These attacks are checked temporarily by treatment, but he is gradually becoming very weak and emaciated. By October he became extremely emaciated. Exploration of chest gave negative results, and he was entirely free from cough. It seems evident he has mesentric tubercles. During the latter part of October and the first of September he was in an extremely marasmic condition. Large ulcers developed about pelvis in spite of every care, and a large abscess formed in right leg, invading the whole calf; it discharged an enormous quantity of unhealthy pus and broken down tissue. His mind remained much deranged, and a diagnosis of tubercular deposit in brain and spinal cord, as well as mesentary, was made. Diarrhoea continued, and he gradually sank and died November 15th. AUTOPSY. Emaciation great. Miliary tubercles were disseminated throughout the mesentery. The mesenteric glands were much enlarged. The brain, aside from general atrophy and anæmia, presented no macroscopical evidence of disease. Tubercles were present in the lungs, but not very extensive; the disease of the lungs seeming to be secondary. A tumor of the spleen was found located on its upper extremity, about three inches in diameter. It presented a white cartilaginous appearance, and was of firm consistence. PATHOLOGICAL REPORT. As an extended pathological report of a similar case appeared in the thirteenth biennial report, this will be merely an abstract, and at the same time the more prominent symptoms that accompany this pathological condition will be presented. The submiliary tubercles were found in this instance in all portions of the encephalon, they being more abundant in the medulla than in any other region. In the great majority of these cases we find no macroscopical evidences of the tuberculosis or other disease of the brain. The microscopical evidences however are prominent, and when these submiliary tubercles are magnified two hundred and fifty diameters, they present the appearance as represented by Fig. VI. Occasionally, however, they are much larger, about four times as large as those represented in Fig. VI and in Fig. III of the thirteenth biennial report. Cross sections of the medulla in this case presented the larger tubercles. The symptoms that occur most frequently in these cases that present submiliary tubercles are those of melancholia; melancholia often of a resistive type; they being opposed to everything their nurses or friends try to do for them. Try to induce them to eat and they will not take a mouthful; leave the food so they can eat it without being seen, and they will often eat quite heartily. And owing to their delusions, hallucinations and illusions, they may become maniacal; the period of excitement does not however long continue. These patients are as a rule extremely suspicious, and it is very difficult to gain their confidence. If they abuse their physician or nurse they will often apologize and seem to feel sorry, but in a few hours will be very likely to repeat the same abuse. They are quite irritable. There is a disinclination to exert the mind,† and sometimes a disinclination to exert the body. Some will for a time be inclined to be on their feet, and it is difficult to induce them to remain in a sitting posture. It is now demonstrated that the source of the virus is the bacilli tuberculosis, if the theory of Koch and Ehrlich is to be believed, and it is now daily demonstrated that myriads of the bacilli may be found in the sputa of phthisical patients. The air in many localities contains these bacilli and we inhale them, or they may enter the stomach with food. The lungs being in a healthy condition, its function or structure is not disturbed by their presence. If diseased in any way these microbes will lodge and may develop tuberculosis. These bacilli may lodge in the intestines and develop tubercular disease there, or if the place of entrance does not afford a fitting nidus, the virus may be carried beyond; being most readily carried by the lumpathics to the nearest lympathic glands, and may there pass into the blood, and the brain or its meninges, being in an abnormal condition, a nidus may be found for their reproduction. We must bear in mind however that the bacilus aids our diagnosis of tuberculosis more than it increases our knowledge of its etiology.* The tables appended to this report contain some valuable information, and have been prepared with great care and labor by Dr. M. E. Witte. CHANGES IN THE MEDICAL STAFF OF THE HOSPITAL. It is with a feeling of sadness that I am called upon in this connection to chronicle the death of my much beloved First Assistant, Dr. H. M. Bassett. At the close of the late war (he was surgeon in two different Ohio regiments, and served with credit to himself and State), +Clouston-Journal of Mental Science, 1863. *Ruhe of Bonn. his active spirit would not even rest after such a contest and so much of hardship, but immediately accepting a position in this Institution, then under the superintendency of Dr. R. J. Patterson, commenced his labors here, serving with ability under him, and subsequently Dr. Mark Ranney, until the resignation of the latter in 1872, when his fidelity as an assistant commended him to the Board of Trustees, and he was appointed Superintendent. He served faithfully for two years in this position and then resigned, intending to enter another department of the profession. Dr. Ranney