Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1894.

Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1894.

Asylums--Michigan--Traverse City--History.

Psychiatric hospitals.

Report of the Board of Trustees of the Northern Michigan Asylum for the biennial period ending June 30, 1894. This report includes the reports of the medical superintendent, treasurer and steward.

Board of Trustees of the Northern Michigan Asylum at Traverse City.

Original document held by Traverse Area District Library.

Lansing: Robert Smith & Co., State Printers and Binders.

30 June 1894

State of Michigan.

This document is in the public domain.

See other reports from the Board of Trustees in the "Traverse City State Hospital" Digital Collection.

PDF.

English.

Document.

TCSH0019

Traverse City, Grand Traverse County, Michigan.

OFFICERS OF THE NORTHERN MICHIGAN ASYLUM.

TRUSTEES.

TRAVERSE Crrr.
ELK RAPIDS.
MANISTEB.
TKAVERSB CITY.
TKAVBKSE CITY.
MTJSKEGON.

THOS. T. BATES,
H. H. NOBLE,
GEO. A. HART,
LORIN ROBERTS,
H. C. DAVIS,
<C. L. WHITNEY,

RESIDENT OFFICERS.

MEDICAL, SUPERINTENDENT.

JAMES D. MUNSON, M. D.,
A. S. ROWLEY, M. D.,
G. G. SPEER, M. D.,
ROBERT HO WELL, M. D.,
HARRY J. KENNEDY, M. D.,

ASSISTANT PHYSICIANS.

NON-RESIDENT OFFICERS.

STEWARD.
DETROIT, MICH., GYNECOLOGIST.

J. P. C. CHURCH,
W. P. MANTON, M. D.,

CHAPLAIN.

TRAVERSE CITY.

REV. D. COCHLIN,

TREASURER.

FRANK HAMILTON,

TRAVERSE CITY.

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MICHIGAN

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ASYLUM.

EEPOET OF THE BOARD OF TRUSTEES.

To the Governor and Legislature of the State of Michigan:
In accordance with the requirements of the law, the trustees have the
honor to submit their report for the biennial period ending June 30, 1894,
and also the reports of the medical superintendent, treasurer, and steward.
Twenty-one regular meetings of the board have been held. Besides the
ordinary duties devolving upon the board, much administrative work has
been necessitated by the improvements within the period, of which the
most important was the completion of the reservoir, the construction of
two new cottages for patients, a general store room, and a farm barn.
As required by the by-laws of the hospital, a committee of trustees have
inspected the Institution once each month, and have made written reports
of its condition, with such suggestions as were deemed best for its improvement and as would bring increased benefits to the patients. These
inspections are of especial value, not only because they bring the patients
and employes in touch with the board, but also that they afford the trustees a personal knowledge of the details of management and of the care of
patients, and bring to their notice the difficulties that the officers and
attendants meet in the regular discharge of their duties.
"We believe that the medical care of patients has been painstaking,
and also feel that in addition to the labors that the medical officers have
regularly performed they have kept themselves well informed of recent
improvements in the treatment and care of the insane. We would
particularly call attention to the fact that the medical staff is too small for
the best care and treatment of a thousand patients, and that until the law
is amended increasing the appropriation for the salaries of officers there is
no way by which it can be enlarged. We would respectfully urge the
legislature to amend the statute providing for officers salaries to $12,000
per year. We wish it to be distinctly understood that we do not urge this
amendment that the salaries of existing officers may be increased, but that
additional members 'to the staff may be employed. It is true, however,
that physicians accepting positions in our institutions must have increased
salary after a period of service if they are to be long retained. It is well
known that the junior medical officers after one, two, three, or more years
of experience resign to enter private practice, because it affords to them
much greater opportunities for financial success than a further continuation
of hospital work.
The trustees are glad to say that the attendants have performed their
duties faithfully, and that they have found the hospital in good order and
that careful and kind attention has been accorded the patients. There
have been but few changes among the chief attendants, and it would be to
the advantage of the patients and to the highest success of the Institution if the services of those engaged in nursing the insane could be made
more permanent. We have no training school for nurses, but believe that

6

NORTHERN MICHIGAN ASYLUM.

such a school would tend to the attainment of this important object.
However, with a limited medical staff, and with the rate of maintenance
reduced to the lowest price, it would be difficult to organize and maintain
a thorough training school.
We have been able to shorten the hours of duty of many of the day
attendants by employing additional night nurses and we hope in the near
future to be able to relieve from duty each attendant once every twelve
hours. We believe that this change could be introduced without additional expense and with much saving in labor to the officers. With such a
system in vogue, all leave of absence could be practically abolished, and
consequently the expense of printing permission blanks, time books, and
also the work of keeping the same, would be obviated. This plan would
also enable many of the attendants to live outside and afford to them a few
hours each day of absolute freedom from responsibility. So far as this
plan has been adopted it has been satisfactory, and we are certain that we
now meet a more cheerful compliance in the performance of duties than
under the former method of continuous work.
With the exception of the accidental death of Mr. Adolf Kaelstrom, the
particulars of which appear in the Superintendent's report, no serious
accident occurred to patients within the period. A mild epidemic of la
grippe prevailed during last winter, and a few cases of rotheln occurred
among the employe's this spring, but apart from these we have been free
from contagious diseases.
The number of patients under treatment during the period was—males,
666; females, 522; total, 1,188. The number of patients addmitted was—
males, 231; females, 147; total, 378. Of this number there were admitted
at county expense as follows:
_
1
Alpena
14 Leelana w
1
Antrim
8 Luce
&
Aranac
3 Mackinac
3
Alcona
3 Manistee
21
Benzie
4 Marquette
5
Baraga
.. 4 Mason
Charlevoix
6 Mecosta
10
26
Clare
6 Menominee
7
Crawford
1 Midland
Cheboygan
7 Missaukee
5
,
19
Chippewa
5 Muskegon
Delta
5 Montcalm
19
2
Dickinson
19 Montmorency ._'
9"
Emmet
7 Newavgo
Gladwin
1 Oceana
9
1
Grand Traverse
14 Ogemaw
Gratiot
14 Ontonagon
1
10
Gogebic _1
11 Osceola
Houghton
22 Otsego
2
Isabella.
Oscoda
1
Presque Isle
2
loscd
Iron
Schoolcraft
4
Kalkaska _
Wexford _
3
Keweenaw
Total .
..:„ 343
Kent
Lake _

REPORT OF THE BOARD OF TRUSTEES.

7

Eleven (non-residents) were admitted at State expense; two at State
expense (transferred from county); and 21 at private expense.
Of the 378 patients admitted—
23 had been confined in county houses,
104 "
"
"
" jails,
29 had been treated in other asylums,
57 were said to have been destructive,
56 had attempted or threatened suicide,
141 were homicidal or had made homicidal assaults,
6 had been treated in hospital, and
64 had been confined or restrained at home.
Doubtless the reason so many of these patients had been confined in
jails was due to the fact that, previous to the completion of the cottages,
the counties had no other means to care for them; 143 of the number
admitted during the period were received since Feb. 1, 1894.
Of the 378 patients admitted only 70 suffered from the simple, curable
forms of insanity. As in former periods, the admission of degenerate,
incurable patients, was largely in the majority. In a public hospital where
no selection is or can be made of patients admitted, and where no cases
presenting signs of constitutional or acquired defect in mental organization are ever discharged cured, the rate of recovery on the whole number under treatment will necessarily be small; but if we examine the rate
of recovery of patients classed in Group I of our classsification, we shall
find that this is large, not less than 70 per cent of the entire number.
The net increase of patients for each biennial period since the opening
of the asylum has been as follows:
From 1886 to 1888, 148
" 1888 to 1890, 131
" 1890 to 1892, 123
" 1892 to 1894, 150
Total for 8 years, 552
During these years additions have been made to the Institution as
follows:
1887—Completion of attics for 50 patients.
1887—Cottage for 50 men.
1889—Infirmary for 30 men, an infirmary for 30 women and a cottage for
50 men.
1881—Cottage for 50 women.
1893—Cottage for 100 men.
1893—Cottage for 75 women.
Besides the above, room was made for 23 male patients by re-constructing a farm house on the Asjlum grounds. This gives an increase of
accommodations for nearly 500 patients at a cost of $132,550, or about $265
per capita.
The number of patients discharged during the period was 135 males and
93 females, total 228. Of this number 67 were recovered, 62 improved, 7
unimproved, and 92 died. Doubtless among the 62 discharged some will
remain well for a number of years, but as many of them presented heredi
tary defect or signs of degeneration they were not considered permanently
cured.
The re-admissions for the period were 17 males and 11 females, total 28.
The re-admissions from the beginning have been 52 males and 43 females,

8

NORTHERN MICHIGAN ASYLUM.

total 95; therefore the total number of admissions 1,862, represents but
1,767 individuals.
The daily average number of patients for the period was 865. The number of weeks spent in the Asylum by patients was 90,172 2-7; this shows an
increase of 100 in the daily average and 10,192 5-7 weeks board over the
last preceding period.
On June 30. 1894, there were 690 patients under treatment at State
expense, 246 at county, and 24 at private expense.
There were 179 persons employed by the Institution June 80, 1894, in
the positions and at the wages shown by the schedule accompanying this
report.
IMPROVEMENTS.

The reservoir which was under process of construction at the time of
the last report has been completed, and within the amount of the appropriation. It is located about one-half mile west of the Asylum and at an
elevation of 105 feet. It has a storage capacity of 2,000,000 gallons. It is
connected with the pumps and fire apparatus of the various departments
of the Institution, and besides affording an ample supply of water for fire
protection furnishes water for purposes other than domestic use. The
cottages, with the exception of Cottage E, and the infirmaries are supplied from it. This affords considerable saving in the cost of pumping.
In addition to the reservoir a smaller one was constructed at a lower level,
50 feet above the building. This is connected with the mains leading from
the larger reservoir and thence by smaller pipes to the various parts of the
grounds. We are now able to keep the lawns fresh and green at comparatively little expense. These reservoirs afford great protection to the Institution from fire, and have been constructed at a trifling expense. The
State more than saves the interest on the investment by the difference in
the cost of pumping water for sanitary purposes. The grounds about the
reservoir have been enclosed with a handsome fence and made quite an
attractive place for patients to visit.
STORE HOUSE.

For a long time the board was aware that the supplies of the Asylum
drugs, groceries, and general merchandise, were being stored in various
parts of the basement of the main building. The original store rooms
were always too small, and as the Institution grew became totally inadequate for the safe keeping of these properties of the Institution. Moreover, the rooms were imperfectly lighted, and in the winter especially the
clerks were obliged to use lamps in their work. It was found impracticable to operate the electric plant in order to light these rooms, and it was
also found impossible to prevent undue waste of supplies under the existing arrangement. Finally, the danger of fire from the use of lamps was
thought to be too great to longer continue so faulty and dangerous a system, therefore it was decided to construct a detached store room of
sufficient size to care for the stores of the hospital. The store building is
located just back of the shop on the west side of the avenue. This building is constructed of stone and brick and has a steel roof. It is 75 feet
long, 28 feet in width, and has a front bay 15x20 feet. On either side of
the bay are covered porches, so that both incoming and outgoing supplies

RESERVOIR.

COTTAGE FOR MEN.

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FIRST FLOOR PLAN.COTTAGE FOR MEN.

EXPLANATION.

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Attendant's Boom.
Bath Room.
Clothes Boom.
Clothes Shaft.
Corridor.
Closet.

CC
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D R
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China Closet.
Dormitory.
Dust Shaft.
Drying Shaft.
Dining Boom.
Hall.
Kitchen.

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Porch.
Parlor.
Pipe Shaft.
Pantry.
Single Boom.
Scullery.

INTERIOR

OF COTTAGE FOR

MEN.

COTTAGE FOR WOMEN.

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Alcove.
A R Attendant's Boom.
B R Bath Boom.
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Clothes Room.
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Clothes Shaft.
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Closet.
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China Closet.
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Dormitory.
D 5 Dust Shaft.
DY S Drying Shaft.
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Hall.
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Kitchen.
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Porch.
Par Parlor.
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Pipe Shaft.
Pan Pantry.
Single Room.
Scullery.
Stairway.
SR
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FIRST FLOOR PLAN.COTTAGE FOR WOMEN.

ALCOVE

COTTAGE FOR WOMEN,

REPORT OF THE BOARD OF TRUSTEES.

9

can be handled without damage during stormy weather. A basement was
constructed under the entire building and is a valuable place for storing
fruit, canned goods, groceries, etc. The store house is one story in height
and is divided into three departments, one of which is used for groceries,
another for clothing, and the remaining one for notions, etc. The latter
contains the distributing counters which separate the distributing room
from, the store proper and are also a barrier to unnecessary intrusion. The
store is heated by steam and lighted by electricity. It was built at a cost
of about $3,500.
SIDEWALKS.

The plank walks laid a few years ago in the front and rear of the administration building, and from the latter to the entrance of the grounds, had
become much decayed, and after most careful consideration of the question
were replaced by Portland cement walks. These walks are very beautiful as
well as durable. The cement walks laid by the Commissioners between the
bakery and kitchen buildings in 1886 are still in perfect condition, and the
walks laid two years ago show no signs thus far of deterioration. There
are still many walks to be constructed in connection with the avenues and
grounds, and we believe it will be true economy for the Institution to use
cement rather than wood for the purpose.
FENCES.
The rapid improvement of the farm by the removal of forests, and also
the purchase of additional land, has necessitated the building of a large
amount of fence. Fortunately the expense of this improvement has not
fallen heavily upon the Institution as the material was mostly procured
from the farm. It might be well to state that the asylum farm when the
Institution was opened was nearly all forest land and there were but few
acres that might be called improved. As fast as the new portions have been
brought under cultivation fences have been required, so that the outlay for
enclosing the farm, while not great, has had to be provided for from year to
year. The amount of new fence constructed during the period has been
about two miles. We may add that the State has never been called upon
for an appropriation to improve the farm, to lay walks, to purchase tile, or
for any other improvements outside of new buildings.
FABM AND GAEDEN.

The clearing away of forest and the preparation of new tracts for cultivation has been steadily pushed during the period. About thirty acres
have been stumped, drained, and broken, and about 25 acres chopped over.
From the latter was obtained posts to the value of $160.00; lumber worth
$969.38; and wood amounting to $1,950.00. Quite a number of drains were
laid in the high lands, and some of these were cut through a muck soil of
from 14 to 18 ft. in thickness. The work of reclaiming much of the farm
has been slow, although the work has been done entirely by patients and
their attendants.
The garden has been much enlarged during the period. The new land
north of Cottages C and D is largely devoted to small fruits and vegetables, and a portion of the farm to the south has been planted to fruit trees,
2

10

NORTHERN MICHIGAN ASYLUM.

apples, peaches, plums, crabs, cherries, etc. It is the hope of the Board
that the farm may produce in years to come all the fruit that the patients
can consume.
During the fall of 1893 a section was added to the series of greenhouses.
The original greenhouses were found to be so valuable for the cultivation
of flowers and vegetables and in forcing plants (melons, cucumbers, tomatoes, etc.), for transplanting to the garden, that it was deemed wise to
enlarge them sufficiently to meet the actual needs of the Asylum. Moreover, experience has demonstrated that the gardener and a few assistants
could be profitably employed here during the winter months. The new
greenhouse is 114 ft. in length and 22 ft. in width. It is warmed from the
boiler in the original houses and cost but little outside of the glass and
labor to erect it. The profits to the Institution from winter gardening have
been great. By this means flowers and dainty vegetables are furnished to
our sick people during a time of year when they cannot be had in the
open market.
Notwithstanding the almost total loss from cholera of our herd of swine,
estimated at $5,000, the farm has been a source of considerable profit to the
Institution for the period just closed. The receipts have been $24,170.81
and the expenditures have been $20,893.98. The latter includes the purchase
of thoroughbred Holstein cattle, horses, farm implements, etc. An itemized statement of the products of the farm is contained in the Steward's
report.
,
Among the minor farm improvements must be mentioned the erection of
a small shed and paddocks for the care of stock. The net profits of the
farm after deducting all expenditures have been $3,276.83. The lawns have
been much beautified by the setting out of a large number of trees and
shrubs, and as previously mentioned, can be kept fresh and green with
water supplied from the reservoirs.
SPECIAL APPEOPBIATION, $25,000.

This appropriation was made by the last legislature for the purpose of
building, fitting and furnishing a cottage for 100 men. This cottage is
situated between the infirmary for men and cottage A, and commands a
beautiful landscape as well as a view of the neighboring buildings and
grounds. Like the other asylum buildings, it is constructed of stone and
brick, a building two stories and a basement in height. The basement is
used solely for heating and ventilating purposes, and the first story, with
the exception of a iew single rooms, is used only by day. This cottage was
designed for an intermediate class of patients and consists of dormitories
and single rooms, as shown in the accompanying plans. As the Institution
was caring for over twenty-five per cent of its patients in dormitory cottages,
it was not thought practicable to extend the system farther without providing an adequate number of single rooms for irritable or noisy patients.
This building was planned accordingly, and it is found that many recent
cases can be treated quite as well, if not more comfortably, than in theintermediate wards of the main building. This cottage has 22 single rooms,
4 of which are specially heated and lighted. It is 204 ft. in length and
varies in width from 37 to 72 ft. The lower floor contains attendants' clothes
and bath rooms, parlors, dining room, pantries, kitchen, clothes shafts, pipeshafts, etc. The dining room occupies the central portion of the building and
is exceedingly pleasant and attractive. It adjoins the kitchen, which renders.

REPORT OF THE BOARD OF TRUSTEES.

11

the serving of food comparatively easy. The main entrances to the cottage are covered either by towers or porches. It is lighted by electricity,
provided with inside and outside hydrants for fire protection, and is furnished with indirect steam heating. The capacity of the cottage is 202,598 cubic ft., and the system of- ventilation, which has been approved by
the State Board of Health, is sufficient to change the air in the building
at least every 30 minutes. The ventilation of the dining room is in excess
of that of other portions of the building, so that during meal hours, when
the population of the building is crowded into a small space, there is no
"stalling "of the air. Only the most improved appliances were used in
the building, consequently it is very complete in its sanitary arrangments.
The cost of the cottage was as follows:
Labor
$10,280 98
Tile, stone, lime and cement
2,150 19
Lumber
3,757 97
Brick
5,305 48
Hardware, nails, etc
429 02
Heating apparatus and pipe
2,290 16
Beds, Mattresses, etc
440 59
Paints
174 12
Electric light
fixtures
171 49
$25,000 00
We regret to report that the appropriation was not sufficient to finish
this building. When completely finished and furnished its cost will not
be far from $28,500.
SPECIAL APPROPRIATION, $18,750.

This appropriation was made by the last legislature for the erection,
fitting, and furnishing of a cottage for 75 women. While it differs somewhat architecturally from the cottage for men, yet the idea of arranging
for the care of an intermediate class of the insane was provided for by the
construction of single rooms. The heating, lighting, fire protection, and
ventilation, are similar to the other cottages in connection with the Institution. This cottage is beautifully located and overlooks the Asylum
grounds, Traverse City, and the Grand Traverse Bay. The central portion of the cottage is occupied by a large alcove which reaches the width
of the building. This affords a large room which, with the sevaral parlors,,
gives ample scope for the patients and obviates the appearance of crowding
so common to our long, narrow corridors. Its capacity is 153,151 cubic
feet. The cost of this building was as follows:.
Labor
18,187 70
Tile, stone, lime and cement
1,201 45
Lumber
3,066 56
Brick
3,215 80
Hardware, nails, etc
248 39
Heating apparatus and pipe
2.118 14
Beds, mattresses, etc._ r 398 91
Paints
.
140 65
Electric light
fixtures
172 40'
$18,750 00-

12

NORTHERN MICHIGAN ASYLUM.

As in the case of the male cottage, the appropriation was not sufficient
to complete it. The furnishings was largely extra, so that the total cost of
the building is about $21,000.
The completion of these buildings increases the accommodations of the
hospital to 1,000 patients. The experiences of the last few years have led
to many improvements in hospital construction, and perhaps the cottage
plan has, next to the abandonment of restraints, afforded more comfort
to the insane than any other reform. In establishing the cottages ill connection with the hospital the trustees have ever had in mind the greater
freedom of the inmates, the more homelike surroundings, and the removal
of all those influences which are gloomy and depressing.
SPECIAL APPROPRIATION, $10,280.

This appropriation was made by the last legislature for the purchase of
120 acres of land. Twenty acres lying north of the grounds and 20 acres
south were purchased from Hon. Perry Hannah, and the remaining 80
acres lying south of and adjoining the Asylum farm were purchased from
Hon. E. Goodrich, of -Traverse City. The State entered into possession
of these lands in the month of June, 1893. These lands are a very valuable addition to the farm and could be sold at any time for a much larger
price than was paid for them.
SPECIAL APPROPRIATION, $1,500.

This appropriation was made by the last legislature for the construction
of a farm barn. We are pleased to say that a building 75x32 feet, with a
stone basement 8 feet, was erected during the summer of 1893, at the cost
of the appropriation.
NEEDS OF THE ASYLUM.

