Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1890.

Report of the Board of Trustees of the Northern Michigan Asylum at Traverse City June 30, 1890.

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, 1890. This report includes the reports of the medical superintendent, treasurer and steward.

Report of the 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 1890

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.

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Traverse City, Grand Traverse County, Michigan.

REPORT

BOARD OF TRUSTEES

NORTHERN MICHIGAN ASYLUM
SE CITY.
JUNE 30, 1890.

V-

BY AUTHORITY.

LANSING:
ROBERT SMITH & CO., STATE PRINTERS AND BINDERS.
1890.

REPORT OF THE BOARD OF TRUSTEES.

To the Governor and Legislature of the State of Michigan :
The Trustees of the Northern Michigan Asylum, in accordance with the
requirements of the law therefor, have the honor to submit their report
for the biennial period ending June 30, 1890.
Eighteen regular meetings of the Board have been held. Besides the
ordinary duties devolving upon the Trustees, the period just closed has
been fraught with much additional administrative responsibility, owing to
the erection and equipment of additional buildings for the use of patients
on the Asylum grounds. As required by the rules and regulations
governing the Hospital, a visiting committee of Trustees has inspected the
Asylum each month and reported to the Board regularly the results of
each inspection. These visitations have been of service to the Trustees,
affording them an opportunity to carefully examine every department of
the Institution, to become acquainted with patients and employes, to
consult with the officers, and to acquaint themselves with the workings of
the Hospital in detail. We feel assured that the Institution has been
conducted with integrity, and in such a manner as to insure the greatest
good to the patients and the greatest economy to the State.
The health of the Institution with the exception of an epidemic of
influenza in the early part of 1890, has been good. Although a large
number of patients and employes suffered from this disease, no deaths
resulted from it.
The Trustees would especially speak of the character of the professional
work of the Asylum. They have been pleased to note the earnestness of
the Staff in their efforts in behalf of the patients, and their desire to be
informed of every new method of treatment promising good results. The
Board have noted these efforts with approval, and to aid them have made
small appropriations from time to time for the purchase of books and
journals for the medical library. As it is unquestionably true, that every
attack of insanity is a start in the direction of mental death, it is of the
greatest moment that patients be promptly given all the benefits that
modern medicine is capable of bestowing. To attain this end, books,
journals and scientific instruments, become absolutely essential in the
work of the medical officers. For neither of our great Asylums, has the
State made provision for a medical library. This, we think, should not be
longer overlooked. Everywhere, the study and treatment of insane conditions are being pushed with vigor, and scientist physicians and alienists
are daily publishing the results of their observation and experience. We
maintain it is of the utmost importance that our Insane Hospitals should
be provided with a complete library of works and journals relating to

6

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

their special field. Heretofore, the medical officers have had to purchase
such books and journals or go without them. We believe that the State
should foster the highest scientific treatment of patients. A library, as
suggested, should not be for the use of the Asylum alone, but should be
open to the use of any physician who chose to consult it. A wider
dissemination of knowledge concerning mental diseases would thus be
favored, much to the benefit of the public.
An added experience of two years deepens the conviction that the
recovery and highest welfare of patients largely depend upon the character
of the attention received from their attendants. The attendants are the
companions and guides to those in their charge, and if they have a full
appreciation of the objects to be attained by a given method of treatment,
and strive for their attainment, their services are invaluable. We believe
the attendants, with few exceptions, have been successful in their work.
To secure and retain men and women of necessary health, character and
qualifications to assume these important duties, is one of the greatest
responsibilities placed upon the Medical Superintendent. The Trustees
feel the importance of an experienced corps of nurses, and believe the
only way by which this can be attained is to make the pay greater and the
hours of service shorter, in order that suitable persons may thus be
induced to seek such positions.
The number of patients under treatment during the period was, males
499, females 408; total 902. The number of patients received during the
period was, males 203, females 143; total 346. Of this number 300 were
admitted at county expense, as follows: Alpena 13, Antrim 7, Arenac 2,
Alcona 3, Baraga 2, Crawford 4, Charlevoix 6, Cheboygan 5, Clare 3, Delta
6, Emmet 10, Gratiot 9, Gogebic 5, Grand Traverse 10, Houghton 27,
Isabella 6, Iron 3, losco 2, Kalkaska 1, Keweenaw 2, Leelanaw 4, Lake 2,
Manistee 14, Marquette 24, Mason 6, Manitou 1, Menominee 18, Midland
8, Mecosta 19, Mackinac 4, Missaukee 2, Montcalm 18, Muskegon 18,
Newaygo 7, Otsego 1, Oceana 4, Oscoda 1, Ogemaw 4, Osceola 5, Presque
Isle 1, Roscommon 2, Shiawassee 1, Schoolcraft 3 and Wexford 10; 20
were admitted at State expense, and 26 at private expense. Twenty-seven
of these had been confined in county houses, and 80 in jails; 38 had
received treatment in other Asylums; 55 were said to have been destructive; 63 had attempted or threatened suicide; 95 had been homicidal or
threatened homicidal assaults; 4 had been treated in hospitals; and 54 had
been restrained or confined at home. Of the 346 admissions, but 98 were
recent cases; that is, in which the duration of mental disease had not
exceeded five months. Quite a large number admitted were suffering
from general paralysis, epilepsy, or from other incurable brain or constitutional diseases. The total number of patients discharged was 215; 61 were
recovered, 76 improved, 11 unimproved, and 67 died. The daily average
number of patients for the period was, 617+. The total number of weeks
spent in the Asylum by patients was, 64,445f.
The rate charged for the maintenance of each patient per day was fifty
cents. This was a decrease of two cents per day over the first half, and
one cent per day over the last half of the preceding period. In addition
to this rate there was the cost of damages done to the property and furniture of the Institution by patients, and for clothing furnished to them by
the Asylum. The latter cost during the past year about seventeen dollars
per patient.

INFIRMARY

FOR MALES, NORTHERN
T R A V E R S E CITY.

MICHIGAN ASYLUM,

REPORT OF THE BOARD OF TRUSTEES.

7

There were under treatment June 30, 1890, at State expense 466, at
county expense 208, and at private expense 13 patients.
The number of re-admissions from the opening of the Institxition to
June 30, 1890, was 38, of which 27 were within this period. The total
number of individuals treated has been 1,092. Of the 27, nine males and
nine females were discharged as improved, three males as unimproved, and
two males and four females as recovered. Of the last, one continued well
two years and six months, two, two years and three months, one, two years
and one month, one, two years and seven months and one two years and
four months. In three of the females, the second attack followed childbirth, but in the fourth the cause was unknown. In the males, it resulted
in each from intemperate habits. Out of a total of 131 recoveries, all but
these, so far as known, continue well.
At the close of the period, Alger county was supporting no patients,
Alpena 10, Arenac 2, Antrim 2, Alcona 0, Baraga 1, Benzie 0, Charlevoix
3, Clare 2, Crawford 4, Cheboygan 5, Chippewa 0, Delta 6, Emmet 3,
Gladwin 0, Grand Traverse 7, Gratiot 3, Gogebic 4, Houghton 21, Isabella
3, losco 1, Iron 3, Kalkaska 0, Keweenaw 2, Lake 0, Leelanaw 4, Luce 0,
Mackinac 3, Manistee 10, Manitou 1, Marquette 18, Mason 7, Mecosta 12,
Menomlnee 13, Midland 5, Missaukee 1, Montmorency 0, Muskegon 14,
Montcalm 11, Newyago 5, Oceana 2, Ogemaw 3, Ontonagon 0, Osceola 4.
Oscoda 1, Otsego 1, Presque Isle 1, Boscommon 2, Schoolcraft 2, Wexford
3, Shiawassee 1.
As a progressive measure of care for the insane, we need not especially
dwell upon the advantages of the cottage system. It has become a fact in
the experience of Asylum management in this State, that certain patients
can be treated and supported in buildings planned and furnished like
ordinary dwellings as well as in the more costly congregate Asylum.
While the cottage system tends in no way to lower the standard of treatment, it is to the financial advantage of the State, and affords, as well,
much more liberty and greater comforts to the patients. At the time of
the last report, the cottage for males was not yet completed, but it was
thought that the appropriation would be sufficient to complete it in
accordance with the plans adopted. It was opened January 7, 1889, and
thus far no accident has occurred to patients. Only able-bodied men are
committed to it. They have worked regularly on the farm, and have
accomplished a large amount of work. Occasionally, a patient becomes
disturbed and has to be brought back to the main building, although such
transfers are comparatively rare. The building was erected for fifty
patients, although it accommodates fifty-six. The appropriation was for
$13,000.00. The actual cost of the building, completely furnished, was
$13,800.00.
The additional cost was in part incurred by carrying the
ventilating pipes out to the open air as suggested by State Board of
Health, and in putting in two boilers instead of a single one, as originally
contemplated.
SPECIAL APPROPRIATION, $30,000.00.

This appropriation was made by the last legislature for the purpose of
building and furnishing, ready for occupancy, an infirmary for thirty male
patients and one for thirty female patients. The infirmaries are located in
the rear of the main building, and are connected with the middle division
of each wing, respectfully, by covered corridors, the one on the male side

8

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

being sixty feet in length and the one on the north side about eighty feet
in length. As the infirmaries are in duplicate, it will only be necessary to
describe one.
The male infirmary is 102 feet in length, and has an average breadth of
about 45 feet. The basement is 8 feet in height, and contains the heating
apparatus. The first story is 12 feet in height and contains nine sleeping
apartments for patients, an attendants' room, a dining room and small
kitchen, clothes room and bath room, two water-closets, two stairways
connecting with the upper stories and one with the basement. The dining
room is for the use of the entire building. An especial feature is isolating
rooms for the care of the acutely ill and those that may suffer from contagious and infectious diseases. They are entirely separated from the main
hall by a small corridor from which they open. These rooms are supplied
with a special water-closet, wardrobe, and clothes shaft. By these arangements, patients can be treated for any length of time without necessarily
coming in contact with others. Soiled clothing, surgical dressings, etc.,
can be removed without danger of giving rise to infection. There are four
of these rooms. The heating and ventilation of them are distinct, and all
their sanitary appliances are of the most improved kind. Another feature
is the special kitchen. The female nurses employed prepare diet for the
sick, and thus secure to them more homelike care than was formely
possible. The second story is of the same general arrangement as the
first, except that over the dining room and kitchen there are small dormitories. The third story is finished off into sleeping apartments for the
night-nurses. The infirmary has a stone foundation and a brick superstructure. It has constructed in an outer wall a pipe shaft, by which is
obviated the necessity of running sewers under any part of the building.
This arrangement has been especially approved by the State Board of
Health, and also by others interested in sanitary matters. The sewer connects with the asylum system. At a point where the sewer enters the pipe
shaft, it is ventilated by means of an iron pipe which extends above the
roof. All the waste pipes are separately trapped, and each trap is ventilated to the open air above the roof. Automatic flushing tanks are used,
and the bath-tubs are of iron. The building is warmed by steam and
lighted by electricity. It was originally designed to place an independent heating apparatus in each of the infirmaries, but disastrous fires
occurring in asylums in various parts of the country led to a change of
plan. It was, after much consideration, determined to add a boiler to the
plant and carry steam to the buildings through large mains. By this
change, the danger from fire is lessened, and besides, the buildings can be
warmed more economically than from small heating apparatuses. The
ventilation is effected by means of separate and continuous flues from each
room to the open air above the highest point of the roof. Wherever
practicable, the foul air outlet is placed under a window or in an outer
wall. A flue passes thence under the floor to an inner wall and empties
above the roof, as described above. This system of ventilation is very
efficient.
The items of cost of the infirmaries were as follows:
Stone ..
Wages
Lumber
Stone window sills and water table
Brick _.

$413 61
11,257 20
3,473 17
570 76
5,013 73

COTTAGESFOR M A L E S , N O R T H E R N

M I C H I G A N ASYLUM,

T R A V E R S E CITY.

RBPOET OF THE BOARD OF TRUSTEES.
Paints, etc
Hardware, nails, etc
Lime and cement
Heating pipes and
Slate
Plated ware
Wire window screens
Beds, furniture and mattresses
Electric light
Sash and Glass
Dumbwaiters
_ __
Locks, etc
Tile..

fittings

__

,:
;.

