individuals in the terms of end reactions as we see them on their admission to the
hospital and to be discouraged; it were better did we think of them in the terms of beginning reactions.
We have been speaking of the child we could just discern as we looked ahead, but the
older brothers and sisters of these children are at hand. They are in the schools today,
they are in the court today, they are entering industry today. And does anyone presume
to deny that these individuals whether in school, court, or industry, unassisted, unrecognized for what they are, unassayed at their true value, misunderstood and misunderstanding, are the source of many of our most perplexing educational, judicial, industrial, and
political problems? Problems of conduct lie in the province of psychiatry. And not
alone insane conduct.
Economic and social problems are to be solved only in a spirit of fairness and upon the
basis of ascertained facts; but with the sifting of data in the ascertaining of facts, and in
the determination of what is fair and just, there must be discussion, division, and even
heated differences of opinion. It is not, however, from such fair differences of opinion,
no matter how sharp, nor from such contentious discussion as may grow from it that many
of our difficulties and disturbances arise, but from the partisan agitation of individuals
who, unhappy and disturbed by unsolved problems in their own personality, make an
effort to maintain their self-respect against a feeling of failure, defeat, and inadequacy,
either by rationalizing their difficulties in terms of the injustices of others, or by transferring the emotions born of their own sense of failure to elements in their environment.
In the understanding of these individuals, whether partisans of one group or another, and
the significance of their passionate outbursts, the atmosphere may be kept clearer for a
proper evaluation and judgment of the issues involved. In assisting these individuals
in the solving of their own problems, not only may neuroses and possibly psychoses be
prevented, but by proper reconstructive efforts the individual may be led to an adaptive
plane, upon which he may find happiness and social usefulness.
We should not overestimate the amount of our knowledge or our ability in helping to
solve some of these problems, but false modesty and an attitude of self-depreciation are
equally wrong. This is not a time for sensitiveness. The need for trained men .who ars
not afraid is greater today than in 1917. Building for peace is an infinitely greater task
than preparing for war, and rebuilding after war has always tried men's souls. But everywhere are strong men engaged in the process of construction. Professional group distinctions are not so marked. There is a new community of interest. In idle days we were
jealous of our problems; interlopers must keep away. Today we seek advice and counsel
in contiguous fields—the jurist calls upon the educator, the industrialist calls upon them
both, and all are asking questions of the psychiatrist. Psychiatry cannot shirk its part of
the burden in such a program of construction. Contacts with these community problems
may be made through a more extensive development of the out-patient departments of the
state hospital, through a well organized and active psychiatric social service department,
and through assuming advisory relationships with boards of education, boards of
charity, courts, labor and industrial organizations.
The state hospital in its district contains the potential for an inestimable service
greatly needed. State hospitals all too frequently are pursuing a negative policy of humanitarianism, a part of, but apart from, the community. With the evolution of medicine
from negative humanitarianism to positive constructive contribution, psychiatry and its
hospitals will undoubtedly become vital dynamic forces in their districts, pooling with
others in a general community interest what they have of special knowledge.
DISCUSSION BY DB. BABRETT OF ANN ABBOB.

Ladies and Gentlemen: Dr. Williams has presnted to us a view of the work of a State
hospital for mental disorders that makes a strong appeal to us. Its practical thought is
that hospitals for mental disorders must adapt themselves to changing situations that are
inevitable in the development of the practice of medicine, and no matter what ideas may
have determined their course in the past they cannot rightfully escape the responsibility
of doing whatever has shown to be of value in curing or preventing mental disorders.
Hospitals for the insane more than any other hospital organization are best prepared
to assume responsibilities for the treatment of the mental disorders that affect the public
health.
Our hospitals for mental disorders have passed through several phases in their development. Their inception and early problems of care, arose out of custodial needs. They
were to care for those who by reason of diseased minds disturbed the life and progress of
the social group. There naturally followed this a phase in which treatment and ideals

STATE HOSPITALS OF MICHIGAN.

15

of cure were emphasized, and this purpose in varying degrees of prominence has determined the medical activities of these hospitals up to the present time.
There now comes a phase in which they are to adapt their activities to efforts for
preventing mental disorders, and one might look still further into the future and conceive
of a plan in which they might be concerned with efforts towards improving the mental
health of the community.
Although a considerable percentage of the mental disorders that require hospital care
are the result of factors that at present seem impossible to attack with any degree of success, there are many others that are of such nature that they can be cured or prevented.
While we have been convinced of this from our work with patients in pur hospitals,
it has become more obvious as we have come in contact with individuals, in the special
classes, in the schools, in dispensaries, and in our out patient services, who are beginning
to drop below the level of normal mental health.
Like many experiences, mental disorders often have their beginnings in simple situations and conditions that can be prevented from becoming more complex and disabling
by proper attention and treatment.
The question that now arises is. What organization can assume a responsibility in
bringing this about? Obviously it is a field of work that comes within the scope of the
activities of a state hospital for mental disorders. No other organization is prepared by
experiences or has such good facilities for doing this work.
Such interests should be welcomed by all hospitals as factors that will stimulate their
medical spirit and keep them in close relations with other medical activities concerned
with problems of public health.
The details of how this is to be done or just what there is to do need not be discussed
at present. The essential point is that State hospitals for mental diseases must recognixe the correctness of the proposition that they must adapt themselves and their activities to all matters that concern the mental health of the State. That they must be active
forces ready to attack conditions at their sources and not be solely concerned with caring
for the mentally sick after their break down has occurred.
DISCUSSION BY DH. ROBERT HASKELL OF IONIA STATE HOSPITAL.

Ladies and Gentlemen: I would like to say a few words on one phase of what Dr.
Williams in his excellent paper chooses to call a positive function of state hospital work.
I refer to positive research on criminologic lines. This may seem to the casual observer
a far-fetched association but just a brief attention to recent studies shows that idea entirely unjustified.
The states of New York, Massachusetts and Illinois have injected into their penal
systems some professional interest and that professional interest is being provided by psychiatrists. The National Committee for Mental Hygiene established at Sing Sing Prison
a Psychiatric Clinic under the directorship of Bernard Glueck. Illinois in its central
Bureau of Public Welfare created a State Criminologist and this official has a member of
his staff, a trained psychiatrist, resident in every penal, reformative and correctional institution in the state. Massachusetts' work has not been so widely organized and has
depended more upon the excellence of several of its prison and reformatory physicians
and certain of its Boston court clinics. Some of these men have contributed work of definite value to the problem of criminology.
The most clear cut researches have been those of Glueck. He examined 608 adult
prisoners consecutively admitted to Sing Sing Prison in a nine months period. Of this
group of 608 unselected adult prisoners he shows that:
' '66.8 per cent were not merely prisoners but individuals who had shown throughout
life a tendency to behave in a manner at variance with the behavior of the average normal
person, and this deviation from normal behavior had repeatedly manifested itself in a
criminal act.
"2. Of the same series of 608 cases, 59 per cent were classifiable in terms of deviations from average normal mental health.
"3. Of the same series of cases, 28.1 per cent possessed a degree of intelligence equivalent to that of the average American child of twelve years or under; of the ninety-eight
native-born defectives 80.6 per cent were recidivists in crime, whose average number of
sentences to penal or reformatory institutions was 3.5; and 85.7 per cent of the group will
have been returned again into the general community within a period of five years.
"4. Of the 608 cases 18.9 per cent were constitutionally inferior, or psychopathic,
to so pronounced a degree as to have rendered extremely difficult, if not impossible, adaptation to the ordinary requirements of life in modern society. This lack of capacity for
adjustment is reflected, on the one hand, in the fact that of the ninety-one native born in
this group 86.7 -per cent were recidivists in crime, whose average number of sentences to
penal or reformatory institutions was 3.9, and, on the other hand, in the fact that a very

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MEETING OP JOINT BOARD OF TRUSTEES.

significant number of them have been total economic failures thus far. Furthermore,
82.4 per cent of these cases will have been discharged again into the general community
within a period of five years.
"5. Of the 608 cases 12 per cent were found to be suffering from distinct mental
diseases or deteriorations, in a considerable number of whom the mental disease was directly or indirectly responsible for the antisocial activities."
There is no reason to believe that conditions in Michigan are any different from those
just summarized. We see constantly in the Judges' statements accompanying convicts
to the prisons a recognition of the fact that there must be something wrong with the man
before him for sentence but an admission of helplessness so far as any ability for comprehension of what that something is or opportunity to get that information except in flagrant
cases. Let me just read the Judge's statement on one A. P., committed to the Michigan
Reformatory on November 16, 1916, at the age of 23 years, to serve a sentence of 2 to 10
years for arson:
"This boy burned up about $12,000 worth of buildings for his father and he has an
apparent niania for setting fires. He is an innocent looking youngster but is certain to
fire anything he gets a chance to touch a match to.
"He burned his father's barn and later burned the house without cause or excuse.
Either he is a Mental Pervert or else he has an insane mania to burn buildings. I do not
know what else to do with him. His parents are very much afraid of him and wish him
retained for full time of his maximum sentence.''
A perfectly candid confession of helplessness, don't you agree? This child is now
eligible for parole and in any case will have to be discharged April 18, 1924.
What is the nub of this particular situation? A. P. was admitted to the State Psychopathic Hospital in 1913 on an observation. He was an overgrown child that you would
take to be about eight or nine years old to look at but whose parents say he is seventeen.
The family is questionably normal. He walked early enough but didn't begin to talk
until 3 and he was 7 or 8 before he could talk at all plainly. He had a double congenital
inguinal hernia and a long adherent foreskin. He had continual nocturnal enuresis until
8 years old.
When nine years old he stole a dollar from a neighbor and ran away for several days.
At 10, 12, and 14, he again ran away for varying lengths of time. Besides this he was constantly in mischief of one sort or another so the last time they sent him to the Industrial
School at Lansing. He was paroled home after a year. He immediately commenced
running away again, breaking into houses and stealing food and money. He was recommitted to the Industrial School where he stayed until 17 years. On coming home he again
began running away and within a few weeks was found by a family in a neighboring town
seated at their table gorging himself on their choicest viands in the middle of the evening.
Complaint was made to the police and the boy came to the attention of the probate
court. The Court was struck with the manifestly puerile appearance of the lad. Doctors
were appointed to examine him; in their official report THEY CERTIFIED TO THE
COURT THAT IF THE BOY'S FORESKIN WERE AMPUTATED AND HIS HERNIA REPAIRED THAT HIS THIEVING AND RUNNING AWAY FROM HOME
WOULD BE CURED. This 17 year old boy by the Binet test is less than 10 years old
intellectually.
He was discharged with a bad prognosis for criminal recidivism and the recommendation that he be committed to Lapeer. There was no room for him there. He got into
further trouble culminating in the Arson for which he was finally sent to prison. No advantage has been taken of the advice available for this case and none will be.
We could detail countless such cases. This one suffices to present the problem.
There is a big field for criminologic research in the State of Michigan. Whether it
shall be started in the prisons which requires a professional spirit to initiate it and push it
through: whether it should be started from the institutions dealing with the insane: whether
it shall be started by private organizations like the newly organized Mental Hygiene Society for example: or whether it shall be started by a state survey on the line of the late
Michigan Commission on Mental Disease, I am not now prepared to recommend. It
would be a very practical way to have a small group composed of a psychiatrist, a psychometrist, a social worker and a stenographer to rotate among the several prisons, including the Detroit House of Correction and also the juvenile reformatory institutions
at Lansing and Adrian. In the beginning, by having in each of these institutions, some
one trained to prepare preliminary records for each new admission, for every person coming
up for parole and for the disciplinary cases as well as the suspected insane, such an ambulant group of examiners could immediately become of inestimable value to the four prison
executives and to the Pardon Board and before a year was over these persons would personally recognize the value of such studies and would demand at least one such positively
trained worker on the prison staffs constantly.