Thus far the management of the farm has been under the direction of
the Medical Superintendent, and the work has been done mostly by the
patients and their attendants The farm has attained such importance that
the trustees believe that a practical farmer must be employed. Before this
can be done it will be necessary to construct a farm house. This should
be large enough not only for the farmer and his family, but for the farm
and barn employes. This is especially necessary, because under existing
conditions the barn and farm employes, teamsters, etc., are provided with
rooms in several of the cottages and in the shop dormitories, an arrangement which is neither satisfactory nor economical. Should a farm residence be granted, all these employes could there reside and their labor
would be entirely under the direction of the farmer. The estimated cost
of such a residence as will be required is $5,000.00. We would respectfully
ask that this amount be appropriated for its construction.
NEW LAUNDRY.

The laundry has always been too small for the work of the Asylum, and
now that the population of the institution is nearly double, it has become
so crowded that the labor employed works at a disadvantage. We would
respectfully request an appropriation of $7,500 to construct and furnish a

REPORT OP THE BOARD OF TRUSTEES.

13

laundry building. The present laundry builditfg can be changed at slight
expense into a home for nurses. A new laundry is one of the most
urgent necessities of the Asylum and we trust it will be granted by the
legislature.
PAINTING AND REPAIR OP ROOFS.

The roofs and gutters of the Asylum have been much damaged by
ice and snow during the past ten years, and likewise the paint on towers,
cornices, wood jams, etc., has suffered from exposure, and should be
renewed. A small appropriation was made by the legislature four years
ago for the repair of roofs and gutters, which has been nearly expended
with good results to the building; but to complete the work and prevent
further damage a small additional appropriation should be made. We
would respectfully ask that $2,500 be appropriated for painting towers,
cornices, etc., and a further sum of $2,000 to complete the repairs to
gutters and roofs, as contemplated by the previous appropriation.
COTTAGE FOR WOMEN.

The trustees would respectfully ask that an appropriation of $8,500 be
granted for the erection and fitting complete of a cottage for fifteen female
patients. There are frequently admitted to the asylum patients who are
disturbed, noisy, and profane to an extreme degree. Such patients doubtless could be much better cared for in a separate building. These are
now distributed throughout the various wards and cottages, and wherever
assigned are a source of discomfort to other patients. It is felt that this
wrong to the many by the few should be correct sd by placing these excitable and irritable patients in a cottage, where every personal comfort
could be afforded, better care given, and in fact where all environments
could be adapted to their especial needs. The trustees believe that such a
cottage would be of the greatest service, although further than this they
would be opposed to the extension of the Asylum. It is true, however,
that the number of insane persons in this district is increasing, and that
provisions will need to be made for their care. We have but few vacancies,
and the room about to be provided at Newberry will not be sufficient to
accommodate the insane of this district for more than a few months.
LIBRARY.

The trustees would respectfully ask an appropriation of $1,000 for the
purchase of books for the library of the Asylum. The commissioners
placed a small library in the Asylum nine years ago, but from constant
use it has become much reduced. Many patients find much pleasure and
benefit from books, and the library should be so selected that all patients
could find literature to their tastes. We trust that this very worthy object
will receive your careful consideration.
RECEIPTS AND DISBURSEMENTS.

The total receipts of the Asylum for the fiscal year ending June 30,1893,
including cash on hand to the credit of the general fund, officers' salaries,

14

.

NORTHERN MICHIGAN ASYLUM.

•and spesial appropriations for detached cottages, purchase of land, and
farm barn, were $219,036.91; arid the total disbursement for the same
period, including amounts expended in special appropriations and officers'
salaries, were $181,290.99.
The total receipts of the Asylum for the fiscal year ending June 30,1894,
including balance on hand, officers' salaries, and special appropriations for
•detached cottages and farm barn, have been $260,277.95; and the total disbursements for the same period, including the amounts expended of officers'
•salaries, and of special appropriations, have been $240,147.96.
There was at the close of the fiscal year ending June 30,1894, $19,946.34
in the hands of the treasurer to the credit of the current expense fund of
the Asylum, and $183.65 to the credit of special appropriations.
A measure that would greatly relieve our asylums would be found in the
establishment of a State hospital for insane epileptics, or an enlargement
of the scope of the Lapeer hospital to include this class or our
dependents. There are over 200 insane /epileptics in our three asylums,
and many more in the other State institutions and in county houses.
We feel that it is an injustice to both the insane and the epileptic to treat
them in the same wards as is now practiced in this State. A hospital for
the treatment of the epileptics of the State should be provided, for the
reason that this class of patients are irritable and often very violent, and
the crowding incident to large wards and the contact with excitable,
deluded patients tends not only to increase their violent tendencies, but to
foster such delusions as they may entertain. Further, they frequently
•develop sudden attacks of homicidal mania, during which they are
extremely dangerous. The asylums are lacking in proper provision for
their care during such outbursts, and hence follows increased danger to
themselves and to those about them, whether patients or attendants. The
epileptic should be cared for apart from others during the continuance of
these paroxysms. No insane or nervous patient should come in forced
•contact with epileptics. But few can witness a convulsion without dread,
and many delicate patients are frightened by them. The impression on a
sensitive, diseased mind of the fearful contortions of a seizure is often
very lasting. Separate institutional care for epileptics is desirable on
account of greater facilities for occupation, better regulation of diet
(which is essential), and to more perfectly remove them from all irritating influences during attacks of maniacal violence. Separate care should
be especially provided for young epileptics, that more attention may be
given to their education. Our asylums do not provide means for the
education of these patients. And, finally, in an institution of this kind,
managed by specialists, much better results would be obtained than is
possible in a general asylum. For these reasons the trustees would
recommend that the legislature establish an institution for the care and
treatment of epileptics. If this is not feasible, the institution at Lapeer
should be enlarged to temporarily provide for this class. If the asylums
could be relieved of these patients, but little additional room would be
needed for the insane during the next two years.
In conclusion we would respectfully ask the legislature to give careful
attention to the needs of the insane. We would invite inspection of the
hospital, and trust that your efforts in behalf of the insane will enable all
of our asylums to adopt every method of care, whether it relates to con-

KEPOKT OF THE BOARD OF TRUSTEES.

15

struction of buildings or therapeutic means, that modern thought
approves.
In October, 1892, Dr. M. Rockwell resigned his position to enter private
practice; in November, 1892, Dr. Charles G. Chaddock, Assistant Medical
Superintendent, resigned his position to enter private practice, and in
January, 1894, Dr. Geo. C. Crandall resigned his position as Acting Assistant Physician. On January 1, 1893, C. A. Crawford, Esq., resigned his
position as Treasurer of the Asylum.
In December, 1892, Grant G. Speer, M. D., of Detroit, Mich., in February, 1893, Eobert Howell, M. D., of Grand Rapids, Mich., and in
January, 1894, Harry J. Kennedy, M. D., of Ionia, Mich., were appointed
acting assistant physicians on the staff. These gentlemen were highly
recommended and had had more or less hospital experience. At the February meeting, 1894, they were appointed assistant physicians. Dr. A. S.
Rowley, who bad served on the staff, was also at this meeting appointed
assistant physician. In January, 1893, Frank Hamilton, Esq., of Traverse
City, Mich., was appointed Treasurer of the Asylum.
The Trustees can but speak of the efficient manner with which the officers
have performed their duties, and would also testify to their appreciation
of the valuable services of the attendants and all others employed in the
institution.
H. H. NOBLE,
T. T. BATES,
' LORIN ROBERTS,
H. C. DAVIS,
C. L. WHITNEY,
G. A. HART,
Traverse Ciiy, June 30, 1894.
Trustees.

TKEAS CTREE'S EEPOET.

ABSTRACTS
OF ACCOUNTS CURRENT OP THE BECEIPTS AND DISBURSEMENTS AT THE NOETHEEN
MICHIGAN ASYLUM, ON ACCOUNT OF CUREENT EXPENSES FOR
THE FISCAL YEAR ENDING JUNE 30, 1893.

THE STATE OP MICHIGAN, In account with O. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending July 31, 1892.

By balance on hand July 1,1892
Cash from State Treasury:
AccouLt of Officers' salaries
Cash from earnings of Institution .

$30,129 43
2,837 50
37,041 51
$69,508 44

To disbursements:
Account of officers' salaries
Account of reservoir __
_..
Account of current expense
Balance on hand to new account-.

$69,508 44

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending August 31, 1892.

By balance on hand August 1,1892
Cash from earnings of Institution.
To disbursements:
Account of reservoir __
Account of current expense
Account of repair of roofs
Balance on hand to new accotmt.

$61,120 78
860 60

$326
16,877
136
44,641

$61,981 33

40
30
38
30
$61,981 38

REPORT OF THE TREASURER.

17

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending September 30, 1892.
By balance on hand September 1, 1892
Cash from earnings of Institution

$44,641 30
1,759 35

To disbursements:
Account of current expense
Account of reservoir
Account of repair of roof6^
Balance on hand to new account

$21,513 44
549 73
364 52
23,972 94

.

$46,400 65

$46,400 65

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending October 31, 1892.

By balance on hand October 1,1892
Cash from State Treasury:
Account of officers' salaries
Cash from earnings of institution

To disbursements:
Account of officers' salaries
Account of repair of roofs
Account of current expense.
Account of reservoir
Balance on hand to new account

$23,972 94
2,387 50
34,98690

_

__
.-

__

._

---

$2,337 50
115 50
14,663 25
288 47
43,892 62

$61,297 34

$61,297 34

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending November 30,1892.
By balance on hand November 1,1892
Cash from earnings of Institution

To disbursements:
Account of reservoir
Account of current expense
Account of repair of roofs
Balance on hand to new account

___

_._

$43,892 62
2,493 90

_

_

$163 45
13,371 48
478 80
32,37279

___

$46,386 52

$46,386 52

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending December 31, 1892.

By balance on hand December 1, 1892
Cash from earnings of Institution...

_-

$32,372 79
1,61646

$33,989 25

DEBITS.

To disbursements:
Account of current expense
Account of repair of roofs
Balance on hand to new account

,
$23,398 5»

18

NORTHERN MICHIGAN ASYLUM.

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending January 31,1893.
By balance on hand January 1,1893..
Cash from State Treasury:
Account of officers' salaries
Cash from earnings of Institution.

To disbursement's:
Account of officers' salaries
Account of current expense
Account of repair of roofs
Balance on hand to new account _

2,007 43
40,161 27

$64,753 98

$2,007 43
11,683 08
30 00

51,033 47
$64,753 98

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending February 28, 1893.

By balance on hand February 1,1893 .
Cash from earnings of Institution .

$51,033 47
4,113 45

To disbursements:
Account of current expense
Account of repair of roofs
Balance on hand to new account.

$13,330 07
2 80
41,814 05

$55,146 92

$55,146 92

THE STATE OF MICHIGAN, In account ivith Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending March 31, 1893.
By balance on hand March 1,1893
Cash from earnings of Institution.

To disbursements:
Account of current expense
Account of reservoir
_.
Balance on hand to new account.

$41,814 05
2,145 99

$9,632 64
62 76
34,284 64

$43,960 04

$43,960 04

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending April 30, 1893.
By balance on hand April 1,1893
Cash from State Treasury:
Account of officers' salaries
Cash from earnings of Institution .

To disbursements:
Account of officers' salaries
Account of current expense
Balance on hand to new acconnt.

$34,264 64
2,103 91
36,444 49

$72,813 04

$2,103 91
9,812 40
60,896 73

$72,813 04

REPORT OF THE TREASURER.

19

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending May 31, 1893.

By balance on hand May 1,1893
Cash from earnings of Institution.
Acconnt of cottage for men
Account of cottage for women
Acconnt of land purchase...

$60,896
2,125
2,500
2,500
10,250

73
58
00
00
00

To disbursements:
Acconnt of current expense
Balance on hand to new account.

$21,755 54
56,516 77

$78,272 31

$78,272 81

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigun Asylum, for month ending June 80,1893.

By balance on hand June 1, 1893
_.
Cash from earnings of Institntion.
Acconntof barn No. 1

To disbursements:
Acconnt of current expense
Account of cottage for men
Acconnt of cottage for women..
Account of land purchase
Acconnt of barn No. 1
Balance on hand to new account.

$56,516 77
621 64
500 00

$7,856
1,093
436
10,250
256
37,745

$57,638 41

00
83
16
00
50
92
$57,638 41

'THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for fiscal year ending June 30, 1893.

By balance on hand July 1, 1892 _
Cash from State Treasury:
Account of officers' salaries*
Acconnt of cottage for men
Account of cottage for women
Account of barn No. 1
Account of land purchase
Cash from earnings of institution.

'To disbursements:
Account of officers' salaries
Acconnt of reservoir
Account of current expense
Account of cottage for men
Account of cottage for women.
Account of repair of roofs
Account of land purchase
Account of barn No. l._
Balance on hand to new account..

$30,129 43
8,786
2,500
2,500
500
10,250
164,371

34
00
00
00
00
14

$8,786
1,522
157,782
1,093
436
1,183
10,250
256
37,745

34
21
75
83
16
20
00
50
92

$219,036 91

$219,036 91

20

NORTHERN MICHIGAN ASYLUM.

ABSTRACTS
OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBUBSEMENTS AT THE NORTHERN
MICHIGAN ASYLUM, ON ACCOUNT OF CURRENT EXPENSES, FOR
THE FISCAL YEAR ENDING JUNE 80, 1894.

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending July 31, 1893.

By balance on handjuly 1,1893
Cash from State Treasury:
Account of officers'salaries
Cash from earnings of Institution
Account of cottage for men

To disbursements:
Acconntof officers' salaries
Account of current expense
Acconntof cottage for men
Account of cottage for women
Balance on hand to new account

$37,745 92
2,212 50
88,895 30
6,500 00

___
_

_

.

$2,212 50
15,860 24
2,178 71
1,082 01
64,020 26

$85,353 72

$85,353 72

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending August 31, 1893.

By balance on hand August 1,1893
Cash from State Treasury:
Acconntof cottage for men
Account of cottage for women
Account of barn No. 1
._
Cash from earnings of Institution...

To disbursements:
Account of cottage for men
Account of cottage for women.
Account of current expense
Account of barn No. 1
Account of reservoir
Balance on hand to new account

._

$64,020 26
8,500 00
9,350 00
1,000 00
1,683 14

_

$5,713 82
1,571 56
27,085 83
173 75
456 28
49,55216

$84,553 40

$84,553 40

REPORT OF THE TREASURER,

21

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending September 30, 1893.

By balance on hand September 1, 1893.
Cash from earnings of Institution...

$49,552 16
1,761 46

To disbursements:
Account of cottage for men
Account of cottage for women.
Account of barn No. 1
Account of repair of roofs
Account of current expense
Balance on hand to new account.

$7,904
3,283
436
67
11,076
28,545

$51,313 62

63
27
40
80
02
50
$51,313 62

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending October 31, 1893.
OEEDTIS.

By balance on hand October 1,1893 ..
Cash from State Treasury:
Account of officers' salaries
Account of cottage for men
Account of cottage for women—
Cash from earnings of Institution.

$28,545 50

2,212
7,500
6,900
36,572

50
00
00
30

To disbursements:
Account of officers'salaries
Account of cottage for men
Account of cottage for women .
Account of barn No. 1
Account of current expense
Balance on hand to new account.

$81,730 30

$81,730 30

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending November 30, 1893.

By balance on hand November 1,1893.
Cash from earnings of Institution..

To disbursements:
Account of cottage for men
Account of cottage for women.
Account of barn No. 1
Account of current expense
Balance on hand to new account.

$46,487 36
1,520 35

$48,007 71

$3,141 76
8,862 61
145 03
13,252 36
27,605 95
$48,007 71

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending December 31, 1893.
By balance on hand December 1,1893.
Cash from earnings of Institution ..

$27,605 95
1,561 08

$29,167 03

22

NORTHERN MICHIGAN ASYLUM.

To disbursements:
Account of cottage for men
Account of cottage for women..
Account of current expense
Balance on hand to new account

•-

_

$1,879 16
1,740 24
11,954 27
13,593 36

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending January 31, 1894.

By balance on hand January 1,1894
Cash from State Treasury:
Account of officers'salaries..
Cash from earnings of Institution.-.

To disbursements:
Account of officers*salaries
Account of cottage for men
Account of cottage for women
Account of cottage "C"
Account of current expense
Balanceon hand tonewacconnt

$13,593 36
_

_

2,212 50
40,912 85

_

._

$2,212 50
473 34
928 15
77 68
15,549 04
37,478 00

$56,718 71

$56,718 71

THE STATE OP MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending February 29, 1894.

By balance on hand February 1,1894
Cash from earnings of Institution. .

_

--

To disbursements:
Account of cottage "C"
Account of current expense
Balance on hand to new account

-

„_•

$37,478 00
2,39423

$39,872 2S

$0 10
12,218 12
27,65401

_.

THE STATE OF MICHIG AN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending March 31, 1894.

By balance on hand March 1, 1894
Cash from earnings of Institution

To disbursements:
Account of current expense
Balance on hand to new account

$27,654 01
8,21553

_

_

..

$11,801 45
24,06809

$35,869 54

$35,869 54

REPORT OF THE TREASURER.

23

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending April 30,1894.

By balance on hand April 1,1894
Cash from State Treasury:
Account of officers' salaries
Cash from earnings of Institution

To disbursements:
Account of officers' salaries
Account of current expense
Balance on hand to new account __

„__

$24,068 09
1

_.

2,174 72
35.680 28
:

:
-

-.

$2,174 72
13,798 72
45,94965

$61,923 09

$61,923 09

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending May 31, 1894.

By balance on hand May 1,1894
Cash from earnings of Institution

___

To disbursements:
Account of current expense
Balance on hand to new account

--

—

$45,949 65
2,544 04

$16,316 02
32,177 67

$48,493 69

$48,498 69-

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for month ending June 30, 1894.

By balance on hand Jnne 1,1894.,
Cash from earnings of Institution

$32,17767
2,204 25

_

To disbursements:
Account of current expense
Balance on hand to new account

$14,251 93
20,129 99

$34,381 92

$84,381 92

THE STATE OF MICHIGAN, In account with Frank Hamilton, Treasurer of Northern
Michigan Asylum, for fiscal year ending June 30, 1894.
CREDITS.

By balance on hand July 1, 1894
Cash from State Treasury:
Account of officers' salaries...
Account of cottage for men
Account of cottage for women
Account of barn No. 1
Cash from earnings of institution

_..
._
-

_
_.

$37,745 92
8,812 22
22,500 00
16,250 00
1,000 00
173,94481

$260,252 95

24

NORTHERN MICHIGAN ASYLUM.

To disbursements:
Account of officers salaries
Account of cottage for men
Account of reservoir
Account of repairing roofs
Account of cottage for women
Account of current expense
Account of barn No. 1_
Account of cottage "C"
Balance on hand June 30, 1894

_._

_

_
,.

_. __ _

_

$8,812 22
28,906 17
944 60
67 SO
18,313 84
187,245 47
755 18
77 6S
20,129 99

$260,252 95

We have carefully examined the accounts of Frank Hamilton, Treasurer
of the Northern Michigan Asylum, for the biennial period ending June 30,
1894, and have compared the same with the books and vouchers; and verified the same by a further comparison with the books of the Steward and
hereby certify to the entire correctness of them.

LORIN EGBERTS,
C. L. WHITNEY,
THOS. T. BATES,

Auditing Committee.

STEWARD'S REPORT
FOR THE BIENNIAL PERIOD ENDING JUNE 30, 1894.

ANALYSIS
OF RECEIPTS AND DISBURSEMENTS PROM JULY 1, 1892, TO
JUNE 30, 1894.

RECEIPTS.
Maintenance, etc., State patients
Maintenance, etc., county patients
Maintenance, etc., private patients
Sundry receipts, interest, miscellaneous, etc
Special appropriations:
Officers' salaries
Land
Cottage, males
_
Cottage, females
Farm barn...

.
_

_..

__

$245,595 95
79,931 26
7,803 68
4,985 06
17,623 56
10,25000
25,00000
18,750 00
1,50000

$111,439 51

DISBDKSEMBNTS.
SALABIES AND WAQES
FOOD:
Meatand
Butter
Flour
Tea
Coffee
Sugar
Miscellaneous

$72,348 00
fish
_

_

_

_
.._

$39,696 02
19,443 63
9,460 33
2,706 50
4,718 58
6,881 93
28,718 50

....
._._

._.

CLOTHING

111,625 49
31,547 17

LADNDEY:
Wages
Soda
Gasoline
Indigo
Starch
Tallow and soap material
Coal........
..
Tubs
._
Irons
Ironer
_.
Baskets
Machinery
Clothes line
Stove
4

_
_

$5,875 52
367 32
55 63
68 05
246 85
976 40
2,76824
8 02
4 86
1568
70
21 75
25
41 46

10,448 73

NORTHERN MICHIGAN ASYLUM.
HEATINQ:
Wages...
Coal
Charcoal
LIGHT:
Wages
.
Electric light
Oil
Lantern globes
Coa]

$4,31198
14,602 31
26 35

fixtures.,..

_
.

„.

_.:_
_

MEDICAL SUPPLIES:
Drugs and glassware
Wine
__
Implements

$2,182 31
18 00
54 31

_.

.

$2,38413
659 53
52 80
737
5,531 55

$18,940 64

8,635 38

2,254 Si

STATIONEBY, FEINTING, ETC. :
Printing
Blank books
._
Stamps
Ink, stationery
Telephones
Postoffioe box rent
Pictures, world's fair
Treasurer's stationery
Rubber stamps

$524 66
503 18
326 00
450 15
575 44
8 00
84 80
36 15
59

_
_
...

