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SUPERINTENDENT'S REPORT.

IOWA HOSPITAL FOR THE INSANE,
MOUNT PLEASANT, IOWA,
November 1, 1869.

TO THE BOARD OF TRUSTEES,

GENTLEMEN :-Another biennial period in the history of the hospital has passed under circumstances of much satisfaction and general prosperity. The health of the inmates has been remarkably good, no epidemic has visited the institution and there has been but little acute disease of any kind. The severe grades of dysentery and diarrhoea which have been so prevalent and fatal in the hospital in former years, have been unknown here during this period; and we have almost ceased to apprehend the existence of any pestilent influence that may give rise to sickness and death among us. Still, I believe all has not been done that can be done to guard against unforeseen conditions unfavorable to health, and to surround us with the best attainable hygienic influences.

Before the date of the last report the number of patients under care exceeded the architectural capacity of the hospital. The number continued to increase, and for several months we have had under care about one hundred more than the proper number. During the period seventy-six patients have been refused admission; and forty-five of the most quiet and harmless patients, believed to be incurable, have been removed by their friends at our request, or discharged by order of your board. All of these persons were proper subjects of hospital care, and would have been received or retained, if there had been possible room; but as they appeared incurable, and the room they would occupy was needed for those patients whose prospects for recovery or improvement

appeared to be more favorable, there seemed to be no other course left for us to pursue.

The first object of this and all similar institutions recovery, cannot be carried out in the best manner, or the highest degree of success reached, by receiving more than the proper number; but the greatest good to the greatest number may permit such a course until the needed accommodations can be provided and no longer. It is a fact sufficiently obvious upon slight reflection, and well established by the experience of a half century, that every patient in the institution of the kind beyond the proper number occasions a great amount of inconvenience, and is a drawback upon the comfort and welfare of the whole. In no other way, however, could we provide for so many patients for whom such relief and care was imperatively demanded.

Believing the design of the corporate is scarcely less fulfilled in taking care of the chronic insane than in aiding the restoration of others, no patient has been refused admission, and no one discharged for the reason alone that they were incurable, troublesome, repulsive or approaching death.

A majority of those received into the hospital had been insane not exceeding one year: but many cases of longer standing have been admitted, among them the epileptic, the paralytic and the hopelessly demented, who had become more or less violent and uncontrollable, and perhaps dangerous elsewhere; and, as a class, have required the most unremitting, watchful attention to prevent those accidents to which a crowded hospital for the insane is always exposed.

When the number of inmates had reached four hundred several months ago, and patients continued to be sent without discrimination, often from a great distance, and usually without previous notice, under circumstances leaving no alternative but admission, a circular was issued requesting previous application, except under the most pressing circumstances. This request has been cheerfully complied with, and the number of patients reduced from four hundred and eighteen, the highest reached, to three hundred and ninety-eight at this date.

Since the opening of the hospital fourteen hundred and twenty-five

patients have been admitted, of whom seven hundred and forty-one were men, and six hundred and eighty-four were women. Ten hundred and twenty-seven-five hundred aud thirty-three men, and four hundred and ninety-four women-have been discharged; leaving three hundred and ninety-eight under treatment at the present time. At the date of the last report there were in the hospital three hundred and forty-four patients-one hundred and sixty-nine men, and one hundred and seventy-five women. During the two years there have been admitted two hundred and thirteen men, and one hundred and eighty-seven women-in all four hundred; and there have been discharged three hundred and forty-six-one hundred and seventy-four men, and one hundred and seventy-two women, leaving in the hospital at the date of this report, three hundred and ninety-eight patients; of whom two hundred and eight are men and one hundred and ninety are women.

Of those discharged there were regarded as recovered, one hundred and eighty-seven-eighty-eight men and ninety-nine women. Thirty-one-fifteen men and sixteen women-were more or less improved. Forty-one-eighteen men and twenty-three womenappeared unimproved; and there have died fifty-three men and thirty-four women-or eighty-seven in all.

The following tables containing some matters of interest, embrace the principal statistical results, and are believed to be as accurate as the means of information within our reach will make them :

Men. Women. Total.

Number of patients in the hospital at the date of last report, October 31, 1867..

Admitted to October 31, 1869...

Total number under care since last report

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240 2391 479

Total.....

Total recovered to October 31, 1860.......

Per cent of recoveries on recent cases admitted, 70.33.
Per cent of recoveries on all (1425) cases admitted, 33.61.

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When the insanity is of less than one year's duration, the case is called " recent."

+ When of one year, or more than one year's duration, it is called "chronic."

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