STATE HOSPITALS OF MICHIGAN.

17

Education of the people as to what possibilities present research offers as a means
toward preventing crime is the hope. This is a big field for the extension activities of all
the state hospitals and is just as much a problem of Public Health as syphilis.
DISCUSSION BY DR. J. D. MUNSON OF TRAVERSE giTY STATE HOSPITAL.

Gentlemen: I congratulate Dr. Williams upon his valuable address. It points out
the possibilities for a wider field of usefulness for a state hospital. It has been very stimulating and I am sure that I shall go home with new courage to promote the work. I shall
not attempt, even in a general way, to discuss all of the topics covered but shall limit myself to those questions in which I have been most interested. We believe that the state
hospitals has an ever widening influence for good in relation to the general population,
especially with reference to the causes and prevention of mental disease.
The relation of the state hospital to the public may be discussed from two standpoints;
—first, the duty of the state hospital to the public, i. e., what it owes to the public;—second,
the duty the public owes to the state hospital.
The fundamental duty of the state hospital is to provide the most modern medical
treatment for its patients. It no longer suffices to provide him perfunctory or routine care
and treatment,—he must be surrounded by trained nurses and psychiatric physicians, be
skilfully and kindly led through his mental and nervous conflicts, that he may escape
mental splitting, dissociation and regression if within the bounds of possibility. The
hospital must guarantee to every case thorough study and careful clinical, laboratory and
psychological investigation and records of the same must be made. This much the state
hospital owes to the public and may be referred to as intra hospital duties.
There are certain other duties which the hospital owes to the public which are extra
hospital and relate not only to the over sight of discharged patients but to the study and
prevention of the causes that lead to mental and physical deficiencies. The extra hospital
trend is to provide over sight for the patient in his home, to correct, as far as possible,
faulty conditions in his environment, habits, occupation, etc. As Dr. Russell has recently
pointed out it is by extending the activities of the hospital beyond the present limits so as
to deal with mental disorder in closer relation with the conditions in which they arise and
in which they interfere with social welfare that the state hospital as an organized agency
can contribute most to the advancement of the aims of the mental hygiene movement.
By this extension, the knowledge and skill which have been acquired in the study and treatment of patients in the hospitals can be brought to bear on the problem of mental disorder
as it exists in the home, in society and in the individual in his natural environment. The
widely prevalent view that the study and practice of psychiatry, and that hospital organizations can be of service only in hopeless conditions may thus be dispelled and their value
in individual and social conditions which are remediable will be practically demonstrated
and accepted. This result has in some measure already been accomplished, and an increasing respect and demand for the services of psychiatrists are distinctly noticeable. I
would respectfully refer to the work of the mental clinics and the value of such work at
Ann Arbor and Kalamazoo and in other places where they have been established.
To carry on such work, i. c., the intra and extra hospital work will require a body of
trained workers. These workers should be a part of the public health service. They
would make community serveys, assist in juvenile court work, study individual cases as
they present.themselves in the home environment, determine social maladjustments and
study the interplay of all those circumstances which in any way might contribute to the
mental illness. In such service the most careful investigation will be given to disease
and poverty. Poverty and disease work in a vicious circle in which cause and effect often
change places. It is certain that disease is one of the most fertile causes of poverty, using
the word poverty in a sense of privation of one or other essentials of physical being.
The extension of the extra hospital service will be a measure of assurance against the
pauperism bred of disease. We are rapidly approaching this broad field of civics and have
made tremendous strides within the last five years, more particularly since our army entered in actual warfare in France. All communities are interested in the health of every
person in the population. A very large part of those who have come to be charges upon
the public are those reduced because of ill health, poverty, destitution, and public dependents are very largely public health problems. Fundamentally they all relate to physical health but there is recognized now as a vast public interest the subject of mental health.
The conclusion is that the importance of health in its broad sense gives the public service
a certain unity which is bound sooner or later to be recognized. (See editorial Detroit
News, Jan. 1920.)
Our institutional facilities for training schools should be enlarged so that they may
train young men and women for public service for an intelligent insight at least into all
the factors which make for public well being. Mental Hygiene associations will be of
great importance and through such agencies some form of conference will bring together

18

MEETING OP JOINT BOARD OF TRUSTEES.

in the public institution official and unofficial workers, dealing with social progress with
hospital and extra hospital activities.
Our state hospitals are fast becoming indispensable to the people. The progressive
community endeavors to place hospital facilities at the service of all suitable cases, per
contra the progressive hospital should endeavor to place sufficient trained psychiatric and
mental hygiene nurses and social workers in each community so as to eliminate as far as
possible all preventable causes of disease. It is unquestionably true that the trend is also
for closer cooperation between intra and extra hospital physicians from the practical value
of the psychiatric work, the mental clinic, etc. In this manner we are developing an increased realization of the need for more exact knowledge of the relation between the psychopathic conditions and crime, pauperism and other social maladjustments.
The Traverse City State Hospital during its existence has cared for about nine thousand patients. These patients have been admitted from almost every neighborhood in
the state. Every such community is directly interested in the work of the hospital and
the success attained in its medical and other work. On the other hand the state hospital
has never had a direct interest in communities. "It has never had means of knowing,
first hand, about the personal and domestic hygiene of such neighborhood, its heredity or
social psychology and has taken no part in examination or training of its children or in a
measure looking to the prevention of ill health and on the sequels that result therefrom.
Our hospitals must be more than medical and custodian institutions, they must be of highest value in scientific work and of highest social value to the public, in as much as they
protect the community from the menace of insane people and others who perform unsocial
deeds. In this sense the state hospital is highly social and we maintain that they should
endeavor to provide to many or all communities the services of trained physicians and
nurses to investigate and report to some proper authority all suitable cases and to work
in cooperation with all organized bodies that are interested in the public health service,
to the end that mental deficiencies may be lessened and the sufferers afforded immediate
medical care and treatment."
The duty of the public to the state hospital is no less important. Communities must
aid and support mental hygiene movements and health organizations which have for their
object the control of ail those conditions which lead to ill health and as a consequence to
poverty, pauperism, mental shipwreck and delinquencies. There are many complex
factors involved in this great field of effort. The public must insist upon the inactment
of health laws, which will be of general applicability to protect and give commensurate
authority to the conditions of legitimate efforts. To this new field of civics the medical
profession, educators, including school boards, jurists and legislators, and all organized
bodies must cooperate to promote the public health. We must not forget that a new situation is arising and its proper solution will have much to do in deyeloping the ^greatest
asset that any state can possess, sound minds and sound bodies, a high degree of health.
We believe that the hospital has the ability to take a leading part in this movement. It
is within the bounds of possibility that the state hospital will establish its own health department, one that will work in harmony with every other organized health organization
of the state, become a coordinate part of the public health service and yet one which will
not be subordinate to any other. We believe it should have a direct part in the very important field of mental hygiene, as well as in all others, which have for their object the
prevention of mental and physical ill health.

STATE HOSPITALS OF MICHIGAN.

19

DO STATE HOSPITAL FARMS PAY FROM A BUSINESS STANDPOINT?
PAPER BY MR. G. B. PIKE, STEWARD OP TRAVERSE CITY STATE HOSPITAL.

Ladies and Gentlemen: This question has frequently been raised and there are some
who persist in declaring that State Hospital farms do not pay. Some have even asserted
that the splendid herds of pure bred Holstein cattle do not pay and that the State might
better own grade herds and scrub cows.
It is a fact, however, that the state hospital farms are a source of profit and that the
pure bred Holstein cattle, with at least three of the four herds producing an average of
12,000 to 13;000 pounds of milk per cow per year—the remaining herd being not very far
behind that figure—play an important part in producing that profit and stand today a
monument to the sagacity of the men who were instrumental in inaugurating them as
state hospital farm adjuncts.
The sales of surplus cattle alone from the Traverse Herd in the last two years have
amounted in round numbers to the magnificent sum of twenty-five thousand dollars, the
last three cows sold bringing an average price of more than $1,500 each. The last cow
sold from the Pontiac Herd brought the splendid sum of $2,050.
Much might be said about the winning of prizes and prize money for advanced registry work, the development of World's record cows and heifers; about these herds obtaining an international reputation of high degree all of which is bound to result in greater
and greater profits in the future. But besides that is the fact that the one best food of all
foods for human consumption, pure, wholesome milk, is produced in abundance for the
needs of the patients.
The hospital farms maintain droves of swine which are kept immunized, in recent
years, against hog cholera by treating the pigs, when weaned, with the double treatment of
serum and virus. These droves of swine are a source of great profit, and besides, through
them, that most troublesome problem of all civic problems, the disposal of garbage, has
been most satisfactorily solved.
The orchards, vineyards, and small fruits are another source of profit. These adjuncts are an especial feature at Traverse City, producing an abundance of apples, cherries,
plums, peaches, and berries, so that the purchase o_f these healthful foods is unknown at
that Institution. Large quantities are consumed in the fresh state and the balance is
canned. The annual production of cherries and berries runs into the thousands of crates.
Beside the money profit from these crops there is an unknown profit obtained from the
consumption of these fruit-foods, the health betterment of the patients, that does not appear in our figures.
More could be said about the soils, the growing of special crops and crop rotations,
experimentation with fertilizers, lime, rock phosphates, etc., but space forbids, and it is
not especially germain to the question—whether state hospital farms pay or not, so the
following table is presented showing the value of farm products and cash receipts, expense
of operation and maintenance, value of products consumed on the farm and net profits
for a series of years. These figures are compiled from data contained in the biennial reports.