AMUSEMENT AND INSTRUCTION:
Medical books
Games
Music for dances
Books for library
Bus hire
_
Entertainments
Programmes

$58 18
64 83
57 00
160 30
5 00
317 25
8 00

.„,

HOUSEHOLD SUPPLIES:
Dry goods
Hardware..
Utensils
Soap
Mats, brooms and brushes
Crockery..
_
Stoves and repairs
Insect powder
Paper and toilet paper
Carpet
Ladder
Sewing machines
Refrigerator.
Wheeled chairs
Pictures....

-.
„.

_

$4,737 29
1,094 99
58966
892 61
948 37
1,389 09
990 85
37 53
428 75
1,135 49
2 10
181 50
125 00
66 30
243 20

2,508 97

695 56

jo 792 71

FUENITUEE AND BEDDING:

Beds and furniture
Pillows and mattresses
,
Bedding, sheeting, etc.
Upholstering
Curtains and carpet
...

$2,928 20
1,201 26
8,076 26
"
4229
1,01779

*

11,265 SO

iMPBOVEMENTS AND REPAIKS:

Wages
Paints, oils, etc
Hardware, iron, etc.
Cement
Hose
Tile and fire clay
Glass
Pipe.
Lumber
Castings
Stone and brick
_
Lime
Locks
Wire guards
Felt
Iron roofing
Refrigerator rooms ...

_
.
_
... _.
"
_

... .. ...

..

$19.186 05
2,497 85
1.781 47
2,217 77
268 90
285 40
240 25
1,558 25
5,795 93
116 87
76482
20 87
501 85
422 85
4837
197 42
33132

36,235 74

27

REPORT OP THE STEWARD.
TOOLS AND MACHINEEV:
Pump
Lnbricating oil _
Tools
_
Pipe cutter
Belting..
Castings
Bone mill
Boiler compound __
Brashes
_
Stencils
Tones
•
Boiler repairs
Packing, etc
Mowers.

fittings.

.._
.

_

1

_

:
.

9

$158 U
159 55
5 55
11 13
119 39
101 84
145 00
3696
9 20
2 66
2 50
89 00
47 67
59 53
$1,138 12-,

FARM, GARDEN, STOCK AND GROUNDS:
Wages
Seeds
Feed and hay
_
Implements
Blacksmithing
_
Repairs, harness, etc
_
Paris Green...
Veterinary
Vehicles
Stock
Tile '
New land
Spray pumps
Wirenetting
Tobacco stems
Dynamite
Fertilizer
Brooms
Flowerpots
Pipe...
Grease

._
._

--

._

$6,950 86
982 32
6.851 19
601 84
741 58
623 10
88 80
6508
125 00
2,644 74
338 87
223 12
27 00
27 52
75
387 68
104 74
3 75
100 32
4 10
1 84
20,893 98

FREIGHT AND TRANSPORTATION:
Hack hire, trustees
Steward's expenses to Chicago and return
Superintendent's expenses to meetings of board...
MISCELLANEOUS:
Expenses, elopement
Fair exhibit
Patients'expenses home
Transfer patients
Refunded money
Undertakers' expenses
Purchases charged back
Miscellaneous.

__

_

_

_

._

_

,..-.

-.

_

$1 00
156 25
113 20
,

270 45

$17340
93 01
630 55
23 45
14 63
221 10
814 91
1,455 79
3,426 84

SPECIAL APPROPRIATIONS:
Cottage
Cottage for males
Cottage for females
Farm barn..
Repairing roofs
Reservoir...
Land

$77 68
25,000 00
18,750 00
1,500 00
1,231 00
1,978 49
10,250 00
• 58,787 17

Officers salaries
Total...

17,623 56
-

-

$421,48895

28

NORTHERN MICHIGAN ASYLUM.
Farm and garden products for the biennial period ending June 30, 1894.
Quantity.

Articles.

it

18J4
41
75 1920-2000
18
8

n

ti

it

it

t<

10
8
11
867,577

trreen fodder, tons
Milk, pounds -. ._
Pork,
i
*
i
i
,,
Beef,
n
c<

.

1,5X2
2,781
3,392
2,212
672
1,010

Beans, bushels -__

_.

. . _._
_

...

Cabbage, heads.

_.

Cucumbers, bushels
it
K

Lettuce, bushels
"
pounds ..
U

it

It

It

Onions, bunches
"

bushels

Radishes, bunches
it
i«
ii
it
Strawberries, quarts
"
bushels
Turnips, bushels

..

„

_..

1
1- $1,086 22

j
25
32
44
7,851

2 50
4 00
4 00

02

00
00
00
54

06

C6!4

07
09

10
05
05W
06

J

^

06 !4 j

07
10
50
80
03
05
75

%

\

1 00
1 50
2 00

18

1 50 )
1 92 [
2 00

76
1,890
160
495
6,209

1 00 1

1A
lYi

I*

00
00
00
00
00

05

690
2,444
344
42
19,785
6,130
315
118
9

$5
6
7
8
9

0514

750
4,694
500
4,294
660

Asparagus, pounds -

Total
amount.

Price.

3,250
10,897
625
357
315
6,162
6,320 !4
3,827
118
5,780
22
96
112
42
40

ZV-A

524

1,142

Tomatoes, bushels
it
it
"
pounds

289
92
118
70
200

Beets, bushels
Buta Bapas, bushels
Cauliflower, heads „
Plums, bushels
Apples,
"

905
75
40
554
20
62

02
04
06
10

!-

30 96

770 80

J

02
08
60

1 00

60

02
03
05
10

189 00

\

01 \
05
10
15 J
06 )
10 >•
2 00
20 \|
25
20
75

1 00

02
04

}-

49 52

244 20

J

25
20
03

2 00

40
60

84 80

I

226 25
15 00
1 20
11 00
45 20

REPORT OF THE STEWARD.
Farm and garden produots.—CONTINUED.
Articles.
Spinach, bushels
Corn, bushels
Carrots, bushels
Potatoes, bushels
ii
ii
it
u
Pumpkins, piece
„„

_

„_

bushels

$0 25

1,180
1,609

40
46
48
50

_

feet

II

41

II

"

(stove),

"

Logs, feet
Kahl rabi, bushels...

... __

Total
amount.
$3 00

40
50
20
25

)
\

H

01

13,900
1,992
2,100
30
53,300

02
01
03
50
01

220
7

1 00

278 00

03

£

10
15
50
25

j

350
350
200

57
80
36,172
800
85
16

6 00
8 50
8 00
2 00
2 50
3 00

178
140

1 50
2 50

1,000

Lumber, M._

Total

12
230
165
9
701

2,913
6,150
2,200

Squash, bushels
"
pounds

"

Price.

725

Celery, heads
Melons, piece

"

Quantity.

1,900
13,945
6,000
10

05

6 00
8 00
1 00

t

j

t

13 60
152 50
225 00
1,311 38
1,860 50

.
95 0»
10 00

$24,170 81

J. P. C. CHURCH,
Steward.

SUMMARY OF

Summary of Inventory Northern Michigan Asylum, June 30, 1894.
Real estate, farm and grounds... .......
Buildings.
Stock on (arm.
_
__
Farm and garden prodnce
_
_
Vehicles and barn
fixtures
Farm implements
Administration building
"
diningrooms
' Trustees' parlor, corridor and reception rooms
Matron's room
fixtures
._
stock
Pathological laboratory
Dispensary
__
_
Medical office
_
Steward's office
Library
_
_
Chapel
._
Wards
Cottage A
B
C
East ..
D
•Cottages F and G
General kitchen
Special kitchen .
Bakery
___
Meat shop
Laundry
_..
Engineers department
Carpenter shop and paint shop
Stores—Dry goods and clothing
Notions, hardware and miscellaneous
Crockery, boots and shoes
Groceries and provisions
Furniture and
fixtures
^
Store silverware
._
Total

... ,

_
_

__
_
_

__
_

_

..'.. ..

$34,89958
625,864 55
4,943 75
24,190 80
1,125 01
1,257 60
8,918 44
487 82
574 20
7390
1,66018
643 95
94465
92491
870 10
581 50
81941
31,88515
2,210 57
1,900 42
2,656 78
1,098 91
3,42978
4,117 62
3,83788
1,059 23
829 88
308 16
2,068 12
1,388 82
703 54
7,592 66
1,492 34
1,351 01
3,749 33
157 79
3826
$774,751 01

REPORT OF MEDICAL SUPERINTENDENT.

To fhe Board of Trustees:
GENTLEMEN—As required by law, I have the honor to submit the following report of the principal operations and events of the Asylum for the
biennial period ending June 30,1894.
The movement of population has been as follows:
For the Biennial Period.
Males. Females. Total.

Patients.
Remaining under treatment June 30, 1892
Admitted
_
.
. .

"

improved

Died

435
231

375
147

810
378

668
135

522
93

1,188
o go

531

429

960

41
38
3
53

26
24
4
39

67
62
7
f<2

From the Beginning.
Males. Females. Total.

Patients.
Total admitted

- 1,061

Died
Total discharged

--

801

1,862

163
157
21
189

105
118
14
135

268
275
35
324

530

372

902

531

429

960

32

NORTHERN MICHIGAN ASYLUM.

The net gain of patients during the period has been 150.
The smallest number of patients under treatment in any one day was
809, the largest number was 978.
The death rate upon the whole number under treatment for the year
ending June 30, 1893, was 4.7 per cent; for the year ending June 30,1894,
4.3 per cent.
The following will show the sex, age, form of mental disease and cause
of death in those discharged died.
TABLE II.
Age.

Sex.

Nativity.

25
43
23
33
25

New York

Male

77
29
(?)

Finland

Female

40

Female -_.
Male
Male .
Male
Female _.

27
50
75
44
77

Female
Female
Female
Male
Female

37
(?)
51
66
(?)

Male
Female . , _
Male
Male
Male. .„„

36
44
58
42
59

Male. .
Male _
Male
Female
Male

71
32
72
69
34

Male .
Male
Female ..,
Male
Female

35
69
35
(?)
&

Female
Female
Female
Male
Male

65
62
27
35
31

Male „_..
Female
Female
Male
Male

52
18
30
60
68

Sweden
Sweden

Male .
Male

(?)
24
52
(?)
54

Ireland .
Ireland .
Finland

73

Pennsylvania.
Ohio
New York
Germany

Male
Female
Male
Male
Female
Male

-

..

Male
Female
Female
Male
Male....

Dan ad a

is'

41
63
43

47

New York
Michigan

New York
Unknown
Michigan
Finland _
Ireland
Canada _
Ireland
New York
New York „
Canada
Michigan
Ohio__
Michigan
Ohio
England
Germany
Michigan
Canada

Form of Disease.

Cause of Death.

B. II, General Paralysis
B. II, Senility
B. II, Delusional
A. II, Dementia

B. II, Senility
B. II, Senility
A. I, Mania
C. I, Epilepeia
B. II, Senility
B. II, General Paralysis
C. II, Paranoia
„.
A. 11, Delusional
A. II, Dementia .
A. II, Dementia .
C. II, Paranoia
. C. II, Periodical
B. II, Organic

Exhaustion.

Exhaustion.
Cardiac Disease.
Cardiac Disease.
Paretic Seizure.
, _ _ . Phthisis Pnlmonalis.
Organic Brain Disease.
Bright's Disease.
Trauma tism.
Organic Brain Disease.
Organic Brain Disease.
Organic Brain Disease.

B. II, General Paralysis
B. II, Brain Disease.-.
A. II, Delusional
A, I, Melancholia

Paretic Seizure.
Organic Brain Disease.
Phthisis Pulmonalis.
Phthisis Pulmonalis.

B. II, Senility
B. II, Senility
C. I, Epilepsia
B. II, General Paralysis ,

Cardiac Disease.
Status Epilepticus.

Meningeal Hemorrhage.
A. I, Melancholia.
Phthisis Pulmonalis.
C. I, Neurasthenia
„-_ . Phthisis Pulmonalis.
Exhaustion,
B. II, Delirium Grave
B. II, Syphilitic
B. II, Senility
A, II, Dementia
Phthisis Pnlmonalis.
Phthisis Palmonalis.
Dysentery.
A. II, Delusional
Phthisis Pulmonalis.
A. II, Dementia—
Tubercular Enteritis.
Dysentery.
B. II, Senility
Phthisis Pnlmonalis.
A. II, Delusional
Cardiac Disease.
Paretic Seizure.
Paretic Seizure.
B. II, General Paralysis.. _.

REPORT OF MEDICAL SUPERINTENDENT.
TABLE II.—CONTINUED.
Sex.

Age.

Male
Male
Female
Male

23
27
53
(?)
W

Male
Male
Male
Female
Male
Female
Female
Male
Female
Male..
Male
Female
Male
Male...
Male
Female
Male
MaleMale
Male..
Male
Male
Female
Female
Male
Male.
Female
Male
Male
Female

Nativity.

Cause of Death.

Form of Disease.

Unknown

C. I, Epilepsia
0. II, Periodical
A. I, Melancholia .

39
67
60
48
68

New York
England
Canada.
Scotland

B, II, General Paralysis
B. 11, General Paralysis _ __ _
R, TT, Organic

Pare tic Seizure.
Pare tic Seizure.

71
37
36
61
41

Pennsylvania
Unknown.,
Canada ._ „

B. II, Senility
A. II, Dementia
A. II, Delusional
A. 11, Delusional

Phthisis Pulmonalis.
Cardiac Disease.
Phthisis Pulmonalis.

41
55
25
72
46

Unknown..
PennsylvaniaIreland.

73
48
70
50
56

Ohio

31
44
47
(?)

Michigan
Canada ,

39
48
58
81

Michigan
Pennsylvania
Ohio.. .
England
England

62
38
72
77

Michigan

New York
New York

A. II, Dementia
.0. II, Paranoia
B. II, Organic
._
C. I, Epilepsia
A. 1C, Delusional
B. II, Senility
C. 11, Paranoia
C. II, Periodical
C.I, Epilepsia-..
B. II, General Paralysis
C. II, Paranoia
C. II, Paranoia
C.I, Epilepsia
B. 11, Organic
C. II, Paranoia.
C. 11, Paranoia

Phthisis Pnlmonalis.

.
_ _

Cardiac Disease.
Phthisis Pulmonalis.
Organic Brain Disease.
Phthisis Pulmonalis.
Exhaustion.
Phthisis Pnlmonalis.
Epileptic Seizure.
Cardiac Disease.
Status Epilepticus.
Organic Brain Disease.
Phthisis Pulmonalis.

"R. TT t Org^nin

Organic Brain Disease.

B. II, Senility
B. II, Senility

Cardiac Disease.

By this table it will be observed that 27—15 men and 12 women—died
of phthisis; 7 men and 10 women of cardiac disease; 11 men and 3 women
from organic brain disease; general paralysis, 10 men and 2 women; 2 men
and 7 women from exhaustion; 1 man and one woman from Bright's
disease; 3 men from traumatism; 2 women from status epilepticus; 2 men
from epileptic convulsions; 1 man from meningeal hemorrhage; 2 women
from dysentery; 1 woman tubercular enteritis; and 1 man intestinal
obstruction.
As in previous years, many post-mortem examinations have been held.
In nearly all interesting changes were found in the brain and nervous
tissue, and frequently, also, extensive organic disease of the bodily organs.
These autopsies have often made clear the cause of death and have also
aided in the explanation of the mental disease, but more frequently have
been but little importance in relation to the latter. Much time has been
devoted to the examination of the central nervous system, both in the
fresh state and after careful hardening, and vast differences in convolutional arrangement and development have been found, which seems to us
most important so far as it relates to insanities, at present quite generally
regarded as degeneracies; e. g., constitutional neuresthenia, hysterical
insanity, etc.
5

34

NORTHERN MICHIGAN ASYLUM.

The following is a brief description of the most important cases:
D. J., male, aged 37, was admitted December 12, 1885, suffering from
melancholia. He improved somewhat during the first two years, but
after this time became feeble mentally and physically until his characteristics were those of a destructive dement. He was much hallucinated
and constantly picked at imaginary objects and at his clothing. Dec. 29,
1893, it was found that he was suffering from symptoms of intestinal
obstruction. Anodynes were administered to relieve pain and large
enemata of water were given to the patient in the knee-elbow position with
a hope of overcoming the obstruction, but without benefit. He was able
to retain liquid diet. On the fourth day of his illness his condition became
critical, and after a consultation, it was decided that an operation should
be performed. At this time his abdomen was very much distended and
tender; temperature 103°: pulse 120. The usual antiseptic precautions
were taken and the abdomen was opened in the median line below the
umbilicus. A very much distended gut forced itself through the incision,
and it had to be punctured before it was possible to proceed further with
the operation. There was considerable congestion of the descending
colon, and a small amount of sero-purulent fluid in the abdominal cavity.
The obstruction was located at the sigmoid flexure and was caused by a
volvulus forward and inward of the descending colon. The colon was
replaced, and soon after the bowels freely moved. The abdomen was
washed out with Thiersch's solution and closed with deep and superficial
sutures. The patient rallied from the shock, had several free movements
of the bowels. He died of peritonitis thirty hours after the operation.
Post-mortem examination showed that the sigmoid flexure had been
twisted upon itself, causing complete obstruction at that point with
strangulation of the blood vessels, which led to peritonitis and gangrene.
Mr. A. F. K., aged 40, native of Sweden, was admitted March 4, 1886,
suffering from melancholia, and was discharged improved, Dec. 16, 1886.
Was readmitted July 7, 1887, much confused mentally, and reduced in
physical health. He improved again, but never regained his former mental
health. He was able to reside at Cottage "A," where he was regularly
employed with the working parties. On the afternoon of Jan. 23, 1894, he
was working with his party in the woods, and was missed just as night was
coming on. Search was made for him but he could not be found. The
next day his remains were discovered. He had been struck by a falling
tree and was doubtless instantly killed. The coroner and prosecuting
attorney were notified, and after inquiring into the circumstances of his
death thought an inquest unnecessary. The post-mortem examination
revealed the following conditions:
Limbs slightly flexed and partially abducted. Hands clenched. Elbows
slightly flexed. Left hand against side; right hand turned from body.
Head turned toward left. Bruise on top of right shoulder. Clotted blood
in both ears. Large stellate scalp wound on top of head. Ecchymosis
above right eye and under left eye. Face covered with clotted blood.
Large effusion of clotted blood under entire scalp. A fracture extended
across frontal bone and involved right orbit; about midway along this fracture another commenced and passed diagonally across right side involving
a portion of the parietal, temporal, and sphenoid bones; and another
extended backwards along left parietal bone. Compound comminution of
right frontal bone above orbit. Comminuted fracture of sphenoid involv-

REPORT OF MEDICAL SUPERINTENDENT.

