SUPERINTENDENT'S REPORT.

To the Trustees of the Iowa Hospital for the Insane, at Mt Pleasant, Iowa:

GENTLEMEN—In accordance with the law of the State, I present herewith the fourteenth biennial report of this Hospital.

Notwithstanding the increased accommodations afforded by the additions now completed, we have been much crowded on the male side of the Hospital, and as the new wards for female patients have only been ready for occupancy since March 1, 1887, our inconvenience in that departmeut during most of the period has been very great. The pressure for the admission of patients, and the number cared for (the grand total receiving hospital care and treatment during the past two years reaching thirteen hundred and eleven different persons; seven hundred and sixty men and five hundred and fifty-one women), has never been as great in the history of the Institution.

At the date of the last biennial report there was shown to have been an unprecedented number of admissions, but the period just closed shows a still greater number admitted during the two years, there having been received seven hundred and sixty-seven; four hundred and sixty nine men and two hundred and ninety-eight women, or thirty-seven more than an average of one per day for the entire period. The whole number discharged during the period has been six hundred and four; three hundred and fifty men and two hundred and fifty-four women. Of this number, two hundred and thirty-five -one hundred and forty-four men and ninety-one women recovered; one hundred and thirty-one, seventy-seven men and fifty-four women were much improved; one hundred and twenty four-fifty-six men and sixty-eight women were unimproved, and one hundred and fourteen-seventy-three men and forty-one women died. Of the latter twenty two died of consumption, twenty-one of general paralysis, eighteen of exhaustion from long standing brain disease, eight from

apoplexy and thirteen from epilepsy, making eighty-two who died from practically incurable diseases, and most of whom were far advanced when brought to the Hospital, several being in a moribund condition when received; there were but six deaths from recent or acute brain disease. Notwithstanding the very large number of these enfeebled cases admitted and under care during the period, but a little over eight per cent died, while thirty per cent of all admitted recovered, and seventy per cent of the recent cases, unaccompanied by other physical diseases, under three months duration when admitted, recovered. A glance at these figures is sufficient to impress the importance of early hospital care upon the physician and friends of all who are unfortunate enough to be afflicted with brain disease and mental alienation. The importance of this matter is two-fold; First, restoration to health, home, family and citizenship; secondly, the economic feature of the case, securing for the life-time of the individual a producer for the State, rather than a consumer, a life burden.

In nearly every report of hospital superintendents throughout the country these facts are emphasized, and that not more than from three to five per cent of the chronic cases will recover, yet even some physicians in the country advise inconsiderately, in delaying treatment at the hospital. The danger to the individual, and the loss to the community by this delay should constantly be kept before the people.

EXPENDITURE OF APPROPRIATIONS.

The balances remaining from the appropriations of the Twentieth General Assembly were expended as specified in the law, and an itemized statement of those appropriations, as well as those made by the Twenty-first General Assembly for repairs and building, appears in this report, and a description of the work accomplished is herewith appended.

FOR RENEWAL OF SUB-BASEMENT WAILS.

The balance of $4,800, remained at the close of the last biennial period, which was all used in completing the renewal of the sub-basement under the entire west wing. The work has been most successfully and substantially accomplished, and we need have no further solicitation in reference to the foundation of the building.

FILTER.

This improvement, which was in process of construction at the date of the last report, has been completed within the appropriation, and for two years we have been supplied with pure water, and our supply for all purposes passes through the following filter-bed:

The water thus filtered is conveyed into a clear water space by drain tiles on the bottom of the filter beds, and is then pumped into the tanks in the attics of the building, from whence it is distributed to all parts of the Hospital as required. The water is perfectly clear and pure, and fills a requirement long needed in the hygienic arrangements of the Institution.

season.

SHELTER FOR CATTLE.

With the balance of this appropriation we completed a substantial brick barn, with sub-basement facing south, and have planned a most comfortable and cozy arrangement for the animals during the winter The barn is 145x50 feet, and arranged to drive through the center, with accommodations for hay on one side and stalls for cattle on the other, and with bins for grain, etc., as may be needed. We believe that in building this structure we have secured a shelter for this purpose as economical as well as complete as there is extant.

FIRE ALARM AND THERMOSTATS.