20

MEETING OF JOINT BOARD OF TRUSTEES.
Year ending Year ending Year ending Year ending Year ending Year ending Year ending
June 30,
June 30,
June 30,
June 30,
June 30,
June 30,
June 30,
1916
1914
1915
1917
1918
1913
1919

For Kalamazoo State Hospital:
Farm Products and Cash Receipts
$70,796 60 $71,332 52 $75,917 20 876,418 59 $81,591 12 J101.018 71 8115,472 07
Farm Disbursements
•
48,866 20 46,824 47 51,646 18 50,086 67 48,533 47 48,801 26
69,771 06
Gross Surplus
21,930 40 24,508 05 24,271 02 26,331 92 33,057 65 52,217 45
45,701 01
Less Products Consumed on
Farm
16,943 08 20,371 22 14,139 30 15,524 26 13,302 58 15,240 25
14,506 95
Net Surplus
4,987 32
4,136 83 10,131 72 10,807 66 19,855 07 36,977 20
31,140 06
For Traverse City State Hospital:
Farm Products and Cash Receipts
38,455 49 38,157 30 36,063 12 37,170 69 63,262 53 72,763 17
90,064 54
Farm Disbursements
25,003 51 24,547 78 20,343 96 29,571 62 32,174 54 47,490 77
57,994 46
7,599 07 31,087 99 25,272 40
Gross Surplus
13,451 98 13,609 52 15,719 16
32,070 08
Less Products Consumed on
Farm
9,059 74 11,891 18 11,002 95
8,421 72
7,865 55
7,388 76
13,098 17
Net Surplus
5,187 80
7,853 61 •1,460 67 19,196 81 14,269 45
6,063 22
18,971 91
For Poatiac State Hospital:
Farm Products and Cash Re48,555 77 38,481 71 66,029 26
ceipts
82,773 28
21,899 03 23,450 38 38,002 69
Farm Disbursements
42,073 14
Gross Surplus
26,656 74 15,031 33 28,026 57
40,700 14
Less Products Consumed on
14,234 64
8,249 99 17,987 20
Farm
22,089 65
12,422 10
Net Surplus
6,781 34 10,039 37
18,610 49
For Newberry State Hospital:
Farm Products and Cash Receipts
18,758 73 22 758 74 20,340 17 26,340 18 40,401 03 40,401 04
Farm Disbursements
14,666 84 19,143 25 17,029 11 22,439 91 25,820 19 30,399 38
3,615 49
3,311 06
3,900 27 14,580 84 10,001 66
Gross Surplus
4,091 89
Less Products Consumed on
3,339 27
3,339 28
3,702 01
3,339 29
Farm
3 339 26
3,167 75
560 99 10,878 83
6,662 37
752 63
276 22
153 31
Net Surplus
•Deficit.

It will be seen from the above table that the net profit at Kalamazoo for the 7 years
beginning July 1st, 1912, and ending June 30th, 1919, was $118.035.86, an average per
year of $16,862.27.
The net profit at Traverse City for the same 7 years was $70,126.13 an average per
year of $10,018.02.
The net profit at Pontiac for the 4 years beginning July 1st, 1915, and ending June
30th, 1919, was $47,853.30 and average per year of $11,963.32.
The net profit at Newberry for the 6 years beginning July 1st, 1912, and ending June
30th, 1918, was $19,284.35 an average per year of $3,214.05.
On July 1st, 1919, a new system of accounting was inaugurated by the Auditor General's department for the state farms. This system involves a complete farm inventory
as of July 1st, each year; interest on investment is taken into account; the food furnished
the hospital is credited to the farm as well as the labor performed for the hospital, while
we are compelled to charge against the farm the patients' labor and the maintenance of
hired help working on the farm.
We present herewith the farm statement according to this new system for the Traverse
City State Hospital for the last fiscal year ending June 30th, 1920. Like reports for the
other state hospitals not being at hand, they cannot be presented at this time.
Analysis of Farm Receipts and Disbursements for the fiscal year ending June 30, 1920.
TRAVEKSE CITY STATE HOSPITAL.
RECEIPTS:
Bulls sold
Heifers sold
Prize money
Service of sire
Feed sacks sold
Old sprayer engine sold
Ear tags sold
Products paid for from Institution Food account
Teaming and labor charged to Institution

$3,900 00
8,119 67
191 00
100 00
174 62
15 00
2 00
69,516 02
12,405 00
t,423 31

STATE HOSPITALS OP MICHIGAN.
DISBURSEMENTS:
Feed
Straw
Registry and testing
Advertising stock
Milking Machine Parts
Harness
Veterinary services
Traveling expense
Spraying supplies
Seed
Coal
Farm Tools, Implements, etc
Freight
Rent of land
Sundries
Wages
Employees maintenance
Interest at 5% on total farm investment

21

$33,456 88
1,690 55
1,520 46
433 58
109 18
134 81
428 26
143 94
316 68
776 51
917 56
879 76
3,415 21
325 00
500 74
19,514 44
2,923 23
8,278 74 $75,765 53

Increase in Farm Inventory

$18,657 78
7,554 51

$26,212 29
(Accrual of Inmates Maintenance, $7,335 09.)
We would respectfully call your attention to the fact that the net profit of the State
Hospital Farm at Traverse City as shown by this statement was $26,212.29 which is 15.83
per cent of the total farm valuation as shown by the July 1st, 1919, inventory. Charging
out the patients' labor, performed on the farm, the net profit was $18,877.20.
DISCUSSION BY A. E. STEVENSON OF PONTIAC STATE HOSPITAL BOARD.

Ladies and Gentlemen: I think the paper was very interesting. I will admit when
this question came up, I was advised by Dr. Ostrander I would be expected to discuss it
to some extent. In looking over our own farm, I was somewhat surprised. I have taken
this question to discuss absolutely from the farm standpoint. I have not taken up the
herd proposition, which Mr. Pike raises, because we know the farmer always suggests you
will make money out of your herds in a way and lose it in another way. So I have studied
this from a point solely as a farm proposition.
We produced at the Pontiac State Hospital last year net products of over $57,000.00.
That docs not take into consideration any sale of cattle nor any increase in the value of
cattle. We produced $57,396.00 and the Pontiac State Hospital got the products. We
produced in milk alone, $22,000 at $3.80 per hundred. I took it this might come up in
answer to some of the criticisms we have heard about these State institutions. We produced it at a cost of $36,000. In other words, we made from the farm alone and garden,
not taking into consideration the increased value of the herds or anything of that kind,
not taking into consideration the cattle sold, or anything of that kind, we made $21,000,
right from the farmer's standpoint.
In getting out these figures, we have allowed for everything we paid out in labor and
•board, over $10,000. We paid out for feed, in order to feed the cattle and horses and
everything on the farm, over $17,000.
I thought possibly the question was aimed purely at the farming proposition, and not
taking into consideration the herds, and I think the average member of the Legislature
in discussing this question, will discuss it without the herd proposition.
So, from the financial standpoint, it seems to me this question can be answered in,
two ways. Are State Hospital farms profitable. I say, yes, if they don't make a dollar,
because it is necessary that State Hospitals have, as the speaker pointed out, a sufficient
supply of good pure milk, and it is impossible to get it in quantities or in quality in any
other way.
Then another thing he pointed out, that we have a great saving in the garbage from our
farm. This past year we produced over 32,000 pounds of pork, so that we can take the
pork, the milk, the apples, and the potatoes, and pay all bills in connection with the farming operation.
Now in that statement, we have avoided padding. The potatoes we raised were put
in at 36 cents a bushel, because we bought potatoes last fall at that. The pork could
not be bought at figures set up. It was put in at seventeen and a half a hundred. It

22

MEETING OF JOINT BOARD OF TRUSTEES.

should have been that live weight. I am merely showing how our figures are arrived at
to show that there was nothing put up to increase the value.
Now, can anyone say, in the face of those figures, gone over by the auditors, approved
by the auditors, that State farms do not pay?
As I say, I would answer that in two ways. Do they pay? Yes, even if they do not
make any money, on account of the milk and on account of having the garbage for your
pigs. And then, are they a success financially, institutions that are making from ten to
twenty thousand dollars a year, are they a success financially? I am saying that without
the herd because we are in a very embarrassing position with reference to the herd. In
fact, it looks to some of us on the Board when we are offered big prices, that we should accept them. I feel that the State is entitled to have a good herd notwithstanding outsiders offer good prices for them. So, going into the herd side of it, we could increase our
profits on this side of it, very materially.
As I said, we are talking purely and solely from a farming position. In five years,
our cattle have increased four times the amount of milk. Now, stop and think, a herd
of cattle that is coming gradually along, not in increased value, but from the actual amount
of milk they are producing, and they have increased that amount, and we have furnished
it at S3.80 per hundred, and I defy any institution to buy it for that by the year and get
quantity and quality.
So I agree with Mr. Pike fully, and say they do pay. And, judging from our farm, I
do not think there is any question about being able to convince any level headed farmer
that State Farms pay.

STATE HOSPITALS OF MICHIGAN.

23

ARE STATE HOSPITAL FARMS PROFITABLE FROM A THERAPEUTIC
STANDPOINT?
BY DK. H. A. HAYNES, SUPERINTENDENT MICHIGAN HOME AND TRAINING SCHOOL, LAPEER.