35

ing anterior and posterior clinoid processes. Fractures of temporal, occipital and parietal bones. Dura mater adherent to skull in parietal and
occipital regions. Laceration of right frontal lobe immediately beneath
comminuted portion of frontal bone. Fracture of sternum at junction of
manubrium and gladiolus. Fracture of first, second and third ribs on left
side. First rib comminuted. Fracture of second rib on right side. Lungs
congested. Pleura injured as the result of fracture of sternum.
It might be well to state that Mr. K. was a considerable distance from
the tree which struck him iu falling. It is fair to presume that he felt
himself at a safe distance, even if the tree fell his way. The tree that
struck him was seventy-four feet in length and was without a limb. Mr. K.
stood at the moment of the accident sixty-six feet from the stump.
Although patients have been constantly employed in clearing forest land,
this is the first accident which has occurred to them.
C. F., male, aged 35, native of Scotland, was admitted to the Asylum
March 25, 1893. He was very much depressed in mind and in delicate
physical health. He had received a severe injury to the spine some
months previously, and afterwards gradually became despondent. He suffered pain in the chest after any sudden jar, but owing to his intense
mental fear, physical examination was extremely difficult and unsatisfactory. He resisted every attention, was suspicious of those about him,
and suffered from visual hallucinations. Appetite poor. On the morning
of March 30 he seemed more apprehensive and restless. His respirations
were increased and labored. A careful examination revealed a fracture of
the right second rib about one inch from the sternum. Three days later
he developed symptoms of pneumonia; temperature from 103° to 104°,
pulse 140, and respirations 40, resisted less, took nourishment better, and did
not refuse his medicine. He was, however, actively hallucinated. Death
occurred April 6. The autopsy revealed that he had had a very severe
injury to his chest; he had sustained fractures of the second, third and
fourth ribs of the left side near their union with the costal cartilages; the
corresponding ribs of the right side were broken, the third in two places.
There was also a fracture of the sternum at the point of union of the
manubrium with the gladiolus. All the fractures had united with the
exception of the second rib on left side, which was joined only by a few
fibrous bands permitting the fractured ends to glide over one another.
There was no inflammation at the seat of injuries. The right pleural
cavity contained about a quart of sero-purulent fluid, and there was some
pus in the mediastinum. The right lung was collapsed and contained pus
in the large bronchial tubes. With the exception of slight bronchitis and
hypostatic congestion, the left lung was normal. There was also considerable effusion in the pericardium. This case was extremely interesting, not
only from the extensive injuries, but also from the mental symptoms he
presented. He was extremely hallucinated and was a typical case of
mental confusion.
M. McG., female, age (?), was received July 23, 1886. She was a typical paranoiac in every respect. She had lived a solitary life, and had
earned a livelihood by peddling. The act which led to her apprehension
and commitment was the shooting of a young man whom she looked upon
as one of her persecutors. The change of scene from her irregular mode
of existence to that of asylum life temporarily relieved her ideas of persecution; but after a few days they began to make themselves manifest. They

36

NORTHERN MICHIGAN ASYLUM.

were intensely acute and persistent; and her periods of comfort were rare
and of short duration. Her health began to fail during the winter of
1890-1. It improved during the summer, but the following spring it
became so much lowered through a mitral lesion that she was no longer able
to take out-door exercise. She became anaemic and suffered from oedema
of the adomen and legs. She gradually failed, and died May 13, 1894, of
oedema of the lungs complicating the valvular insufficiency. A post-mortem
examination held nearly twenty-four hours after death showed the following conditions: Lungs, especially the base of the right, infiltrated, portions
sinking readily in water, the pericardium free, containing an unusual
amount of fluid, and the heart large and flabby. Large vegetations were
found on both the aortic and mitral valves. The liver was rather large,
the gall bladder empty. The skull cap had become thinned at different
points by internal pressure of the pacchionian bodies, and was so strongly
bound down by the thickened membranes that it» was removed with great
difficulty. The convolutions were very rudimentary in their arrangement.
The brain substance was less firm than normal, and a large ecchymosis
covered a greater part of the right frontal lobe.
M. W., female, aged 54, was received April 6, 1893. Previous to any
mental symptoms she had suffered from indigestion and diarrhoea. In
July, 1892, she became elated, excitable and irritable. She heard the voice
of the Savior, and other voices which were abusive. She was uncleanly
and destructive in habits, and indecent in language; not suicidal, but on
several occasions had exhibited homicidal tendencies. When admitted
she was very feeble in mind and body. Physical examination revealed
the following: Pupils contracted equally, but dilated unequally, the right
being the larger; skin sallow and anaemic; fingers markedly club-shaped;
pulse 78, heart's action regular with a soft systolic murmur, best heard over
the apex; respiration somewhat exaggerated; tongue pale and flabby; intestinal secretions prof use; gait feeble but no signs of paralysis; general health
very poor. The patient's appetite was ravenous. The pain in the stomach
was frequent but not constant; the diarrhoea was more troublesome in the
afternoon, and was little affected either by medication or diet. On the
morning of April 24 she passed a small quantity of bright red blood.
This symptom occurred at irregular intervals for a period of about a
month, the blood being usually dark, but at times, as in the first instance,
a bright red. About the time of the first hemorrhage there was noticed a
slight febrile movement. Physical examination May 5 showed a dullness
over the upper part of the right lung; respiration much roughened, with
expiratory murmur; pulse irregular and becoming intermittent on the
slightest exertion. There was quite marked pyrexia. She finally died
from exhaustion, August 23, 1893.
A post-mortem examination was held eighteen hours after death. The
skull cap was of medium thickness; the membranes slightly adherent at the
apex, but not congested; pachionian bodies very noticeable and
some effusion. An oedematous body was found in the posterior cornu of
each lateral ventricle. The cerebrum was much softened. On opening
the thorax the lungs collapsed, but otherwise appeared normal. The
heart was of normal size. "With the exception of the left ventricle, it
was filled with post-mortem clots. The pulmonary and aortic valves
were in good condition. The tricuspid and mitral valves, especially
the latter, were atrophied and roughened. The kidneys were apparently

REPORT OP MEDICAL SUPERINTENDENT.

37

normal. The liver was pale and sligtly sclerotic. The gall bladder was
partly filled with its normal fluid. The stomach was empty and the inner
coat was much conjested and mottled. The small intestine and caecum
were normal. There was an entire absence of peritoneal fat except around
the sigmoid flexure and rectum, where it hung in hardened masses. The
walls of these portions of the bowel, to a lesser degree the descending colon,
and portions of the transverse colon, were much thickened and their
lumen contracted. The inner surf ace of the intestine was covered with
mucus and debris, but not fsecal matter. There were marked signs of
chronic ulceration, the whole of the internal coat of the affected bowel
being destroyed; and noticeably to be seen, freely scattered over its
roughened and contracted surface, were small polypoid growths surmounted
by a hemorrhagic spot, entirely covering the apex.
M. E., female aged 57, native of New York, was admitted to the hospital
March 21, 1892. She was much impaired mentally, apparently, due to
organic brain disease. With the exception of a brother who was insane,
her family history was good. She was married, and had three children.
She had an attack of rheumatism about seventeen years ago, after which
she had convulsons, which recurred nightly for a period of two years. The
convulsive attacks ceased and did not recur until her present attack. Her
health continued good until three years ago, when, after a serious disease
of the stomach said to be ulceration, she became insane. During the first
six months of the attack she slept most of the time, but during her waking
moments appeared depressed. She had several paralytic attacks, always,
with one exception, affecting the right side. She had been uncleanly in
habits and had frequently received self-inflicted injuries during her seizures. Her sight and hearing had gradually failed and when admitted she
was found to be absolutely deaf and blind. Her temperature was normal;
pulse 90, but very irregular in force and rhythm. Her arteries were found
to be hardened and atheromatous. She was too restless and noisy to permit a satisfactory physical examination, but later it was discovered that she
had a marked systolic murmur. Physically, she was very delicate, with
impairment of muscular powers, as well as incoordination of movement.
Her pupils were dilated, but reacted to light. An opthalmascopic examination showed the optic nerves to be atrophied. There was no ansesthesia,
and her sense of smell was extemely acute. Owing to muscular impairment and incoordination, she had to be cared for in bed. Her speech was
drawling, and although deaf, she was actively hallucinated and seemed to
hear the voices of her husband and daughter constantly calling to her.
At times she was resistive, and would strike, swear, and make use of the
vilest language. She had convulsive seizures of a most interesting character. They usually commenced on the right side with twitching of the muscles
sternocleido at the angle of the mouth, followed in sequence by contraction
of the sternocleido mastoid, flexion of the right arm and leg, of the left
arm and leg, and finally by spasmodic movements of all the muscles. During
these attacks the eyes deviated to the right and the breathing was labored
and stertorous. Occasionally the seizures were very slight and of brief duration solely consisting of twitching of an arm and leg, associated with lateral
deviation of the eyes. She died shortly after one of these seizures. The
autopsy showed the following: Dura-mater abnormally adherent to the
skull along the median line, pia mater cloudy and thickened, sinuses greatly
distended, and lateral ventricles extremely dilated. On both sides the middle occipital convolution, the angular gyrus, and the cuneus, were wholly

38

NORTHERN MICHIGAN ASYLUM.

or partially destroyed, by cystic degeneration, probably the result of obliteration of the blood vessels supplying these regions. The involvement of
the left side was more marked and the cavity, which was about two by one
and one-half inches in size, communicated directly with the lateral ventricle. On the right side, in addition to the above areas, the middle parietal
convolution was also involved in the cystic degeneration, but the cyst did
not communicate with the lateral ventricle as it did in the opposite hemisphere. The right hemisphere was nearly one-third larger than the left.
The arteries of the brain were extremely atheromatous. It is easy to comprehend the cause of the blindness, but the deafness cannot be so readily
explained from the lesions found. It is probable, however, that the degeneration extended into the upper portion of the temporal lobe sufficiently to
involve the cortical center of hearing.
A. F., male, aged 45, was admitted June 23, 1893, suffering from general
paralysis. Six weeks before his admission he had a paretic seizure. In
habits he had been restless, filthy and destructive. He had threatened to
kill his wife and children, and had otherwise manifested homicidal tendencies. His speech was slurred and hesitating, gait spastic, and reflexes
exaggerated. Hemorrhoids, in addition to other venous congestions,
developed. He suffered from terrifying delusions, which were worse at
night, causing him to be noisy. In the afternoon of April 19, 1894,,
another paretic seizure occurred, after which he became semi-conscious,
with right arm and leg paralyzed, breathing rapid and stertorous. The
failure of his vital powers was gradual, and he died without regaining consciousness April 27, 1894. The autopsy revealed the following: Abdominal viscera? normal. Both lungs adherent to the thorax over the greater
part of all their surfaces. Minute nodules distributed through both lungs.
Heart and pericardium normal. In the left hemisphere of the cerebrum,
the temporal sphenoidal and occipital lobes, and the posterior portion of the
parietal lobe as far forward as a line drawn from the outer extremity of the
horizontal limb of the fissure of Sylvius to the outer extremity of the
occipito-parietal fissure, were necrotic. Over these portions of the brain
the membranes were firmly adherent. The decay had so far advanced in
the temporo-sphenoidal lobe that the brain substance was in a semi-fluid
state, and only held together by the adherent membranes. In the occipital
lobe the degeneration was not so marked; while in the supramarginal and
superior parietal convolutions it was in its early stages.

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40

NORTHERN MICHIGAN ASYLUM.

A brief study of this table is extremely interesting from the fact that it
shows that out of 1,862 admissions only 374, or 20% of the cases, were
incident to the normal brain, the remainder being incurable by reason of
organic brain disease, or of hereditary defect. This serves to explain the
hopelessness of cure in the majority of cases and likewise why psychiatrial
therapeutics are not attended by better results. Apparent recoveries may
occur among the degenerate, but relapses are so constant that such cases
are never discharged recovered.
The recovery rate in the first group of cases is about 70 per cent, which
result compares favorably with any obtained in the field of neurological
medicine. In my judgment, the constant increase of insanity is not so
much due to faulty methods of care and treatment as it is to an utter lack
of knowledge or total disregard of the laws of heredity in the breeding of
the human race.
In about one-half of our patients it was impossible to trace the ancestry,
but in the remainder family defect existed to an alarming extent.
Of the 378 patients, 80'per cent were incurable at the time of admission;
6 per cent suffered from terminal dementia, or secondary delusional
insanity; 16 per cent from organic brain disease; and 56 per cent from
primary mental deterioration. These statistics need no further explanation to show their importance. That insanity is a disease that in many
instances arises independently of causes that are controllable by the individual, is generally known, and that the offspring of certain individuals
should become neurasthenic paranoiac, or criminal is a physiological fact.
We take the liberty of presenting to you a few words relative to
NEURASTHENIC INSANITY.

By neurasthenic insanity, we understand a form of mental disorder
characterized by depression of mind, morbid fears, and imperative conceptions and impulses, developing by reason of weakness of the nervous system, either congenital or acquired. Out of 205 cases in which the ancestry
could be determined, heredity existed in 120 and was denied in 85. Of the
latter, in some instances there existed a hereditary tendency to intemperance, consumption, and nervous weakness not amounting to insanity,
and which doubtless was the point of departure for the neurasthenic constitution in some of these individuals.
The essence of constitutional neurasthenia lies in the neuropathic diathesis of the ancestry. Krafft-Ebing says that insanity, " regarded broadly,
is a phenomenon of degeneration, whose determining conditions are to be
sought in congenital morbid dispositions transmitted to the germ in consequence of hereditary pathological states of the brain in the antecedents,
or in injuries of the cerebral organization of the individual incurred in the
course of life."
The pathology and etiology of neurasthenic insanity rest upon that of
neurasthenia. Anatomically, it has no discoverable lesions, although it
may be assumed that nerve cells which abnormally functionate must suffer
intra-mollecular changes more or less organic in nature. The idea of
" irritable weakness " of nerve centers presupposes, at one and the same
time, diminished power or tone and an increased reactibility to impressions
made upon them.
A knowledge of the phenomena of physiological fatigue aids in the

REPORT OP MEDICAL SUPERINTENDENT.

41

elucidation of some of the symptoms of nervous exhaustion. Any organ,
through over-use, will soon attain a state in which it will react feebly, if
at all, to accustomed stimuli. The mental worker flags in attention and
concentration of effort, and similarly the physical worker finds his muscular powers diminished and even lost; with rest, the balance between waste
and repair is soon regained, and with it the normal reactions of mind and
body. The effects of excessive physical action, says Fere.* are manifested
not only by exhaustion of nervous functions and general impairment
of nutrition, but by alterations in the coagulability of the blood. Hunter
noted in deer, dead after a long chase, that the blood had lost its coagulability, and Alfort observed the same condition of the blood induced by
prolonged pain. Claude Bernard observed that under the influence of
fatigue the glycogenic function disappeared.
The effects of fatigue are not solely limited to the motor functions.
Sensibility in all its forms is altered. The muscular sense is impaired,
prolonged anorexia may be induced and also derangement of peristalsis,
and modification of the gastro-intestinal secretions. Fatigue repeatedly
incurred is a very important factor in the production of neurasthenia.
Its first effect is to impair the nutrition of the nervous system. Functional weakness or exhaustion is thus established and marks the second
period of the disease. Impaired nutrition, no matter how induced, may
affect the whole nervous system, or be limited to certain centers. Weakness and nervous irritability, can thus exist side by side in certain central
parts of the nervous system, and that without the remaining centers
presenting phenomena of functional over-reaction.
As the functional relations of the various centers of the brain are
dependent, in part, upon their anatomical connection,f so it is comparatively
easy to comprehend that with partial inanition of the nerve centers
they may present coincidently phenomena of increased irritability and
diminished inhibitory power. The impairment of the inhibitory influence
suffices to induce the phenomena of increased excitability in subordinate
centers, and aids to explain the multiplicity of disordered functions met
with in neurasthenia, particularly so those of the digestive, cardiac, and
sexual mechanisms. Concommitant with digestive disorders of nervous
origin, there is another etiological factor which intensifies the neurasthenic
state, i. e., auto-infection from the absorbtion into the system of ptomaines,
unchanged peptones, and leucomaines. Doubtless all the organic ferments
coming in contact with the tissue elements produce substances exceedingly
poisonous.
Dr. Aitkin says that " the healthy living organism may become poisoned
(gradually and more or less slowly) by the accumulation within itself of
deleterious substances normally elaborated. Hence the slow and insidious
onset of much ill health, and from which recovery is correspondingly slow."
We have constantly to deal with definite toxic influences in the processes
of nutrition and the discharge of energy in the organic mechanism. It is
true that we have as yet little precise knowledge of these toxic substances
and of their effects upon the nervous system. Many of those obtained
are probably formed by the action of the reagents used in the analysis,
when their existence in a free state, in healthy tissue, is very doubtful.
But though this science is yet in its infancy we know enough to recognize
* Pathology of the Emotions.
t See Lowenfeld, Neurasthenia and Hysteria.

42

NORHTERN MICHIGAN ASYLUM.

the immense clinical importance of studying the chemical elements whose
positive influence in the production of nervous symptoms now stands as
an unquestioned fact. It must be remembered also that we are still compelled to study functional " activities " and disordered conditions of which
we can find no trace in the organism. (Cowles, Boston Medical Journal,
Vol. 125). Acute infections may rapidly lead to nervous exhaustion and
mental disturbance, but insanity so produced according to our observation, more frequently presents the confusional type.
The Russian author, Kowalewsky, states " that excessive work of nerve
elements causes defective nutrition of their protoplasm, and auto-intoxication from increased catabolic and insufficient anabolic processes. Accompanying this auto-intoxication there is general insufficiency of tissue
oxygenation and retrogressive blood changes which further damage the
nerve elements, and through impoverishment of the blood interfere with
general nutrition. Hereditary neurasthenia is attributed to poisoning of
the central nervous system with ptomaines and leucomaines from hereditary defective processes of metabolism. Lowenfeld observes that neurasthenia would be better understood if the changes which take place during
the stage antecedent to physiological fatigue were better known. The
changes in the nervous system in neurasthenia must be molecular and are
never gross. During the waking state full restoration of used-up material
and removal of the products of the activity of the central nervous system
does not occur. If the nervous capital is to remain the same, it must be
restored during sleep. In neurasthenia the accumulation of waste products
is so great that the period of sleep is no longer sufficient to fully remove
them, so that a chronic overlading of the nervous system takes place. In
this way a neurasthenic condition is produced, and Kowalewsky's theory
holds good for a great many cases, but the occurrence of neurasthenia from
physical or mental shocks, from insolation and poisoning, cannot be thus
explained. If, however, a severe commotion of the nervous elements can
produce their metabolic activity, an accumulation of toxic products may be
supposed to take place."*
Lowenfeld, quoting Mosso, states that fatigue is not solely due to tissue
waste, but is in part due to the presence of the products of decomposition
within the organism. The blood of a fatigued animal is poisonous, and if
injected into a normal animal causes in it the phenomena of fatigue.
Bouchard maintains that the primary cause of neurasthenia is to be
found in dilitation of the stomach. Accompanying this condition is insufficiency of HC1., and stagnation of the gastric fluids, i. e. mucus, saliva,
gastric juice, digested foods, and alimentary detritus, all of which is
eminently favorable to fermentations and putrefactions. Toxic soluble
products more or less comparable to ptomaines, are the result of these
fermentations and putrefactions. Once absorbed, they produce a kind of
intoxication in the organism which is being constantly renewed, and give
rise to a series of local or general symptoms of disordered function. (See
Mathieu, N. p. 135.) While dilitation of the stomach doubtless exists in
some cases, yet many patients who suffer from this malady, or from obstruction of the pylorus from malignant disease, do not present neurasthenic
symptoms. I should be inclined to regard the gastric disorder as the result
and not the cause of the neurasthenia. In regard to Glenard's theory of
" Enteroptosis," while displacements of the viscera due to relaxation of
* Brain, Part LXV, of Lowenfeld, N. &H.

REPORT OF MEDICAL SUPERINTENDENT.

43

their supporting tissues are not rare, we may agree with Bouveret that
" Enteroptosis is no more the cause of neurasthenia than functional
disorders of the uterus and ovaries are the cause of hysteria."
Every day experience teaches that in those individuals markedly predisposed to neurasthenia, all causes lead much more rapily to nervous
exhaustion, because the power of resistence of the nerve cells to overstrain and their energy to recuperate after undue effort, is normally
deficient. This recuperative power of the nervous system varies widely in
individuals. In some overexertion may produce an exhaustion, which is
soon relieved by rest, in others it may continue almost indefinitely.
Strictly speaking, all neurasthenia is constitutional, since no being
comes into the world perfect in mind, form, or feature, but the terms
constitutional and acquired are convenient expressions to separate those
presenting coarse defect from those presenting slight traces of defect.
It is doubtless true in many instances that the predisposing and exciting
causes act conjointly in the production of neurasthenia, the former
requiring the latter to bring it into full development. Heredity is the most
important predisposing cause. The ancestry were found to have suffered
from mental disease in 120 out of 205 of our cases.
This did not include the heredity of neuropatic states, syphilis, tuberculosis, etc., in the parentage. Doubtless if a perfect history could have
been obtained of each acquired case, a much greater percentage of
defect would have been discovered than is here stated. Sex has but little
influence as a predisposing cause. More men than women seem to suffer
from the constitutional forms. No doubt our northern climate from its
extremes of heat and cold has a predisposing influence in the acquired
disease.
Beard believed neurasthenia to be essentially an American disease, but
it is now known to be common in all parts of the world. The Russians
and Jews are said to be especially liable to the disorder. Our patients are
of various nationalities, but all having lived in America for longer or
shorter periods, little importance attaches to their racial peculiarities.
Age is doubtless of considerable importance, as most cases are found
between 20 and 50. Hosslin* remarks that beyond 60, neurasthenia is less
frequent, because the instability of the brain diminishes with old age. In
neurasthenia we do not meet nervous disorders due to retrogressive metamorphosis. These are dependent upon anatomical changes in the nervous
tissues. Hosslin further remarks that civil condition is of little importance as a predisposing cause of neurasthenia. In single life certain conditions are found which unfavorably affect the nervous system, e. g.,
neurasthenia sexualis is mostly found in the unmarried. It is true that in
young single life irregularities of habits and excesses of all kinds are
more frequent than in the married. On the contrary, married life through
conditions of existence, loss of children, and disappointment in attaining
life's aims, very often predispose to nervous weakness. Constitutional
modifications thus acquired are likely to be transmitted to the descendants
and predispose them to aggravated forms of the disease.
Of the exciting causes, psychical over-strain, and more rarely physical
over-exertion, lead to derangements of nutrition and to the retention
within the system of toxic products injurious or destructive to nerve cell
activity. Over-mental work often begins in school life, especially in pre* Mailer's Hand Book Neurasthenia.

