poor, although the law contemplates that they shall have different treatment and be kept separate. Tables showing the movement of population to and from the various institutions referred. to will be found elsewhere in this report. It will be seen that in a few particulars the tables do not agree with corresponding tables in our first report; for example, the tables in this report show that there were 991 insane in the county institutions in this state on the 30th day of June, A. D. 1899, while table XLIV of our first report shows that on the next day there were 659 insane in poor houses and 621 in county asylums, or a total of 1,280. The table referred to was prepared from the best information we were then able to obtain from county officials and stewards of poor farms, and the tables contained in this report were compiled chiefly from official reports made by inspecting officers. Those officers found it difficult to ascertain with accuracy the number of insane in many of the counties at different times, for the reason that records showing the number had been kept imperfectly or not at all, and in numerous cases no distinction was made between idiots and insane persons. It is believed that the reports of our inspectors are most nearly correct, and that the discrepancy of 289 between the two reports is chiefly, if not wholly, due to the including by county officials of the idiots and feeble-minded with the insane. Strenuous efforts are being made to have the records of county institutions kept with greater fullness and accuracy, and to obtain only reliable reports.

CHAPTER X.

RESULTS OF TREATMENT OF THE INSANE.

The condition of a human being bereft of reason is pitiable. Such an affliction may come suddenly, or, as is often the case, may be manifested in various ways, and the progress of the disease may be so insidious in its earliest stages as not to impress friends and relatives with the real nature of the malady. Come as it may, it is of the utmost importance that those who may be in a position to control the care of the one thus affected should act promptly. It seems almost impossible to impress the friends of one thus afflicted with the supreme necessity of affording him immediate means for proper hospital treatment. Friends who thus delay sending an insane person to the hospital, and attempt to care for him at home, are only doing the patient an injury, and possibly foreclosing, by such action, all hope of recovery. Such an one needs early the care, attention and treatment which skilled physicians and trained nurses in a well conducted hospital can give. As a rule, the longer the disease runs without proper care and treatment, the more fixed its character and the greater the liability of its becoming a permanent condition.

Kind friends are often deterred from promptly sending insane people to the hospital because they have been led to believe that such institutions are prisons in every respect except in name. They imagine that here the patient will be incarcerated behind iron bars, that he will never be permitted to see the daylight, or enjoy the sunshine and flowers. If these people could or would visit our hospitals they would see the situation as it really is. Here the state has provided everything which modern medical skill and science has suggested as proper to promote recovery. Every patient who is physically able is taken out of doors from two to three times a day, when the weather permits, for exercise and recreation They walk and sit under the trees, and read or sew; they swing, they have their picnics, their trips to the woods and streams, the same as sane people do. If they like to work they do so in the garden, on the lawn or farm, in the shops,

kitchens, dining rooms, sewing rooms, tailor shops, shoe shops, etc. If they are in the wards they have billiard tables, pianos, all kinds of games, newspapers, magazines and books. Pictures adorn the walls; easy chairs and lounges are provided; and flowers are there for them to look upon. Among the amusements provided are theatricals, sociables, dances, band and orchestra concerts. An abundance of good, wholesome food is furnished, and dainties for the sick.

Added to all this, provision is made for the best of care by kind and skilled physicians, nurses and attendants. The purpose of modern hospital treatment is to divert the mind of the patient from himself and his condition, and direct it into natural and normal channels, by making his hospital life as near like the life of an ideal home as is possible under the circumstances. The largest liberty possible is allowed patients, and, strange as it may seem, they do not often abuse the confidence placed in them.

If one will study with care the statistics furnished in the published hospital reports of any state, as to the percentage of recoveries in cases where patients are promptly sent to the hospitals when the disease first manifests itself, and if he will then compare them with the percentage of recoveries in cases of patients where a long time intervenes between the first indications of the disease and the time treatment in a hospital begins, he will be profoundly impressed with the conviction that every interest demands that hospital treatment shall follow as speedily as possible the first indications of mental disorder.

The results of treatment of patients in our hospitals during the biennial period ending June 30, 1901, furnish a convincing argument in support of what has been said about the importance of placing the insane person under hospital treatment just as soon as possible after he is first attacked.

The lesson to be learned is obvious. In cases of insanity do not delay but place the patient promptly in the hospital where he may have the benefit of everything that human skill and care can do, and at a time when there is hope for the best results.

The standard of care in the hospitals of this state is constantly being elevated. The results justify all the state is doing for these unfortunates. The duty of the state to afford them a high degree of care and the best medical attention, is being fully discharged. It is the aim of the Board to do everything reasonably possible to promote the recovery of the insane committed to the hospitals.

The statistics show also that in addition to the hundreds of patients cured during the period, hundreds more have been so much improved as to live with their friends in a reasonable degree of comfort and usefulness, while a large number are constantly out on parole, the majority of whom are after a time fully discharged. Of that other class whose cases seem to be hopeless, they are provided with pleasant surroundings, and in their declining years are rendered as comfortable as possible.

We said in our first report that "no further reduction in the cost of support need be expected and, indeed, if prices continue, to advance, the actual cost may increase." It appears that the cost of support in the several hospitals, while materially less per capita during the biennial period ending June 30, 1901, than during the biennial period ending June 30, 1899, still it has been more than the cost during the year ending June 30, 1899, the part of said biennial period when the institutions were under the control of this Board At the hospital at Mt. Pleasant it cost $144.72 per capita per year during the period covered by this report; at Independence, $156.84, and at Clarinda, $148.53. It will be observed that the per capita cost was in excess of the per capita allowance at the hospitals at Mt. Pleasant and Independence, but this increased cost was met from the surplus which existed in the support funds of these institutions at the beginning of the biennial period on July 1, 1899, as well as from the proceeds of shops, farms and gardens. The constant upward tendency in prices compelled us to expend some of this surplus to maintain the standard of care demanded at these institutions. It is apparent that, in view of market conditions, it will, during the period upon which we have now entered, require the exercise of economy tokeep within the funds available. We think, however, that there must, ere long, be a decline in the prices of many articles, and that we can go through the new biennial period, in view of the surplus on hand, without in any respect lowering the standard of care.

CHAPTER XI.

LEGISLATION RECOMMENDED-THE INSANE.

The three state hospitals contained, on the thirtieth day of June, A. D. 1901, 378 insane persons who were state patients, that is, patients whose legal place of residence is unknown, and who are kept at the expense of the state. Section 2283 of the Code. authorizes county officials to remove non-residents of the state found to be insane to the place of their legal settlement, and authority is also given, if such persons are in the state hospital, to remove them to such place. Section twenty-eight of Chapter 118, of the acts of the Twenty-seventh General Assembly, provides that no patient shall be received in the state hospital to be maintained at state expense without the formal order of this Board. The policy of the law as expressed in these provisions is not to receive into a state hospital any non-resident insane person if the place of his legal settlement be known, and he can be removed to it, and that such a person should not be kept in a State Hospital after the place of his legal settlement is ascertained.

In practice these provisions, so far as they apply to non-resident insane who have not been received into any state hospital, often work an injustice to counties in which such persons are found. There is reason to believe that many insane persons who did not have a legal settlement in this state have been supplied with transportation and sent into it, or have been brought into it and then abandoned, to be discovered and cared for by the local authorities, and that this has been done by officials or other persons, for the purpose of relieving themselves and their communities of the care of the persons so sent into the state or abandoned. Some of the counties of the state, particularly those border counties which contain railway centers, have been put to much trouble and expense to care for non-resident insane found within their limits. We submit that it is unjust to impose upon any county the expense of removing an insane non-resident to the place of his legal settlement, and it would be a serious drain