The therapeutic value of institution farms is well known to the members of this organization, but for reasons some of which are beyond our control, the farms may not have
been used to their fullest capacity towards the rehabilitation of our patients.
The general idea is, that a farm is purchased for an institution for the purpose of supplying fresh vegetables, milk, meat, etc., for the patients and like most farms it should
return profit. It appears to have been forgotten that it is more expensive and important
to produce men than to produce beans and corn. For that reason institutions are sometimes criticized when the profits from their farms fail to reach the average earnings of
similar acreages used only to produce crops.
Institution farms must not be considered of value only in proportion to the financial
returns, for their primary object is to add to the health and happiness of the patients by
the products furnished and the occupations offered. The man and not the product. The
farmer of necessity has as his primary object—profit. He frequently sacrifices health and
happiness to attain this end. The trend of modern times makes us all think of the money
value, and the value of occupational therapy and the needs of general health and happiness
are overlooked.
The amount of labor that may be performed by patients should be considered incidental, if by the doing their conditions may be made better. In other words the farm should
be considered as much a part of the medical treatment of a patient as the gymnasium is
in the education of the school boy. The fact that so many of our patients formerly lived
on farms and the breakdown was the result of keen competition in congested cities, affords
a large group who have already had farm training an opportunity to again work on the
farm under good supervision and adds to the general content and improvement of the
patient.
The routine of farm work without the noise, hurry, and crowds found in the industrial
rooms and cottages, and the sunshine of great outdoors furnishes that something for the
unfortunate which cannot be supplied from the pharmacy.
Not only must the farm be considered as a large industrial room but also as a recreational center and sun parlor where patients may become interested in caring for the crops
they like best. Often times this activity will change the line of thought from that of worry
and discontent to that of happiness.
The idea of occupational therapy is neither new nor on the other hand, has it reached
its greatest development. It is perhaps as old as civilized man, as the savage, probably,
when depressed or out of sorts, turned to the making of a new arrow or spear head for diversion.
The earliest recorded history we have of occupational therapy, however, is in 1798
when Dr. Rush of the Pennsylvania State Hospital requested his Board of Managers to
provide certain employment for the deranged who were still capable of working. Among
the activities suggested in this letter, were for the men, grinding Indian corn in a hand mill
for food for the institution cattle and horses, cutting straw, sawing boards and working
in the gardens. For women, he suggested, spinning, sewing, churning, etc.
In 1835 the Friends built a circular railroad for the use of patients in their hospital
for the insane. They had for this, a car which two people could propel. Later they
placed animals in the patients yards and furnished material for drawing, writing, and
reading when within doors.
From 1836 to 1850 several hospitals reported that many of their patients were working at various industries such as carpentering, gardening, and farming, and a few were allowed to care for anmials. About this time libraries began to find a place in the hospitals.
Thus we find the idea growing and developing but it was over a century before it became
systematized.
The first course of training given was as late as 1906 when Miss Susan Tracy gave a
course of ten lessons designed to educate a nurse to care for different classes of patients.
Since then, however, many schools have opened up courses for such training. The World
War has given the greatest impetus to such training and work.
Occupational Therapy falls naturally under three heads: Invalid Occupation, Occu-

24

MEETING OF JOINT BOARD OF TRUSTEES.

pational Therapy, Vocational Education. Invalid Occupation, is, as its name implies
chiefly diversional, aiming to divert the mind of the patient from his own ills and then to
create interest and cheerfulness. Occupational Therapy has as its chief object the improvement of function, either physical or mental and the third, or vocational education,
seeks to train for the future and may only find a place under this general head as it aims to
reestablish a function, and to form a more normal view of life.
Any form of work to be curative must be able to create interest for the patient. Increased interest in the occupation goes hand in hand with progress towards recovery. In
assigning an occupation it may be that some work which is entirely new to the patient
will do more to stimulate interest. On the other hand we sometimes find that patients
do better when given work with which they are already familiar. It is better that patients
do bad work than none at all. In other words it is better to be employed in useless work
than to be idle.
Our problem to-day, the institutional farm, covers all three headings. For some patients, it is invalid occupation. This is especially true in an institution for the feebleminded. The work is done almost entirely by the patients. Many are assigned to farm
duties as a diversion, others, of course, are assigned for the definite purpose of physical
and mental improvement. Occupational Therapy would find its chief strong hold in
hospitals for the insane and the tubercular. The man or woman who has been closely confined to the office or other indoor work and, as a result of such activity, directly or indirectly becomes mentally disturbed and is placed in a hospital will have need of industrial
training such as is best afforded in farm activities.
What hospitals suffer from more than anything else is suppression—spiritual suppression. In order that the human spirit may develop, it must express itself. Recent
demonstrations show that in the last analysis emotions cannot be successfully suppressed,
that they find expression in some way and if not directed along healthy, normal constructive lines, prove terribly destructive.
It is an established fact that many people have in them the tendency to mental illness but because of particularly favorable surroundings never develop into institutional
cases. Equally true is it that many of the mental patients in our hospitals and institutions to-day are there because of unfavorable surroundings and we wonder if the marked
tendency of the people of this country to leave the farm and seek the high wage and the
excitement of the city is not responsible for at least a small percent of the mental misfits.
High wages and to the city movement, means strong competition. Strong competition means worry and frequently despondency, also an effort to be one hundred percent on
the job and all this means highly increased mental strain. The excitement of the city,
the complexity of it, as compared with the quiet life, brings too great a drain upon the
nervous system. Granting this to be true, what better antidote could we supply than a
return to the rest and quiet of the farm. The air, the sunshine, the soil and the absence
of driving bosses allows the overwrought nervous system to relax, rest and recuperate.
This applies also to the feebleminded. A high grade feebleminded person placed in
a highly complex surrounding is as we all know, an object of pity. He is jostled about in a
helpless fashion, is the laughing stock of some and the tool of others. Place the same individual in a simple environment such as the farm offers and he at once becomes a more
efficient person. His defect is not so apparent and he feels that he is a useful member of
society.
This is even more true in the institution, for here his co-workers are more nearly his
own level. He ceases to indulge in self pity and builds his simple aspirations. He becomes interested in the work at hand and is proud of the product of his labor.
But there is still another angle from which to view the benefits of the institutional
farm, that is as a normalizer of the institution. Dr. Mary Lawson Neff has written a fine
article on normalizing the institutional life of the insane and what she says holds true in
a large measure for all institutions for the mental and nervous abnormalities. She points
out that we, as institutional heads, take excellent care of. the physical side of pur patients
but too frequently fail to get back to the fundamentals of their psychological welfare.
She aptly points out that the normal psychological life is a series of responses to the main
motives of life, necessity, and ambition, and that in committing a person to an institution
we cut off these motives for the most part. For the greatest good of these patients these
motives must be replaced in so far as possible.
The patient resists the monotony of the four walls of the ward or cottage; his pent up
energy refuses to allow him to sit apathetically and do nothing. He wants the normal
amount of change. As we think over these points, which Dr. Neff gives us, the farm looms
up as a solution to a great number of our psychological as well as the physical needs. Where
can ambition be better stimulated and repaid than on the farm? The boy has a team to
care for and he keeps them sleek and shiny. They are naturally admired by all visitors
who come to the farm and that means a great deal to that boy. You can see it in his man-

STATE HOSPITALS OF MICHIGAN.

25

ner and expression; in the pride with which he informs the admirer of his relation to the
well being of the horses. Another assists in preparing the soil and planting the seed. His
mind is quite taken up with the task and he waits with eager expectancy the first show of
green. It has aroused in him a real ambition and pride.
Of course the farm affords the necessary variety. He is planting to-day, working
about the barn to-morrow due to a shower, preparing the soil for the crop of harvesting it.
The farm garden, the small fruits and the canning, offer splendid opportunities for the female patients.
Farm work, as well as any other occupational therapy should be given under the direction of a physician who knows the patient mentally and physically, and who will watch
and measure the effect of the task upon the patient. Even good things may be overdone.
It should be borne in mind that the institutional farm is first and last'for the benefit of
the patient and not the patient for the farm.
This is not a mere theory that I am giving you to-day. As I have said we have a
farm and our patients work on it. They are well physically and happy mentally. They
feel it is a fine privilege to be allowed to work on the farm and resent being kept in a day
when it is thought best for physical reasons.
They take great pride in the way they care for the stock, the buildings and land. They
are happy in it to the extent that when I am tired from the worries of the Institution, I
go over to get a fresh hold on myself and let their optimism rekindle mine.
Often times instead of having the patients do work that is worth while they are assigned to some sort of busy idleness. The insistent demand of patients for something to.
do, should never go unheeded. Establish small colonies for twenty five or thirty patients
conveniently located on the farms. Here they can care for certain portion of the herd,
chickens, ducks, pigs, etc., and are happy in the doing. We known the best results must
come from individual expression, and that we must respect that individuality, it matters
not what the intrinsic or economic value of the finished article may be. Bear in mind that
we are not conducting arts and crafts schools. Let a few of the difficult patients get on
the farm as audience, if need be, for weeks, before we become discouraged. Don't defeat
the purpose of the physician by an effort toward getting the patient to work.
The fundamental principles of occupational therapy are that the work should be
carried on with cure as the main object. The work must be interesting. The patient
should be carefully studied. That one form of occupation should not be carried to the
point of fatigue. That it should be carried on with others. That work resulting in a poor
or useless product is better than idleness. Man to be happy must have something to
work for, something to hope for and something to love, and it is up to us to supply the
needs for those under our supervision.
Without the institutional farms, many patients would be deprived of the therapy
most needed for their cure. We like our farms and would not be without them, but hope
the day will soon come when they will be considered a real part of the hospitals and not
as appendages for profit and be maintained for the therapeutic value they offer our unfortunate population.
DISCUSSION BY DR. B. A. CHRISTIAN. SUPERINTENDENT PONTIAC STATE HOSPITAL.

Ladies and Gentlemen: There are three minutes that intervene between now and
the next feature on the program, and in that time, I think I can say all that can be said
on the subject. I do not know how to discuss a question that has but one side to it.
I never heard of anybody opposing the view that occupation on the farm was valuable
therapy. The answ_er to the question, if there is any question is to be found in experience
only, and the experience of all the hospital superintendents that I know of has been emphatically to the point that farm occupation is of great benefit for promoting the comfort
of the patients, and for diminishing the expenses. It would be a very interesting question,
if we could determine just what the value of patient farm labor is. Unfortunately, human
effort is not capable of the same mechanical measurement that machine activities are.
I would venture a guess, that from a financial point of view, it would take four or
five average insane men to be as productive as one ordinary farm hand. But that is not,
the point in the matter of financial returns. Man is an animal. If he is kept in confinement, he will get like any other animal, he will become resistive, discontented, and he will
find expression in destruction, all of which adds to the upkeep of the plant, and we know
from experience to put a patient to work, particularly in a form of labor that is productive
and not ornamental, it adds very much to the peace and contentment of mind, and that
works for the benefit of the patient and reduces his restlessness, and produces economy.

26

MEETING OP JOINT BOARD OF TRUSTEES.

STATISTICAL ANALYSIS OF THE BIENNIAL REPORT OF MICHIGAN STATE
HOSPITALS FOR THE INSANE FOR THE BIENNIAL PERIOD 1915-1918.
BY ALBERT M. BABHETT, M. D., MEDICAL DIRECTOR OP THE STATE PSYCHOPATHIC HOSPITAL.