44

NORTHERN MICHIGAN ASYLUM.

disposed children, and induces what Kirchoff calls " psychical trauma."
No doubt long-continued fixed mental work tends to exhaustion of certain
nervous centers. Care, anxiety, disappointed affections, unsatisfied ambition, grief, want and privation, and business reverses, are frequent causes
of neurasthenia. Concomitant with the mental worry which these causes
induce, there is emotional excitement of more or less intensity which
increases the nervous exhaustion and not infrequently leads to mental
torpor. The cause of the mental outbreak was ascribed to ill health in
over 20 per cent of our cases. Careful inquiry showed that most of these
individuals had been neurasthenic for years, and that the appearance of
psychosis only marked the further development of the malady. Fright
is a powerful factor in the production of brain exhaustion. Several of our
cases were due to this cause. In one very interesting case the patient was
held up by highwaymen, partially hanged, and afterwards robbed. Soon
after he became depressed and developed morbid fears and imperative
impulses. Although he visited Europe for treatment, he has never recovered from the effects of the fright. The mechanism of fright, like that of
shock and traumatism, is not known, but doubtless the morbid mental
manifestations are due to modifications of the nutrition of certain cortical
areas.
Cancer, tuberculosis, Bright's disease, diseases of the heart and of the
blood making organs may induce ansemia and neurasthenic conditions,
but the insanity which breaks out in the course of such diseases does not
present the typical features of neurasthenic insanity. Persistant irritability, mutism, with hallucinations, is the mental type of these disorders.
Acute infectious disease, typhoid and scarlet fever, measles, la grippe,
acute pneumonia, puerperal fever, etc., are more apt to be followed by
acute confusionai insanity, either of the hallucianatory or asthenic variety.
Pain arising from diseases of the sexual organs, stomach and bowels,
causing disagreeable sensations both by day and night, and the impairment
of nutrition and consequently of blood formation may lead to neurasthenic
conditions.* Syphilis was not found in any of our cases. We frequently
find syphilophobes among neurasthenics, but they are very rarely
syphilitic.
All these causes whether physical or mental, whether acute infections
or chronic local or general diseases, impair the chemical activities of the
tissues, the quality of the blood, and directly affect the nutrition of the
brain and nervous centers. As Lowenfeld remarks, no other organ
exhibits the influence of nutrition on its functional activities under both
physiological and pathological conditions, so exquisitely as the brain.
If temporary variations in the nutrition of the brain are of such importance for the mental activities of certain individuals, so are the special
variations which may occur during the whole period of life not without
importance in the functionating of this organ. Lowenfeld, from numerous
examinations, asserts that in constitutional neurasthenia the ratio of the
cerebral arterial area to the brain weight is less than normal, and deduces
therefrom that imperfect development of the cerebral vascular system is
the basis of a predisposition to all disorders which appear in the train of
causes that lead to nervous exhaustion and impairment of the nutrition of
the brain. It is evident that an organ which is so sensitive to variations
in the supply of its nutritive material must manifest modifications of its
activities in keeping with the quantity and quality of its blood supply.
*H06slin Mullera, Handbook, etc.

REPORT OF MEDICAL SUPERINTENDENT.

45

SYMPTOMS OF NEURASTHENIC INSANITY.

It would be impossible in this report to discuss all the psychical
symptons of neurasthenia. In the constitutional forms mental peculiarities may have existed from childhood. These are shown by frequent
headaches, digestive derangements, passionate outbursts, dreams and night
terrors, and elementary anomalies in thought and action. There is
ready exhaustibility of the nervous force and often eccentricities in
conduct. These persons are frequently excessively conscientious, and
seek repeated assurances that their word and acts have not caused pain to
others. They are apt to be precocious, often inclined to look on the dark
side of life, to find much to speculate and worry over, and present many
idiosyncrasies. Mental or physical stress, excesses, care, disappointments
or other depressing influences, develop the mental derangement, which
may continue with various remissions through life or be gradually transformed into fixed forms of insanity as hypochondria or paranoia.
Acquired neurasthenic insanity, as a rule, is developed upon long existing
states of impaired nutrition of the brain. Whether the mental derangement is ingrafted upon a constitutional or acquired neurasthenia, it presents certain characteristics which separate it from the simple psychoses
and psychoses developing upon the great neuroses. Neurasthenia insanity
may resemble hysterical insanity and with it may be associated hysterical
symptoms, but spasmodic phenomena are lacking in neurasthenia.
The cardinal symptons of neurasthenia, headache, metal irritability and
enfeeblement, and insomnia, are present in most cases of neurasthenic
insanity, and the most prominent mental symptoms may be observed to be
mental depression, mental weakness, and more rarely exaltation, morbid
fears, and imperative thoughtsandimpulses. Neurasthenic depression is less
intense than that of simple melancholia, is not so entirely out of proportion
to the cause imagined, and is not marked by self-accusations and the feeling
that the suffering is a just punishment of the sins or crimes imagined
to have been committed. The depression of neurasthenia is usually
associated with some fixed hypochondriacal ideas which are ever uppermost
in the patient's thoughts. These may lead to the fear of death, to the fear
of organic disease, and to endless visceral delusions. These imperative
ideas no doubt arise in part from some functional derangement of the various organs. Palpitation of the heart may give rise to fear of sudden death
and often to paroxysms of great mental distress; disorders of the sexual
organs induce great despondency and a multitude of fears. Imperative
ideas, that is the obtrusion into the mind of a thought, a word or
series of words or thoughts, or that a certain word must be followed by
the utterance of some other word, are common. The patient is generally
conscious of the morbid nature of these ideas, but cannot inhibit them.
They constantly obtrude into the patient's association of ideas, in spite of
his mental preoccupation. These imperative ideas may gradually become
fixed, and we see the disease transformed into paranoia, with hallucinations
and delusions of persecution. Imperative acts are no less interesting. The
sight of certain objects impel to certain deeds, that of a rope or water to
suicide, or that of a weapon to homicide. One of our patients, a grocery
clerk, at the beginning of his atteck dare not serve his customers with
meat, because the sight of the knife he was accustomed to use, excited in
him an almost uncontrollable impulse to assault them. He finally felt

46

NORTHERN MICHIGAN ASYLUM.

compelled to give himself up to the authorities, lest he should under his
impulses do some overt act. Imperative impulses may not always be suicidal or homicidal in content. They my find expression in sudden destructive acts, grotesque movements and attitudes, the touching of certain
objects on the hall or along the walks, or in violent outbursts of profanity or
vulgarity. Every person no doubt experiences imperative impulses at some
time in the course of life, but in the normal man they are inhibited before
the motor discharge is liberated. Morbid fears or phobias are frequently
met with in neurasthenic insanities, and really constitute the pathognomonic feature of the malady. There may be fear of contamination; fear
of other men; fear of poison; fear that the house will fall upon them; fear
of being in the open air; lear that the sky will engulf them; fear of crowded
places; and fear that their food has been prepared from the flesh of dead
bodies, etc. All of these ideas suffice to cause paroxysms of intense anxiety
and often anguish of mind. In some instances these phobias impel to suicide,
not because the patient believes that he is unfit to live, but to relieve himself of the terrible torment suffered. In the milder forms of neurasthenic
insanity the true nature of these fears is recognized and the patient struggles against them, but our experience is that in some patients these fears
often have the force of delusions, and largely control them.
Dr. Cowles says of these imperative ideas, " Morbid association being
once formed, it becomes fixed by habit, inducing or increasing the cerebral
fatigue, and constituting an association of psychoses, or more properly an
association of psycho-neuroses." (B. M. Jour. Vol. 125.) There is met
among neurasthenic insane patients a special fear, that is, a fear to move,
to speak, to eat, to look, etc., and in which questionings, attentions, or any
attempt at examination causes intense distress. During lucid moments
these "(patients do not seem to attribute the fear to persecutory or other
delusive ideas.
Headache, or more properly speaking a feeling of pressure in the head,
is present in almost every case of neurasthenic insanity. The pain is
generally located in the brow, although sometimes it is complained of in
the top of the head and sometimes at the base of the brain. The feeling
is as if the head were compressed in a vise or by a too tightly fitting hat,
and is often accompanied by a feeling which the sufferer expresses as
"numbness of the brain." He sometimes feels that his brain is too large
for his skull; or, on the contrary, that it is greatly shrunken. Tenderness
of certain areas of the scalp, frequent flushings of the face and neck,
coldness of the hands, burning of the feet, etc., etc., are probably due to
vaso-motor disturbances and are extremely frequent in insane neurasthenic
patients.
Insomnia is almost constant. Patients may go for days and nights
without more than a few hours rest. Some patients sleep a little during
the day; others early in the night, and still others secure rest only in the
early morning.
Mania as a result of neurasthenia has been rarely met with. It is more
apt to follow some sudden exhausting cause, like fright or acute disease.
In these patients are found destructive, obscene and profane impulses.
Such cases usually pursue a short course, and as a rule end in recovery.
Neurasthenic insanity may closely resemble general paralysis, and the
differential diagnosis cannot always be readily established. We recall a
young married man, who was quite free from hereditary taint except

REPORT OF MEDICAL SUPERINTENDENT.

47

remotely on his mother's side. He was of a pleasant, genial disposition,
and a very skilled mechanic. He had never had syphilis. He had been
subject to attacks of sick headache all his life, but otherwise enjoyed good
health. In the winter of 1892 he suffered from a severe attack of la grippe,
commenced work too soon and came down with violent headaches and
" racking pains," and in a few days became insane. He was confused,
violent, and tried to choke his wife. On admission pulse was 126 and
feeble, respiration slightly accelerated, and he was apparently debilitated.
His expression was somewhat apprehensive, sight defective, pupils unequal
and dilated, skin dry, and secretions fair. The fibers of sternal portion of
left pectoral muscle were wasted. His reflexes were exaggerated, speech
hesitating, gait sluggish, tongue when protruded deviated to the left and
was somewhat tremulous, and there was some sensory paralysis of the third
and little fingers of the right hand. His mental action was 'slow and
inclined to incoherency; memory poor, especially for recent events. His
writing was inco-ordinate, and he was unable to copy accurately. He had
several violent outbursts, and threatened to whip his attendants. Sometimes he was confused, again would refuse to speak, and at other times
excessively irritated by trifles. He was very forgetful of recent events,
and careless and indifferent about his personal appearance. His reflexes
became more exaggerated, and tremor persisted. He was sometimes
depressed, sometimes elated, but never manifested delusions of grandeur.
He was discharged four months after admission, mentally improved. He
still presented tremor, exaggerated reflexes, hesitancy in speech, and other
symptoms of general paralysis. He steadily improved, and is now well
and successfully employed at his trade.
Another case was that of a man aged 56, of strong physical development
and excellent health. He was a hard worker, and by his energy and
pluck had gained a high position in his profession; very irascible, and
when worried or when engaged in work requiring close application lie
became nervously excited. About five years ago he began to have attacks
of severe headache and vertigo, these attacks always following business
perplexities, the headaches preventing sleep and the vertigo continuing for
hours and sometimes days after the pain had ceased. No disturbance of
the stomach occurred during these attacks. He also was a fine whist
player, giving the same earnestness and energy to this as to his work, and
defeat was apt to be followed by the same headache and vertigo. About
one year ago a change was noticed in his manner and he became less
attentive to his business, amusing himself when driving or walking by
giving attention to very trifling things, such as counting the dogs, rocks,
tin cans, etc. At this time his headaches and vertigo ceased to trouble
him. This condition of mental weakness has continued and increased.
He now complains of being continually tired. Matters that formerly greatly
interested him now occupy but little of his attention. He cannot carry on
any conversation which requires any concentration of thought. His
memory has failed, and he frequently repeats the same expression in a
short conversation of five minutes. Nearly all his waking hours are spent
in the game of solitaire. Formerly a great reader and a voluminous correspondent, he now pays but little attention to books and writes but
imperfectly a short business letter each week. While he rarely ever slept
more than 7 or 8 hours, he now retires at 7 p. m. and rises at 8 or 9 a. m.
There is no paresis so far as can be discovered, and his vision and hearing

48

NORTHERN MICHIGAN ASYLUM.

are not impaired. He is much less careful than formerly of his associations. He seems to have lost nearly all his former self respect. This
case came to us in consultation, and the facts as stated were given by his
attending physician. No doubt this man is suffering from a very severe
form of cerebral neurasthenia; but there is a possibility that it may end in
paresis.
Tremor of the hands, fibrillary twitching "of the muscles, and tremor of
the tongue are common in the neurasthenic insane. Dilated, sometimes
unequal but mobile pupils, hesitancy of speech, and tremulousness in writing, have been seen in many of our cases, and yet we have never met with
a case of neurasthenia which eventuated in general paralysis, although as
before stated, no doubt such a result may occur.
Neurasthenic mental disorders, however, not infrequently terminate in
paranoia, • especially if marked neuropathic taint exists in the patient.
Delusions of persecution, with hallucinations of sight and hearing, arise
after a long period of nervous exhaustion, and are aggravated or improved
in keeping with the physical condition of the individual. These paranoiacs
^always exhibit a mixture of the two disorders. The persecutor^ ideas have
their point of departure from some bodily sensation which the patient
ascribes to some external influence or to persons whom he fancies are
inimical to him. The bodily symptons in neurasthenic insanity are as
as multiform as in general neurasthenia. Functional gastric and intestinal
disorders are frequent and intensify the mental disorder. Functional
derangements of the heart are exceedingly frequent and give rise to paroxysms of extreme distress and anxiety. Derangements of sexual function
are also frequent and lend especial oolor to the contents of the imperative
or delusional ideas. The special senses may be acutely sensitive, and also
general sensibility may be disordered. Often there is great muscular
unrest; the desire for movement of the limbs being so great as to sometimes impair sleep and even give rise to painful sensations of heat and
cold in the hands and feet. The impairment of the muscular sense often
gives rise to that imperative feeling which impels to ceaseless movement.
Neurasthenic patients are often relieved by such movements, and many of
them are inclined to walk incessantly or to persist in the standing position.
Subjective organic sensations no doubt give rise to morbid fears through
perverted psychological interpretations of them.
The diagnosis of neurasthenic insanity must depend largely upon the
existence of long-standing functional nervous derangement, the presence
of morbid fears, insistent ideas, and imperative ideas and impulses without
the presence of hallucinations. In very marked cerebral exhaustion the
symptoms resemble those of general paralysis. There may be inequality
of the pupils, muscular tremor, in co-ordination of speech and gait, exaggerated reflexes, etc., but the delusions of grandeur are lacking. Violent and
destructive outbursts may occur in neurasthenic insanity, but the patient
is often conscious of their true nature after the attack, which is not true of
general paralysis.
The prognosis of neurasthenic insanity is grave for the constitutional
forms, although as a rule improvement takes place in most cases. Apparent
recovery is often observed, but our experience has been that sooner or
later relapses occur. In cases terminating in hypochondria or paranoia
the manifestations of mental derangement are permanent.

REPORT OP MEDICAL SUPERINTENDENT.

49

TREATMENT.

Great attention must be paid to improving the nutrition of the patient.
Absolute rest is of great importance and it is very necessary to carefully
regulate the diet. If indigestion exists associated with g§stric fermentation
or with dilitation of the stomach, it is well to determine the chemical conditions of the gastric juice by the Ewald method, and correct any deficiency
or excess of gastric elements that may be found by the proper use of
drugs. Lavage of the stomach, in cases associated with nervous
dyspepsia, is, often followed by great relief. If gastric fermentation is
due to deficiency of HCL or to defective peristalsis, the use of HC1 and
the administration of antiseptics are of paramount importance. We have
used in such cases Napthol B and found it apart from its slightly irritating effects, a valuable remedy. Calomel in laxative doses from time to
time, followed by a saline, is valuable. Salol has been found very useful
not only for its antiseptic action in the stomach but for antiseptic action
on the urinary tract. If by lavage of the stomach and the use of antiseptics, HCL, etc., fermentations and putrefactions can be prevented, and if
constipation can be overcome, the absorption of toxic products from the
alimentary tract is avoided, and, at the same time, elimination of waste
products of nerve cell and other tissue activity, is stimulated. By these
simple means two important factors of cure have been obtained, i. e.,
decreased production and increased elimination of poisonous compounds.
The increased irritability of the nervous centers, ever present in neurasthenia, is best relieved by rest, massage, and sedatives. Bathing, a carefully regulated but rich diet, electricity and tonics, are all valuable means
of cure in certain cases. These patients are much benefited by kindly
encouragement from their physicians and nurses, and repeated assurances
of improvement are often very comforting to them. There is no class of
patients that require more careful personal attention than these, and
recovery follows as a rule after a long convalescence.
CONFUSIONAL INSANITY.

As before mentioned, infections and brain exhaustion repeatedly
induced are more apt to be followed by acute mental confusion than by
the mental derangement characteristic of neurasthenia. Mental confusion,
in a certain sense of the word, is present in all forms of acute primary
insanity, but reference is only here made to that type of mental confusion
that is concomitant with hallucinations of sight and hearing. These
morbid sense impressions often completely occupy the attention of the
sufferer, and from their intensity and rapidly changing contents lead to
confusion, perturbation and distress of the patient. Generally he can be
momentarily diverted from them, and also he is able to recognize friends
and surroundings, although strange persons and places may be mistaken
for those familiar. This multitude of impressions upon him tend to
bewilder him, and he is only able to form correct notions slowly, if at all.
Acute mental confusion is almost invariably toxic in origin. Heredity
may exist, but it is of less importance than in neurasthenic insanity. In
our cases it followed typhoid, puerperal, la grippe, and alcoholic excesses,
but doubtless it may be also produced by prolonged physical effort, mental stress, vicious indulgences, or any cause which quickly leads to impair7 .

50

NORTHERN MICHIGAN ASYLUM.

ment of nutrition of the brain, e. g., hemorrhage, trauma, etc. The
disease usually develops rapidly after a short prodromal stage, which is
characterized by perturbation, anxiety, irritability, loss of sleep, restlessness, and a condition of mental helplessness in which the power to think
and to act is greatljr impaired. The patient is in a state of doubt and
uncertainty. His perception and imagination are defective and memory
weak. Hallucinations of sight, and frequently those of hearing, develop;
the mental agitation increases, and the patient soon becomes incoherent,
loquacious, depressed, and even frightened by his visions. Doubtless the
varying mental moods of the patient are in part dependent upon the constantly changing contents of the hallucinations; and as Seglas points out,
the disease is not due to disturbances in the elementary sensations, but in
the psychological interpretations of these sensations. Acute mental confusion developing in the course of, or after, typhoid fever, resembles the
continuation of the febrile delirium, but it is not so dreamlike in character.
The patient may be extremely confused and entirely .unable to answer
questions relevantly.
Hallucinations of hearing are not so constant in acute mental confusion
as those of sight, but when present add to the perplexity and confusion of
the patient and tend to render him more irritable and impel him to
destructive and violent acts. Sight hallucinations relate to a multitude of
objects, many of which frighten the patient and give rise to feelings of
apprehension and distress. Not rarely in asthenic states, stupor, interrupted by paroxysms of excitement may characterize the entire course of
the disease. There may be remissions during which the patient is partially
coherent, but after recovery there is absolute forgetfulness of what
occurred during the attack. States of depression, excitation and stupor
may alternate with one another, but such changing forms, according to our
experience, are rare in the same individual. Excitation and depression
are, however, quite frequent.
Acute confueional insanity in a majority of cases terminates in recovery,
in proportion of 5 to 3, in our experience. The duration of the disease in
those who recover is from a few weeks to six months. The bodily health
of the patients previous to the onset of the disease is impaired, which
impairment is increased during the attack by refusal of food, loss of sleep,
and derangement of the digestive functions. There may be marked
emaciation and great weakness of the muscular power. The gait is often
unsteady, and tremor of the hands and tongue are common. There is
rarely during the course of the disease much febrile disturbance, although
a temperature of 100° and 101° has been frequently noted. Delusions are
comparatively rare, although are sometimes present, as is shown by the
fear that the food is poisoned, or that the attendant are inimical to them.
The treatment consists in rest, isolation, the administration of concentrated foods, laxatives, antiseptics, bath, stimulants and tonic remedies.
Sleeplessness is best combated by sulphonal. Convalescence may be protracted, but as a rule is prompt.
The following interesting study of hysterical insanity was prepared by
Dr. Rowley.
HYSTERICAL INSANITY.