Total

$64 08
896 12
1,150 42
3,055 32
1,029 18
120 00
291 34
504 50
91020
648 88
5200
313 17
45 23
130,000 00

With the exception of the cost of the additional boiler above mentioned,
which in fact forms a part of the original plant, the infirmaries were completed within the amounts of the appropriation. The infirmaries are very
perfect in their appointments, and the State can well be proud of them.
The male infirmary was opened on the 10th of March, 1890, and the female
infirmary on the 25th of April. It is designed to treat in these hospitals
the acutely ill and those that require very careful medical supervison and
treatment, and special watching and nursing. They have rounded out the
Institution, and have enabled us to adopt the methods that are commended
the world over to so individualize patients that they can receive the most
thonragh medical care. Quite a large number of patients have already
been cared for in them, and the results obtained have been eminently
satisfactory. They are neatly furnished, and their interiors resemble much
that of an ordinary dwelling.
SPECIAL APPROPRIATION, ttS.OOO.

This appropriation was granted by the last Legislature for the erection
and equipment of a cottage for fifty male patients. As it is similar in plan
and construction to the cottage described in the previous report, further
detail will be omitted here. It is located about three hundred feet south
of the present cottage for males. It will contain, exclusive of basement
and attics, 83,000 cubic feet of space. It will be heated by a low-pressure,
automatic, steam-heating apparatus, and lighted by electricity. It is not
yet finished, but will be furnished ready for occupancy within the amount
of the appropriation.
These buildings were put up under the general direction of the Board,
and special direction of the Medical Superintendent. Mr. C. M. Prall, the
architect, superintended their construction, and we are much indebted to
his intelligent and zealous oversight for the rapid, economical and substantial manner in which the work was finished. Mr. Bauld, who superintended the plumbing, heating and lighting of these buildings, completed
his work in the most efficient and satisfactory manner.
THE FARM.

The improvement of the farm has been steadily pressed forward during
the period. Much of the timber has been cut, and much of the labor of
the last season was expended upon stumping, fencing, ditching and tiling.
The receipts from the farm during the period were $13,012.70 and the disbursements for the same time were $16,035.35. The excess of the disburse2

10

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

ments over the receipts is accounted for by the fact that the farm is new
and required much outlay in its development. Without attempting to
itemize every expenditure, we may say that additions to the farm buildings
have cost about $1,000, and that new fences, tiling, etc., have cost nearly as
much more. In addition to these expenditures, the dairy has been
enlarged by several cows, and two spans of horses have been purchased
and charged to the farm. The Trustees would recommend, for the careful
consideration of the Legislature, the desirability of increasing the acreage
of the asylum-farm. A vast amount of patient labor can be utilized in
clearing, and other farm work, and it will only be a comparatively short
time before this work will be finished unless the farm is enlarged. Lands
can be purchased adjoining the Asylum premises at reasonable rates, and
we believe it would be wise policy to secure additional lands in the near
future. The timber on such lands would nearly pay the purchase price
and further, if the Institution is to be enlarged by the erection of cottages,
it will be absolutely necessary to extend the grounds to provide suitable
sites for them.
GROUNDS.

The grading has been finished in front of the Asylum, and but little
remains to be done about the Institution. Many trees and shrubs have
been planted to ornament the lawns. There is yet much ornamental
gardening to be done although the grounds are rapidly growing in attractiveness and beauty.
CONDITION OP ROOFS.

We would again call attention to the condition of the roofs of the
Asylum. Much damage has resulted to the building from ice and snow
accumulations, and thus far, for lack of means, we have not been able to
prevent it, except in a few places where experimental repairs have been
made. It is absolutely necessary, if the building is to be saved from
further damage, that this subject should receive prompt attention from the
Legislature. An appropriation of $5,000.00 is respectfully requested with
which to effect, in part at least, necessary changes in the roofs and gutters,
to overcome the evil, as recommended in plans submitted by Mr. G. W.
Lloyd of Detroit.
RECEIPTS AND DISBURSEMENTS.

The total receipts of the Asylum from July 1, 1888, to June 30, 1889,
including $5,500.00 of the special appropriation for detached cottage for
males, have been $121,719.75, and the total disbursements for that fiscal
year, including the amounts expended of special appropriations were
$119,819.12.
The total receipts of the Asylum for the fiscal year ending June 30,
1890, including $45,000 from the special appropriations for detached
cottage for males and infirmaries, have been $176,090.38, and the total
disbursements for the same period, including the amounts expended of
special appropriations, have been $170,519.77. There was at the close of
the year June 30, 1890, $15,127.97 in the hands of the treasurer to the
credit of the current expenses of the Asylum, and $1,956.73 to the credit
of detached cottage for males fund.

KEPOKT OF THE BOAED OF TRUSTEES.

11

During the period, a cold storage-room for meat and butter was erected
at a cost of $678.50. The original cold-room proved not only too small, but
very imperfect. The storage ice melted rapidly, and it was difficult to
keep meats from spoiling during warm weather. The new building,
although small, is perfect in its workings, and there is no difficulty in
keeping a two weeks' supply of meat during the hottest weather.
The original root cellar threatened to cave, which rendered it necessary
to wall it with stone. The cost of this improvement was $353.47.
A new ironing machine was purchased of 8. H. Sinclair of Chicago, at a
cost of $200.00. This machine is easily operated and does most excellent
work.
Owing to increasing requirement, the kitchen range was enlarged by the
addition of a section, at a cost of $200.00.
FIBE PROTECTION.

The Trustees deem it of the greatest importance that the attention of the
Legislature be called to the fact that the amount of water for fire protection is dangerously inadequate under the present system of its storage.
The cisterns and tanks can be emptied within a very few minutes, and in
case a fire should occur and get much headway, it would be impossible to
prevent its spread. The fire protection apparatus, consisting of fire pump,
hydrants, ladders, and hose both in and out of the buildings, are quite
sufficient. What is required to make the system more surely effective is to
secure a full suppy of water. This can be very easily accomplished by
building a reservoir in connection with a stream which flows through the
grounds at a point one hundred and sixty rods west of the Institution.
Between this and the building, there is a fall of eighty-nine feet. The
estimated cost of constructing such a reservoir, and connecting it with the
fire-pump and with the various hydrants and water-pipes throughout the
building is as follows:
2,640 feet eight-inch cast iron pipe
Lead and yarn for joints
Two eight-inch water gate valves
Sixty cords stone, laid
Fencing
Sewer pipe
Tees, valves, etc. _
Labor
Hydrants and connections
Total

$3,230 00
220 00
100 00
720 00
150 00
50 00
500 00
800 00
230 00
$6,000 00

The Trustees would especially urge and recommend an appropriation of
$6,000 for this specific purpose. The numerous fires which have recently
occurred in asylums demonstrate not only the constant liability to such
accidents, but that the loss of life may be apalling, to say nothing of the
loss of property caused thereby. In some of these cases it has been found
that the fire protection apparatus was either unserviceable, or that the
water supply failed at a critical time. We have an organized fire department, but feel that it is an important duty on the part of the State to
afford the Institution the most perfect protection attainable.

12

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
RECOMMENDATIONS EOK ADDITIONAL BUILDINGS.

The Trustees in their last report gave some statistics to show what probable increase of insanity would be in the district during the next two
years. It was there claimed that 750 insane people would require care in
this Asylum district by 1890. Basing their recommendations on these
statistics, they relunctantly suggested an appropriation for the infirmaries
and for a male and female cottage. There are now under treatment 687
patients, and by the close of 1890, 750, the number previously estimated,
no doubt will be reached. It is to be regretted that the present census is
not so far completed as to enable a comparison between the actual growth
and the estimate of two years ago. From what can be learned, however, it
appears that the increase of population in this district has been very great
during the last ten years. As only room exists, including the new cottage,
for about sixty patients, the Board deems it a duty to again suggest, for
the careful consideration of the Legislature, an appropriation for a cottage
for fifty male patients, and an appropriation for an extension to the North
wing for the accommodation of ninety female patients. The Trustees have
considered the matter carefully, and feel that a semi-detached extension of
the Asylum, for women, would be more desirable than a separate cottage.
The per capita cost, however, of such an extension would be somewhat
greater, as it would necessitate the erection of a structure to correspond
with the architecture of the main building.
CAEE OF THE INSANE.

The public charities of a State may be regarded as an index of its philanthropy and of the moral principles underlying its social life. Although
the extension of our Asylums has been rapid, yet it has scarcely kept pace
with the requirements for such Institutions. For nearly thirteen years,
the commitment of insane to asylums has been compulsory, and during
this time improvements have been made which have brought about the
present state of completeness of our system of care. Diiring these years,
it has been illegal to confine insane persons in any jail or almshouse.
Provisions for the insane have not only been in the direction of better
accommodations, but for the prevention and curative treatment of mental
diseases. If we compare present methods of treatment with those that
existed a few years ago, it is clearly evident that great advances have been
made. The insane were often kept in dens of the vilest description, where
vice, crime and misfortune flourished, and where disgusting diseases, filth
and vermin, were not uncommon. If we compare the medical treatment of
those years with that of today, we find quite as much progress has been
made as in the moral treatment. Great additions have been made to our
knowledge of mental diseases within the past few years, and the treatment
of these disorders is constantly attaining a more scientific basis. In our
judgment, it is of the highest importance that the policy of care and treatment of the insane now pursued by the State, be continued and strengthened, if possible. Although this policy may not be perfect, it is harmonious and consistent, economical, affords the same care to the rich and
poor, and favors no locality. It also affords what is so essential,—publicity
of care, and thorough supervision of the insane. Not until recently have
there been any to question the wisdom of this policy. Recently a county
asked the right to maintain its own Asylum. We fail to comprehend how

REPORT OF THE BOARD OF TRUSTEES.

13 •

the welfare of its insane would have been better subserved had this been
ranted. During the period it exempted its patients from the State
nstitutions, it accumulated a large number of patients in its Asylum who
were, if we are correctly informed,—non-residents,—not entitled to support in any county of the State of Michigan. It has been held that the
counties should be chargeable for the maintenance of patients, and that
the law transferring to State maintenance, after two years of county support, should be repealed. We believe this law has many practical advantages. It has tended to early treatment, and has thus been a great factor
in checking the accumulation of chronic cases. Do we not know that
many patients at the time of admission, are incurable? No doubt many of
these would recover if Asylum treatment were begun sufficiently early, but
not in all, because there are cases "foreordained to mental death," no matter what skill may be brought to bear in their treatment. The repeal of
this law would bring hardships to the insane, and be followed, we believe,
by a rapid increase of chronic cases. Counties could then assume the care
of cases, and soon, we would revert to conditions of mixed care as they
existed previous to the enactment of 1877. We need not enter into the
evils arising from county care of the insane. The difference between it
and State care is only a question of dollars and cents; and we have no
faith in a philanthropy that only counts its money cost. It is more expensive in the end than one that aims at the highest alleviation of human
suffering. That county care is more economical than State care, we feel,
too, is a delusion. In New York, it was shown by the only county keeping
separate accounts for the maintenance of its insane that the cost was as
great as that charged for the support of patients at the Willard Asylum.
If the cost of couty Asylums, farms, buildings, and management of same,
etc., could be accurately shown, we doubt not that the expense of supporting patients in them would be greater than for better accommodations under
State supervision. We should regret to see our State descend from the
eminence of humanity she has attained in the care of her mentally
afflicted, to a less perfect system. The State should aim, in this charity,
as in all her charities, at perfection. The alleviation of family distress, the
protection of society, and the prevention and cure of insanity, has been
largely secured by her existing policy.
Between 1870 and 1880, there was an increase of insanity over the
growth of population, of about two hundred per cent, while from 1880 to
1889, under compulsory commitment to our Asyhims, notwithstanding
every type of mental disease has been treated, the net increase of insanity
will probably not exceed seven per cent, while the growth of popxilatioii
during that period will, at least in this district, exceed twenty-five per
cent. If the methods of the last decade are compared with those of the
one preceding it, it would seem that many beneficient results had been
secured to the mentally diseased by this charity. In 1880 there was 2,796
insane people in the State. There are now in the Asylums, including
epileptics, 2,744 patients, of which 2,543 are supported at public expense.
It was estimated upon most careful inquiry, at the time this Asylum was
opened, that there was 3,000 insane people in Michigan. 2,744 are now in
Asylums, to which add 256 for those in various ways cared for elsewhere,
and 7 per cent of increase since the census of 1880, and it gives about
3,200 insane people in the State. What State can present a better showing
than this? New York is overwhelmed with the yearly increase of her
insane, and other States are groaning under similar burdens.
What