Ladies and Gentlemen: There is no report published in Michigan that shows in one
series of tables, the combined statistics of the various state institutions caring for the insane. The separate biennial reports that are published by the State hospitals for the insane relate solely to their own problems and local institutions, and no where is there any
statistical consideration of the problems of the care of the insane as they affect the State
as a whole.
Unless this knowledge is available it is impossible to formulate any satisfactory constructive policy for future developments.
It is also of much interest to the subject to ascertain what factors are active in the
production of mental disorders and whether or not there are changes for better or worse.
In 1915, a commission appointed by the legislature made a report on the extent to
which insanity existed in Michigan at that date, and various factors that bore a relation
in its occurrences. Some comment was also made of changing relations that had taken
place in the progress of years.
It is my purpose in this discussion to continue some of these statistics to the present
date and to present some comments as to existing conditions in the hope that they may
be an aid in determining future policies.
Table 1:—Number under treatment in Michigan State Hospitals for the Insane on
June 30th of each year.
1915
M
Pontiac
Traverse City
Newberry
State Psychopathic Hospital
Ionia
...
Wayne County Hospital . . . .
Total . .
Ratio per 10,000 population

F

I 917

1916
T

M

F

T

M

F

1918
T

M

F

T

1162 1065 2227 1145 1102 2247 1162 1116 2278 1110 1097 2207
788 665 1453 812 689 1501 816 682 1498 791 684 1475
882 779 1661 916 777 1693 916 816 1732 988 867 1855
561 413 974 565 425 990 564 440 1004 560 460 1020
25 35 60 26 28 54 26 28 54 24 37 61
393 62 455 413 64 477 421 62 483 425 66 491
298 320 618 368 360 728 390 375 765 339 402 741
4109 3339 7448 4245 3445 7690 4295 3519 7814 4237 3613 7850
24.2

24.6

24.6

24.3

In Table 1 are given the number of insane under treatment in the state Hospital for
insane in the years 1915-1918. Statistics for the years previous to this may be found in
the report of the legislature commission published in 1915.
There were under treatment in all of the state hospitals caring for the insane on June
30, 1918:—7850 patients. The population of the State at that time was estimated to be
3,230,512. The number of insane under treatment in State hospitals bore a ratio of
24.3 to each 10,000 of the state population.
These figures concern only the insane that were in hospitals supported by the state.
There are a considerable number of insane cared for in County infirmaries and in private
institutions. We have no figures regarding this number for the year 1918, but in 1914 it
amounted to 673 patients.
There is a little difference in the rate per 10,000 population between 1915 and 1918
it seems that they correspond closely, with other states having a similar geographic position, and equal hospital facilities. The rate to population of insane in state hospitals
directly depends upon the hospital facilities that are provided for the insane. These
facilities vary much among the states.

STATE HOSPITALS OF MICHIGAN.

27

HOSPITAL ADMISSION.

Table 2:—Number of annual admissions to Michigan State Hospitals for the Insane.

Kalamazoo
Pontiac
Traverse City
Newberry
State Psychopathic Hospital
Ionia
Wayne Co. Hospital

M

F

391
236
215
165
94
51
101

286
185
158
115
114

1 91 7

1 91 6

1915
T

677
421
373
280
208
51
69 170

M

F

400
261
237
152
126
45
139

288
178
152
97
125

T

688
439
389
249
251
45
103 242

19 1 £

-M

F

T

M

F

T

388
254
220
164
110
45
137

242
165
133
87
138
1
89

630
419
353
251
248
46
226

339
235
173
163
91
50
152

273
163
146
115
136
1
151

612
298
319
278
227
51
303

1253 927 2180 1360 943 2303 1318 855 2173 1203 985 2188

Total
Ratio per 10,000 population

7.1

7.3

6.9

6.8

In table 2 are given the annual admissions to the state hospitals for the insane for the
years 1915-1918.
In 1918 there were admitted to all of the Michigan State hospitals caring for the insane 2188 patients. This bore a ratio to 10,000 population of the state of 6.8. Between
1915 and 1918 there has been a slight decrease in the admission rate. In the former year
it was 7.1 in 1916, 7.3 and in 1917 it was 6.8.
The comments made thus far relate to the total number of insane in relation to the
State as a whole. In order to more clearly comprehend the problems of care that concern
the districts hospitals, a matter that is of much importance for determining future policies,
a separate statistical statement is given in Table 3, regarding the number under treatment
and the admissions for the year 1918.
As a state problem the main provisions for the care of the insane, concern the four district hospitals, Kalamazoo, Pontiac, Traverse City and Newberry. With these must be
included the Wayne County Hospital at Eloise, which shares with Pontiac the care of the
insane in the Eastern district of the State. The population of the several districts is taken
from the official estimates of the Secretary of State. There is a considerable variation in
the populations of the various districts.
Table 3:—Number under treatment and admissions in relation to Hospital districts

District
Kalamazoo
Pontiac & Wayne
Co. Hospital
Traverse City
Newberry
State Total

Under
Rate per
Treatment
10,000
Population June 30, 1918 Population

Admissions
1918

Rate per
10,000
population

898 059

2 207

24 5

612

6 8

1,290,778
640,882
400,793

2,216
1,855
1,020

17.2
29 0
25.5

701
319
278

5.4
4 9
6 9

3 230 512

7 298

22 5

1 910

5 9

The four district hospitals, and the Wayne County Hospital, on June 30, 1918, had
under treatment 7,298 patients. This bore a ratio of 22.5 to each 10,000 population of
the entire state. There is wide variation between the population of the different hospitals
districts, and while there is no reason to believe from the character of the population of
the different districts that one should have a higher percentage of insanity in its population
than another, there are marked differences in the ratio of the number under treatment
in a district and also in the admission rate.
There are two hospitals in the state that are able to receive all that apply for admission.
These are Kalamazoo and Newberry. The ratios for these hospitals are 24.5 and 25.5
per 10,000 of the districts population. The other two hospitals have ratios that vary
much from these. That of Pontiac and the Wayne County Hospital being much smaller
and Traverse City much larger.

28

-MEETING OF JOINT BOARD OF TRUSTEES.

There is much uncertainty in attaching a meaning to these differences, but the fact
is known that the Pontiac and Wayne County Hospital have for some time been unable
to care for all of the inside in the eastern district and that the Traverse City Hospital has
had sufficient accommodations to receive for treatment patients who have been transferred
from other districts.
In the matter of admissions there is also much variation in ratios to population. Kalamazoo and Newberry are about equal, while the other two hospitals much lower than the
average for the state as a whole.
AGE AT ADMISSION.

The matter of the age of patients at admission is of importance as showing at what
periods of life insanity is most likely to occur. In Table 4 is given a comparison of the
relative frequency for age periods of the admissions for the year 1892 and 1918.
Table 4:—Percentage frequency of ages at admission for years 1892 and 1918.

Below 15
.
15-19
10-29
30-39
40-49
50-59
60-70
70 and above . . .

.

. .
...

1892

1918

41
5.3
23 4
25 5

2
2.4
17.8
22.2
19.0
13.2
13.2
11.5

19 7
12.2

87
50

..

In both years the largest number of admissions occur between the ages of 30 and 39.
It is of interest to note as bearing upon the problem of care of patients, that there
has been a marked increase in the relative frequency of admissions after the age of 50. In
1892: 22 percent of the patients admitted were over 50 years and in 1918 the percentage
of patients admitted above the age of 50 was 38.4. This corresponds to the relative increase in the same period of the clinical forms of mental diseases that are incident to the,
later years of life, a fact that receives comment in the discussion of table 6, which gives
the clinical types of the admissions.
NATIVITY OF PATIENTS.

In table 5 is given the relative proportion of foreign born patients among the insane
admitted to the Michigan Hospitals for the insane, for the biennial period, 1914, 1916, and
1918.
Table 5 percentage of foreign born patients admitted to State Hospitals for biennial
periods 1914, 1916, 1918.

Kalamazoo
Pontiac
Traverse City . . . .
Newberry

.

1914

1916

1918

21 5
41.3
26.0
60 4

19 8
33 9
27.9
61 6

29 9
38 5
30.7
52 8

'For their relative proportion in the population of the State the foreign born contribute
more largely to the admission to the insane hospitals than do those who are born in this
country. In 1914 the rate of the foreign born among the insane admitted to the hospitals
for the insane in Michigan was 8.9 per 10,000 of the foreign population of the State, and
for the native born was 5.4 per 10,000 native population. Considerably over one-half of
the admissions to the Newberry State Hospital were foreign born.

STATE HOSPITALS OF MICHIGAN.

29

Table 6:—Frequency of clinical forms of mental disorders among admissions.
1916

1918

4 9
.98
11
6.98

5.94
2.87
4 17
12.98

4.3
4.5
28
11.6

2.3

.02
2.59

2 3

2.61

1.2
6
1 85

9 4
1.25

10.3
2.57
.08
12 95

9 1
2.4
.006
11 506

5 1
9.08
03
.08
.21
05
02
3.42
24
18 23

6 3
10 2
06
01
.5

1914
Intoxication Disorders :
Alcoholic Insanity
Chronic Alcoholism

.

.

...

Total
Infectious Metabolic Disorders:
Pellagra
Thyrogenic
..
Infectious —Exhaustive
Miscellaneous Somatic Disorders
Total
Syphilitic Disorders:
General Paralysis
Cerebral Syphilis
Tabes
Total

...

....

Organic Brain Disorders:
Senile Insanity
...
Cerebral Arteriosclerosis
Cerebral Tumor
Traumatic injuries
. .
Huntington's Chorea
Sydenhams Chorea
Multiple Sclerosis
Epilepsy
Miscellaneous Organic Disorders
Total

10 65
...
...
....
4 7
1 3
21 24

Endogenous—Psychogenetic Disorders :
Manic Depressive Insanity .
....
Melancholia
Dementia Praecox
Paranoid Disorders
...
Paranoia
Hysteria
Psychasthenia
.
...
Neurasthenia . . . .
Total
Constitutional Inferiority :
Psychopathic Inferiority
Feeblemindedness
Sexual perversions
Total
Unclassified
..
Not insane
. . ..

7 5
7 4
14
03
.17

...

22 7
5
14 3
4 4
.38
8
43.08

...

2 06
5 13

....

7 19
70
15

....

18 7
14 9
36
.48
1 06
16
29
39.19
19
6 1
13
8 13
4 35
1 52

005

005
2.7
2
20 02
19 5
01
16 5
4 1
1 i
12
4
42 81
15
5 3
6 8
4 7
7

In table 6 is given a statistical analysis of the clinical forms of mental disorders admitted to the Michigan State Hospitals for the insane for the biennial periods 1914, 1916,
and 1918. The various disorders are tabulated in the percentages they occur among the
admissions of each period.
Somewhat arbitrarily these have been grouped under headings, that in a more or less
specific way indicate their etriological relations. A summary of these groups shows rather
clearly the problems of causes and may suggest directions for efforts at prevention.

