FOURTH REPORT

OF THE

VISITING COMMITTEE

TO VISIT THE

HOSPITALS FOR THE INSANE.

1881.

PRINTED BY ORDER OF THE GENERAL ASSEMBLY.

DES MOINES:

F. M. MILLS, STATE PRINTER.

REPORT.

HON. JOHN H. GEAR, Governor of Iowa:

ANOTHER biennial period is past, and again it becomes the duty of your committee to make a report of their proceeedings.

The personnel of the committee remains the same as at our last report; one member has been absent from the State for the past five months, and the duties devolving upon the committee have been performed by the other members as well as possible under the circumstances. The monthly visits of inspection have been regularly made at each hospital, and the examination into the condition of the different wards and departments has been thorough;-they have been found cleanly, bedding of good quality and sufficient, the quantity of food abundant, and the quality excellent. Patients are freely conversed with at each visit, and their complaints attended to and alleviated as far as possible when there appears to be any cause for complaint.

RECOMMENDATIONS AS TO THE FUTURE POLICY IN THE MANAGEMENT OF

THE INSANE.

The hospitals for the insane are too constantly over-crowded to become in the highest degree successful in the cure of their cases, and we believe that the Hospital at Independence should, as soon as practicable, be completed according to its original design; the Superintendent could then make his classification more complete.

The Superintendent at Mount Pleasant Hospital will ask for an extension of that building (so as to increase his room and improve the classification) by changing three small wards in each wing into full-sized ones, thereby increasing the capacity of the Hospital about 120 patients. We believe this addition very desirable.

There are now 1,068 patients in the hospitals. A large per cent of these are incurable, and this class is constantly increasing in hospital. There are out of hospital, scattered around in the different counties, about 500 chronic insane and incurables. Most of the counties have no suitable places provided for them, and they are kept in jails and poor-houses, and some farmed out to the lowest bidder. There is, also,

a class of State patients accumulating in the hospitals, mostly tramps, who have not a residence in any county; these bid fair to increase to such an extent as to take up a large per cent of the hospital room to which the residents of the State are entitled. This condition of our hospitals brings us to a consideration of the means by which we may from time to time unload our curative institutions of the surplus of chronic and incurable cases. Two plans have been considered by your committee, for this purpose, as follows:

First, by erecting additional buildings upon the hospital farms, substantial two-story brick structures, not costing more than $5 per patient for the number accommodated.

This plan might include a home for convalescents, which would be very desirable. All these to be under the same supervision as the present hospitals, supplied from the central or hospital building, and possibly heated from the same sterm-heating apparatus.

The other plan is to obtain a suitable location, centrally situated in the State, and the buildings to be of the same class as described in the first; they should be planned so that they could be added to as necessity required.

We would recommend the first plan, except for two or three important considerations. Eventually there will be needed one, and, perhaps, two hospitals in the western part of the State, of the same character as those we already have. Another objection to the first plan is, that we do not think the location of either of the present hospitals desirable: they are too far from railroads, making transportation of supplies expensive; the farms are not first-class; the water supply is not permanent at either place; and these are all grave objections in such establishments.

Taking into consideration all the points, we regard the second plan as the best one for the future, and we consider as imperative the necessity for the immediate commencement of the institution.

We consider the management of both hospitals during the biennial period to have been good. The mortality has been at least as light as in other institutions of the same character; and, considering the constantly crowded condition of the wards, we think the hospitals, on the whole, have been very successfully conducted. Very few cases of complaint have occurred, and no general charge has been made against either hospital, except at Mt. Pleasant, and this was investigated by the committee, with the result as stated in this report.

It is to be regretted that Dr. A. Reynolds, Superintendent at Inde