f

14

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

further provisions for the insane are to be recommended? The by-law of
the Asylums governing the discharge of unrecovered patients, practically
takes the place of the boarding-out systems of Massachusetts and Scotland, and that withoiit their disadvantages. It affords careful selection of
cases, places them under the guardianship of relatives and friends, and
relieves the county and State of their support and also of the cost of their
direct supervision. It would seem that nothing more in behalf of the
quiet, but chronic, insane could be desired by the public. It would be
impossible in the sparsely settled districts of Northern Michigan, to board
out patients, even if it were desired so to do, without great difficulty and
to adopt the system woiild be more expensive than it now is to maintain
patients in the Asylum. The mixed system, as carried out in Wisconsin
and in many of the States, and as recently abandoned in New York, is not
to be recommended. As we have seen, there are probably about 500
patients in excess of the present asylum accommodations.
In view of the good results obtained by the present system of care,—by
holding in check the increase of mental disease; by relieving families and
communities of distress and danger; by placing patients in comfortable
homes; by caring for them at a constantly lessened expense—it would
seem to the highest interest of the public, both from a humanitarian and
economical standpoint, to continue it. For this purpose, our coming
Legislature is requested to make necessary appropriations for the erection
of additional accommodations in connection with this Asylum,' to provide
for the cases that will occur in this district during the next three years.
The institution can be enlarged to this extent or more without endangering its greatest usefulness, although the necessity for a new Asylum
should not be overlooked, if no break is to take place in our present
system of caring for the insane.
It having been asserted that certain patients in our Asylums do not
actually need Institutional care, we have caused a careful investigation of
the mental status of the patients under restraint in this Institution to be
made in order to determine if there were any who could be safely placed
in the custody of friends. It may not be generally known that the by-laws
governing the Asylums permit unrecovered patients, able to safely reside
with relatives or friends, to be discharged to their care, provided such
friends or relatives can furnish satisfactory evidence that they are able to
assume such a responsibility. This provision provides a satisfactory
method of accommodation for a certain number of patients, and prevents
the accumulation of the so-called harmless and quiet lunatics in our
Asylums; and, we may say, also stands in refutation of the allegation that
insane persons are maintained at public expense that could just as well be
cared for otherwise. At this Asylum patients are cared for so long as
treatment improves them, but tidy, demented patients, without active
delusions or recurrent attacks of mental excitement, and in whom the
mental condition is stationery, are allowed to go home in keeping with the
above resolution. No direct harm has resulted to the public from this
practice, but on the other hand, we know of 110 instance where permanent
mental improvement has followed. Some have been returned, and in such
it is always noticeable that a lowering of the mind has occurred, or that a
more hopeless degree of dementia has been induced. If the latter is true,
then there has resulted indirect harm to the public and an irreparable

REPORT OF THE BOARD OF TRUSTEES.

15

injury to the individual. The following statistics will show the mental
status of the patients under treatment here:
Total number of patients
Number of patients suffering from chronic mental disease who
are, in the opinion of the medical officers, harmless under Asylum
influences

633
219

Of the two hundred nineteen twenty-three are erotic, or have sexual
delusions, or have sexual perversions. Forty-seven possess tendencies to
degradation, and are only kept clean and comfortable by personal attention of the day and night nurses. From a purely economical view, this is
the most expensive class of the insane, as the constant care required only
ends with the death of the patient. Many of this class at times are noisy
and destructive.
Three are alcoholic dements; i. e., the existing mental impairment was
induced by prolonged alcoholic indulgence.
Eighteen are relapsing cases, but during lucid intervals present marked
evidences of dementia.
Thirty-five are suffering from pronounced dementia, and are without
family or friends. Many of these could be classified with those possessing
tedencies to degradation. All require more or less personal care; i. e.,
assistance in dressing, bathing, etc.
Eight are epileptic. These patients were extremely demented when
admitted, and all were said to have been violent.
Eight possess vagrant tendencies. These patients avail themselves of
every opportunity to escape. If successful, they simply wander aimlessly
about, find lodgings in barns, or lie out. if at home, the same tendencies
exist.
Sixty-four are unable, by reason of delusional dementia, to reside at
home, or anywhere, comfortably, unless with attendants' care.
Thirteen are senile cases. No class of lunatics is more troublesome or
more deserving of Asylum protection than this.
In the above groups, no patient is counted more than once, although
large numbers of them pertain to two, three, four, or more classes.
Of the two hundred nineteen patients:—
Forty-nine were formerly homicidal, or threatened homicide.
Seventeen were suicidal.
Three were both homicidal and suicidal.
Eight are imbeciles.
Six are private, or pay, patients.
Seventy-seven are actively hallucinated.
Sixty-four are chronic delusional cases, but not hallucinated.
Thirty-nine were, and are, dirty in their habits.
Forty-eight are above the age of sixty, and though not all classed as
senile cases, not one of these individuals could be cared for at home. A
large percentage of these suffer from secondary delusional insanity, and
are harassed by the most active form of delusions. The oldest man in the
Institution, now past eighty, is one of the most irritable, violent, and
troublesome patients here.
In the above groups, many of those formerly homicidal or suicidal are
now hallucinated or deluded; hence are counted more than once.
Although imbeciles are excluded by law from Asylum care and treat-

16

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

ment, owing to a lack of an Institution in the State to care for them, and
owing to the violence, licentiousness and degradation of these unfortunates,
they are cared for here. It would be cruel to force these creatures back
upon their friends, and wrong to expose them to the dangers of personal
freedom.
From the above, it will be observed that we have no cases that can safely
reside outside the Institution. Every patient who has reached a stage
where we feel this can be attempted, we urge his removal on trial by
friends, as provided for by our by-laws.
In December, 1889, Dr. Henry Hulst resigned his position of assistant
physician in order to engage ill private practice in the city of Grand
Rapids, and Dr. J. H. Dawson, Assistant Medical Superintendent resigned
his position in April last to enter private practice at Marquette, Mich.
Dr. I. L. Harlow, of Brooklyn, N. Y., was appointed in June, 1890, to the
position of assistant physician, and in June, 1890, Dr. G. C. Crandall, of
Linden, Mich., was appointed acting assistant physician.
In February, 1890, the Chaplaincy was made vacant by the death of
Rev. Dr. Van Alstine. Dr. Van Alstine's loss was keenly felt by the
Trustees, officers, employes and patients alike, as he was much respected
for his kindly impulses and great integrity of purpose. The Rev. Demas
Cochlin, of Traverse City, Mich., was subsequently appointed, to the position of acting chaplain.
Dr. C. G. Chaddock, who was absent in Europe for one year, returned
early in 1889, and at a recent meeting of the Board he was promoted to
the assistant medical superintendency of the Asylum.
With the Medical Superintendent and his assistants rests the important
trust of the direct care of the patients and the immediate administration of
the affairs of the Institution. Upon the faithful and intelligent performance of the varied duties devolving upon these officers depends, in very
large measure, the success of the Institution, both from a humanitarian
and a financial standpoint.
The trustees desire in this public manner, to again express their entire
confidence in the ability and integrity of the Medical Superintendent, whose
eminent fitness for the important position he occupies is only made more
apparent as time goes on, and to him, and his very able corps of assistants,
the trustees desire to express their thanks for the earnest and successful
efforts they have made to ameliorate the physical and mental condition of
the patients in their care.
We would also express, to the attendants and other employes, in all departments of the Institution, our satisfaction with the manner in which their
respective duties have been discharged. There seems to have been an
earnest desire upon the part of all to do well what has devolved upon them
to do.
THOS. T. BATES
H. H. NOBLE
GEO. A. FARE
VARNUM B. COCHRAN
LORIN ROBERTS
JOHN BENJAMIN
Trustees.
TRAVERSE CITY,
June 30, 1890.

TREASURER'S REPORT.

ABSTRACTS
OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT
THE NORTHERN MICHIGAN ASYLUM, ON ACCOUNT OF CURRENT
EXPENSES FOR THE FISCAL YEAR ENDING JUNE 30, 1889.

THE STATE OF MICHIGAN, In account with G. A. Crawford, Treasurer of Northern
Michigan Asylum,, for month ending July 31, 1888,
By balance on hand July 1, 1888

$9,«18 ,IH

Gash from State Treasury:
Account of officers' salaries: _ _
Cash from earnings of Institution

],671 88
26,363 67

To disbursements:
Account of officers' salaries
Account of Detached Cottage No. 1
Account of current expense
Balance on hand to new account July 31, 1888

___
_

.$87,649 01

$1,67188
2,041 82
7,186 Ofi
26,749 25

THE STATR OP MICHIGAN, In account with G. A. Crawford, Trewnirur of Northern
Michigan Asylum, for month ending August HI, 1888.
By balance on hand August 1, 1888
Cash from earnings o f Institution

_

_

_

To disbursements:
Account of Detached Cottage No. 1
Account of current expense
Balance on hand to new account August 31, 1888

_

_

_

_

_

$26,749 25
1,145 4 1

$2,032 41
7,987 74
17,874 51

.137,894 66

$27,894 66

18

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending September 30, 1888.
CREDITS.
By balance on hand September 1, 1888
('ash from earnings of Institution

$17,874 51
911 09
- $18,785 60
DEBITS.

To disbursements:
Account of Detached Cottage No. 1
Account of current expense
Balance on hand to new account, September 30, 1888

$999 79
7,515 88
10,269 93

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending October 31, 1888.
CREDITS.

By balance on hand October 1, 1888_______________,_____________________________________$10,269 93
Cash from State Treasury :
Account of officers' salaries
_ _ _____ ________________________________ 1,94337
Account of Detached Cottage No. 1_____________________________________......-.
5,500 00
('ash from earnings of Institution _
26,247 42
- $43,960 72
DEBITS.

To disbursements;
Account of officers1 salaries
_ .. _ ......... _____ .......... __________________ $1,94337
Account of Detached Cottage No. 1_____________________________________....._______2,030 66
Account of current expense________________________________________________________18,516 34
Balance on hand to new account, October 31, 1888
21,470 85
- $43,960 72

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending November 30, 1888.
CREDITS.
By balance on hand November 1, 1888_________________________________________________$21,470 35
Cash from earnings of Institution - . .
________
725 86
-$22,196 21
DEBITS.

To disbursements:
Account of Detached Cottage No. 1_________________________________________________$1,487 18
Account of current expense,.____________________......____________________________8,771 26
Balance on hand to new account, November 30, 1888. .
_
_.*,..
______
11,93777
-$22,196 21

THE STATE OF MICHIGAN, In account with C. A. Craw-ford, Treasurer of Northern
Michigan Asylum, for month ending December 31, 1888.
CREDITS.
By balance on hand December
lecember 1,1888
tigs of Institution.
Cash from earnings

—

$11,937 77
1,15356

$13,091 33

DEBITS.

To disbursements:
Account of Detached Cottage No. 1__
Current expense
Balance on hand to new account December 31, 1888 -

:

$1,333 44
7,485 37
4,272 52

$13,091 33

REPOBT OF THE TREASURER.

19

THE STATE OF MICHIGAN, In account with C. A, Crawford, Treasurer of Northern
Michigan Asylum, for month ending January 31, 1889.
CREDITS.
By balance on hand January 1, 1889
Cash from State Treasury:
Account of officers' salaries
Cash from earnings of Institution

$4,272 52
1,862 50
28,04894

To disbursements:
Account of officers' salaries
Account of current expense
Balance on hand to new account, January 81,1889

$1,862 50
8,562 29
23,759 17

$34,188 96

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending February 28, 1889.
OKED1TS.

Bybalanceon hand February 1, 1889
Cash from earnings of Institution

$23,759 17
1,47569

_

To disbursements:
Account of current expenses
Balance on hand to new account February 28, 1889

$6,902 17
18,332 69

$25.234 86

$25,234 86

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending March 31, 1889.
CREDITS.
By balance on hand March 1, 1889
Cash from earnings of Institution

$18,332 69
94845

To disbursements:
Account of current expense
Balance on hand to new account, March 31, 1889...