30

MEETING OF JOINT BOARD OF TRUSTEES.

Endogenous —Psychogenetic
Organic brain disorders . . '
Syphilitic disorders
Intoxication disorders
Constitutional Inferiority
Infectious — Metabolic . .
Not insane

1914

1916

1918

43
21
10
6
7
2
7
1

39 19
18 23
12 95
12 98
8 13
2 61
4 35
1 52

42 81
20 02
11 51
11 6
6 8
1 85
4 7
7

08
24
65
98
19
3
0
5

The largest group of mental disorders is represented by those whose etiological relationship is least known. Their most outstanding causes seem to be inherent in the
mental constitution of the individual that makes difficult the maintenance of a normal adjustment of mind to the demands of life. It is in this group that we find the highest percentage of hereditary influence. The attack against the group must be directed against
the perpetuation of impaired family stock, and efforts should be directed towards a more
careful training of mental habits during childhood, and a regulation of the environment
for those who are ill adapted for meeting the responsibilities of life in the usual way.
In the organic group are placed those disorders that are the result of demonstrable
changes in the normal structure of the brain. The causes of these pathological conditions,
in part lie in hereditary factors such as in in Huntington's Chorea; in infections as in Sydenham's chorea, and in the effects of toxic and metabolestic influences which seem to have
a part in the production of arteriosclerosis and senile brain atrophy. As our understanding of the pathology of these disorders becomes more complete it may be that ways may
be opened up that may lead towards their prevention, but at the present moment we know
little definitely regarding the factors that are active in their production.
Both senile dementia and cerebral arteriosclerosis are occurring in greater frequency
among hospital admissions than in former periods.
The statistics relating to epilepsy and feeblemindedness show that in spite of special
state hospitals for these disorders, they still are admitted to the hospitals for the insane
in considerable numbers.
The disorders due to syphilis are third in order of frequency among the general groups.
This is the group whose etiological relationship is best known, but whose prevention forms
one of the most difficult social problems.
The most hopeful method of attack seems to lie in a more general education of the
public as to the effects of venereal diseases, and a more thorough treatment of these disorders during their early stages.
The group of disorders caused by intoxication is still of serious size, but is one that
promises to be progressively diminished in future time. A considerable number of patients
of this group were admitted under the statutes providing for the treatment of inebriates
and drug addicts in hospitals for the insane, and were not definitely insane.
The remainder of the clinical groups is composed of disorders that occur in relatively
small numbers.
The number of unclassified cases has diminished perceptibly in the last two biennial
periods.
While no definite recommendations for future policy are formulated in this statistical analysis, it gives to us a better idea of the problems we are dealing with than is otherwise obtainable.
It is to be hoped that in future time the state will provide for a more complete and continued presentation of the statistics of our work in connection with the treatment of the
insane. As long as this is lacking it will be difficult to formulate a satisfactory constructive policy.

STATE HOSPITALS OF MICHIGAN.

31

REPORTS OF MEDICAL SUPERINTENDENTS
KALAMAZOO STATE HOSPITAL.
BY DR. OSTANDER.

To the Joint Board of Trustees:
Herewith is submitted a brief report of the operations of the Kalamazoo State Hospital
during the past fiscal year:
MOVEMENT OF POPULATION.

Patients remaining July 1, 1919
Admissions during the year, 1st adm..
Readmissions
Returned on old order
Total number under treatment.
Of the Admissions there were:
Voluntary
Drug
Inebriate
Inebriate and drug
Trans, from other hospitals
Regular commitments....
Returned on old order
Discharged:
Recovered
Improved
Unimproved
Died
Not insane
Escaped
Trans, to Ionia
Trans, to Wahjamega....
Trans, to Alton, 111
Trans, to Lapeer
Trans, to Chicago
Deported to Canada

Men. Women.
1,102
1,072
247
327
42
25
44
20

Total.
2,174
574
67
64

1,485

1,394

2,879

406

296

702

1,079

1,098

2,177

Men. Women. Total.
14
29
15
7
19
26
2
2
0
2
2
4
11
6
17
238
325
563
44
64
20
Men. Women. Total.
47
18
65
83
67
150
32
50
82
123
314
191
5
4
9
2
35
37
2
2
37
37
1
1
1
1
2
2
1
1
1
1

Remaining July 1, 1920
There was a net increase in the population of only 3.
BOARD OF TRUSTEES.

The only change in the personnel of the board was that caused by the death of Trustee
Cook. At present there are but 5 members of the board.
CHANGES IN THE MEDICAL STAFF.

Doctor—formerly Lieut. Roy A. Morter resumed his duties on July 15, 1919, after an
absence of 10 months, 15 days during which time he was in the service both in the United
States and overseas. Major S. W. Perry began service in the institution on August 2,
1919, as physician at the Colony Farm in place of Dr. David Weissman who resigned on

32

MEETING OF JOINT BOARD OF TRUSTEES.

July 31st. Dr. C. C. Jones gave his resignation to take effect June 30, 1920. Dr. James
Denton terminated his services as pathologist on August 10, 1919 because of the sudden
death of his wife, and Lieut. F. C. Potter, a graduate of the Medico Chirurgical College
of Philadelphia and late in the service was appointed to succeed him.
Miss Alice Campbell has served the institution during the past year as psychologist,
her chief duties consisting in making mental tests, taking histories and assisting in the outclinic work. The work of the staff will be supplemented by the services of a psychiatric
social worker as soon as a suitable one can be obtained.
OCCUPATIONAL THERAPY.

At the solicitation of the Newberry Home in Detroit arrangements were made to receive a limited number of its under-graduates as pupil occupational therapists, they to
receive credits for work done here. This affliation will be continued during the present
year. The staff of instructors has been increased so that the work may be carried on at
the Colony Farm and extended to the wards of the Male and Female Departments. A
very creditable exhibit of the work of this department illustrating its benefit to patients
was made at the meeting of the American Medico Psychological Association last month.
RECREATIONS.

Classes in physical exercise and games are being conducted daily among women patients, the object being to not only place amusements and recreations under intelligent
supervision but to awaken some activity among the old dementia Prsecox cases and reeducate them to better habits. This kind of service will be extended to the Male Department some time in the fall.
OUT-CLINICS.
It is the aim and policy of the board of trustees to extend this service in this hospital
district, as rapidly as a suitable staff can be obtained and funds made available for the purpose. Public sentiment is such that the counties where the clinics are held may be easily
persuaded to bear the greater share of the expense. At present our activities are still
limited to Kalamazoo, Kent, Ingham, and Jackson Counties. I desire to present a brief
resume of the work accomplished during the past four years or since the starting of these
clinics.
1732 cases have been examined. The accompanying chart shows a decrease in the
number of cases examined during the past year. During the first year of clinic work, many
cases were brought in merely for Wassermann or neurological"examination, and the name
of the patient, and the result of that examination, only were recorded. During the.past
year, complete histories and thorough examinations were made of all patients coming to
the Clinics, and a greater number have come than could be examined during the limited
time. No effort has been made on the part of the hospital during the past year to obtain
Clinic patients, but the number referred to Clinics by charitable organizations, schools,
relatives and physicians has increased 7.5%; 3.9%; 21.8%; 5.9% respectively. In tabulating nationality, those whose parents were not American-born were considered Foreign.
Of the total number of histories obtained 85% showed insane, feebleminded or criminal
and moral taints. It is quite probable that many of the negative histories would not
prove such, if thoroughly investigated. Feeblemindedness comprises 32% of the total
number of cases, and delinquency 24%. Two hundred ninety-seven delinquents were
given mental tests. Of these two hundred fifty-eight were feebleminded, making 63% of
the tested delinquents feebleminded. 18% of the whole number of cases examined had a
definite psychosis. Of the 1240 Wassermanns examinations made, 18% were positive.
Two hundred twenty family groups were represented. Of this number 38.6% were syphilitic. The cases for whom no recommendation was made, include the normal patients,
relatives accompanying patients, and those coming for Wassermann, which proved to be
negative. One hundred thirty-nine women suffering from venereal diseases were examined for the government. Recommendations for the disposition of these cases included
commitment, supervision, and release from supervision. The column under disposition,
headed ' 'At large'' includes the cases released from supervision by the court, those known
to have left the State, and those who are now able to live without being disturbing to their
environment. It is interesting to note that 21% of the total number received no more
than 4th grade education. This percent does not include Juveniles who would normally
be in the first four grades.

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.STATE HOSPITALS OF MICHIGAN.

35

FUTURE NEEDS.

Since my connection with the Kalamazoo State Hospital, 32 years, the institution has
not refused to take patients because of lack of room it being deemed by the board of trustees more humane to over crowd the institution than to leave these people uncared for in
their homes; in the county houses, and jails. Beds have been set up in corridors, parlors
and other places intended and needed for other purposes. Two beds have been placed in
single rooms intended for one. Dormatories intended for 4 to 6 persons are crowded to
8, 10, and even 12. The hope has always been that the legislature would meet this condition by providing sufficient room in some way. Matters have gone on in this way until
we have gradually come to measure the normal capacity of the institution by the number of
beds now in use, which is 2295. I have recently had our architect measure the cubic capacity of all the sleeping quarters for patients and make a detailed report of the ventilation.
The older buildings contain a large number of single rooms, 498 in all, while the more
modern buildings are constructed largely on the dormitory plan. The average cubic content of the single rooms is 1220 cubic feet, a few a little larger. Very many of these rooms
house two patients. If each single room housed but one patient, and if the other patients were
allowed an average of 750 cubic feet of air space it woudl be necessary to remove 550 beds.
In other words, we have for years crowded beyond our normal capacity by about 450
patients.
The tubercular wards are particularly crowded and these cases are housed in shacks
that the great State of Michigan ought to be ashamed of. I am opposed to increasing the
number of patients, but I am most certainly in favor of enough buildings to decently house
what patients we have.
Furthermore, this institution needs more rooms, more baths, assembly rooms and
better home life for it's employes. In answer to a recent advertisement for physicians I
had a number of promising applicants. They were married men, however. We haven't
suitable quarters for all the married members of our present staff. If it is urgently necessary that the law requiring medical officers to live in the institution should remain operative, the state should build homes for these men, so that some semblance to family life
might be enjoyed. Personally I see no reason why institutions of this size should not have
sufficient night force on duty to take care of emergencies, pay its officers money in lieu of
food and lodging and let them buy homes of their own. Indeed, this policy might be extended to other departments with benefit to both the institution and the employe.