This system had been placed in the Hospital at the date of the last report, and the appropriation has since been drawn to cover the amount due for the work. Having been in operation for two years, we can bear testimony that it is entirely satisfactory, and is a most important protection to such a hospital with so many lives at stake.

REPAIR AND CONTINGENT FUND.

The balance on hand at the date of the thirteenth biennial report was expended before the Twenty-first General Assembly adjourned,

and the work of renovation continued in several of the wards, as far as possible. With the small amount appropriated by the last legislature, we have continued this work, and have renewed the floors in three male wards, paneled the doors and strengthened them, and repainted throughout six wards on this side of the Hospital. The entire surface of the roof of the Hospital and all of the cupalos have been repainted to prevent deterioration and decay. The demand for repairs in a building so extensive is constant, and much has been left undone from a lack of necessary funds to carry on the work. A small balance remains from the appropriation of the Twenty-first General Assembly, which will all be used this summer to continue this necessary work. A summary of all these expenditures appears in the financial statement of this report.

ADDITIONAL WING FOR MALE PATIENTS.

This addition at the date of the last report had been partially completed, so that we had one ward occupied by patients. Before winter all the wards were completed, and as stated in the thirteenth biennial report would be the case, the balance from the appropriation made was sufficient, not only to complete the structure, but to heat, light and furnish it throughout, thus saving any additional expenditure to the State for those purposes. Every bed in this wing was promptly filled as the wards were completed, and we have experienced a great relief in the administration of this department from the excellent opportunities afforded for classification and proper care. Any one familiar with the old plan, can but observe the decided difference in the demeanor of patients and comfort of surroundings. We procured two horizontal steel boilers with forty-eight four-inch flues of Peter Fawcett, Burlington, Iowa, to increase our heating capacity sufficiently to warm this wing.

ADDITIONAL WING FOR FEMALE PATIENTS.

The Twenty-first General Assembly appropriated $100,000 to construct and furnish a wing for female patients, to correspond in character and capacity with that erected two years ago for males. The work of excavation was commenced as soon as the bill became a law, and was finished before the first of May, and the foundation, cellar and first story completed before the first of July, when we could draw the first installment from the State treasury, such was the language

of the bill as amended and passed. This was a great annoyance to us throughout the entire process of building, and prevented the economical purchase of some of the material for building. The law not per mitting us to pay interest from the current fund of the Hospital, we were hedged about on all sides. We secured, however, a premium on some of our warrants, and by using this were enabled to secure sufficient funds in advance to pay our mechanics the first quarter, and keep pushing the work without laying off the workmen. We had a severe wind storm on the twelfth of August, which destroyed much of the extensive scaffolding about the building, blew out window frames and damaged the work to the extent of about $450-which amount was advanced to the Hospital by the Governor from the Providential Fund; by advice and consent of the Executive Council, this amount was afterward used to pay interest upon over drafts necessarily made to permit us to proceed and complete the work within the specified time. The contract for cut stone was awarded to Messrs. Beckwith & Porter, of Mt. Pleasant, and also a large amount of building stone. remainder with all the dimension stone for corners and window jambs, was procured from other quarries in this vicinity, five in number.

The brick was manufactured as in the other wing, on the land belonging to the State by J. H. Day. The lumber was furnished by the lowest bidder, the Mt. Pleasant Lumber Co. The architects of the former wing, Messrs. Willett & Pashley, of Chicago, very considerately furnished all necessary plans at actual cost of labor and material for draughtsmen. The plan is an exact duplicate of the wing for males, but in this wing the stone work was all done by days work and is better in every particular. The roof was put on by Messrs. Janes & Cole, of Mt. Pleasant, and was in position before December 1st, so that, as we had the heating apparatus and an additional boiler promptly in place, we were enabled without delay to commence plastering and finishing the inside work. On March 1st we had two wards ready for occupancy, and moved into them four months before the time contemplated by the act of the Legislature. All of the wards are now completed and are rapidly being filled as the patients are received, and before the next General Assembly shall have convened, every bed will be filled. In this wing as the first, the work has been accomplished of constructing, heating, lighting and furnishing, within the amount appropriated for the purpose. Thus during the past three years we have made this most substantial, cheerful and comfortable provision for four hundred of the unfortunate insane of