$7,969 84
11,311 30

$19,281 14

$19,281 U

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending April 30, 1889.
CREDITS.
By balance on hand April 1, 1889.,.
Cash from State treasury:
Account of officers' salaries .".-.
Cash from earnings of Institution

To disbursements:
Account of officers' salaries
Account of Detached Cottage No. 1
Account of current expense
Balance on hand to new account, April 30,1889

$11,311 30
1,862 50
27,46062

-

... -

$1,862 50
13 45
7,61459
31,143 88

$40,634 42

$40,634 42

20

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

THE STATE OF MICHIGAN, In account with G. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending May SI, 1889,
CREDITS.

By balance on hand May 1, 1889
(lash from earnings of Institution

_

.$81,148 88
1,43452
-

_ ^

To disbursements:
Account of current expense
Balance on hand to new account, May 31, 1881L,

$32,578 40

$13,073 02
19,50538
- $82,578 40

..

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum for month ending June 30, 1889.
CREDITS.
By balance on hand June 1, 1889
Cash from earnings of Institution _ _ _ _

_.__

To disbursements:
Account of current expense
Balance on hand to new account Juno 30, 1889

v_

__

:

_ .

$19,505 38
304 52

$8,295 81
11,51409

» 90

$19,809 90

THE 'STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer Northern
Michigan Asylum, for fiscal year ending June BO, 1889.
CREDITS.
Balance on hand July 1, 1888__________________________________________________________$9,613 46
('ash from State treasury:
Account of officers' salaries_____________________________________________________7,340 25
Account of Detached Cottage___________________________________________________5,500 00
Cash from earnings of Institution.....______________________________________116,21975
--$138,673 46
To disbursements:
Account of Detached Cottage No. 1____________________________________________$9,938 75
Account of officers' salaries. . . . .__________________________________________. . . . ._ _
7,340 25
Account of current expense.___________________________________________________109,880 37
Balance on hand to new account June 30, 1889
__
11,514 09
-$138,673 46

REPORT OF THE TREASURER.

21

ABSTRACTS
OF ACCOUNTS CURRENT OF THE RECEIPTS AND DISBURSEMENTS AT
THE NORTHERN MICHIGAN ASYLUM, ON ACCOUNT OF CURRENT
EXPENSES. FOR THE FISCAL YEAR ENDING JUNE 30, 1890.

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending July 31, 1889.
By balance on hand July 1, 1889
Cash from State treasury:
Account of officers' salaries
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Cash from earnings of Institution...

$11,514 09

.

To disbursements:
Account of officers' salaries
Account of Infirmary Buildings- . ,
.... .
Account of detached Cottage No. 2
Account of current expense
.
-.. - - _ r
Balance on hand to new account July 31. 1889
1

1,94688
4,200 00
800 00
28,75983

$1,948 88
39491
90 11
7,635 37
37,153 53

$47,220 80

$47,220 80

THE STATE OF MICHIGAN, In account with G. A. Craicford, Treasurer of Northern
Michigan Asylum, for month ending August 31, 1889.
CBEDITS.

By balance on hand August 1, 1889
Cash from earnings of Institution

$37,153 53
1,39748

To disbursements:
Account of Infirmary Buildings.
Account of Detached Cottage No. 2
Account of current expense
Balance on hand to new account August 31, 1889.__

$3,628 86
448 39
8,447 74
26,031 02

$38,551 01

$38,551 01

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending September SO, 1889.
OBEDITS.
By balance on hand September 1,1889
Cash from State treasury:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Cash from earnings of Institution...

$26,031 02
10,750 00
8,075 00
433 82

$40,289 84

DEBITS.

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of current expense
Balance on hand to new account September 30,1889 .

$2,929 70
239 26
7,357 56
29,76832

$40,289 84

22

NORTH BEN MICHIGAN ASYLUM FOR THE INSANE.

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum for month ending October 31, 1889.
CREDITS.
By balance on hand October 1,1889
Cash from State treasury:
Account of officers1 salaries
Cash from earnings of Institution

$29,768 32
2,887 50
7,848 24

,$39,949 OB

DEBITS.

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of officers' salaries
Account of current expense...
__ _
__ _ .
Balance on hand to new account. October 31, 1889

$7,235 06
2,723 05
2,837 50
18,881 25
13,772 20

__

$39,949 06

THE STATE OF MICHIGAN, In account with C. A. Craivford, Treasurer of Northern
Michigan Asylum, for month ending November 30, 1889.
CREDITS.

By balance on hand November 1, 1889
Cash from earnings of Institution

__

To disbursements:
Account of Infirmary Buildings ...
-.- Account of Detached Cottage No. 2
Account of current expense
Balance on hand to new account. November 30.1889

..

_ _

$13,772 20
22,85298

$3,08401
4,073 09
12,213 62
17,254 46

$86,625 18

$86,625 18

THE STATE OF MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending December 31, 1889.
CREDITS.

By balance on hand December 1, 1889
Cash from State treasury:
Account of Infirmary Buildings
Account of detached Cottage No. 2
Cash from earnings of Institution...

$17,254 46
7,300 00
3,300 00
21550

.

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of current expense
Balance on hand to new account, December 31. 1889

$1,772 20
634 43
9,026 64
16,636 69

..

THR STATE OF MICHIGAN, In account ivith C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending January 31, 1890.
CREDITS.
By balance on hand January 1, 1890
Cash from State treasury:
Account of officers' salaries
Cash from earnings of Institution

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of officers' salaries
Acconnt of current expense
Balance on hand to new account January 31,1890

$16,63669
2,312 23
34,129 40

.

$2,712 88
860 02
2,312 236,883 98
40,809 26

$53,078 32

$53,078 32

REPORT OF THE

TREASURER.

23

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending February 28, 1890.
CREDITS.
By balance on
Cash from
Account
Cash from

hand, February 1. 1890
State treasury:
of Detached Cottage No. 2
earnings of Institution

$40,809 26
.

;

To disbursements:
Account of Infirmary Buildings
...
Account of Detached Cottage No. 2
Account of current expense.. ... __
Balance on hand to new account February 28, 1890

_

4,000 00
2,307 41

..

....

$4,774 53
1,625 87
11,82149
28,894 78

_.

$47,116 67

$47,116 67

THE STATE OP MICHIGAN, In account with C. A. Crawford. Treasurer of Northern
Michigan Asylum, for month ending March 31, 1890.
CREDITS.
By balance on hand March 1, 1890
Cash from State treasury:
Account of Infirmary Buildings
Cash from earnings of Institution _

$28,894 78
...

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of current expense
_
...
Balance on hand to new account March 31, 1890

7,750 00
853 04
- $37,497 32

_

_

.
,

$2,44032
301 62
H,189 58
28,566 30

_

$37,497 82

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending April 30, 1890.
CEEDITS.
By balance on hand April 1, 1890
Cash from State treasury:
Account of officers' salaries
Cash from earnings of Institution

$26,566 30
2,338 15
29,591 57

To disbursements:
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of officers' salaries
Account of current expense
_ _
... ...
Balance on hand to new account, April 30, 1890

..

$],027 58
536 55
2,338 15
15,013 78
. 39,579 96

.

$58,496 02

$58,496 02

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending May 31, 1890.
CREDITS.

By balance on
Cash from
Account
Cash from

hand May 1, 1890
State treasury:
of Detached Cottage No. 2
earnings of Institution

To disbursements:
Account of Detached Cottage No. 2
Account of current expense
_
_._---.
Balance on hand to new account. May 31, 1890

$39,579 96
3,825 00
2,071 02

_

_ ._ _

_

$514 32
13,760 68
81,200 98

$45,475 98

$45,475 98

24

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for month ending June 30, 1890.
CREDITS.
liy balance on hand June 1, 1890
Cash from earnings of Institution _

_

$31,200 98
630 09

_

To disbursements:
Account of Detached Cottage No. 2
Account of current expense
balance on hand to new account, June 30,1890 ...

..

$1,501 56
13,244 81
17,08470

-.

$31,831 07

$31,831 07

THE STATE OP MICHIGAN, In account with C. A. Crawford, Treasurer of Northern
Michigan Asylum, for fiscal year ending June 30, 1890.
t

Halance on hand July 1, 1889
Cash from State treasury:
Account of officers'salaries.,
Account of Infirmary Buildings
Account of Detached (lottage No. 2.
('ash from earnings of Institution

CREDITS.

$11,514 09
...
.. _

To disbursements:
Account of officers' salaries
_
Account of Infirmary Buildings
Account of Detached Cottage No. 2
Account of current expense
lialance on hand to now account June 30. 1890

.

...

. .
.

Respectfully,

._

.....
.

8,93476
30,000 00
15,00000
131,090 38

$8,934 76
30,00000
18,043 27
127,476 50
17,084 70

$196,539 23

$196,539 23

C. A. CBAWFOBD,
Treasurer.

We have carefully examined the accounts of C. A. Crawford, Treasurer
of the Northern Michigan Asylum, for the biennial period ending June 30,
1890, 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.
LOEIN BOBEKTS,
JOHN BENJAMIN,
THOS. T. BATES,
Auditing Committee.

STEWARD'S REPORT,
FOE THE BIENNIAL PEEIOD ENDING JUNE 30, 1890.

ANALYSIS
OF RECEIPTS AND DISBURSEMENTS FROM JULY 1, 1888 TO
JUNE 30, 1890.

RECEIPTS.
State, for maintenance, etc., of patients
. $152.869 25
Counties, for maintenance, etc., of patients
86,838 18
Private patients
6,165 48
Sundry accounts:
Purchases for patients charged back, interest on delinquent accounts, etc., miscellaneous
967 43
Farm:
Amounts derived from sale of horses not required, hides, etc.
_
469 79
Special Appropriations:
Detached cottage
Detached cottage for males
Infirmaries
._

_

..

..

$247,310 13

$5,500 00
15,00000
30,00000

50,500 00
$297,810 18

DISBURSEMENTS.
Attendants
Clothing
Amusements:
Music for dances
Entertainments
Circus tickets
Hames
Theatricals

.'.
_

_

__

.

.

.-.

..
...

Farm;
Wages
Tile
Plants and seeds _ i
.
Hay and feed
Implements, harness and blacksmith ing
Horses, pigs and cows
Wagon and carriage painting
Fencing
Wood chopping
Miscellaneous
_

4

__ _ __
_•_.
....

Dispensary:
Wages of druggist
Drugs and medicines
Books
Instruments

Fire protection:
Wages of watchman.
Hose, repairs and piping

. .$38,697 94
22,905 92

......

$198 95
22 50
19 50
74 24
400

319 19

$51600
2,291 23
184 86
4658
3,038 67

...

..
.

..

'
_
.

__

.
_

.

....

$4,54535
63 05
37982
6,820 49
799 69
1,801 80
12165
499 60
920 91
83 49
$788 99
178 21

16,035 35
967 20

26

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

Furniture and stores:
Wages
Dry goods...
Toiletpaper
Soap
Hardware
Crockery
Brushes, brooms, mops, etc.
Furniture, chairs, etc
Baskets
Mattresses
Carpet
Beds
Sewing machine
Miscellaneous...
Greenhouse and grounds:
Wages
Lawn mowers
Sprinkler.
.
Plants and trees
Wheelborrowa and implements
Tile

.
.._-__

_
__

•:

...

__

.... .

_

_
-

$2,736 08
5,47098
1810
$7,891 56.
_.
868 07'
1.345 99
—
480
$5,247 72
232 65
56 28
11 34
55444
2,061 45
182 32
45 10
5290

..

$2,793 00
11464
4,097 15
60354
202 37

-

Miscellaneous:
W_ages, administration building
Kitchen, dining room
Telegraph, express and travel
Patients'expenses home (as per Sec. 34, Act 135, Laws 1885)
Undertaker's expenses.
Miscellaneous amounts charged back
Architects' expenses. Roofs
Treasurer's expenses. Stamps, etc
Survey of boundaries of farm

.

. . .

ribbon

...

Out-buildings:
Wages
Lumber
Hardware and cement
Provisions:
Meatandfish
Butter
Flour
Sugar
Tea
Coffee
Miscellaneous provisions.

...

