hospitals during the biennial period was 213, and the number of patients transferred from the hospitals to county institutions exceeded by seventeen the number transferred from the latter to the former. If that rate of increase be continued, additional hospital accommodations equal to those now furnished by the largest of our state hospitals will have to be supplied every ten years. The capacity of the hospitals at Cherokee, Clarinda and Mt. Pleasant can be largely increased at comparatively small cost by means of cottages similar to those in use at the hospital at Independence.

CHAPTER IX.

THE INSANE IN COUNTY AND PRIVATE INSTITUTIONS.

Chapter 144 of the acts of the Twenty-eighth General Assembly placed under the supervision of this Board all county and private institutions in which were kept insane persons, and required that each institution be inspected twice annually. It also authorized the Board to make rules and regulations for the care and treatment of the insane, and vested in it other powers which need not be enumerated here.

The first inspections of the institutions were made in the last half of the year 1900 by members of this Board, and inspections as required by the act have been made during the current year by a member of the Board and by competent and disinterested persons appointed by us for that purpose. With one exception, the persons so appointed were superintendents and assistant physicians of the State Hospital for the Insane.

The first inspections were made by us personally that we might have direct knowledge of each institution placed within our jurisdiction, and thus be enabled to know its condition, to judge of the merits of the reports of subsequent inspections, and to understand the importance of recommendations which should be made. Physicians of the state hospitals were appointed inspectors in order that they might become familiar with the condition and management of the institutions inspected, and for the reason that the institutions might have the benefit of their knowledge of and experiences in the treatment of the insane. The expenses of the inspections made in A. D. 1900, and the first half of the current year, including $48.00 for blanks, amounted to $608.66. The small cost of the inspections was due to the fact that but one inspector received the compensation of $5.00 per day, which the law authorizes. All other inspectors were receiv ing salaries paid by the state and were not therefore allowed the statutory per diem. But the duties of this Board require so much time for other purposes that it will not be practicable for its members to make many inspections, and the duties of the hospital

physicians are such that it will not be advisable to take much of their time in the future for inspection purposes. Therefore, it is probable that most inspections to be made hereafter will be by agents appointed by us, at the compensation provided by law, and appropriations for that purpose should be continued.

The number of county institutions in which insane persons were kept, inspected in the year 1900, was fifty-two, and the number of private institutions inspected during the same time was four. Nearly all of these county institutions, and all of the private ones, were again inspected during the first half of the year 1901. The insane of several counties were transferred to state hospitals after the first and before the second inspections were made. We have found it difficult to determine accurately all of the counties which are keeping insane persons in local institutions. This difficulty is caused in part by inaccurate reports made to us by a few county officials, and in part by the fact that persons supposed to be insane are sometimes received in county institutions, not as insane, but as poor people, without any examination as to their sanity. The first reports received indicated that not more. than fifty-three counties were keeping insane persons in county institutions, but reports made since the 30th day of last June show that in twelve additional counties persons who have never been adjudged to be insane by commissioners of insanity, or other competent authority, are regarded and held as insane by the stewards of the poor farms. It is probable, notwithstanding these reports, that many, if not all of the persons so held, are not insane, but idiots, within the meaning of section 2298 of the Code, and not under our jurisdiction. However, we have directed the inspecting officers to examine all such persons with the purpose of having those who are really insane adjudged to be so and treated accordingly.

According to the most reliable information we have been able to obtain the number of insane persons kept in county institutions on the 30th day of June, A. D. 1899, was 514 males and 477 females; on the 30th day of June, A. D. 1900, it was 514 males and 465 females; and on the 30th day of June, A. D. 1901, it was 513 males and 458 females. It also appears that the number of insane persons kept in private institutions on the thirtieth day of June, A. D., 1899, was 170 males and 214 females; on the thirtieth. day of June, A. D. 1900, it was 167 males and 248 females; and on the thirtieth day of June, A. D. 1901, it was 172 males and 261 females. It is thus shown that the total number of insane

persons kept in the county and private institutions was 1,375 on the thirtieth day of June, A. D. 1899, 1,393 on the thirtieth day of June, A. D. 1900, and 1,404 on the thirtieth day of June, A. D. 1901. Hence it appears that there was a net increase of the insane population of the institutions specified, during the biennial period, of twenty-nine, there having been a decrease of twenty in county and an increase of forty-nine in private institutions.

During the biennial period ending June 30, A. D., 1901, there were transferred from county and private institutions to state hospitals eighty-one patients and from state hospitals to county and private institutsons 100 patients. The transfers made for the last year of the period, by virtue of Chapter 144 of the Acts of the Twenty-eighth General Assembly, were from county and private institutions to state hospitals fifty-seven patients, and from state hospitals to county and private institutions seventytwo patients.

In November, A. D., 1900, acting under Section 5 of the Act mentioned, we adopted rules and regulations in regard to the care of the insane in county and private institutions. The rules took effect to some extent on the fifteenth day of the month with provisions for further time in certain cases in which to comply with them, but they were to be in full force on the first day of February, A. D., 1901.

Most of the institutions affected by these rules have complied substantially with their requirements. The buildings in some of the counties were of such a character that suitable provision could not be made for the insane, and in some counties in which but few were kept the cost of giving them the care required by the rules made it inadvisable to keep them longer. The insane of six counties of these classes have been transferred to state hospitals, and when the Cherokee hospital is opened and additional room thus provided, transfers from other counties in which provision for the care of the insane is inadequate should be made.

The operation of the law requiring supervision of county and private institutions in which insane persons are kept has been most salutary. It is true that before it was enacted the insane in many counties were furnished with kind and skilful attendants, good food and sufficient clothing, and were given all the care which could have been reasonably demanded in their behalf. But in several county institutions the insane were treated with

less consideration and care than the careful farmer gives to his live stock. Troublesome inmates were locked up and treated as criminals; the food furnished was frequently insufficient in variety, badly prepared and poorly served; wearing apparel and bed clothes were of poor quality, neglected and filthy; and little or no attention was paid to the cleanliness and personal habits of the inmates; in some institutions they were seldom if ever bathed; in some so many as six or more inmates were bathed in the same water; in many cases the room in which inmates were kept and appurtenances were indescribably filthy, the walls and ceilings were broken, and vermin were to be found in furniture, beds, floors, walls and ceilings wherever lodgment could be made. In one case a young man was given charge of six insane women, and other cases were found where men had unobstructed access to the rooms of female inmates.

The bad conditions which prevailed at some of the institutions were not due in most cases to intentional wrongdoing, but to the policy which prevails in some counties of awarding contracts for keeping the poor and insane to the lowest bidder, or to persons on account of their ability to manage the general business of poor farms without regard to their qualifications for taking care of the insane. In some counties humane and competent stewards are unable to give proper accommodations and care to the insane intrusted to them because of insufficient buildings and lack of supplies and help. We have found as a rule that the officials in charge of insane persons are anxious to know and to practice the best methods of caring for their wards, and are quick to adopt improved methods when known.

The general result of the inspection of county and private institutions, made as required by law and by the rules and regulations adopted by us, and of their enforcement, has been to close the institutions which were not taking reasonably good care of the insane, and to greatly improve the management and condition of others. Much remains to be done, however, to make the care of the insane in some of the institutions what it should be. In our opinion it is not wise for any county to attempt to care for a small number of insane persons. To give the insane the care they should have would in most cases be more expensive than to maintain them in a state hospital; yet, according to our latest reports, each of thirty-one counties is caring for insane people fewer in numbers than twelve. In nearly all of those counties the insane are kept with and treated the same as are the