returning and being chosen to fill the place made vacant prevailed upon Dr. Bassett to remain. He continued thus in the service of the State for a period of about twentytwo years. During between four and five years of this period he has been my highly valued First Assistant and friend, and I desire to testify to the marked ability displayed in his professional career, his earnest devotion to duty, and self sacrifice, and his loyalty as a friend. It seems mysterious that a life so full of good works and usefulness should be cut short, but it can be said, that if his years were measured by what he had accomplished, he even at the age of forty-seven had filled up the time to the alloted space of three score years and ten. He died February 28, 1887, after a brief illness of only one week. I would suggest that some mention by your Board, by resolutions or otherwise, would be appropriate, considering his long and faithful service here and the great loss to all of us by his death. Dr. M. E. Witte, who has fafthfully served the Hospital as Second Assistant for five or six years, has been appointed to fill the vacancy, and Dr. F. P. Peck, who has performed the duties of Third Assistant, as well as pathologist, has been advanced to the place of Second Assistant. More than a year ago, after the wing for males was filled with patients, Dr. P. F. Straub was appointed Fourth Assistant and apothecary. Dr. Straub is a graduate of the medical department of the Iowa State University, and had served as apothecary faithfully while a student. His services during the past year have been acceptable, and we expect now that he is advanced to the position of Third Assistant, the same growth hitherto noticeable. You are now requested to confirm in addition to the above, Dr. J. M. Aiken, as Fourth Assistant and apothecary, also a graduate of the Iowa University, who comes to us with recommendations from the faculty and other leading men of the State. Mr. E. N. Nelson has continued to perform the duties of Steward in a most careful and conscientious manner, and has shown marked ability in purchasing stores for the Hospital, and tact in his relations with persons with whom he has been called to do business. Mrs. F. V. Cole remains in the position of Matron, and has continued to devote herself assiduously to the duties of the position, and in watchfulness of the interests of that portion of the Institution under her immediate care. A large amount of clothing, underwear, etc., has been manufactured in the sewing-room under her direction, and it is to be hoped that she may have better facilities, in all of the domestic departments by a wise provision of the next Legislature. Miss Lollie Crawford, who for nearly four years faithfully performed the duties of book-keeper resigned her place and was succeeded June 1, 1887, by Miss Flora Chalfant. Miss Trope continues to be the same faithful and devoted Supervisoress as in years past, and too much credit cannot be given for her constant vigilance and untiring industry. Mr. J. G. Miller was appointed early in November, 1884, to fill the vacancy created in the office of Supervisor of the male department, by the resignation of Mr. G. H. Lyons. To all these, my assistants and co-laborers, together with many devoted attendants and employes, I desire to return sincere thanks for earnestness of purpose, faithfulness to duty, and loyal service. ACKNOWLEDGMENTS. A larger number of newspapers have been sent us than ever before, and have been a source of great gratification to our patients. The following list is now sent to the Hospital gratuitously, which we trust will be extended: Daily Register, Des Moines, Iowa. Daily Capital, Des Moines, Iowa. Daily Evening Gazette, Burlington, Iowa. Republican, Montezuma, Iowa. Journal, Mt. Pleasant, Iowa. Free Press, Mt. Pleasant, Iowa. Times, Cedar Rapids, Iowa. Wapsie Index, West Liberty, Iowa. German-American, Waterloo, Iowa. National-Democrat (German), Dubuque, Iowa. Sentinel, Sauk Rapids, Minn. The Democrat (German), Davenport, Iowa. The Miner, Marysville, Iowa. The Guthrian, Guthrie Center, Iowa. Herald, Oskaloosa, Iowa. Monona County Gazette, Onawa, Iowa. Electric Light, Marshalltown, Iowa. To the officers and directors of the Henry County Fair we are indebted for complimentary tickets for all of our patients who were able to attend, thereby affording them much gratification. From the Henry County Bible Society we have received another installment of bibles for our wards. During the two years the following named individuals or firms have contributed to our amusement fund or for our holiday festivals for the patients' benefit, either by some appropriate gift or in money to procure the same: Messrs. Marshall, Field & Co., Orr & Lockett, C. T. Raynolds & Co., Wm. Blom, E. Baggott, Quincy White Lime Co., Crane Bro's Manufacturing Co., Skeen & Stuart, Geo. W. Gordon, Donahue, McCosh & Co., Western Electric Co., J. A. Fay & Co., J. L. Mott Iron Works, Maj. Jas. R. Willett, Thos. R. Lyon, Bicklin, Winser & Co., L. H. Drake, Thos. Kane & Co., Hon. J. H. Craig, Keokuk; Gilbert, Hedge & Co., A. L. Ide & Son, Geo. W. Pitkin & Co., Pilger Bro's, Hyde & Southworth; Price & Henry, A. Palmer, Bell, Smith & Segner, C. W. Webster, Peters & Barnard, H. E. Parks, L. R. Warner, Richard Green, Willett & Pashley, Dearborn Foundry Co., Root & Sons Music Co., E. H. Kellogg, Janes & Cole, John Blaul & Sons, |