FINANCES.

Since the completion of the wing for males, or the commencement of this biennial period, the amount specified by law, sixteen dollars, per capita, per month, that may be drawn if necessary, has not all been required. Fifteen dollars per capita, per month, was the requisition from July 1, 1885, to December 31, 1886. The additional number since that time accommodated at the Hospital, and the exceedingly low price of all staple articles, has admitted of a reduction to fourteen dollars per capita, per month. If this amount could be drawn in advance instead of to pay a quarterly deficiency each three months, it would enable us to pay cash for each article purchased, and thereby save the cash discount for each transaction, and avoid much annoyance to ourselves and patrons. I would submit to you the importance of some arrangement, or legislation if necessary, whereby this important change may be made, in the interest of economical management. Every careful and successful business man in his own transactions knows that the only sound business principle to adopt is, "to pay as he goes." In matters pertaining to the business of the State, or in the distribution of State funds, this should certainly be emphasized, and the Hospital should never be indebted to any individual. As stated in another place in this report, the amount appropriated for the construction of the wing for females has been sufficient for the purpose, and the wards are now completed and furnished; ready for occupancy, and the bills all paid for construction, furnishing and heating. The Trustees' and Steward's exhibits show an over-draft of $20,000, from the fact that the period closes June 30, and the last $20,000 of the appropriation could not be drawn, according to the language of the law making the appropriation until July

1st.

We have a small balance on repair fund, which is being used for the purpose appropriated.

FARM.

The year 1885 was a very trying one with us in regard to crops. Grasshoppers appeared in our midst in July and destroyed the most of our vegetables, a garden of twenty acres being despoiled by them, and much other damage accomplished. Last year, 1886, we suffered from a severe drought, and all our crops were much below the average per cent. Below will be found a table of farm products raised in 1885 and 1886.

Investigations in this department have been continued, and pursued with as much constancy and zeal as other duties would permit. Dr. F. P. Peck has in this work manifested the same careful and delicate manipulation in preparing specimens, from the post mortem examination, through the process of hardening, cutting, coloring and mounting on slides, as indicated by the pathological report of two years ago. In each case examined we have the history before admission, and during the residence in the Hospital, to which is added the post

mortem and pathological examinations, with illustrations by microscopical slides, and micro photographs taken from them. This is all made a permanent record, and each case in all its completeness can be referred to at any time. As a matter of interest to the medical profession of the State and to alienists and pathologists we present for publication, as a part of this record of the biennial period, a report of four cases. The second one is particularly interesting from the fact that the delusions manifested by the patient during life of hearing and vision, appear to have a solution in the evidences of localized pathology discovered. By a multiplicity of these examinations by the different hospitals of the country, and a collation of authority can we arrive at difinite conclusions in reference to cerebral localization of disease, and thereby valuable results follow to the alienists, as well as the profession in general, in reference to diagnosis, prognosis, treatment and prevention of brain disease.

GENERAL PARESIS.

Case 5425. Admttted April 27, 1884. Male. Age 44. Married. Farmer. Native of Indiana.

This is the first attack; the first symptoms were noticed in the fall of 1883, by being incapable of going any place alone. Disease is increasing; is variable with irregular rational intervals. Is deranged on no particular subject. He fails to accomplish anything he attempts, and talks but little since the commencement of the disease. He requires watching; lost himself last winter. No disposition to injure himself or others or to disorderly habits. No relatives insane. No peculiarities before the accession of the disease. Never intemperate. No treatment. Cause unknown. He has some disease of the kidneys.

ABSTRACT OF HISTORY AFTER ADMISSION.