Whatever differences of opinion may exist among alienists and neurologists regarding the nature of hysteria and its sequelae, i. e., whether a

REPORT OF MEDICAL SUPERINTENDENT,

51

psychosis or a neurosis, there is little doubt as to the true signification of
this abnormal manifestation. Hysteria is one of the stigmata of a degenerate state. A degenerate individual is one who, anthropologically speaking, is lower in the racial scale than his ancestry. It is not always possible to demonstrate this hyposthesis by histories of patients. There are
many apparent exceptions in the direct line of descent, but a close investigation of the different branches of the family tree will almost invariably
corroborate the statement that hysteria is degeneracy. Some authorities
go even farther than this and make hysteria hereditary. Charcot, for
instance, was very firmly of this belief. He taught that the primary cause
of hysteria was always heredity.
It is not intended to enter much into the theory of the causation of this
malady. Much has been written that would tend to establish the necesity of a primary abnormal state in the nervous system, in order that hysteria might be manifested. Good authorities advocate the theory that
hysteria, with its protean symptoms, is due solely to functional disturbances in the cerebral cortex. This includes, the Ideogenetic theory and
makes hysteria a pure psychosis. It would seem that from the manifold
cases reported by observers, and from the statements made on both sides of
the question, that there need be no such disparity of opinion. Hysteria does
not appear in the individual whose nervous system is normal. The antecedent abnormality may be congenital or acquired, but is essential. The exact
pathological state is not evident. Theories are numerous. For the present it seems better to express the condition in terms of its principal manifestations. " Irritable weakness," irritable as referred to the increased
reaction to external agents in the form of psychical disturbances. Irritations which have little or no effect in the healthy, give rise in the hysterically predisposed to disagreeable and even painful sensations, together with
motor, secretory and vasco-motor reactions. The entire nervous system is
more easily influenced by emotional processes than is possible in the healthy.
It is more common that irritability is largely in excess of weakness. In
fact the latter state may not be present, or if present, only occasionally
manifested. In addition to the above manifestations, largely referable to
the general nervous system, there are psychical anomalies which are noticeable in the hysterically predisposed. Krafft-Ebing says, " Psychical anomalies are constant antecedents of the protean symptoms of hysteria, although
in the majority of cases only as elementary disturbances." The author
makes the above statement in his consideration of the hysterical character.
Regis, Lowenfeld, Schule, and others, devote considerable space to the
discussion of the "hysterical character." At a very young age most hysterical cases have manifested a peculiar train of symptoms. No two cases
present the same in detail. Each one's environment, educational advantages, etc., have served to modify, partially subvert, or hasten the hysterical
outbreak. The following may be taken as some of the more important
psychical anomalies presented in the early life of the hysterical.
It is agreed that the female sex is more frequently affected. As a matter of observation they are intellectually bright, precocious, and of keen
perception, emotional and self-assertive. Their delight consists in fixing
the attention of their associates on themselves, and in order to do so adopt
just or unjust means. As inferred from this last statement, the moral
.sense is quite apt to be perverted, if not entirely wanting. Their lives are
full of contradictions, today friendly, tomorrow at enmity. Preeminently

52

NORTHERN MICHIGAN ASYLUM.

unstable in everything, with a particular tendency toward imitation.
There is noticeable little or no originality
Many of the hysterically predisposed females have been ansemie, have
suffered from sleeplessness or from night terrors, dreams, cardiac palpitations, etc. Frequently there is coupled undoubted physical disease of one
or more organs. Too great stress has been laid on the influence that the
sexual organs have played in the development of hysteria. The particular
epochs of life in the female have sometimes proved the exciting (not the
primary) cause of insantyin the hysterical individual.
Hysteria has its undoubted abnormal mental manifestations even from
the beginning. A large proportion of the cases never reach asylums or
hospitals. The more pronounced cases among the rich are cared for at
home, their troubles aggravated by sympathetic relatives who little
understand the nature of the malady, and proper hospital treatment is,
therefore, seldom received by other than the poorer classes. Much might
be said along this line. Many cases could have been benefited, if not
cured, if they had early been intrusted to institutional care. The cases
herein reported demonstrate the long continuance of the malady previous
to commitment to an institution for treatment.
During the past three years we have had under treatment several cases
of hysterical insanity, i. e., insanity developed on the hysterical neurosis.
It is thought that a comparison of the cases, with their preliminary
histories, psychical manifestations, etc., may be of interest. Reference will
largely be made to five of the more pronounced cases. All of these considered are females, 3 single, 2 married. In two, there was undoubtedly
an hereditary taint. In one of the two, the father and paternal uncle
were affected similarly to patient; in two the family history was not
obtainable; and in one there appears to have been no abnormal mental
manifestations in either branch of the family. All cases had been insane
for years previous to commitment. The length of the period varied from
2 to 9 years, average 4.9 years.
The exciting cause of the insanity has in several instances been difficult
to ascertain. In the one whose family history was clear, the cause was
doubtless properly attributed to grief after the loss of a sister. One was a
climacteric case. Three had been gradually approaching the state of insanity for some time before the final breakdown. Three had been fairly well
educated, were bright students, but had manifested their hysterical character during their school days. The onset in one was sudden and attributed
to partial sunstroke. The youngest case was 18 years old when taken
insane, and the oldest was 46 years, average 28 years. In each of the above
cases the neurosis was present for some time before they became insane, and
the above statistics only apply to their insanity. Two of the cases had been
treated in other institutions previous to their admission here. One of the
two was much improved when she left the former institution, but soon
became suddenly worse after taking a dose of medicine some what irritating
in character. The effect was an hysterical throat upon which she developed
many illusional ideas. All cases had been more or less despondent and
even hypochondriacal for some time previous to their admission. One had
threatened suicide and even went to the river to drown herself, but lacked
the courage. Three had been subject to hysterical seizures more or less
pronounced according to the exciting cause, which was usually of the
nature of an opposition on the part of some friend or relative. Two cases

REPORT OF MEDICAL SUPERINTENDENT.

53

belonged to the class of "Hysterical Sleepers." One had slept most of the
time during four years previous to admission, had taken food occasionally
when not watched. One had been in a stupid cataleptoid state much of
the time for about six weeks before commitment and only ate when alone.
Three had been mute for some time, one had not spoken for nearly four
years, one only occasionally for months, and one not at all for six weeks.
When received, three were apparently in an almost helpless state, inactive
from choice, defective will power, or from the predominance of the idea of
helplessness. One was in a very emotional condition, weeping and lamenting, resisting all efforts towards caring for her. The fifth was quiet, but
resistive; claimed that she could not walk to the ward, but after being
assisted for a short distance she made a break for liberty, running like a
deer for several rods before she could be caught. In all cases, even the
stuporous ones, sensibility to pain was present. Three were hypersesthetic
one extremely so. In three the knee reflexes were exaggerated. One case
presented many signs of primary spastic paraplegia, but closer investigation failed to reveal any disease of the cord. Special senses were unimpaired in any of the cases as far as could be ascertained. It was impossible
in the majority of the instances to make perimetric observations. The
pupillary reflexes were normal in each case. In each instance (substantial
proofs in two cases appearing some time after admission) the memory was
unimpaired. No disease of heart or lungs was discerned in any of the five
cases. Lately, however, from inactivity one has developed phthisis. Two
cases had been chronically affected with dyspepsia, manifesting many of
its pronounced symptoms. There was dilatation of the stomach in each
with hyperacidity. Most of the individuals considered had been sufferers
from chronic constipation. In two cases the perineum was somewhat
lacerated. One had borne several children since the development of her
insanity. Her children are all weaklings (mentally and physically). The
same case had frequently aborted. Both patients had received a great
deal of treatment for their special weaknesses and each attributed much of
her mental distress to derangements in the generative organs. However,
observation of these and other cases does not lead us to regard disorders
of the sexual apparatus as very important aetiological factors in the production of hysterical insanity. Two cases were somewhat ansemic, but, as
a rule, it may be said that tjhe physical condition of each was good, there
having been but little loss of flesh even in stuporous individuals who had
taken but little nourishment.
From this summary of their preliminary histories and general condition
on admission, we shall consider the psychical manifestations of these five
individuals.
Hysterical insanity from our observation is characterized by hallucinations of one or more senses, hallucinations of sight being seldom absent,
that of hearing frequently found. In some cases hallucinations were only
occasionally present. One individual was periodically bothered by the
presence of numberless cats. When free from these visions, the memory
of the same was clear and she would chide herself for having been so
annoyed. In most of the cases the hallucinatory impressions have been
unpleasant ones, disagreeable to the patient and not cherished.
In many instances it has been difficult to separate the pure hallucinations
(if there be such) from falsely interpreted impressions, i. e., to distinguish
them from illusions. Not a few have suffered more or less from functional

54

NORTHERN MICHIGAN ASYLUM.

physical disorders. Visceral illusions are very common. Illrasioual ideasare changeable. A patient's inind will one day dwell on disagreeable
or painful stomachic sensations; from these she may decide that her
stomach is gone, or that it is being devoured by animals. JBorborygmi may
be interpreted as the movements of foreign bodies. Again the same
patient may dwell on cardiac sensations apparently oblivious to any other
visceral disturbances. These false interpretations of visceral sensations
are common to forms of insanity other than hysteria. The changeablenessof the same are peculiar to the latter disease according to our observations. In contrast to the varying visceral illusions, there is noticeable in
some instances the controlling presence of one set of ideas. For example,,
the cases that have persistently refused food for months, remained in a
stuporous state, or have been mute for a longer or shorter period. For nine
mouths after admission one case was fed and otherwise cared for each day,
was perfectly inactive and offered not the slightest resistance during that
time. Suddenly she began to speak, to take cognizance of people and
things, and has since eaten and moved voluntarily. Her inactive state wasprompted as revealed by herself by the fixed idea that she belonged to the
"Hillside Sleepers" and must sleep for five years. The stuporous cataleptoid state of another arose from the continuous fixed idea of helplessness.
In this insanity, developed on the neurosis, there is noticeable the same
lack of adequate will power, more pronounced however than in pure
hysteria. As a result of this condition, there naturally will be changeable
moods, depression, elation and various degrees of emotionality. Such
cases go up and down the wards shouting and behaving in a most
unbecoming manner, fully aware of their doings and yet unable voluntarily
to do otherwise. Paroxysmal outbreaks, maniacal in nature, have been
frequently observed. These attacks seem to be prompted by delusional
ideas which are extremely changeable. The attention is never fixed on
one subject longer than an instant, and their actions being en rapport
with their conceptions are proportionately diversified in character. Regisvery aptly speaks of this outbreak as having the appearance of a dream
which suddenly breaks forth into action. Following the maniacal condition, there is usually present the opposite state of stupor with mutism,
refusal of food, tendency to self-injury, etc. In some cases persecutory
ideas are uppermost and the insanity is somewhat of the paranoiac type,,
although there is no very marked systematization of the delusions. Onecase
after several years of stupor with mutism, manifests very intense persecutory
delusions. She accused her associates of every conceivable crime and misdemeanor and is violent in her tendencies, having assaulted several individuals. One individual manifests much mental confusion. Much of the time
her language is quite meaningless, being a monotonous jargon. Many perversions of the sexual nature are observable. Fancied irregularities, such
as giving birth to the lower animals, etc., characterize some cases. Others
believe themselves pregnant when there exists no such state. Vicious
habits are quite common. As would be inferred from the historical
portion of this article, we have had several cases of prolonged mutism.
Each of these has presented interesting psychological problems. Only
one has persistently remained mute since her admission. In the other
instances there have at times been modifications of the mute state. Twoconversed freely for a month or more at a time, and afterwards suddenly
became silent. Many interesting psychical manifestations referable to-

REPORT OP MEDICAL SUPERINTENDENT.

55

the general nervous system have been observed. Among these, hemianaesthesias, partial and complete, parsesthesias, and hypeKesthesias. One
case has repeatedly presented the above anomalies. The peculiar transference of anaesthesia from side to side, also the substitution of hyperaestnetic for anaesthetic areas, has been observed. It has been the rule that
the hypersesthetic areas were especially sensitive to light touches, while
more forcible manipulations gave but little more than ordinary pain.
Although three of our cases had been subject to hysterical seizures before
admission, very few convulsions have been noticed among our patients.
One case, however, was at one time affected with hysteria major and
manifested many of its more common motor symptoms. Opisthotonous
theatrical attitudes and cateleptoid states were at various times assumed
by this patient.
It is not difficult to recognize hysterical insanity. The presence of the
neurosis and the preliminary history render the diagnosis comparatively
easy. Our prognosis in hysterical insanity is not usually a very favorable
one. One of the five cases has returned home considerably improved
both mentally and physically; another is some better than when she came;
while the other three are passing into the stage of dementia of the apathetic type. The treatment is largely symptomatic. Stomachic disturbances have been satisfactorily treated with antiseptic washings. A
thorough cleansing of the stomach with a diluted solution of betanaphthol
lias proved very grateful to the patients. One individual was especially
benefited by the S. Weir Mitchell treatment, modified somewhat to suit
the case. Hypnotic suggestion employed in one quite susceptible individual was of considerable use as a temporary agent. By means of suggestion the peculiar transference of anaesthesia from side to side was brought
about. Maniacal outbreaks were often brought to a sudden close by
means of hypnosis and the suggestion of a few hours' sleep, after which
the patient would usually awaken in a quiet frame of mind. Four of our
cases were not susceptible to hypnosis, and suggestions in the waking state
have not proved very servicable. However, it is thought that the conditions of stupor, mutism and catalepsy manifested by several cases were
largely the result of auto-suggestion. We cannot agree with some that
hysterical insanity is quite amenable to treatment. It is possible that
more could have been accomplished had our cases been earlier placed
under treatment, but holding as we do to the rule that hysteria is a neurosis
and a manifestation of a degenerate state, the possibility of cure must
consist in a total transformation of the individual. Our degenerate cases
are often benefited, and many are even returned to their friends quite
able to care for themselves under suitable circumstances.

56

NORTHERN MICHIGAN ASYLUM.

TABLE IV.—Degree of Heredity.
For the Biennial Period.
Total.

Malee.

2
18
11

7
26
8
27
24

17
58
32
64
34

12
52
18
76
38

29108
50
140
72

11
4
47
117

11
4
48
44

22
8
95
161

57
19
198
584

69
24
228
284

126
43
426
868

231

147

378

1,061

801

1,862

Males.
Paternal and material

Paternal remote
Maternal remote
None

Total

_
_-

.

From Beginning.

5
14
6
14
13

Females.

2

la

Females.

Total.

The study of the hereditary taint exhibited by our patients proves interesting, and would be more so could the facts in all cases be ascertained.
This, however, we are unable to do, for many cases classed under the
headings "None" and "Unascertained" could be placed in their appropriate places were we not dependent to such an extent upon the incomplete
medical history that so frequently accompanies the patient. Still, with
the facts at our disposal we are able to prove that in 57 per cent of all
cases from the beginning the hereditary predisposition was apparent from
the family history, while in the other 43 per cent such is denied; and for
the period just closed our statistics show that these figures are 56 per
cent and 44 per cent respectively.

57

REPORT OP MEDICAL SUPERINTENDENT.
TABLE V.—Occupation of those Admitted.
For the Biennial Period.

Billposter

Males.

Females. Total.

Males.

1
4
2

2

1
6
2

5
20
2

10

1
5

1
15

2
1

i
2

3
3

5
29
2
2
1

3
13
1

3
13
3

41
1

95
3
1

1

1

_ .

Baker .

._

Book-keeper

_

Batcher

_ „

Cabinetmaker
Cook
Cooper
_.

_

Cigarmaker

.

Editor

.
2

-...

Expressman

_

Fisherman florist
Gambler- _

-

Harness maker

_

54
3

:. -.
_

....
93

Liveryman

__ _.

..

4
1
1

Miner
Merchant..

...

.

_

.

Miller

3
12
1

4
2

Painter
Printer
Physician

From the Beginning.

_

-

Sailor.
Soldier ___
Stndent _ .

_

29
2

122

1
1
3
11

1
1
8
31
2

2
20
2
2

7
49
2
4
3

10

3
65
10
1

2
3
65
20
1

239
3

1
199
3
1

1
438
6
1
1

1
179

1
1
39
3
654

3
12
1
1
3

5
24
2
1
13

2

1
1
3
475
2
12
1

39

1

6
1
1
1

10

5

3
17
1
4

15
63
1
3

8
35
3
5
1

23
98
4
8
1

1
1
2

1
1
8
2

1
2
23
6
3

3
5
24
1

4
7
47
7
3

1
1
1

1
8
5
4
17

1
4
1
1
14

2
12
6
5
31

6
1
6
1
1

15
1
17
5
3

4

1

1
2
5
2
6

1

1

2

9

2
2
2

3
1
1

5
3
3

11
4
2

I
4
2
5

Females. Total.

Teacher
Telegrapher
Tailor
Unascertained
Weaver

3

3

2
10

18

2
28

4
1
6
45
2

7
95
2

16
1
13
140
4

Total

231

147

378

1,061

801

1,862

12

58

NORTHERN MICHIGAN ASYLUM.
TABLE VI.—Nativity of patients admitted.
For the biennial period.
Males.

Austria _
Belgiam

.

Connecticut
Denmark

.

_ .

England
Finland
Germany

__

Holland
Ireland .
Italy
Indiana .

Females.

From the beginning.

Total.

Males.

6

1

7

38

28

66

17
1
152

3

I

4

11
2
12
19

6

4
10
1
3
1

5
9
1
3

13

5
1
107
2
11

22
2
259
2
24

17
2
17
28

1
50
4
54
96

33
1
22
73

1
83
5
76
169

5
13
1
3
1

11
63
7
10
6

6
45
1
12
5

17
108
8
22
11

1
1
5
4

1
1
2
9
5

1

Kansas..

Michigan _ . _.
Minnesota

„_.__._

3

3

42

25
1

67
1

4

3

7

1
4
1
151
1
1
21
3
8

New Jersey
Nebraska __
New York
Ohio
PennsylvaniaPoland
Scotland
Switzerland
_ _

Wisconsin _ _
Wales
Unascertained

_____

Total.

144
1
20
1

298
2
1
41
1
3
S
1
184
2

13

15

28

104
1

1
80
1

6
6

11
3

17
9

1
36
26
8
2

46
17
6

1
82
43
14
2

18
1

20
1

38
1
1

106
13
5

74
8
7
1
2

180
21
12
1
5

2

2

4

3

1

4

5
1
14

26

8

34

6
1
12
1
61

37

11
2
26
1
98

231

147

378

1,061

801

1,862

3

Vermont

Females. Total.

BEOAPITTJLATION.

Native born..
Unascertained
Total

.

_.
__

147
207
24

724
1,050
88

378

1,862

59°

REPORT OF MEDICAL SUPERINTENDENT.
TABLE VII.—Clinical groups.
For the biennial period.
Males.

Females. Total.

Adolesence
Brain disease

6

Congenital
Constitutional disease
Epileptic
Idiopathic _ _
Masturbatic
Opium habit
PhthisicalPost-connubial
Post-febrilb
Puerperal
Senile
Syphilitic

6

4
7
3

10
7
9

1
19
2

1
4
2

2
23
4

93

71

164

28

27

55

Total

Females. Total.

8
99
32
6
29

18
1
22
62
16

7
80
19
105
171

5
50
18
6
130

12
130
37
111
301

2&
100
54
68
45

1

18
1

129
1
84
15
1

165
2
10
9

294
3
94
24
1

1

1
10

2
10

14

12
1

21
14

9
87
18

8
134
15
36
4

22
134
24
73
22

7
24

22
50

25
52
1
209
1,862.

4

3

7

125

3
2
1
84

231

147

378

1,061

801

7
24

.

Males.

17
1

9
18

Toxic
Unascertained
Unclassified

From the beginning.

TABLE VIII.—Duratian of disease previous to admission.
From the beginning.

For biennial period.
Males.
Under two months,
Five months and under nine
One year and under two

..
-. _

Two years anfl nnrtar fivft

Ten years and under twenty
Unascertained
Total

.. _.

Females. Total.

Males.

Females. Total.

61
35
10
3
25

31
19
13
4
13

92
54
23
7
38

174
102
64
17
127

120
76
55
16
75

294
178
119
33
202

22
11
11
1
52

23
14
11
3
16

45
25
22
4
68

186
109
102
40
140

139
112
107
44
57

325
221
209
84
197

231

147

378

1,061

801

1,862

60

NORTHERN MICHIGAN ASYLUM.
TABLE IX.—Civil condition of patients admitted.
For the biennial period.
Males.

Married
Single .
Widowed

.- -

Unascertained

—.

._

Total

Females.

From the beginning.

Total.

Males.

Females.

Total.

78
122
14
2
15

100
26
19
1
1

178
148
33
3
16

393
559
49
11
49

555
154
75
14
3

918
713
124
25
52

231

141

378

1,061

801

1,862

TABLE X.—Age of patients admitted.
For the biennial period.
Males.

From the beginning.

Females. Total.

Males.

Females. Total.

15 years and under 16 to 20
21 to 25
26 to 30
31 to 35

1
If
30
37
26

6
10
28
22

1
24
40
58
48

8
62
128
157
133

4
41
73
123
116

12
103
201
280
249

36 to
41 to
46 to
51 to

29
24
14
5

21
12
18
9

50
36
32
14

141
118
59
49

112
87
79
44

253
205
138
93

8
16
3
20

9
10
4
5

17
26
7
25

38
56
21
91

29
46
9
38

67
102
30
129

231

147

378

1,061

801

1,862

40*
45
50
55

56 to 60 ..
61 to 70
70 and upwards
Unascertained
Total

-

61

REPORT OF MEDICAL SUPERINTENDENT.
TABLE XI.—Probable exciting causes.
For the biennial period.
Males.

Disappointed affections
Domestic infelicity
Fever
.Fright
111 health

Nostalgia
Opium habit

_-

„

Females.

4
14
6
9

6
6

Religions excitement
Seduction . _.

Total

. ..

Males.

Females.

Total.

41
12

3
6

13
26
19
32

14
14

54
38
19
46
14

4
18

3
3

7
21

1

4

5

5
8
83
2
14

4
24
50
5
11

9
32
133
7
25

1
8
'32
2
3

4
16
7

5
24
32
2
10

5
72
156
9
3

13
117
2
1
7

18
189
158
10
10

9

3

12

3
15

3
15

1
14
1
1

11
5
8
140

1
25
6
9
140

2
3

2
1
2
3

2
1
4
8

3
2
8

5
3
3
4

5
6
5
10

6
15

7
2

13
17

10
36

1

4

13
6
3

23
42
3
4

9
5
65
14

10
39
2

19
5
104
16

32
22
360
122

30
4
241
10

62
26
801
132

231

147

378

1,061

801

1,862

1

Unascertained
Vicious habits

Total.
10
20
6
12
6

Prolonged lactation .__.
Phthisis
Previous attacks

From the beginning.

'62

NORTHERN MICHIGAN ASYLUM.
TABLE XII.—Residence of patients admitted.
From the beginning.

For the biennial period.
Males.

rhwhnygan

Delta
Dickinson

... ..

..

Grand Traverse - .
Isle Boyal .
Isabella

Kalkaska
Kalamazoo
.Kent

._

-

.- .

-

.-

Mason
Midland.

„ I

Mnskegon

_. .

Newaygo

Osceola

...

...

Otsego

...

„_.

. ...

-

State
Totals...

..

Females. Total.