$503 10
21 75
50 12
601 50
6398
81 46

Light:
Wages
Oil and scale dissolvent
Coal
Lamps, etc
Wire, etc.

Office, printing, stationery, etc.:
Wages....
Stamps
Stationery
Postoffice box rent
Ink...
Blank books
Typewriting machine _
Typewriter
Printing

._

1_

.

Kitchens and bakery:
Wages
Range and cooking utensils.. ....
Coal and fuel
Oil

_

.

Heating and ventilating:
Wages
_
__
Coal
Scale dissolvent

Laundry:
Wages
Starch and indigo
Gasoline
Wringer, line and wax
Soap making...
Coal.
Irons
Stove
(Ml...

...-.

....

.$2,295 91
9,66069
33987
48541
848 26
962 91
608 24
1,021 46
37 00
1,22880
1,156 44
421 08
25 00
487 71
- $19,558 78

$941 25
302 32
530 62
443 55
573 00
1,534 30
66 90
4143
10 00
.$3,661 77
274 00
601 24
6 00
5 98
144 20
8500
6 00
241 92
$1,127 49
628 46
1769

.

$28,05164
8,728 88
9,32958
9,077 53
2,28293
2,384 74
14,810 69

1,321 91

8,225 11

10,110 42

8,444 20

7,810 70

4,443 37

5,026 11

1,773 64

74,665 99

27

STEWARD'S REPORT.

$331 50

Kefunded money
__
Benewals and additions:

$6,056
1,888
2,049
698
316
227
824
488
420
50

Paints, glass, oils, etc
Hardware, tools and iron.
Coal
Brick and lime
Cement and stone
Lumber
Pipes and connections
Miscellaneous
Belting and grease
Telephones:
Wages operator
Phones and rent of linesRepairs and zincs

05
25
55
82
81
40
77
18
26
37

13,015 46

$315 60
520 48
11 82

Water distribution:

$782 81
363 70
661 00
10 00

Pipes and fittings.
Coal
Oil...
Special appropriations: >
Detached Cottage
Infirmaries...
Detached Cottage for males.

847 90

1,817 51
9,938 75
30.000 00
13,043 27
$290,338 89

Farm and Garden Products for the Biennial Period ending June 30, 1890.
Number.
Apples, bushels
Beets, bushels
Beef, lbs.._ ..
Cabbages, heads
Carrots, bushels...
Cucumbers, bushels
Cauliflowers, heads. ...
Celery, bunches
Egg plant, heads

_

278
76
1,096
1,824
256

30
100
08
03
02

83 40
76 00
87 68
54 72
5 12

266
5
25
163
140,000

04
8 00
20
40
800

1064
40 00
5 00
65 20
1,120 00

37,959
167
356
1,618
338

14
75
35
25
60

5,314
125
124
404
202

26
£5
60
50
80

14.800
'672
5,182
1.264
j
10

04
20
03
01
250

592
134
155
12
25

00
40
46
64
00

22
205
447
432
2

80
40
40
50

34 50
164 00
178 80
172 80
1 00

844
147
1.585%

20
1 00
1 50

188 80
147 00
2,378 62

I

Hides, lbs._
Hay, tons
Kahl Babi, bushels.... .
Lettuce, bushels.
Lumber, feet
Milk, gallons. _.
Onions, bushels
Oats, bushels
..
Potatoes, bushels
Peas, bushels

_

_

_

«

•

„

_

Pork, pounds...
Pumpkins, cwt.
Badishes, bunches
Ehubarb, Ibs.
Bye feed, loads
Strawberries, bushelsString beans, bushels. ...
Squash, cwt
Sweet corn, bushels
Sweet herbs, bushels
Turnips, bushels...
Tomatoes, bushels.
Wood, cord

..

_ _

_ ...

15
00
21
00
15

$085
25
061/
03
05

I

_ __ ..

$24
124
296
390
294

69
496
4,557
13,000
5,883

!

$13,012 70

J. P. O. CHURCH.
Steward.

SUMMARY OF INVENTORY.

Summary of Inventory Northern Michigan Asylum, June 30, 1S90.
Farm
Buildings
Stock on farm
Produce from farm
Vehicles
•
Administration building...
Wards
Medical office
Steward's office
Matron's room...
Chapel
Library
DispensaryPathalogical laboratory
Kitchens and bakery
Cottages, south and east
Engineer's department
Carpenter's shop...
Laundry
Stores—Dry goods and clothing
Silver plated ware.
Crockery
Hardware and miscellaneous
• Groceries, etc
Total.—

II
„

I.
.

.
....
__

_

.

_

„ $23,871 46
524,553 40
4,67050
13,012 70
1,468 04
3,375 84
31,95497
604 11
346 75
93 23
1,326 94
451 50
1,09392
374 22
3,974 89
2,864 64
1,414 85
1.11514
2,374 04
6,191 75
9335
243 14
225 27
2,302 85
.. $628,187 00

REPORT OF MEDICAL SUPERINTENDENT.
To the Board of Trustees:

GENTLEMEN—As required by law, I have the honor to submit the following report of the operations of the Asylum for the biennial period
ending June 30, 1890.
The movement of population has been as follows:
FOR THE BIENNIAL PERIOD.
Males.

Patients.
Remaining under treatment June 30, 1888- ,
Admitted

Died

"

-

.

unimproved

Females. Total.

298
1
202

260
1
142

556
2
344

499
122

403
93

902
215

377

310

687

37
45

24
31

33

34

61
76
11
67

122

93

215

7

4

FROM THE BEGINNING.
Males.

Patients.
Remaining under treatment June 30, 1888
Temporarily absent June 30, 1888
Admitted
Total under treatment

Discharged recovered „.
"

unimproved

Died
Temporarily absent

.

Females. Total.

1
622

1
508

2
1,130

628
246

509
199

1,132
445

377

310

687

76
75
11
77
7

55
66
6
70
2

131
141

246

199

445

377

310

687

17

147
9

30

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

The net gain of patients during the period has been 131.
The smallest number of patients under treatment in any one day was
556, and the greatest 688.
The death rate for the year ending June 30, 1889, was 4.4 per cent; and
for the year ending June 30, 1890, 4.3 per cent. The following table will
show the sex, age, form of mental disease, and cause of death in those discharged, died:
TABLE II.
Sex.

Age

Male ..
Male- ..
Female.. .
Male
Male,-..

45

Germany

Dementia, Senile

Male-...
Female...
Female...
Male
Male.....

44
35
55

Unknown
Unknown
Michigan

Dementia, Chronic.

36

Michigan

General Paralysis

Female...
Male
Female...
Male
Female...

60
73
46
38
20

Germany..

Female...
Female...
Female...
Male
Male.....

34
17
38
74

Sweden
Canada

Indiana.
Sweden
Wisconsin
"58" New York
28 Sweden

58
58
Female.., 36
57
Male
Male

81
53
57
66
30

Female.- .

53
Female— 34
Female... 63
Female-. 40

Form of Disease.

Maine
Mania, Acute.
-_.-,.
Penneylvania. General Paralysis T Kansas
Melancholia

52
41

Female- 27

Male.,,
Male
Male —
Male.....
Female...

Nativity.

Organic Brain Disease.
Exhaustion.
Dysentery.
Paretic Seizure.
Dementia after Epilepsy. . . Pneumonia.
Delirium, Grave..
Dementia, Chronic
Mania, Acute
Dementia, Chronic

Dementia after Melancholia Cancer.
Phthisis.
Dementia after Epilepsy . . . Status Epilepticus.
Dementia after Epilepsy,., Status Epilepticus.
Cardiac Failure.

Austria.

Melancholia

Canada .
New York
Finland
New York
Ireland.

Phthisis.
Phthisis.
Dementia after Epilepsy. __ Status Epilepticus.
Intestinal Perforation.
Dementia after Epilepsy. _ _ Status Epilepticus.
Maniaj Chronic
Mania, Chronic
Mania, Acute.. _.

Ireland
Kentucky
Germany

Female.. :
Male
Male
Male
Female...

66
51

24
81
66
53

Exhaustion.
Exhaustion.
Exhaustion.
Organic Brain Disease.
Phthisis.

Sweden
New York.
New York
Michigan.
New York

FemaleMale ._
FemaleMale-...
Male ....

42
43
39

Paretic Seizure.
Paretic Seizure.
Organic Brain Disease.
Paretic Seizure.
Paretic Seizure.

Dementia, Chronic-

Unknown., _ _ Dementia, Chronic
New York... Dementia Monomania .
Switzerland . . Dementia; Chronic
Melancholia
Dementia, Chronic
Germany

Female ...
Male.....
Male
Female—
Female— .

Exhaustion.
Paretic Seizure.
Phthisis.
Paretic Seizure.
Exhaustion.

Melancholia

Female-- 52
Male.-.. 69
Female... 54
Female.- _
Female.. . "37"
42
69
28
42

Cause of Death.

Addison's Disease.
Ovarian Tumor.
Dysentery.
Exhaustion.
Cardiac Failure.
Exhaustion.
Cardiac Failure.
Organic Brain Disease.
Dysentery.
Dysentery.

Canada

Dementia Monomania
General Paralysis
Dementia, Chronic
Dementia, Chronic.
General Paralysis
.

Dysentery.
Paretic SeizureDysentery.
Multiple Sarcoma.
Paretic Seizure.

Denmark
New York
Canada
Sweden
Virginia

General Paralysis
Delirium, Grave
Dementia after Epilepsy. __
Dementia, organic
Dementia Monomania..

Paretic Seizure.
Exhaustion.
Phthisis.
Paretic Seizure.
Pneumonia.

Michigan
Michigan
Scotland
England
Unknown

Dementia MonomaniaDementia after Epilepsy..,
Dementia, Senile
Dementia after Epilepsy- ..
Melancholia

Apoplexy.
Apoplexy.
Apoplexy.
Exhaustion.
Organic Brain Disease.

REPORT OF THE MEDICAL SUPERINTENDENT.

31

TABLE II.—Continued.
t

Sex.

Age

Nativity.

Female—
Female-Male..-.
Male--.
Male

45
24
48
28
23

New York
Ireland
Austria
Ireland Sweden

Form of Disease.
Dementia after Epilepsy
Imbecility .
. Dementia MonomaniaDementia after Epilepsy. _.
Melancholia

Caust3 of Death.
Status Epilepticus.
Phthisis.
Phthisis.
Status Epilepticus.
Phthisis.

Male --- 20
Female— 41
IT
43
Male..
Male — -- 88

Michigan
Ohio
Scotland—
Ireland-, .
Canada

Dementia after Epilepsy _ _ Phthisis.
Dementia after Epilepsy. . . Exhaustion.
Exhaustion.
Melancholia
Meningitis.
General Paralysis
Paretic Seizure.