36

MEETING OP JOINT BOARD OF TRUSTEES.

PONTIAC STATE HOSPITAL.
BY DR. CHRISTIAN.

I wish, very briefly, to summarize the conditions as at present existing at Pontiac and
the activities of the past year.
I want to say at the outset, our energies have been confined to keeping an organization at work that would meet with the minimum requirements of such an institution, to
keep it functioning. What the difficulties are, you very well know, but to illustrate what
the condition is, I might cite that at the end of the last year, just closed, out of the normal
force that we should have on the pay roll of 80 men attendants, we had 55; out of a female
force of about the same number of women attendants, we had something over sixty. We
have not been able to give the patients the personal attention that is required, nor have we
been able to meet the needs of the hospital activities in the way of working parties out of
doors on the farm and various other activities because we lack the attendants to eare for
them.
We have had a waiting list of insane women that we have not been able to receive and
for whom application has been made, because of lack of accommodations. We have a new
building almost completed which would give adequate relief for at least a year, and perhaps more. If that building were completed today, and thrown open to patients, I couldn't
open it because of lack of attendants to man it.
Those are some of the adverse conditions under which we have been trying to work.
Another illustration: The pay roll for last June, 1920, as compared with the pay roll
for June, 1919, showed a 25% increase of expenditure in dollars and cents with 10% less
names on the pay roll. In other words, we made an effort, by increasing the wage scale
to attract, and with indifferent success. When unskilled workmen can command, in the
Pontiac factories from ten to fourteen and fifteen dollars a day, you can see what we are
up against. We secure enough men and women to work. They come to us and remain
a few days, until such time as they can secure a position in a factory and perhaps a lodging
place in town and then leave us. The consequence is that our turn over of labor is enormous.
We are still short on our medical staff. Salaries offered are no attraction, and I want
to emphasize my hearty accord with what Dr. Ostrander has said relative to the necessity
of the State offering decent, normal conditions of life as an attraction for medical men and
women who wish to enter this service, and until that approximates the normal standard
of living, we cannot look forward to anything but deterioration in our medical services.
Our population, as you can infer, has not changed much in the past year. We have
not been able to increase census of women, because of lack of room. It is an interesting
fact, that notwithstanding the fact we have been able to care for all the men who have applied, the number of admissions is no greater for the past year than normal.
Another interesting fact is that notwithstanding the very great increase in population
in the district of the Pontiac State Hospital, the number of new cases of insanity arising
and coming to us is less than it has been in any preceding year for sometime, which means
that there has been an unmistakable decrease in the occurrence of new cases.

STATE HOSPITALS OF MICHIGAN.

37

TRAVERSE CITY STATE HOSPITAL.
BY DH. MUNSON.

The movement of patients during the year ending June 30th, 1920, was as follows:
Male. Female.
997
849
155
107
37
44
56
2
9
7

Patients in hospital June 30, 1919
First admissions during year
Readmissions
Transfers from other institutions
Drug Addicts, Alcoholic
Total Admitted
Total under treatment

257
1,254

Discharged:
Recovered
Improved
Unimproved
Not Insane
Transferred
Died

1601,009

Total.
1,846
262
81
58
16
417
2,263

20
41
24
22
18
126

18
35
10
8
1
65

38
76
34
30
19
191

Total Discharged

251

137

388

Census June 30, 1920

1,003

872

1,875

There was an increase of twenty-nine patients during the year. Barring transfers to
and from other hospitals there was a decrease of ten patients during the year. Of the four
hundred seventeen only three hundred thirty-six were first admissions. The number of
alcoholics and drug cases was sixteen,—a steadily decreasing number,—and the death rate
based on the whole number of patients under treatment was_ low,—slightly exceeding eight
percent. Theie was some influenza during the winter but it was not so prevalent as last
year. There were about fifteen cases of small pox and a few cases of measles, scarlet fever
and diphtheria among patients,—all in mild form and without fatality.
The medical work of the hospital has been well sustained, notwithstanding several
changes in the personnel of the staff. During the last few months an effort has been made
to resume staff meetings and other research and scientific work that was impossible during
the war period and much more personal care of patients has been possible.
The industrial departments are in excellent condition and the institution has been kept
in a high state of repair, in fact we are able to report that it never was in better physical
condition.
The general hospital continues to be successful. During the year it received 406
patients—360 surgical and 46 medical. The net earnings for the last fiscal year were
$4,528.80. We hope to be able to enlarge this department to fifty beds. This would enable the institution to maintain an independent training school'. The supply of trained
nurses is entirely inadequate to meet the demands of the institution to say nothing of the
public and private service. There is great need at the present time for institutional nurses,
private nurses and nurses for social welfare, community and public health service work.
With a modern and thoroughly equipped general hospital and training school our institution would be able to aid in general mental hygiene work, in after care of patients and cooperate with the public health department.
PERSONAL SERVICE.

The expenditures under this head show a deficit for the fiscal year ending June 30th
1920, of over $18,000.00. and owing to the greatly increased cost of supplies and especially
of the increased cost of labor, etc., there is an estimated deficit of over $60,000.00 for the
ensuing year, or that of 1921. This matter has been one of grave concern to the management and has been carefully considered with the budget commissioner. The situation is

38

MEETING OF JOINT BOARD OF TRUSTEES.

such that unless this money can be supplied the institution will'be compelled to close at
least a portion of its doors. In other words unless provisions are made to meet these increased over head charges the institution will be unable to carry on the work for which it
was created.
COST OF MAINTENANCE.

The daily cost of maintenance computed on the former basis was 74.74 cents per patient per day. If the cost of farm products consumed by patients is included the cost is
85.00 cents. The gross amount spent for food this fiscal year was $138,203.54 or 20.04
cents per patient per day. The previous year it was 20.35 cents. If the cost of foods
raised on the farm is added the daily food cost was 23.67 cents per patient per day. If
the cost of production of food supplies raised on the farm is not deducted then the cost of
foods was 30.30 cents per patient per day. The gross cost of foods produced by the hospital farm was $69,516.02 and the disbursement was $44,960.74, or a net value of food
supplies of $24,555.28. It might be of interest to enter into further details of the value
of the farm to the state but, our Steward, Mr. G. B. Pike, has presented to you careful
details during this meeting.
There was very little building during the year. During the coming year, a new store
will be completed at a cost of $28,000.00, a new boiler installed as well as coal crushing and
ash handling machinery.
Scarcity of help continues to be a problem. ' At this date the institution is twentyfive percent short of women nurses. On the men's side the supply about meets the demand.
The outlook for this service is more promising for the coming year. AYe have been so depleted that it has been a source of great anxiety and the officers have been compelled
to remain at home for fear of accident.
The introduction of the new method of accounting, the new system of purchasing for
the institution as well as the limitations of the budget have added much to the labor of
the institution as well as to the responsibility of its management. The writer believes
that the budget will work out satisfactorily, and the accounting systems. The writer
does not, however, believe that the central purchasing method can ever be made as practical as the unit plan formerly in use. It would seem that our institutions are old enough,
large enough and capable enough to do this work as well, and I believe better, than any
other method thus far devised.
There has been no untoward event in the institution during the year just closed worthy
of mention in this connection.

STATE HOSPITALS OF MICHIGAN.

39

NEWBERRY STATE HOSPITAL.
BY DR. CAMPBELL.

1 beg to present a brief synopsis of the conditions of the Newberry State Hospital
during the fiscal year ending June 30, 1920. The following table shows the movement of
the population.
MOVEMENT OF POPULATION.

Men. Women. Total.
562
454
1,016
136
112
248

Number of patients under treatment June 30, 1919
Total admissions during the year
Total number of patients under treatment during year.
Discharged:
Recovered
Improved
Unimproved
Not Insane
Died

Men. Women.
17
25
47
41
7
13
1
4
53
29

Total.
42
88
20
5
82

Total number of patients under treatment June 30, 1920...

698

566

1,264

125

112

237

573

454

1,027

The year ends therefore, with an increase of 11 patients in the Hospital population.
The total number of admissions is considerably less than the preceding year and the same
is true with the discharges, indicating that the service of the Hospital has been less active.
For instance, during the year ending June 30th, 1919, the total number of patients under
treatment during the year was 1306 as compared with 1,264 during this past year. The
number of first admissions, 189, is also less than the number of first admission the preceding year. A number of causes have produced this result; some of which are probably permanent—others more or less transitory. The enactment and in our district, at least, the
fairly strict enforcement of the prohibition law, has had an affect. No cases of definite
alcoholic insanity have been admitted, while prior to this enforced prohibition the admission rate of this disorder was approximately 5%. In addition we formerly received a
considerable number of inebriates.
This period of great prosperity through which the country is passing, has undoubtedly
in many ways been a factor in lessening the number of persons admitted to the Hospital.
Anyone who wishes may now work at wages that a few years ago would have been regarded as fabulous. There is at present no competition which drives out the unfit. Because
of the shortage of labor and the prosperity of families it has been easy to arrange for the
discharge of many patients, who in ordinary times would remain in the Hospital.
We have departed somewhat from traditional methods in the discharge of patients.
An effort has been made during the past few years to weed out those who seem capable of
supporting themselves—those patients who succeeding in getting a fair adjustment of their
difficulties in the Hospital. Work has been procured for many of them and they have been
discharged on parole, reporting about once a month to the Hospital either in person by
letter. The result has been surprisingly good. One realizes, however, that an industrial
depression would change all of this. In such an event, many of these individuals would
return to the Hospital and there would undoubtedly occur a greater rate of admissions necessitating more accommodations than are present.
The original plan at Newberry of a number of cottages arranged in a quadrangle have
been completed. The number of beds originally planned was 975; divided as follows:
For men, 540; for women, 435; On July 1st, 1920, there were present 1,027 patients,
showing an over-crowding to the extent of 52. This condition, of course, should be remedied soon—more especially so when one considers the causes that for the past few years
have produced the low rate of admissions.
At Newberry, we are facing a somewhat perplexing condition in view of the fact that
future buildings must be erected at some distance from the original quadrangle, necessitating the extension of water and steam mains, sewers, etc. Another thought is that not only

40

MEETING OF JOINT BOARD OF TRUSTEES.

a different type of building might be built but also that by its location, etc., it might be to
a considerable extent, disassociated in the public mind, at least, from the Hospital proper.
It might be that our usefulness would be greater were we able to care for a somewhat different type of mental disorder or at least receive more individuals at an earlier period of
their difficulty. Patients apparently enter the Psychopathic Hospital at Ann Arbor, with
little hesitation, and the public does not evince toward them, that peculiar feeling that
they do toward those patients committed to the State Hospital. We have in mind something along this line.
The matter of securing efficient and adequate help has been exceedingly troublesome;
more so I believe the past year than at any time during the period of war. Wages have
been increased a number of times. At present male attendants receive a minimum of
$50.00 per month with a maximum of $84.00 after ten years' service; women a minimum of
$40.00 and a maximum of $60.00. Graduate nurses, $65.00, pupil nurses, $30.00 all with
maintenance. Under present conditions there seems to be no relief. There is always a
limit to the amount of wages and that may be justly paid for a certain type of duty and it
is possible that limit has nearly been reached.
Practically no building has been done through the year although an effort in spite of
shortage of labor, has been made to keep the plant in as good repair as possible. The last
legislature appropriated $13,000 for additional boilers which have been purchased and
erected.