7
5
1
3

14
9
3
3

32
17
6
3

30
24
4
6
1

62
41
10
9
1

3
3
4

1
8
3
2
1

4
4
6
6
1

10
4
15
16
5

4
8
15
6
7

14
12
30
22
12

4
4
3
4

3
1
3
3

7
5
6
7

17
13
23
22

1
15
6
11
13

1
32
19
34
35

1
14
5
12
8

5
6
3
6

19
11
15
14

1
15
16
37
35

1
6
16
25
36

2
21
32
62
71

17

55
1
15
10

148
1
32
27
2

3
4
8
1
1

13
12
16
1
2
18
25
2
21
52

6

23

93

2
2
1

5

7
2
1

17
17
2

4
1
2

1
2
1

5
3
3

10
8
8

1

1

4

6
I
3
3

9
12

2
1

1
1
2

9
28

9
13
2
12
24

11
6
9
20
2

10
1
1
7
5

21
7
10
27
7

78
15
37
79
13

51
10
29
29
25

129
25
66
108
38

4
13
12
4

i

5
22
21
11

8
66
58
19

1
8
65
49
29

1
16
131
107
48

1
7
1
1
4

1
5

2
12
1
1
10

1
22
8
4
21

1
19
6
6
31

2
41
14
10
52

1
1

1

2
1
2

6
3
2
5
3

4

10
3
4
10
3

2
2
1
11
3

2
1

4
3
1
11
3

16
20
6
67
3

8
22

378

1,061

801

2
1

Mackinac

Males.

7
4
2

1

Lake

Schoolcraft
Wexford
Wayne

Females. Total.

231

9
9
7

6
2

147

2
5

13

19
42
6
80
3
1,862

REPORT OF MEDICAL SUPERINTENDENT,

63

CHAPEL SERVICES.

Chapel services have been regularly conducted by Rev. D. Oochlin,
-Chaplain of the Asylum, assisted by Revs. A. E. Wells and G. S. Northrup.
The services, as in former years, have been largely attended and a source
of much benefit and comfort to our people.
PLANS OF NEW COTTAGES.

As required by law,-the plans of the new cottages were submitted to
the State Board of Corrections and Charities, and the following is their
report on the same:

LANSING, June 3, 1893.
JAMES D. MUNSON, M. D., Medical Superintendent Northern ^Michigan Asylum,
Traverse City, Michigan:
DEAR DOCTOR—The Board of Corrections and Charities, at a meeting held at your
institution the first inst., examined the plans of one cottage for one hundred male
patients, and of one cottage for seventy-five female patients, to be erected at the
Northern Asylum, provided for by act of the Legislature of 1893, and find that such
plans are satisfactory to it, and have instructed me to certify such finding to you.
By order of the Board,
Yours very truly,
L. C. STORRS, Secretary.
ACKNOWLEDGMENTS.

The following papers have been donated for the benefit of patients by
their respective editors:
Alpena Argus.
Big Rapids Herald.
Cheboygan Tribune.
Church Helper.
Deaf Mute Mirror.
Grand Traverse Herald.
Hemlandet.
Index and Review.

Michigan State Democrat.
Native Copper Times.
Pontiac Gazette.
Practical Farmer and Fruit Grower.
Traverse Bay Eagle.
Transcript.
Three Rivers Tribune.]
Triumphs of Faith.

This is a kindness deeply appreciated by our people. We are also
indebted to C. L. Lockwood, Esq., Gen. Pass. Agt., G. E. & I. R. .R., for
regular donations of a large number of papers and journals; to the Michigan Board of Agriculture for reports of 1888-92; and to Mrs. Hall and
Sarah Hill, of Traverse City, Mr. James Wylie, of Petoskey, and Mrs.
Jacard of St. Louis, Mo., for Magazines and papers.
I am under renewed obligatirns to the officers, chiefs of departments,
and attendants, for their zeal in the discharge of their duties, and most
sincerely thank the members of the staff for the many personal kindnesses
extended to me. I am also greatly indebted to the Board of Trustees for
acts of kindness, and sincerely thank them for the interest and aid given
to me in the discharge of my duties.
The period just closed has seen many important improvements in the
institution, and we hope that a greater measure of success may attend all
our efforts for the coming period.
Respectfully submitted,
JAMES D. MUNSON,
Medical Superintendent.
Traverse City, June 30, 1894.

OFFICERS AND EMPLOYES
OF

THE NORTHERN MICHIGAN ASYLUM, AND THE WAGES
SALARIES PAID TO EACH, JUNE 30, 1894, AS REQUIRED
BY SECTION 2, ACT 206, LAWS 1881.

Name.

Service.
Assistant physician

A. S, Rowley
Robt. Howell
J. P. C. Church
D. Cochlin

41

41

tl

ft

Chaplain

'

-

T. H. A. Tregea
H. H Fuller
S. G. Howard
T. Reif
H. W. Pierce

Watchman
K
Assistant Engineer

Chas. E. Kenyon _
H. Dumbrille
E. C. Kent
F. Beebe

Stenographer
Clothing Clerk
Telegraph Operator .

. --

.

___

Jennie Bargett
B. Burns.
C. Bryan
M. Campbell
M. Case

F. Cree

. --.

Barnman
Attendant

Time.

$3,000 00
1,100 00
900 00
900 00
800 00

«
i
4

1,500
250
500
1.200
40

00
00
00
00
00

t

45
40
32
36
36

00
00
00
00
00

u
"
"
"
"

60 00
"
"
55 00
1 75 Per day.
70 00
35 00
ti
27 00
4
12 00
4
45 00
t
26 00
t
30 00
28
18
18
15
32

F. H. Alderman
M. J. Bailey
H. Booth
Wm. Brown

Kate.

i
i
*
44

2 "
1 **
i "
i i*
1 **
2 "
2 "
2 "
11
44
11
14
41

00
00
00
00
00

I

tt '

4

14

t

14

t

K

13
16
22
15
12

00
00
00
00
00

(,

4

It

27
18
12
20
15

00
00
00
00
00

1

It

00
00
00
00
00

4t

22
15
18
26
25

4

(4

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41

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4

44

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41

41

14

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44

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OR

65

OFFICERS AND EMPLOYES.
OFFICERS AND EMPLOYES.—CONTINUED.
Name.

Service.

L^E. Chamberlain
Thomas Dale
S. JDaggett
T, Drainer
V. Drake

Attendant
11
ti
11
„
>[
«i
u
ti

E. Decker
M Dennis
K. E. Dobson
C. Easterday
C. D. Edwards

u

Rose Evry
E M. Faxon
B. M. Faxon
F Flanders
M. Flanders

It
11
It
tl

M. Flint
H. Gage
P. Garlock

,;
it
>f
n

Geo. E. Graham

(t

u
11
II
tt
tt

J W. Goble
F. M. Hale

u

0 Harris

II
11

*

W. D. Hollister

tt
«

„

S. Howard
M. Huff
C. Hub bard

11
11
II
li
„

D W. Kelley

tt
tl
tt
it

Allie Knlley
Nellie Kent
Chas. H. King

,,

F Knight

LI

J Magi 11
J. D. May
E. Middleton

"
It
II

C. Moe

^_

M McDonald
F ?Jorth

u

II
II
it
tl
,J

E. North
C. J. Oren
V Patrick

t(
tl
II

C. Patterson

Adm'n building.-

S. Potter
Wm. Purple
N. Par pie
S. Richter
Z. D. Rule
J. A. Rule
Thomas Shaw
Lena Hmaltz

it
*t

_

.

Adm'n building
tt

Rate.

Time.

$12
18
15
21
22

00
00
00
00
00

18
15
13
22
30

Per month. Resident.
it

U

11
It

(
I

00
00
00
00
00

it
il
tt
(t
«

1
t
t
tl
**

16
16
12
32
20

00
00
00
00
00

It

il

It
It
11
tl

II
II
*t
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21
22
15
15
22

00
00
00
00
00

II

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II.
II

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II

22
22
12
26
14

00
00
00
00
00

II

li

tl
II
t
t

li
tl
tl
II

15
28
22
28
18

00
00
00
00
00

t
I
1
1
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It
It
tt
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II

22
20
18
13
24

00
00
00
00
00

II

11

II
tt
It

it
II
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(1

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30
20
18
25
30

00
00
00
00
00

it

tt

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ti

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it

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18
24
24
22
23

00
00
00
00
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II
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It
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tl
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24
22
22
22
28

00
00
00
00
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II
II
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11
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11
11
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11

18
24
28
15
10

00
00
00
00
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it
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11
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II

18
12
32
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11
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11
11

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11

41

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66

NORTHERN MICHIGAN ASYLUM.
OFFICERS AND EMPLOYES.—CONTINUED.
Name.

Rate.

Service.

A. S. tUaghnis
H. Stafford
D. Starring
F. M. Stehr

ii
i«
i«

F. Spears
J. E. Snivel
Rhoda Smith
Jennie Smith
W. D. Stitt

11
ti
"
n

(1

^

u
•'
"
"
i'

M, Stewart
T- Shipp
L. Shipp
J. Tinker
W. D. Turner

11
ii

M. Wallace
H. Waleh
E. Walsh
F. Washburn

u
K,,

Eva Weese
E. F. Weese
M. Williams
E. Williams

(1
*l
ll
I*

J. M. Whiting
J. Thomas __ . ..
W. Weston

,

(l

Laundryman
Laundry assistant

P. Schrader
0. Secor
Li. Mort
8. Lloyd
M. Daggett
M. Schrader „
J. Fuller
Ira Curtis .

ll

tl

tl

11

il

It

U

L(

ti

((

it

ii

ii

It

11

U

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Assistant cook
Kitchen assistant

W. Kettle

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E. Frost „

I

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E. Clark
F. Wilhelm
H. J. Pray
W. Lyons

1

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Batcher „
Special kitchen
Assistant baker

E. Biladean
J. Secor
E. Bradley
T. Bates

Teamster
11
t(

C. L. Marsh
J. Shea
W. Travis

Fireman

H. Cree -

u

W. H, Mather
C. Latshaw
W. H. Bauld
C. M. Prall
Wm. Attwood

it

Barnman
Chief engineer
Gardener

$22
18
18
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32

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OFFICERS AND EMPLOYES.

67

OFFICERS AND EMPLOYES.—CONCLUDED.
Name.

Laborer

F. Nagel
W. Chahoc "
"
T. Bondrou "
"
C. Getchell
.
F. A. Wright
Bert Wilhelm
Chas. Chadwick
J. W, Robertson
S. H. McMichael
O. S. Ayers

Laborer

$1 75
2 25
4 00
1 50
2 00

.

3 00
3 00
3 00
1 50
1 50

.

14

Carpenter

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1 50
2 00
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2 50
1 75
1 50
1 50
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u

O. P. Stevens
J. Stables
E. H. Wood
E, I. Davis
Wm. Champion

Rate.

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CORRESPONDENCE.

The following correspondence relating to proposed appropriations for
this institution is respectfully submitted:
NORTHERN MICHIGAN ASILUM,
)
Traverse City, Mich., August 11, 1894. )
HON. L. C. STORES, Secretary State Board of Corrections and Charities:
DEAR SIR—I am directed by the Board of Trustees of the Northern Michigan Asylum
to request your Board to examine the estimates of appropriations that will be asked of
the Legislature for the year 1895. The following statement is an aggregate of each
appropriation requested:
$2,500 for painting towers, cornices, window jams and window sash of the Asylum;
$2,000 for the continuation of repairs to roofs and gutters;
$7,500 for a new laundry building and additional laundry machinery;
$5,000 for a farm dwelling;
$8,500 for a cottage for fifteen women, and $1,000 for library.
The plans and estimates for the proposed buildings are now ready for your inspection.
We shall be pleased to have you visit the Institution at an early date.
Yours very respectfully,
JAMES D. MUNSON,
Lansing, Michigan.
Medical Superintendent.

NORTHERN MICHIGAN ASYLUM,

.1

Traverse City, Mich., Sept. 25, 1894,
To the State Board of Corrections and Charities,
HON. L. C. STORRS, Secretary:
GENTLEMEN—In accordance with the provisions of the law, I herewith, submit estimates of cost of buildings, etc., requested of the coming Legislature by the Board of
Trustees of this Institution:
I. COTTAGE FOR FIFTEEN WOMEN.
Labor and material:
280,000 brick, in wall, at $10 per thousand
$2,800 00
30 cords stone, laid, at $12 per cord
360 00
54 windows, at $10
540 00 '
Cut stone window and door sills
130 00
2,780 yards plastering, at 20c
556 00
7,000 feet maple flooring, at $25 per thousand
175 00
36,000 feet hemlock lumber, at $8
288 00
15,000 feet dressed hemlock lumber, at $9
135 00
10,000 feet dressed, matched pine lumber, at $16
160 00
39 doors, complete, at $10
390 00
Painting
200 00
52,000 shingles, at $2.75
.'
143 00
Hardware and tin work
225 00
Carpenter work
400 00
$6,502 00

CORRESPONDENCE.

69

Heating and plumbing:
One low-pressure heating apparatus, complete; 50 sections Gold's Pin
Radiators; standard lap-welded, wrought-iron pipe for steam and
water distribution; water and steam-fitting castings; radiator and
angle valves; automatic and compression air valves, etc
$597 50
Three iron, enameled, rim-flush hoppers for water closets; three automatic flushing tanks; one bath tub; enameled sectional slabs and
bowls, with brackets and other fixtures; slop sinks; kitchen sinks;
grease trap and brackets; basin cocks; compression stops; Bennor
sink traps; bath trap, and iron ferrules for iron pipe
78 75
Twelve lengths extra heavy cast-iron soil pipe, 4. in., 3 in. and 2 in.,
with fittings for same
29 00
Lead pipe
10 00
Four-inch cast-iron water pipe, with fittings; water and hose valves
for fire protection
100 00
Hot water apparatus and
fittings
200 00
Labor.. ._'...'
__.
:
__.
200 00
$1,215 25

Electric light:
Copper wire, fixtures, cut-outs, switches, lamps, labor, etc
Furniture and furnishings:
Fifteen bedsteads
Fifteen hair mattresses
.
Fifteen woven wire mattresses
Blankets, sheeting, toweling, and comfortables
Table ware
.
Range and kitchen furniture
Chairs, wardrobes and bureaus
Pillows, etc. -

200 00
56 25
142 50
30 00
7500
50 00
130 00
74 00
25 00
$582 75

RECAPITULATION.

Labor and material
Heating and plumbing..
Electric light
Furniture and furnishing

$6,502 00
1,215 25
200 00
582 75

.

$8,500 00
II. FARM HOUSE.
Twenty-four cords stone, in wall, at $12
15,000 brick, laid, at $10
1,800 yards plastering, at 20c
7,000 feet flooring, at $25
25,000 feet hemlock lumber, at $8
6,000 feet siding, at $20
30,000 shingles, at $3 per thousand
8,000 feet finishing lumber, at $25
5,000 feet dressed, matched pine, at $20
15,000 feet dressed lumber, at $10
2,000 feet matched pine ceiling, at $28
1,500 feet pine lumber, at $40
Buildmgpaper
Carpenter work and labor
Hardware, nails, and tin work
Thirty-four windows, complete, at $9.—
Thirty-two doors and frames, at $10
Painting and
finishing
Heating, plumbing, and furnishing
Water supply and sewers
'.
..

...

;

$288 00
150 00
360 00
175 00
200 00
120 00
90 00
200 00
100 00
150 50
56 00
60 00
30 00
590 00
240 00
306 00
320 00
290 00
775 00
500 00
$5,000 00

9*

70

NORTHERN MICHIGAN ASYLUM.
III.

NEW LAUNDRY,

Thirty-eight cords stone, in wall, at $14
210,000 brick, in wall, at $10
Seventy squares tin roof, at $8
10,000 feet lumber, at $15
25,000 feet lumber, at $9
Twenty-seven windows, complete, at $11
Twelve doors, complete, at $11
1,000 feet concrete floor, at 16c
Cut stone
5,000 feet lumber, at $20
1,800 yards plastering, at 20c
Nails and hardware
Carpenter work and labor
Painting
Machinery, electric light, heating, plumbing, and sewers^

_.

.

$532 00
2,100 00
560 00
150 00
225 00
297 00
132 00
160 00
90 00
100 00
360 00
178 00
450 00
175 00
1,991 00
$7,500 00

IV. Library
$1,000 00
V. For painting towers, cornices, jambs and window sash of the Asylum.. $2,500 00
VI. For continuation of repairs to window, roofs and gutters
$2,000 00
Respectfully submitted,
JAMES D. MUNSON,
Medical Superintendent.
BOAED OF COEEECTIONS AND CHABITIBS, )
Lansing, October 3, 1894.
)
JAMBS D. MUNSON, M. D., Medical Supt. Northern Michigan Asylum, Traverse City,
Michigan:
DEAK SIK—Your communication to the State Board of Corrections and Charities,
submitting for its consideration and opinion the proposed appropriations for your institution, for the years 1895 and 1896, was duly received. We visited the Northern Michigan
Asylum as required, September 25, 1894, and investigated the " condition and needs of
the same." We have carefully considered the appropriations proposed, and respectfully
submit herewith our opinion of the same; such opinion was governed largely by the
following resolution:
" WHEREAS, In the present condition of business, citizens, and especially those who
are dependent on constant employment, must find it difficult to meet their taxes;
" Resolved, That this Board, while recognizing the desire to increase the efficiency of
the institutions of the State, feels that its recommendations should be made in view of
these circumstances, and that special appropriations should contemplate only what is
absolutely necessary."
Painting towers
Repairing roofs and gutters
Additional laundry building and machinery

$2,500—Approved.
2,000—Approved.
7,500

The room in the laundry has become very limited, and as a consequence the work is
being done at a greater expense than it should be as, were it larger, much patient help
could be utilized and a large saving be made. The machinery will have been in use
some ten years before any change can be made even now, and is worn out, and should
be replaced. The item is approved.
Farm building, $5.000. The Board would approve of $3,000 for this item. If necessay to come within such amount, we would suggest that a frame house be built on stone
foundation.
Cottage for 15 women, $8,500. While it is desirable to separate the class of patients
from others, as is the purpose of this new cottage, still, in the opinion of this Board, it
can be postponed for the present, and we therefore do not approve of this item at this
time.
Library, $1,000. Approved at $500.
Yours respectfully,
GEO. D. GILIESPIE,
L. C. STORRS, Secretary.
Chairman.

APPENDIX

LAWS GOVERNING THE ASYLUM.

The act organizing the asyulms of Michigan and providing for the
admission, maintenance, and discharge of patients is known as Public Act
135, Laws of 1885.
GOVEKNMENT.

SEC. 10. Each board of trustees
by-laws as it may deem necessary
duties of officers, attendants and
support, and discharge of patients,
of the institution under its charge;
and regulations for the internal
asylum.

is hereby directed and empowered to establish such
and expedient for regulating the appointment and
assistants; for fixing the conditions of admission,
and for conducting in a proper manner the business
also, to ordain and enforce a suitable system of rules
government, discipline and management of the

ADMISSION OP PATIENTS.

The following by-laws govern the admission of patients:
First, Indigent and pauper insane will be admitted upon orders granted by the
proper officers, in accordance with the laws of the State, and no indigent or pauper
insane person shall be admitted without such authority.
Second, Pay patients (or private patients) can only be admitted to the Asylum for
care and treatment upon compliance with the following requirements:
(a.) The certificates of two reputable physicians, under oath, appointed by the Judge
of Probate of the county where the alleged insane person resides, possessing the
qualifications required by Section 22, Public Act No. 135, laws of 1885, as amended by
Act No. 220, Laws of 1889, and the certificate of the county clerk.
(b.) A bond, in the sum of one thousand dollars, duly executed by two persons of
responsibility, to be approved by the medical superintendent, shall be delivered to
the superintendent at the time of the admission of the patient, obligating the bondsmen to pay all the patient's expenses while in the Asylum.
(c.) An order from the Judge of Probate of the county of the patient's residence,
committing him (or her) to the Asylum as a private patient.
(d.) Pay for thirteen weeks' board and treatment must be made in advance of the
admission of the patient.

No patient shall be detained in the Asylum after the medical superintendent shall determine that he is of sane mind.
Indigent insane persons are admitted on the orders of judges of probate,
in accordance with the provisions of the following section:
SEC. 23. When a person in indigent circumstances and not a pauper becomes insane,
application may be made in his behalf to the judge of probate of the county where he
resides; and said judge of probate shall immediately notify such alleged insane person
of such application, and of the time and place of hearing to be held thereon and in the
10

74

NORTHERN MICHIGAN ASYLUM.

discretion of the judge of probate any relative or other person having said alleged
insane person in charge or custody, shall likewise be notified of said time and place of
hearing; and shall also call two legally qualified physicians and other credible witnesses
and also immediately notify the prosecuting attorney of his county, and the supervisor
of the township or the supervisor or alderman of the ward in which said insane person
resides, of the time and place of such hearing, whose duty it shall be to attend the
examination and act in behalf of said county; and said judge of probate shall fully
investigate the facts in the case, and either with or without the verdict of a jury at his
discretion, as to the question of insanity, shall decide the case as to his indigence, but
this decision as to indigence shall not be conclusive; and if the judge of probate certifies that satisfactory proof has been adduced, showing him to be insane and his estate
insufficient to support him and his family or, if he has no family, himself, under the
visitation of insanity, on his certificate under the seal of the probate court of said
county, he shall be admitted into the asylum, and supported there at the expense of
the county to which he belongs, until he shall be restored to soundness of mind, if
effected in two years, and until otherwise ordered; and the judge of probate shall in
no case grant such certificate until fully satisfied of the indigence of such insane person. The judge of probate in such case shall have power to compel the attendance of
witnesses and jurors, and shall file the certificates of the physicians taken under oath,
and other papers in bis office, and enter the proper order in the journal of the probate
court in his office; and he may appoint a proper person or persons to conduct such
insane person to the asylum, who shall receive pay for expenses and services, in the
discretion of said judge, the same as any other officer. The judge of probate shall
report the result of his proceedings to the supervisor of his county, whose duty it
shall be, at the next annual meeting thereafter, to raise money requisite to meet the
expenses of support accordingly.