Male.--- 28

Germany
New York

Organic Brain Disease.
Dementia Monomania
Dementia after Epilepsy, „ . Status Epilepticus.
-

From the above, it may be found that death was due to exhaustion in 12;
paretic seizure in 12; phthisis in 10; organic brain disease in 6; dysentery
in 6; status epilepticus in 7; cardiac failure in 3; apoplexy in 3; pneumonia
in 2; cancer in 1; intestinal perforation in 1; Addisoii's disease in 1; ovarian
tumor in 1; meningitis in 1; sarcoma in 1.
During the period post-mortem examinations were made in all those
cases where the consent for such examinations could be obtained, and in
cases that presented points of interest. The total number of such examinations was 23. The following are brief extracts from the post-mortem
notes of a few cases to show the character of the work that has been done
in this direction.
Case of Mrs. U. B., aged 51, an inmate for two and a half years, and
suffering from dementia monomania. Her physical health has been below
par most of this time. There was partial paralysis of the left side of her
face, with ptosis. Formerly, her left arm and leg had been useless, but
had recovered so that her gait was steady. Speech was perfect. Up to
Jan. 20, 1890, she had no serious illness, though her strength was slight.
On that date she had an apoplectic seiziire with paralysis of the right side,
which resulted in her death 24 hours later. The following are a few of
the findings at the autopsy. Old adhesions of pleura on both sides.
Lungs normal. There was marked hypertrophy of left ventricle of the
heart, but the valves were competent. The aorta was dilated at its origin
and along the arch, and there were atheromatous patches and calcareous
plates as large as a finger nail deposited in its coats. The stomach was
enormously dilated, but the other abdominal organs were normal. The
brain was anaemic, the convolutions were flattened, and there was distension of the meningeal vessels, but no signs of inflammation. Clots of
blood were found lying below the anterior perforated space and between
the crura, and there was a large effusion of cerebro-spinal fluid at the base.
The arteries were in a state of atheromatous degeneration, especially the
anterior cerebral and the basilar with its branches. At some points the
arteries could be broken between the fingers like a pipe stem. The left
lateral ventricle was filled with dark clots and enormously distended, with
some destruction of brain tissue. The optic thalamus-left was quite
broken up, also the posterior portion of the caudate nucleus. The left
crus had likewise been broken up at its entrance into the optic thalamus,
and the blood had forced its way into the opposite ventricle. Blood was
also found in the pons, but had caused no destruction of tissue. Between

32

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

the lenticular nucleus and the island of Riel on the right side, was a spot
of softening of a dirty brown color, probably an old hemorrhage.
Miss E. B., aged 29 years, an inmate since November 30, 1885. The
patient was an epileptic and had suffered from convulsions since four years
of age. During the last year, they averaged about three per week. Her
death occurred during a series of convulsions lasting eight or nine hours.
The post-mortem showed the thoracic and abdominal viscera to be in a
healthy condition. Of her brain, the motor zone of the left hemisphere
was very much congested. The base of the third frontal, and the base of
the ascending frontal convolutions of the left side, were the seat of hemorrhagic extravasation. The dura was tightly adherent to the calavarium.
Hard nodules containing cholesterin crystals and fatty degenerative material
were found. One in the course of right middle cerebral artery at its origin.
One in the course of right anterior cerebral artery a short distance from
its origin. One in terminal extremity of left fissure of sylvius, and several
smaller ones (size of small pea) in both corpora striata.
H. J. F., was admitted in December, 1885 at the age of 48. She was choreic
and much demented. There was gradual failure of her physical powers
during 1889, and she died August 6. On post-mortem, her brain, with
medulla and one inch of the cord, weighed 34J ounces. The skull was
thick, and dura non-adherent. There was marked atrophy of both anterior lobes, and the sub-arachnoid space contained an effusion of straw-colored and milky fluid. There was shrinking of all the convolutions and
gaping of the sulci over the occipital lobes. There was a congestion of left
motor region. Both lateral ventricles were dilated and contained clear
fluid. The vessels were normal.
A. F., A case of chronic dementia, aged 38, was admitted in May, 1888.
She had been insane four months previous to her admission, and had been
blind for one year. She was somewhat demented and had delusions of a
hypochrondriacal nature. One morning in January, 1889, she was found
in bed suffering from clonic spasms of the right side, with head drawn over
upon the shoulder. These continued with occasional remissions until
August, when she died. At the autopsy her brain, with membranes, was
found to weigh 28^ ounces. There were 3J ounces of straw-colored fluid
beneath the coverings. The brain was anaemic and much atrophied,
especially over the frontal lobes. Nothing else pathological in its nature
could be found on macroscopic examination.
Mr. A. T., aged 28, a chronic dement of seven years standing, was
admitted December 31, 1888. He was in good physical health. In
August, 1889, he said that a patient struck him with a stick and caused
one of his testicles to swell. No remedies seemed to exercise any control
over the trouble, and the thickening increased steadily. In October he
suffered considerable pain in the lumbar region and numbness of the left
side. On the 21st of that month, owing to the progress of the growth
pointing to malignancy and to his failing health, an operation for removal
of the testicle was undertaken. It was successfully performed and the
-owth found to be sarcomatous. His general condition did not improve,
ovember 10th, he suffered from retention of urine accompanied with
severe pains in back and hips. His power over his legs was failing.
The tendon reflexes were exaggerated. The thickening about the scrotal
wound was extending upward and could be traced through the external ring.
On November 20, paraplegia of lower limbs became absolute, tendon reflexes
absent and sphincters paralyzed, with partial anaesthesia of the surface.

f

KBPOET OF THE MEDICAL SUPERINTENDENT.

33

December 3, paresis of right upper extremity came on. It was almost
impossible to move his bowels. A new growth within the pelvis was found
pressing on the bowel and firmly fixed by adjacent tissues. There were also
evidences of effusion into left pleura! cavity. He continued to fail, and died
on the 17th. The autopsy showed that the external tumor extended up
through the abdominal ring. A growth springing from the left ilium was
of the same sarcomatous nature as the primary one. Another extensive
neoplasm laid along the left side of the vertebrae, and the whole column
was the seat of small tumors growing from the periosteum, the bone being
bare and carious in each instance. A rib which had been diagnosed as
broken, was the seat of one of these tumors, which had caused a necrosis
. and solution of continuity. Diaphragm on the right side was the seat of a
growth the size of a lemon. The lungs at the base were infilterated with
growths the size of a pea and smaller. The pleural cavities contained each
about a quart of sanguineous fluid. A more thorough examination was
impossible, owing to disposal of remains by friends.
W. J. D., age 43, a case of grave mania, was admitted December 19,
1889. He was destructive, noisy and violent, and acutely hallucinated.
Had more or less fever during the whole course of the disease, rapid pulse
and accelerated respiration. Special attendants were required day and
night to control him. The downward progress of the case was rapid, and
on the 28th death occurred. Post-mortem examination of the head showed
skull normal, veins of the dura much congested. Extensive inflammation
of meninges of vertex along median line on both sides. Meninges adherent
to each other. About one ounce of lymph was found beneath the arachnoid.
Adhesions of membranes, occasioned by inflammatory exudates. Cerebral
veins much congested. Lungs normal. Heart had undergone fatty degeneration. Abdomen not examined.
D. M. B., age 54, a case presenting symptoms of general paresis, was
admitted December 3, 1883. He had been insane five years, and during
that time had had several "seizures." His gait was feeble and incoordinate, and his speech thick and indistinct. There was marked glossolabio laryngeal paralysis. Swallowing was difficult, and he could not move
his tongue. The face was absolutely without expression, and he was
depressed, and mentally, much impaired. He had less use of his right
side than of his left, and the surface was anaesthetic. Tendon reflex was
absent on that side. He had an epileptiform seizure on January 6, and
on the 26th another occurred. Death took place on the 29th. Autopsy
—Brain:—large, convolutions well developed. The dura of the left side
was greatly thickened and covered with nodules (10 in number) about
the size of a bean. These projected into the brain tissue of the three left
frontal, lower third of the ascending parietal convolution, anterior twothirds of temporo-sphenoidal lobe, except the inferior convolution, and
into the lower two-thirds of the ascending frontal convolution. The
nodules were hard, yellowish and firmly attached to the dura and to the
brain tissue, so that when torn from the convolutions masses of brain tissue
were torn away. Right dura thickened and firmly adherent, but with not
so many nodules as on the left. The dura on right side was adherent
to middle third of first temporal convolution, with large nodule projecting
into the same. There was a similar condition over the lower third of the
right ascending parietal. This nodule was larger than the others. The
posterior third of the second frontal, the third frontal, and the lower third
of the ascending frontal, were covered with adherent dura lined with
5

34

NORTHERN MICHIGAN ASYLUM FOB THE INSANE.

nodules. There was an old patch of softening in the right crus indicating a hemorrhage at some time.
J. T., aged 80, admitted June, 1888, was a case of senile dementia. On
the morning of September 13, he was found sitting in his chair unable
to speak, and with paralysis of the right side. He recovered from this by
December sufficiently to walk. Later on, owing to the failure of his vital
forces, he became bed-ridden and continued thus until his death on February 26, 1890.
Post-mortem.—Body emaciated, muscles wasted. Cartilage of ribs
ossified so that a saw was necessary to open the thorax. Some fat in
abdominal walls. Heart:—amount of pericardial fluid normal. Enlarged
and dilated on right side, filled with fluid blood. Eight auricle contained
a well organized fibrinous clot, white and intimately adherent to walls of
auricle, but its removal caused no injury to cardiac wall. Weight 12£ oz.
Left ventricle hypertrophied. Considerable deposit of fat on ventricles;
vessels atheromatous. Milky line on each side of coronary arteries.
Myocardium apparently healthy. Aorta dilated—calcareoiis deposits in the
wall. Aortic valves contained large amount of calcareous deposit and
were incompetent. Mitral valve in a similar condition; pulmonary healthy,
and also tricuspid. Wall of pulmonary artery thin. Large aneurism (hen's
egg) of abdominal aorta, just above the bifurcation. One wall of aneurism
was much thickened. On section, flat, calcareons plates were found, and
between the wall of artery and the organized deposit on the interior, was a
mass of caseous degenerative material. All the arteries showed atheromatous changes. Lungs:—left adherent about apex. Atrophied, weight 13
oz., air in all portions. Deeply pigmented, bronchial walls contained calcareous matter. Calcareous nodules size of pea found at apex. Bight
lung - no adhesion, otherwise like the left, weight 26f oz. Liver:—with gall
bladder, weight 38|^ oz. Cirrhosis, "nutmeg" liver. Spots of atrophywhite fibrous tissue. Spleen, 4f oz., capsule contained calcareous matter.
Left kidney:—weight 4 oz., cyst at upper extremity size of walnut,
smaller ones over the organ. Organ shrunken and cii'rhotic. Cicatricial tissue on outer surface. Bight kidney:—weight 3 oz. Cyst at lower
portion, and in same condition as left. Brain:—Dura adherent posteriorly,
—large amount of cerebral fluid. Ventricals somewhat dilated, full of clear
fluid. Membranes thickened along longitudinal sinus,—meningeal vessels
show a milky line on each side. Arachnoid floated up well from convolutions. Membranes strip from convolutions without tearing cortex. No
congestion. Substance of hemispheres rather pale. Consistency reduced
a little. Vessels at base generally atheromatous. Bight vertebral markedly
dilated. Convolution plainly shrunken. Sulci gaped some. Weight of
brain and medulla with membranes, 42 oz. Bight cerebrum 20 oz., left 13J
oz. Left lenticular nucleus was the seat of an old hemorrhage, and left
caudate nucleus quite atrophied, except its anterior and rounded portion.
No other coarse lesion found.
Mrs. H. K., admitted Nov. 9, 1888, suffering with melancholia, was
hallucinated and demented to some degree. Her health remained good up
to the last of January, 1889. At that time, she had slight fever, tenderness in right hypochondric region, headache and nausea with icterus
(slight). Later on there was a dulness on right side, cough, muco-purulent sputa, respiration labored. At the end of two weeks she had recovered, but still had some cough. The last of May she took the bed, had
slight fever, cough increased, and slight trace of albumen in her urine.

REPORT OF THE MEDICAL SUPERINTENDENT.

35

She continued to fail, and died on the 21st of June. Post-mortem the
following morning. Body well nourished, hypostatic congestion remarkably slight. The yellow hue of the skin persisted after death. Rigor
mortis not marked. A thick layer of fat was present beneath the skin.
Lungs:—the pleura! surface of the right were generally and intimately
adherent, by reason of a thin inflammatory exudate which was in the first
stages of organization. Small amount of fluid in pleural sack. Left side,
but slight adhesions. The lower lobe of the lung was much congested,
especially in its posterior portion, but it contained a due amount of air.
In other respects the lungs were normal, except that they were markedly
oedematous. The mucous coats of the bronchi showed no evidence of
inflammation, and all evidence of tuberculous disease was wanting.
The pericardium: heavily ladened with fat and adherent to the pleura
on the right side. Sack contained 3J of straw-colored fluid. Heart
covered with a deposit of fat. In the right cavities were immense antemortem clots. One occupied the right auriculo-ventricular orifice and
prevented closure of tricuspid. In the cavities of the left heart were also
ante-mortem clots, but less extensive. Right auriculo-ventricular orifice
much dilated. Ventricle proportionately dilated. Other valves normal.
Heart muscle flabby and pale. Organs of the abdominal cavity were
normal but anaemic. Spleen normal in size, consistence and color. Liver
anaemic, but not abnormal in any other respect. Kidneys remarkably
anaemic, being almost white.
Brain—No adhesion of dura. Longitudinal sinus contained small an tern ortem clot. Cortical substance light in color, and all portions of brain
anaemic. Careful examination revealed no other macroscopic abnormality.
Microscopically—Sections of the heart muscle from different portions of
the organ showed uniform fatty degeneration of the fibers, scarcely one
being free from fat granules. The transverse striation of the myocardium
had pretty much disappeared. The kidneys showed fatty degeneration in
the epethetial cells. No amyloid degeneration present. Examination of
congested portion of the lungs showed proliferation of epithetial cells,
which are also in a state of fatty metamorphosis. Examination of the
healthy portions failed to show this.
FORMS OF MENTAL DISEASE.
CHANGE OF CLASSIFICATION.