STATE HOSPITALS OF MICHIGAN.

41

IONIA STATE HOSPITAL.
BY DR. HASKELL.

The following is presented as a report of some of the activities of the Ionia State
Hospital for the past hospital year.
Male Female Total
Population 6-30-1919
438
68
506
Admitted
59
5
64
Discharged
37
0
'37
Remaining June 30, 1920

'.

460

The patients were admitted from the following sources.
Civil Insane
Hospitals
Penal Institutions.
M F
M F T
Jackson
24 0 24
Kalamazoo. . . 2 0
Ionia
1 0 1
Pontiac
3 2
Traverse City 0 1
Marquette
9 0 9
Newberry. . . . 0 0
Det. H. of C... . 1 0 1 11
1 0
E^oise
44

1 45

73

533

Courts.
T
2
5
1
0
1

Circuit....
Recorders..

M
5
4

9

6 3 9

T
6
4

1 10

Last year I said something about the increase in the number of negroes. The same
condition has continued. The last year we admitted
Male Female Total
Negroes
18
2
20
In other words 33% of all the patients admitted last year were negroes.
Of Foreign Born patients there were admitted:
Male. Female.
17
0

Total.
17

That is, approximately 28% of admissions were foreign born. Thirteen of these men
came from the prisons; 1 from the Hospitals and 3 from the Courts.
Another 16 patients, 15 men and 1 woman, had one or both parents Foreign P/orn.
While we are speaking about admissions I may say that these patients, 12 men and 1
woman, had committed at least one murder. They originated as follows:
Male. Female. Total.
From Prisons
..........
7
0
7
From Hospitals
From Courts
12

13

This group constituted 21% of all admissions for the year.
We are obliged to refuse admission to one male patient during the year.
DISCHARGED 1919-20.
Recovered. . .
Improved.. . .
Unimproved..
Died
Not Insane...
Eloped
Suicide. .

M
4
2
3
16
7
1
1
34

F
0
00
0
0
0
0
0

T
4
2
3
16
7
1
1
34

42

MEETING OF JOINT BOARD OP TRUSTEES.
MANNER OF DISCHARGE.

Returned to Prison
Dismissed
Deported
Eloped
Dead

'

:

M
6
6
4
1
17

F
0
0
0
0
0

T
6
6
4
1
17

34

0

34

We have been particularly interested the past year in getting rid of patients who are
not legal charges against the State of Michigan. We have actually got rid of four such
cases. This month since July first we have sent two negroes back to their points of origin.
Our laws are not flexible enough. A foreigner who is sent to prison for 6 months for
some simple crime within 5 years from the date of his entry into this country and there
becomes, or is found to have been already, insane can be deported.
A foreigner who
murders, even within a 5-year period, and is found to be insane and for that reason is committed to the Ionia State Hospital cannot be deported even though he can be shown to
have been insane at the time of his immigration to this country. Similarly a foreigner
who murders and is sent to prison for life and then becomes insane can't be deported, even
within 5 years, because one must wait for the termination of his sentence which is "at
death."
These restrictions may all be reasonable but I can't reconcile myself to them.
Increases in salary the past year, particularly in those positions that carry no, or little,
responsibility, have been considerable and range from as low as 20 per cent in the case of
executives to 150 per cent on the wards.
That increases alone will not get the men one can see from the fact that we much are
shorter than ever, even during the then hard days of actual war time. The following
tables explain themselves.
July 1, 1910
July 1, 1915
July 1, 1920

No. of Patients.
429
455
533

No. of Employees
60
72
56

Ratio.
1:7
1:6.3
1:9.5

We have on our wards today 20 day attendants. We are short 12 today on a norma 1
working basis. In other words we are 37.5% short of a normal minimal working force.
We could not get along if it were not for the fact that today we have by all odds a higher
class and more efficient group of attendants than at any time in 10 years.
We are very hopeful over the ward problem. The following table gives us good reason,
we believe.
Number of Employees in Service Over 12 Months.
July 1,1910
July 1, 1915
July 1, 1920

Total No. Employees.
60
72
56

In Service over 1 yr.
21
21
31

Percentage.
35%
28%
53.3%

The Board is now planning to evacuate a Patient's Building, turn it over into a Male
Employees's Home and put the employees' rooms on the wards into use for patients. We
probably shall ask the legislature for funds to build 5 or 6 small cottages for married employees on the hospital grounds.
Better accommodations for all and particularly facilities for real home life in a separate cottage with better rates of pay would settle all these problems. I believe this Joint
Board should consider the matter of Insurance and Pensions. I have seen Insurance introduced in some local factories this year with good results.
In connection with the labor problem I w_onder if we are not competing too much
among ourselves. Here are three instances which serve to illustrate my query: (1) One
state institution, 93 miles from Ionia, runs an advertisement for one week in the Ionia daily
paper seeking applicants for attendants. (2) An attendant in another hospital, the 7th
position in Michigan insane hospitals in a twelve-month period, let go from here because
of agitating activities trying to organize a strike, allures a man to that institution from our
employ merely out of spite, warning the man however that he must not let on that he had
been working in any other Michigan hospital. (3) The third and more recent is a man
writing to another Michigan institution for a position, sending a self-addressed and stamp-

STATE HOSPITALS OF MICHIGAN.

43

ed envelope, the return address showing So and So's cigar store, Ionia. The position was
offered him at a certain figure. He wasn't satisfied with the wage offered and wrote back
saying he wanted more money. His request was granted and they increased their offer
$10.00 a month. He then asked us to let him go right off to accept this offer and was considerably put out because we wouldn't let him go without working out a two week's notice.
Wise in his day, he wired his new situation for a two week's period in, which to report for
duty so he could work out his notice and be eligible to come back here again when he found
the grass in the new field to be no greener than in the present pasture, which extension was
granted him—by wire. He then slept over the situation and finally turned the seductive
offer down. His reasoning was this: "If I had stayed on here in years past instead of
leaving at the end of each year or so, I'd have charge of a ward now, I'd be getting $30.00
a month more than I am now and $45.00 more than they offered me there and probably
I'd have quite a stake in the bank. I guess I'll give up this drifting from this place to that
and always trying to get back here.''
I don't know how you are going to correct all these evils. I can't help thinking that,
if all the insane hospitals in the state were to send in to some one office all the men coming
and all the men going each week and attach thereto some label of the reasons why, the result would be beneficial for all concerned, employees as well as institution. With regard
to the last case personally we do not correspond with any man in a city either in this state
or in any other state where the Directory of the A. M. A. shows an institution to be located,
without in any case first learning from the Hospital Superintendant that that man has already handed in his notice,—usually we do not answer his letter for we don't have a very
high regard for his type. We have today only four men who have ever worked in any other
hospital and two of that number worked here first.
Apart from these cottages mentioned, the Hospital's needs most urgent now are a new
Kitchen and Dining Room Building. This would release an old building which could
easily be turned into a patients' building and furnish us space adequate to expansion in
the male department for 10 years to come. We need greatly expanded office room. We
need a medical clinic building. Our other serious needs can be met gradually by expansion
of present facilities.

44

MEETING OF JOINT BOARD OF TRUSTEES.

STATE PSYCHOPATHIC HOSPITAL.
BY DB. BARRETT.

Report of the State Psychopathic Hospital at the University of Michigan for the year
ending June 30, 1920.
To the Joint Board of Trustees of the Michigan State Hospitals for the Insane.
Gentlemen: As Medical director of the State Psychopathic Hospital at the University
of Michigan I have the honor of submitting the following report of the general work of the
hospital for the year ending June 30, 1920.
MOVEMENT OF POPULATION.

M
24

F
36

T
60

126
6
132
1
133
157

118
12
130
....
130
166

244
18
262
1
263
323

5
35
26
27
33
4
37

8
43
24
29
24
6
32

13
78
50
56
57
10
69

OUT PATIENT SERVICES OF THE HOSPITAL.
Ann Arbor Service:
Referred from University Hospital
214
Other sources
63

212
68

426
131

280

557

Patients in hospital July 1, 1919
Admissions during year:
First admissions
Preadmissions
Total admissions
Transfers from other hospitals
Total received during year
Total under treatment during year

'.

Discharged during year:
Recovered
Improved
Unimproved
Not insane
Transfer to other institutions
Died during year
Remaining in hospital at close of year

Total
Detroit Service (Wayne County Psychopathic Clinic):
Referred from Courts
Referred from Police Department
Referred from City Schools
Referred from Charitable organizations
Referred from General hospitals
Referred from industries
Referred from private physicians and families
Referred from state institutions
Total
Total patients examined in hospitals and out patient services

277

277
24
10
217
76
24
21
7
656
1536

STATE HOSPITALS OF MICHIGAN.

45

SEROLOGICAL WORK.
The following table shows the number of serological examinations made in the laboratory of the hospital foi the year ending June 30. 1920.

Kalamazoo
Pontiac
Traverse City
Newberry
State Psychopathic
Wayne Countv Hospital
Ionia
Social Services
Total Hospitals for Insane
University Hospital . . . .
Private Examinations
Total

...

Blood.

Spinal
Fluid.

859
343
378
519
314
332
5
150

335
84
35
37
90
10

2 900
11,112
216

14,228

2
593

1,711
18

2 322

Total.
1,194
427
413
556
404
342
5
152

3,493
12,823
234

16,550;

There has continued a cordial cooperation in scientific work with the State Hospitals,
During the year the laboratory of the Psychopathic Hospital has examined many specimens of neuropathologica! interest that have been received from the various state hospitals.
Reports of studies of this material have been sent to the hospitals sending the specimens.
During the year the medical director has visited each of the State hospitals, spending,
several days at each in conference with the medical officers.
Respectfully,
ALBERT M. BARRETT,
Medical Director.
G. F, INCH, M. D.,
Secretary,



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