The provisions of this section secure the benefits of the Institution to a
class by far more numerous than any other in this State, who, though
possessed of some property, find it insufficient to meet the expenses of
treatment and the support of the family at the same time. The form of
order arranged in accordance with the requirements of this section, copies
of which may be procured at the Asylum, is as follows:
STATE or MICHIGAN,
County of
At a session of the probate court for the county of
holdenat the probate office in the
of
on the
day of
^
in the year one thousand eight hundred and
Present
, Judge of Probate.
In the matter of
,an indigent insane person;.
This day having been assigned for hearing the petition, now on file in this court, of
alleging that
, a resident of
in said county,
is insane, and praying that said
may
be admitted to the Northern Michigan Asylum at Traverse City, there to be supported
at the expense of the county of
, and having duly notified the said
, also
relative, _of the said
, also
prosecuting attorney for said county, and
supervisor of
in which said insane person resides, of the time and place of hearing said petition, and
having filed the certificates, taken under oath, of
and
two legally qualified physicians,
and having taken the testimony of
credible witness
and having inquired into h settlement, and having fully investigated the facts in the case with
the verdict of a jury as to the question of insanity
and indigence, I, the judge of probate, in and for said county, do find that said
._
is in indigent circumstances, and certify that satisfactory proof has
been adduced showing the said
to beinsane; that he has
acquired a legal settlement in said county of
and that h
estate is insufficient to support h
and h
family under the
visitation of insanity.
And it appearing to the court that said
under and

LAWS GOVERNING THE ASYLUM.

75

according to the provisions of Sec. 23 of Public Act 135, laws of 1885, is entitled to
admission into the Northern Michigan Asylum, at Traverse City.
It is ordered that the said
be supported in said
Asylum at the expense of the county of
until restored
to soundness of mind, if effected within two years, and until otherwise ordered.
Judge of Probate.
STATE OF MICHIGAN,
~
, f !•) ss.
County, )
I hereby certify that the foregoing is a true copy of the original order and certificate
made by me.
In testimony whereof, I have hereunto set my hand and affixed the seal of the
Probate Court, at
this
day
of
, A. D. 18....
Judge of Probate.
I hereby appoint and direct
said

to conduct
to the Northern Michigan Asylum.
•Judge of Probate.

Indigent insane patients having no legal settlement in any county of the
State of Michigan, can be committed to the Asylum, as non-resident State
patients, in accordance with the provisions of Sec. 25, Act No. 135, Laws
of 1885, as amended by Act No. 62, Laws of 1887.
Dependent or pauper insane persons are admitted on orders of judges
of probate granted in accordance with the following section:
SEC. 26. The county superintendents of the poor of any county, or any supervisor
of any city or town to which a person who shall become insane may be chargeable by
reason of being a pauper, shall make application to the probate judge of said county,
who shall proceed to inquire into the question of the insanity of said person, and for
the purpose of such inquiry shall call upon and may compel the attendance of one or
more legally qualified physicians, and such other witnesses as he may deem necessary,
and if satisfied of the insanity of said person, said probate judge shall make the same
certificate and order for admission into the insane asylum, and the same record and
report as are required to be made, by section twenty-three of this act, in the case of an
insane person in indigent circumstances.

The form of order is the same as prescribed for indigent patients under
Section 23.
Pay patients (or private patients) are admitted in accordance with the
following sections of Act 135, Laws of 1885, as amended by Act 220,
Laws of 1889.
SEC. 21. No person shall be admitted or held as a private patient in any asylum,
public or private, or in any institution, home, or retreat for the care or treatment of the
insane, except upon the certificates of two reputable physicians under oath, appointed
by the judge of probate of the county where such alleged insane person resides, to
conduct an examination, and an order, from said judge of probate, setting forth that the
said person is insane, and directing his removal to an asylum or institution for the care
of the insane. No person shall be held in confinement in any such asylum or institution
for more than fourteen days without such certificates and order. The judge of probate
shall institute an inquest and take proofs as to the alleged insanity, before granting
such order; and said judge may, in his discretion, call a jury of six persons in each
case to determine the question of (insanity) sanity. Said jury shall be summoned and
impaneled in accordance with the law governing justices' courts. The said judge of
probate shall, if satisfactory evidence is adduced showing the alleged insane (person)
persons to be of unsound mind and in need of care or treatment in (an) any asylum,
home, or retreat, grant an order for the removal of such insane person to such
institution, there to be supported as a private patient. If from any cause such inquest
has not been held previous to the admission of such alleged insane person to the
asylum, it shall be the duty of the medical superintendent forthwith to notify the

76

NOBTHERN MICHIGAN ASYLUM.

judge of probate of the county in which said person resides of the fact of his admission
to the asylum. Immediately upon the receipt of such notification, the judge of probate
shall hold an inquest, and take proofs as to alleged insanity, such hearing to be held
within two weeks following the date of said insane person's admission to the asylum.
Said judge shall direct that two qualified medical examiners in insanity investigate the
mental condition of said alleged insane person and may, in his discretion, subpoena
other witnesses. It shall be the duty of the medical superintendent to retain such
alleged insane person under his care until such matter is determined by the judge of
probate, and an order received from said judge for his care and treatment, unless the
said medical superintendent shall determine that he is not a proper person to be so
held; and'in case the judge of probate shall deem it advisable to have the alleged
insane person present at the inquest, and his condition shall be such as to render his
removal from the institution for that purpose proper and safe, it shall be the duty
of the medical superintendent to produce such person under his own charge, or that
of a competent attendant.
SEC. 22. It shall not be lawful for any physician to certify to the insanity of any
person for the purpose of securing his admission to an asylum, unless said physician
be of reputable character, a graduate of some incorporated medical college, a permanent
resident of the State, registered according to law, not related by blood or marriage to
the alleged insane person nor to the person applying for such certificate, and shall
have been in the actual practice of his profession for at least three years; and such
qualifications shall be certified to by the clerk of the county in which such physician
resides. No certificate of insanity shall be made except after a personal examination
of the party alleged to be insane; and it shall not be lawful for any physician to
certify to the insanity of any person for the purpose of committing him to any asylum
of which the said physician is either a trustee, the superintendent, proprietor and
officer, or a regular professional attendant. The county clerk's certificate of qualification, of which there shall be one for each certifying physician, shall be in the
following form:
STATE OP MICHIGAN, )
County of
}
I hereby certify that
of
, is personally known to me as a reputable physician, and is -possessed of the qualifications required by section 22 of Act No.
135 of the Session Laws of 1885, as amended and now in force, and that, as appears byhis oath on file in my office, he is a graduate of
medical college, and that he
has been in the practice of medicine for a period of
years, and is registered according
to law.
[L. s.]
County Clerk.

The following blanks haVe been adopted for the admission of private
patients:
JUDGE OF PKOBATE'S OEDBB.
STATE OP MICHIGAN,
County of
At a session of the Probate Court for the County of
holden at the probate
office in the
of
, on the
day of
, in
the year one thousand eight hundred and
Present
,.
, Judge of Probate.
In the matter of
an alleged insane person.
To the Medical Superintendent of the Northern Michigan Asylum:
Having received the certificates of
and
duly qualified
medical examiners in insanity, appointed by this Court, by whom
of
an alleged insane person, was personally visited and examined,
and after notifying the said
of the proceedings to be taken in h—
case, and having taken the testimony of
credible witnesses, and having fully investigated the facts in the case with
the
verdict of a jury, as to the question of insanity, I, the Judge of Probate in and for
said county, do find that the said
is insane and a fit person for
care and treatment in the Northern Michigan Asylum.
It is therefore ordered that the said
be removed
to the Northern Michigan Asylum, there to be supported as a private patient.
Judge of Probate.

LAWS GOVERNING THE ASYLUM.

77

LAWS GOVERNING THE ASYLUM.
STATE or IYLICHIGAN,
Countv { BB'

Probate Court for said County.

I HEREBY CERTIFY, That the foregoing is a true copy of the original order and
certificate made by said Court.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the
Probate Court at
,.
this
day of
A. D., 18
Judge of Probate.
APPLICATION FOE ADMISSION.
To Hon
County of
The application of

Judge of Probate for the
, in the State of Michigan:
.

of the

of

in said county, respectfully shows that
who is a resident of the.
of
in said county, is insane and in need of asylum treatment: That said petitioner will
furnish a bond with sufficient sureties to the Treasurer of the Northern Michigan
Asylum at Traverse City, to guarantee payment of the expense of the maintenance
and care of the said
in said asylum.
That petitioner is
and is
well acquainted with the pecuniary circumstances of said
•__
and make this application in behalf of said
that he may be
admitted, on the certificate of said Judge of Probate, in the Northern Michigan Asylum, and there supported at private expense, according to the provisions of Act No.
220 of the Laws of 1889.
Dated
STATE OF MICHIGAN,
County of

18.
,$

the above named applicant,
being duly sworn, says that the above application by him signed, is true, as he verily
believes.
Subscribed and sworn to before me this
day of
A. D.18..__

Judge of Probate.
APPOINTMENT OF MEDICAL EXAMINEES.

STATE OF MICHIGAN,
County of
B
At a session of the Probate Court for said County of____________________held at the
probate office in the________________of__________________,on the________________day of
________________,in the year one thousand eight hundred and ________________________
Present,____________________________________, Judge of Probate.
In the matter of________________________________an alleged insane person.
Application having been made to this Court for an order for the admission of said
alleged insane person to the Northern Michigan Asylum as a private patient,
______________________________ ;_______and _________________________________
two reputable physicians, qualified medical examiners in insanity, are hereby appointed
to examine said alleged insane person, as to such alleged insanity.

Judge of Probate.

'78

NORTHERN MICHIGAN ASYLUM.
BOND.

Know all Men by these Presents, That we,
and
in the county of
, are held and firmly bound unto
treasurer of the Northern Michigan Asylum, at Traverse City, and his successors in
office, in the sum of one thousand dollars, for the payment of which we jointly and
severally bind ourselves, our heirs, executors and administrators by these presents.
WHEREAS,
of the
of
in the county of
an insane person, has been admitted as a patient into the Northern Michigan Asylum,
at Traverse City.
Now, therefore, the condition of this obligation is that if the said obligors shall pay
the treasurer of said Asylum, the sum of
dollars and
cents per
week, for the care and board of said insane person so long as
shall continue in said
Asylum, with such extra charges as may be occasioned by
requiring more than ordinary care and attention, and also provide
with suitable clothing, and pay for all
such necessary articles of clothing as shall be purchased for
by the steward of
the Asylum, a statement of which, by the steward, shall be taken as conclusive, and is
hereby agreed to by the undersigned, and remove
whenever the room occupied
by
shall be required for a class of patients having preference by law, and also
pay for all damages that
may do to the furniture or other property of said Asylum,
and for reasonable charges in case of elopement, and funeral charges in case of death;
such payments for board and clothing to be made quarterly, and at the time of removal,
then this obligation to become void, otherwise to remain in force.
Sealed with our seals and dated the
day of
,
in the year 18
Signed and sealed in the presence of ]
t ' '\
STATE OP MICHIGAN, )
County of
, $

and
of the
in said County, sureties named in the within and foregoing bond, being duly sworn
depose and say that they are each worth in unincumbered property not exempt from
execution under the laws of this State, the sum of two thousand dollars after payment
of all just debts, claims and liabilities.
Subscribed and sworn to before me, this

day of

Notary Public in and for

189 „
County, Mich.

PHYSICIANS' CERTIFICATE.
STATE OF MICHIGAN, )
County of
, \
In the Probate Court for said County.
In the matter of the application of
in behalf of
an alleged
insane person praying that he may be admitted into the NORTHERN MICHIGAN ASYLUM.
I,
a permanent resident of
in the County aforesaid, being a graduate of
, and
having practiced as a Physician
years, hereby certify under oath, that on the
day of
, 18-_, acting under the direction and by the
appointment of the Hon.
, Judge of Probate for the County of
, I personally visited and examined
of
, a1
aged
years, by
occupation a
and2
and that the said
is insane, and a proper person for care and treatment,
under the provisions of Section 21, of Act No. 135, of the Session Laws of 1885, and
acts amendatory thereto.
I further certify, That I have formed this opinion upon the following grounds, viz:
[Here insert delusions, insane conduct or other evidences oi insanity.]
And I further certify and declare, That I am not related by blood or marriage to said

LAWS GOVERNING THE ASYLUM.

79

insane person, or to the person applying for this Certificate, and that I am not a trustee,
the superintendent, proprietor and officer, or a regular professional attendant of the
Northern Michigan Asylum, and that my qualifications as a Medical Examiner in
Insanity1 have been duly attested and certified by
Clerk of
County.
(Signed)
, M. D.
Sworn to and subscribed before me, this
day of
, 18_.
1 Male or Female.
2 Married, single, widowed

or divorced.

Judge of Probate.

COUNTY OLEEK'S CERTIFICATE or QUALIFICATION*.
*See Public Act No. 220 Laws of 1889.
STATE OF MICHIGAN, )
County of
, jrss
I hereby certify, That

of
is personally known to me as a reputable physician, and is
possessed of the qualifications required by Section 22 of Act No. 135, of the Session
Laws of 1885, as amended and now in force, and that, as appears by his oath on file in
my office, he is a graduate of
Medical College, and that he
has been in the practice of medicine for a period of
years, and is registered
according to law.
County Clerk.

Patients are transferred from private to county charge in compliance
with the provisions of the following section:
SEC. 24. When an insane person in indigent circumstances shall have been maintained by his friends in the asylum as a private patient, for three months, and the
superi itendent of the asylum shall certify that he is insane and requires further treatment, the judge of probate, on application by the friends of such patient, shall determine the question of such indigence, according to the provisions of the preceding
section, with or without further evidence of the insanity, as in his discretion he may
think best, and if the indigence be established, he shall make a certificate authorizing
the admission of said patient into the asylum as a county charge, and the report to the
supervisors required by the preceding section; and the said patient, as in other cases of
indigence, shall be supported at the asylum at the expense of the county until restored
or for a period not exceeding two years.
THE REMOVAL OF PATIENTS TO THE ASYLUM.

In conveying a patient to the Asylum do not deceive him. Truth
should not be compromised by professing a visit to the Institution, and,
on arrival, suggesting to the patient the idea of staying, when his admission has already been decided upon; nor should patients be induced to
come and "stay a few days to see how they like it," under the impression
that they can leave at pleasure. This course not only destroys confidence
in friends, but also in the officers of the Asylum by giving patients an
impression that they are parties to the deception.
Removal to the Asylum should never be attempted when the patient is
much prostrated or laboring under severe bodily illness, and care should
be taken that the excitement attending accute mental disease be not
mistaken for physical strength.

80

NORTHERN MICHIGAN ASYLUM.

The attention of county officers is particularly directed to the requirements of the following section in reference to a female attendant,
clothing, etc.:
SEC, 35. All town and county officers, sending a patient to the asylum, shall, before
sending him, see that he is in a state of perfect bodily cleanliness, and is comfortably
clothed and provided with suitable changes of raiment as prescribed in the by-laws of
the asylum, and shall provide a female attendant, of reputable character and mature
age, for a female patient or patients, unless accompanied by her husband, father,
brother or son. Any person or officer who shall bring a female patient to the asylum
in violation of the last preceding provision of this section, or who shall, under the provisions of law, or otherwise, bring or accompany any patient to the asylum, and not in
due time deliver him into the lawful care and custody of the proper officer of the
asylum, taking his receipt therefor, provided he be admitted, or who shall willfully
leave, abandon, neglect, or abuse such patient, either in going to or returning from
the asylum, shall be deemed guilty of a misdemeanor, and on conviction shall be liable
to a fine not exceeding two hundred and fifty dollars or to imprisonment not exceeding
one year, or to both in the discretion of the court before which the conviction shall be
had.
REMOVAL OP UNRECOVEBED PATIENTS.-

An unrecovered patient may be removed • from the Asylum in accordance with the following by-law adopted by the Board of Trustees, Jan.
18, 1888:
An unrecovered patient supported at private or county expense may be
allowed to leave the Asylum on trial, with the approval of the medical
superintendent, under the charge of a guardian, relative or friend, and
may be received back without the formality of a new bond or order, provided, that the period of absence be not longer than six months.
CLOTHING.
As friends of patients are often in doubt as to what articles of clothing
it is necessary to provide, the following suggestions are made:
Male patients require 3 new shirts, 1 new and substantial coat and vest
2 pairs pantaloons, 3 pairs socks, 2 pairs drawers, 2 undershirts, 1 hat or
cap, 1 cravat, 3 collars, 6 handkerchiefs, 1 pair shoes or boots, 1 pair slippers, 1 overcoat.
Female patients should have 3 calico dresses, 3 chemises, 3 pairs drawers,
4 pairs hose, 3 night dresses, 3 cotton flannel skirts, 6 handkerchiefs, 4
collars, 1 pair shoes, 1 pair slippers, 1 shawl or cloak, 1 hat, hood or nubia,
4 aprons.
The outfit should be liberal when circumstances permit. As nearly all
the patients go regularly into the open air each day it is desirable that they
be furnished with clothing of a character to enable them to go comfortably
in all weather, and also to appear at little social gatherings. When
desired, articles of clothing, etc., will be furnished at the Institution.
Jewelry should not be brought with patients. If such articles are left in
their possession the Asylum cannot be responsible for their safe keeping.
CORRESPONDENCE.

All letters concerning patients, from individuals having the right to
make inquiry, will be answered at once, and'friends are promply advised

LAWS GOVERNING THE ASYLUM.

81

of any severe illness, accident, or event of moment or interest. The postoffice and telegraphic addresses of one correspondent in each case are
recorded, to whom such communications are sent. Letters are frequently
received to which replies cannot be mailed, for the reason that the postoffice address is not clearly given. A little care on the part of friends will
often save them disappointment and the Asylum unmerited censure. Information concerning inmates will not be given to casual visitors, except at
the written request of friends.
MEDICAL HISTORY.

Application for admission should be made before the patient is brought
to the Asylum, and the following facts should be furnished when possible,
in reference to his case:
1. Please state the name, residence, age, nativity, civil condition, occupation, education and religion.
2. Give facts pertaining to family history.
3.. Speak of any physical peculiarities or defects, of the habits as a child,
and later as an adult; state the temperament, disposition and tastes; the
success in business; if adicted to the use of liquor, opium or tobacco; if
the patient has any vicious habits.
4. State if the patient has ever had convulsions, or any previous attack
of insanity, the age at time of attack, its character, duration and the treatment employed; if sent to an asylum, state where, and the result of
treatment. Give the particulars of subsequent attacks.
5. State the supposed cause or causes of the attack, also any facts that
will throw light upon the case.
6. State the date of the first indication of any change in the usual condition, habits, disposition, or temper of the patient. What was the change?
What was the physical condition? Give the subsequent, history of the
attack, and the treatment employed.
7. Give full particulars of every attempt to injure self or others;
whether in any way destructive, or careless and uncleanly in habits.
8. If it has been necessary to use restraint or confinement, state in what
form and for how long a time.
9. Give present condition. Physically—whether in usual health, or
feeble and ematiated; pulse, respiration, appearance of pupils, whether
equally dilated. Voice, whether natural, or if there is any unnatural
hesitancy or stammering while speaking; appetite, sleep, digestion, hearing, sight; if there is any evidence of paralysis, or loss of power or of
control of muscles.
Mentally—if excited or quiet, pleasant or moody and irritable, the character of the delusions, how occupied during the day.
10. Give name and address of attending physician.
If the case will admit of delay, blanks for this history will be furnished
on application.
Idiots are especially excepted by law from the benefits of the Asylum,
and cannot tinder any circumstances be received.
All correspondence in reference to patients may be addressed to Dr.
James D. Munson, Northern Michigan Asylum, Traverse City.
11

INDEX.

Accounts, classification of
Accounts, current
Acknowledgments
Additional buildings, recommendations for
Admission of private patients
Admission of indigent and pauper patients „
Admissions and discharges
Age of patients. Table
Appendix
Admission of non-resident patients...
Appropriations, report on
Cottage for women
Civil conditions. Table
___
Clinical groups. Table
Classification
__
Confnsional insanity
Divine service
Duration of disease. Table.
_
Deaths, causes, etc
._
Exciting causes. Table
Farm and garden products
Farm and garden
__
Form of disease. Table
Government of the asylum
_
Heredity. Table
Hysterical insanity
Improvements
Inventory, summary of
Movement of population. Table.
„
Nativity of patients. Table
Names of officers and employes
Needs of the asylum
_
Neurasthenic insanity
__
_
Occupations. Table
_..
._
Report of trustees
Report of treasurer
.
Report of medical superintendent
Report of steward
___
Report of auditing committee
Report of State Board of Charities and Corrections
Roofs
Receipts and disbursements
Residence of patients. Table
Special appropriations
Support of patients by counties
_

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