Our study of mental diseases has never been in accord with the system of
classification that has heretofore been in use in this State and it is but
logical to adopt a classification that shall more accurately express the facts
we recognize in our clinical work. With this end in view, we have made
for our use the following modification of the well-known classification of
Krafft-Ebing:

36

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Melanchol
, Mania _ _ _ _

REPORT OF THE MEDICAL SUPERINTENDENT.

37

In group A are placed all the forms incident to the normal brain. Subgroup I. is made up of the acute primary psychoses, each form comprehending all the clinical varieties of that form. Thus katatonia is considered
a clinical variety of melancholia, though it is regarded by some authorities
as sui generis. If it is to be separated from melancholia, we would be
inclined to give it a place among the insanities of the degenerative type.
In this psychosis, as we have observed it here, it has been possible
to demonstrate the existence of an underlying constitutional neu^
ropathic state. Although some of the cases apparently recover, yet our
experience inclines us to look upon the recovery in the light of a remission,
which after a longer or shorter -period is followed by a relapse.
The insanities placed in sub-class II. express mental states; terminal or
secondary to those placed in sub-class I., Group A
It is true that many of the acute toxic insanities are wanting in characteristics to distinguish them from the pure psychoses, but they form
a step in the evolution of the more chronic forms on which the toxic cause
imprints its distinctive seal, and these chronic types are a second step in
the series culminating in the forms that are symptomatic of brain degeneration. The separation of these cases thus serves to mark a transition
from the functional to the organic insanities.
Objection made to the introduction of an aetiological factor into the
schema must also be extended to syphilitic insanity, which in many instances
might properly be considered a variety of "dementia with gross brain
lesions." But in both chronic alcoholism and dementia due to cerebral lues,
there are elements of curability, which make it important to distinguish
them clinically; in the one case from progressive paralysis, in the other
from dementia with apoplexy, trumors, etc.
A logical arrangement in the classification of the degenerative forms
(Group C.) is attempted by placing them in an order progressing from the
milder forms of constitutional neurotic taint, to the mental deficiencies due
to arrest of brain development.
Any of the forms of group A. may complicate those of group B.;
indeed, from the very nature of the relations of the groups the insanities
of the degenerative type must express themselves in terms of the simplest
forms of group A., but the vicious constitutional sub-stratum lends to the
symptoms peculiarities all its own, and at once stamps them as degenerative.
The forms of group B. are quite as apt to affect the degenerate as the
normal brain.
Some observers might question the propriety of placing neurasthenic
and hypochondriacal insanities in group C., but a careful study will not
fail to show that there are nervous and mental organizations of which
these neuroses are the natural expression. In classifying such cases it is
of course necessary to distinguish between neurasthenia and hypochondria
as forming the basis of an insane state, and these conditions arising as
symptoms in the pure insanities.
The difficulties in the way of a perfectly satisfactory classification of
mental diseases are well known. No schema thus far proposed is free from
defects. The adoption of the classification here explained, is only an
attempt at a more systematic grouping of the various forms of insanity as
we meet them in this Asylum.

38

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
TABLE III.—Clinical Groups.
For the Biennial Period.
Males.

Brain disease
Constitutional disease
Climacteric
Epileptic
Masturbatic. .
Opium habit
Paretic .

Senile....
Traumatic.
Unclassified.
Idiopathic.

~

.„._

.
.
...

Males.

1'emales.

2

5
28
7

8
99

9

9

18
1
13
4
50

26
100
27
10
58

12
19
26
31

3
10
1
51

15
29
27
82

17
56
105
97

10
86
6
132
2

27
92
111
229
3

18

1
31
3
3
1

19
31

53

2
4
(i

5
7
7

8
14
10

5
111
15

58
111
23
22
17

9
3
35

5
2
17

14
5
52

17
13
93

.

.

Pubescence .
Phthisical
Post Febrile

Total.

3
28
5

Adolescence

;
.
..

From the Beginning.

Females.
2

1
6

1
1

Unascertained
Toxic

1
1

3
1

8
7

Total,

15
2
62
7

32
15
155
• 7
1

3
1

6
1
1

1

Total

202

142

344

622

508

1,130

The aetiological grouping oi insanity has been retained because of its
value in reference to causation, period of occurrence, and suggestions as to
treatment it affords. At first, it may appear to the inquirer that the clinical neurasthenic group, must include a wide, too general, a type of mental
disease. This is true if compared with neurasthenic insanity of the foregoing classification. If it is borne in mind that in the latter instance, the
insanity is engrafted upon a constitutional neurosis, and that in the clinical variety, the neurasthenia itself is secondary to other conditions of
ill-health, leading on to insanity, and giving it special characteristics, the
seeming inconsistency of the clinical grouping will be explained.
MELANCHOLIA.

Mental depression may be incident to nearly every disease of the brain,
but we would only here speak of that form of depression which arises
independently of any palpable lesion of the brain. It must be, however,
that a mind disorder, presenting such marled symptoms as are seen in
melancholia, is due to modifications in the cellular structures of that
organ. These modifications may without doubt, be superinduced in many
ways. They may owe their origin to vaso-motor disturbances, malnutrition, as is witnessed in anaemic and debilitated patients; to septic and
toxic agents in the blood, as seen in puerperal and alcoholic depression; to
shock, or to prolonged mental agitation and suffering. Doubtless molecular changes in the nerve cells are constantly taking place, but not until
after these have passed a certain limit are they productive of morbid
mental manifestations. When mental symptoms appear, however, they

REPOET OF THE MEDICAL SUPERINTENDENT.

39

mark a step in the direction of nervous degeneration, as is witnessed by
decadence of function, yet destructive alterations in the delicate nervous
elements do not necessarily follow. A severe melancholia may sweep by
without leaving a trace, but on the other hand, a weakened mind may
result which attests to a loss in the mind producing elements. If the
different degrees of secondary dementia may be looked upon as an index,
the extent of such loss varies widely from slight to widespread destruction
in the ideational centers.
Twenty-six men and forty-three women admitted during the period suffered from melancholia. Its duration had been from one week to six
months in 42; from six months to one year in 18; from one to two years
in 2; over two years in four, and in 3 it was unknown.
Twenty-one were native born, and 44 were foreign born. The nativity
of 5 was unascertained.
Hereditary predisposition to mental disease existed in 23; in 21 no taint
was found; and in 25 no facts concerning the ancestry could be obtained.
Twenty-three have recovered, and it is thought that 14 others at least will
recover, the total of which will not be far from the usual recovery rate of
this psychosis. Eight were discharged improved, so that of the 69 cases
65 per cent are or will be able to live outside of the asylum.
Four of the 69 died, a mortality of about 5.5 per cent.
The cause was ascribed to ill-health in 19; to phthisis in 5; to typhoid
fever in 1; to rheumatism in 1; to puerperal in 14; to over work in 2; to
disappointed aifections in 2; to grief privations in 5; to bodily injury in 1;
' to religious excitement in 1; to vicious habits and excesses in 4; to business
reverses in 3; and unknown in 11. In addition, to these causes we must
not overlook the fact that one third of these patients were hereditarily
predisposed to insanity. Moreover, could we but know completely the
history of these individuals, we should find " Circumstances in mental
habits or in mental discipline " tending to mental disease.
A study of these causes only tends to confirm the belief that the substratum of melancholia is physical. Anaemia from any cause, toxaemia,
long continued strain either physical or mental, tend to lowered nutrition
and to impaired function of the nervous centers. Why a series of
apparently widely different causes should be followed by melancholia, is
not explicable, unless due to molecular modifications of the cells and fibres
of the ideational centers of the brain.
The onset, course and termination of melancholia, will in part depend
upon the inherited quality of brain, the training and intellectual traits of
the patient.
Melancholia may develop suddenly, but generally there is a pre-stage
during which brooding abstraction, loss of sleep, indifference to pursuits,
emotionality, and vague feelings of suspicion, dread and apprehension,
exist. Thus, slowly but surely the feelings of the patient undergo a painful reaction to events in his objective world. If he compares these saddened feelings one with another, delusional judgments are engendered, and
thought is deranged. The instinctive fears, passions and emotions now
rise into spontaneous action to impel to acts that are beyond the control of
the will. As Dr. Mercier beautifully shows, if an event in the environment is cognized as noxious and imminent, the corresponding feeling is one
of alarm, dread, etc., but if cognized as noxious and as having occurred, the
corresponding feeling is one of grief, anguish, sorrow, etc. So long as the
mind is wholly occupied with the striking parts of its painful cognitions,

40

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

not only is there powerlessness to enjoy, but to initiate or awaken
the higher sentient states.
The outward manifestations of such
depression will also show a "remarkable conformity or resemblance" to the
feelings that produce them. The emotions will be inverted from joy to
fear, from patience to irritability. It is during the pre-melancholic period
that Bevan Lewis speaks of a decline in object-consciousness, which invariably inaugurates a corresponding rise in subject-consciousness. The
latter is shown "in the prevalence of painful mental states,—the predominance of gloomy emotions." "This is the positive aspect of the patient's
mental state, and this aspect is the one which obtrudes itself upon our
notice. It is characterized especially by an all-prevailing gloom, varying
in degree from mild depression up to acutely painful mental states. The
patient is hyper-sensitive over trifles, irritable and impatient, or his querulous humor may alternate with sullen silence and obstinacy. Even in
this reticence and retirement from social responsibilities, this growing
apathy to all around, or feeling amounting to dislike or direct hostility,—
we recognize the origin of that subjectivity or egoistic state which, in more
advanced affections of the mind, conjures up delusions of encroachment and
persecution." He also lays stress on the failure of the muscular element
of thought, i. e., a decline in the specific energy of muscular nervous
impressions, through which we gain our notions of form and of our
position in space. "It is obvious," he thinks, "that the muscular element
is the first to decline, for, cases of intense grief, as from a sudden mental
shock, are associated with a notable contraction of this sphere, and space
dimensions are altered and contracted. This field is one of importance,
since it clearly tends to the decline of the more rational elements of the
perceptive process."
Ladd says: "By nature the nervous mechanism is so arranged that certain other bodily motions of peripheral origin are started on occasion of
the pleasant or painful feeling, and these motions are adapted to enhance
the feeling, if pleasant, and to relieve it if p'aiiiful. The feelings thus
become further connected with the ideas of the motions that modify them;
yet the mechanism of the motions is not to be regarded as originally
dependent upon the ideas, but rather as originated in connection with the
feelings of pleasure or discomfort, and naturally adapted to secure an
increase of the one or a diminution of the other." According to Sully, feeling
stands in a particularly close relation to the process of motor innervation.
If we take the simplest form of attention, that directed outward to an
impression of the sense, it becomes obvious that mental adjustment is
affected in part, at least, by a muscular adjustment. It is easy to recognize in the pose of the body, the movement of the head and eyes, the
presence of a vigorous motor factor when we are awaiting an impression
of sight or hearing. The attitudes, gestures, pose, and facial expression
of the melancholiac are in keeping with the predominant depressing
sentiment.
In the majority of cases melancholia is quickly or slowly induced by
causes which undermine the powers of physical and mental resistance. The
melancholiac gradually becomes pre-occupied with painful feelings, leads
a joyless existence, avoids society and eschews all forms of work and
pleasure. The notion obtrudes itself that he has, without knowing it, been
sinning all his life. He seeks consolation in prayer or in the Bible. It
often happens that during moments of intense supplication, hallucinations
come—voices telling him, perhaps, that he must die—die with all his sins

REPORT OF THE MEDICAL SUPERINTENDENT.