At the time of admission this patient was in a very much impaired and obscured state of mind. He had lost his memory to a very great extent, and could not concentrate his mind on anything. He was inclined to walk about at random without reflection or purpose, and appeared to act on momentary impulses. He complained of sleeplessness, but this was soon relieved. By the latter part of May he became less restless and said, "he felt quite well." By this time he was strong and vigorous, but there were some evidences of cerebral hyper

aemia. During the month of June there was no material change. His memory, more especially for recent events was defective. He enjoyed very good physical health, and rendered a little assistance in light work on the farm, but it was noticed his movements appeared clumsy. By September he appeared more demented. His mind was considerably confused and he was not as careful and neat as he had been. During October he was very much confused, his mind being much impaired. He required a good deal of attention. He was able to exercise but little control over his sphincters, and there were involuntary discharges, he being apparently unconscious of the act. In December his mind was still impaired and obscured, and he required almost constant care and attention. With his mental impairment, progressive loss of motion kept an even pace. He was irregular and unsteady in his movements. There was evidence of passive hyperaemia of the brain. A marked bronzing of the skin was noticeable, also large bloody tumors of both ears. The pathology of this case seems to be that of general paresis with Addison's disease. By the middle of January the impairment of mind and power of motion had become very great. Pneumonic complications also developed. His appetite was voraceous to the last. January 18th and 19th he was only partially conscious during a small portion of the time and died at 3 o'clock A. M. January 20, 1885.

AUTOPSY.

Autopsy was held fourteen hours after death. External inspection revealed post mortem rigidity, a well nourished body and bronze colored skin, especially of the face.

Cranium.—There was considerable effusion of blood underneath the scalp. On removal of the calvaria the meningeal vessels were found to be greatly distended. Examination of the brain revealed general atrophy. Convolusions were somewhat flattened. The pia was removed under water, and the brain with a portion of the congested pia retained for miscroscopical examination.

Lungs.—Examination of the lungs revealed double pneumonia; base of right lung invoived, commencing pneumonia in upper lobe, and present in left lung posteriorly.

Heart was of normal shape and size.

Liver of normal shape, size and consistence.

Supra renal capsules a very little larger possibly and firmer in consistence than normal.

PATHOLOGICAL EXAMINATION.

Section 1 is a transverse section of the upper cervical cord, and with an amplification of two hundred and fifty diameters there may be seen cellular proliferation of the pia. This proliferation of round cells is in all probability the result of a former meningitis. With the same amplification, peripheral myelitis due to a long standing inflammatory process is discerned. Many of the vessels have thickened walls, and the vessels themselves are dilated, occluding the perivascular spaces. The central canal is filled with small round cells, and have taken a deeper stain than the rest of the tissue; this latter condition may be found in healthy cords. Sections from the same region stained with osmic acid reveal many patches of miliary sclerosis, these may be seen well with a two-third objective and are found in every column of the cord. In both gray and white matter they appear to be composed of cellular elements, varying in number in each patch from one to ten or more, and each cell appears as large under a three-fourths objective as a pus corpuscle does under a onefifth. In other words these corpuscular elements are about four times the size of pus corpuscles.

Figure 1 represents these sclerosed patches as seen through a one and a half and a two-thirds objective, the latter being in substage inverted, the slide placed below this (two-third) objective, tube drawn out one inch, giving an amplification of about twenty diameters.

This section represented by figure 1, as well as the one represented by figure II, is from the lumbar portion of the cord, the sclerosed patches differing in this region from those in the cervical and dorsal portions only in number. These sclerosed patches appear dark in the figure. Their appearance depends very much upon the illumination. Figure II represents these sclerosed patches as seen by reflected light, and magnified seventy-five diameters. Thus illuminated they present a very uneven surface, not greatly unlike the surface of a mulberry calculus. To show these patches in relief it is necessary to turn the stop lens at an angle, this necessarily diminishes the amount of light that passes through one side, and accounts for the one side of the cut being so much darker than the other. Bramwell says, “in true inflammatory swelling the enlarged nerve cells stain deeply with carmine." If this is true, then this is not a case of enlargement of the cells due to an inflammatory process, but rather what is known as "glassy swelling." These patches do not take up the carmine stain.