41

upon him. Although, startling and bewildering to him, these hallucinations may at first be corrected, but constantly recurring, and possibly
dreams and visions of hell, and fearful things being superadded, deeply
confirms in his mind the idea of his eternal damnation.
Melancholia may pass through all phases of its evolution without the
intrusion of "voices" or "visions," an intense dread, an indescribable
anxiety characterizing its course. Its outward physical and mental manifestations may be those of passivity, or they may be active as expressed by
great muscular or mental agitation. The interesting clinical facts in the
development of melancholia are, the increasing feeling of depression, and
the effort of the patient to account for it. In this connection Schule says:
"The patient, in searching for the cause of his incoherent thoughts,
becomes inconsolable, and tries to find some adequate reason for his condition in his past life, or seeks to explain it by the idea that an evil spirit
has brought this condition of indefinable dread upon him. Now illusions
appear, and the patient finds in all his perceptions something that acts painfully upon him."
"Very frequently the inner feeling of pain is an increasing, constant
moral consciousness of an incapability of fulfilling the ordinary duties or
occupations."
Melancholia may be divided into four groups: 1. Simple Melancholia,
2. Hypochondriacal Melancholia, 3. General Malaiieholia and its clinical
varieties, and, 4. Stuporous Melancholia, including Katatonia.
Only a brief reference to these forms will be attempted.
SIMPLE MELANCHOLIA.

This form of melancholia is characterized by absence of hallucinations
and delusions. Comparatively few cases of it are seen in asylum practice.
Only one of the 69 cases was so classed. This was that of a large, finelooking man aged 42 years. He had been out of health and had suffered
at times from vague feelings of depression. Several months before his
admission, he lost his second wife. His first wife, from whom he was
divorced, was still living and an inmate of an asylum. After the death of
his second wife, he began to think with remorse of the fancied bigamous
relationship in which he had lived with her, and the thought that he had
done wrong preyed continually upon his mind. This, together with grief
for her loss, led to more pronounced depression. While in this mental
state, he entered into a business transaction in which he was defrauded,
and this mishap further deepened his melancholia. Notwithstanding the
unfavorable state of his mind at this time, he worked regularly, but failed
in physical strength; he was worried and taxed; could not see his way clear
to the attainment of any object; and finally became sleepless, and felt that
life was not worth living. He had suicidal feelings, but made no serious
attempt to injure himself. During all these months, he is quite sure that
he had neither delusional nor hallucinatory promptings. After his admission he began to improve. With tonics, rest, and assurance of recovery,
he became bright and cheerful, gained rapidly in weight, and at the end of
three months left the Institution quite recovered, and has since continued
well.
6

42

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
HYPOCHONDKIACAL MELANCHOLIA.

This variety of melancholia is characterized by the predominance of
sensuous and visceral illusions and delusions. We must distinguish this
form of melancholia from hypochondriacal insanity. , The latter, as before
mentioned, is grounded upon a neurosis, a morbid, nervous constitution,
and is but an exaggerated expression of the natural mental reactions of the
individual. Hypochondriacal melancholia is preceded by the symptoms of
the simpler forms, and hence is secondary to, or complicates, the course of
the more common clinical forms of melancholia. In the one hypochondria
is necessary, in the other accidental. It is graver in its import and more
distressing to the individual than simple melancholia, and is usually
grounded upon a nervous debility affecting the whole organic sensibilities
of the sufferer. While the reasoning powers of the patient may in many
ways be logical, yet he invariably reverts to himself and craves sympathy
by relating his ailments and the tortures which he suffers from them. He
is harassed by the impression that his organs are diseased or gone; that
foreign bodies are placed within him; that his spine has been removed;
that he is wasting, that food cannot pass into his stomach, that he is syphilitic, that his flesh is decaying, and that his children will die a loathsome
death because of his sins—and form many similar delusions. " A noteworthy fact," Maudsley says, "in. connection with these strange sensations,
which are seldom actual pain, but more alarming than if they were pain,
is that when they reach a certain pitch of intensity they cause an indescribable pain and distress, so that the patient feels as if the foundations
of his being were taken away, and is perhaps driven to do some wild act
of violence in order to deliver himself from his insufferable state."
One of our sypilaphobes, who imagined his flesh decaying, made repeated
suicidal attempts, and another patient, who suffered intensely because of
the delusion that he had neither stomach nor brain, soon after his removal
from the asylum, committed suicide by blowing out his brains, a mode of
suicide inconsistent with his predominating delusion.
.
Mysophobia, (if indeed are not all the phobias) if not a clinical variety,
is closely allied to this form of melancholia. It existed in three cases.
Two, because of hallucinations of smell, fancied themselves polluted, and
would constantly watch for opportunities to gain access to the lavatories in
order to cleanse themselves. In the other case there was a general feeling
of uncleanliness. No matter how often bathed or how neatly dressed, he
always complained of being "dirty."
GENERAL MELANCHOLIA.

In this group are included all patients in whom delusions of a painful
character existed, and in whom illusions and hallucinations, when present,
determined ideas of persecution, or other disturbances of the intellectual
faculties. Some of these patients imagine they must suffer a terrible
death; that they are not fit to live, because they have committed an unpardonable sin; that their souls are irrevocably lost, or that the Devil has
actual possession of them. Others imagine that by their wickedness they
have caused the death of the Savior; others that they are to be deserted,
or that they are pursued by enemies for various malign purposes. A very
oommon delusion with melancholiacs is that they must not eat, because of

REPORT OF THE MEDICAL SUPERINTENDENT.

43

Divine commands that it is wrong, or from fear that it is "doped" or
poisoned.
A long list of these delusions might be given, but the foregoing are sufficiently typical of the general melancholiac. It has seemed to us that some
of the delusions of melancholiacs were really but illusions of memory; that
in some way past events were awakened or re-vivified in their minds. How
else are we to explain illusions of identity, by which a stranger is called by
the name of a friend, or a child is caressed and called by the name of a
child, very often, that has long been dead. The perception may not be at
fault in these instances, but in its cognition the mental adjustment is based
upon a memory and not upon the actual presentation. In some melancholiacs the mental distress seems out of proportion to the delusional ideas.
For instance, one of our patients, after speaking in an Adventist gathering
against the substitution of Saturday for the Sabbath day, conceived the
idea that he had committed a great error, which led to the further belief
that there was for him no God. He manifests the greatest distress whenever he reverts to the subject. Many melancholiacs show great muscular
agitation, and others great loss of control over their emotions. They
wander about bemoaning their fate; wring their hands and seem to be in
the deepest despair. Attacks of frenzy sometimes occur, during which the
patients may knock themselves against the wall, attempt suicide, and even
in their agony assault those with whom they come in contact. These
motor and mental perturbations are but expressions of sensory impressions
and cognitions that are not guided and controlled by the will. The
violent agitations of anger are simply expressions of the same thing in
kind.
Another group of melancholiacs are extremely apprehensive. They fear
bodily injury; think that everyone is against them; that they are to be
poisoned, or that they are persecuted by various agencies.
Another group are extremely resistive to attentions, and very rarely, we
find patients who only do things directly opposite to those desired, or
which they themselves may wish to do. This condition is the so-called
psychic contrast of Kaggi. The patients are conscious of their paradoxical actions, yet say they are impelled by some imperative power to their
manner of conduct. Hallucinations of the senses are very common.
In 32 out of the 69 patients, those of hearing prevailed. "Why auditory
hallucinations should be most frequent in this as in other forms of
insanity," Maudsley says, "is a question which has apparently not been
considered; but the main reason, perhaps, is that we do most of our
thinking by means of words, the thoughts as they arise being instantly
translated into their proper words; consequently, when a morbid thought
is vividly conceived and acts intensely upon the sensory center, the words
into which it is forthwith translated are heard as actual sounds or voices,
and thereupon attributed, in accordance with normal experience, to an
external cause." Hallucinations usually refer to imaginary voices. These
may continually tell them that they are lost, accuse them of wrong-doing,
that they are to be killed, or about to die—and the like. Sometimes
voices are menacing, vilely obscene, or blasphemous, and often exceedingly
distressing to the patient. Commands from the Deity are frequent. In
the minds of some patients there are painful upstartings, as if someone
were talking to them silently. Maudsley, in speaking of hallucinations,
says: "In vain we attempt to convince the patient so afflicted that the
thoughts momentarily precede and really cause the voices; he hears them

44

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

as plainly as he hears our words, and has the same certitude of their
reality; and he is not expert introspectionist enough to be able to watch his
ideas and to catch them at the instant of their rise before they are transformed into sounds."
In twelve there were hallucinations of sight. In three, hallucinations of
smell existed, and visceral hallucinations were common in the hypochondriacs. The genesis of hallucinations, if known, would form an interesting chapter in the pathology of melancholia. Doubtless they most frequently arise centrically from the same causes that give rise to exalted
subjective consciousness in general.
STUPOBOUS INSANITY—KATATONIA.

Stuporous insanity indicates a much wider departure from mental health
than do the other forms of melancholia. The origin and subsequent development of the depression resembles up to a certain period that of the simpler varieties, but farther on a profound torpor of mind is attained. The
patients are apparently oblivious; they do not voluntarily move; and they
seem to be in a state of mental and physical anaesthesia. These patients
will endure pain, heat or cold without outward manifestations of discomfort. Often there is an extreme condition of muscular tension; usually
the flexors are more or less contracted, causing the patient to sit with
bowed head, the chin resting on the chest, body drawn forward in a fixed
attitude. The saliva may escape from the mouth as fast as secreted, and
the mucus from the nose may cause excoriation of the lips. Often they
sit with their eyes tightly closed, and from this may ensue much irritation
to the lids and even disease of the cornea. The eyeballs may be rolled
upward and fixed, and if the patients see, they re-act not to the sight
impressions. The bodily functions may be normally performed, although
the secretions are voided without sense of decency; there is absolute
refusal of food and much wakefulness. So far as our experience goes,
these patients seldom weep, and oftentimes it is difficult to discover in
them the slightest perceptible ray of intelligence. They may continue in
this condition for weeks or months. It is claimed by some that patients of
this class are overpowered by a delusion, but we have not yet seen a patient
recover from this state that had memory of what occurred during it. Some
pass into confirmed dementia, others improve, and a very small number
recover. Doubtless, in these cases there is profound alteration in the
nutrition of the brain. This not only paralyzes the ideation al centers of
the brain, but impairs all its functions. In those cases in which death
has resulted, the post-mortem examination usually reveals much blanching
and wasting of the convolutions.
Katatoriia is by some alienists considered a distinct psychosis, but most
recent authorities maintain that it is but a variety of stuporous melancholia.
These patients are extremely depressed and apathetic, and usually occupy
fixed positions. They do not ask for food, or eat it when placed before
them. The most striking characteristics of the disorder are seen in the
cataleptic conditions. Usually the circulation is enfeebled, the impulse of
the heart weak, and the blood vessels imperfectly filled. There may f>e
• momentary outbreaks of impulsive and destructive excitement, during which
the patient may talk in an unintelligible gibberish. There is often a condition of muscxilar tension, as noted in stuporous states. Some patients will
answer questions, but with a scanning, drawling kind of enunciation.

REPORT OF THE MEDICAL SUPERINTENDENT.

45

There are trophic and motor disorders, as is manifested by the excessive
flow of tears and saliva; wasting and flabbiness of the muscles; feebleness
of the heart's action. By verbigeration, is meant a peculiar utterance of
meaningless words or sounds. This symtom has not been pronounced in
our cases, although it has existed in some. The catalepsy is very marked,
the patients are like wax, and will remain in any position. The cataleptoid
state may last indefinitely, and may, as Mickle points out, represent the
delusion in .terms of gesture and attitude. It is a curious and wonderful
thing how long the limbs will preserve unnatural positions. The same may
be said of the body; it will keep without apparent fatigue, during relatively
long periods, positions, often the most difficult ones, that may have been
communicated to it. When the limbs are raised or moved, they seem light,
i..e., without weight, and even if they are flexed or extended, the articulations offer no sense of resisten.ee. These patients, if placed in cataleptic
attitudes, preserve perfect equilibrium and appear as if petrified. If the
eyes are open, the gaze is fixed, the physiognomy impassive, but expression
pathetic. The pathology of this disease is not determined, but it usually
occurs in those hereditarily predisposed to insanity, and from exciting
causes of a debilitating, exhausting nature. The prognosis is bad, and in
the few cases we have seen, no cure has been recorded.
Space will not permit us to take up the general conditions of melancholia
or its treatment.
ALCOHOLIC CASES.

The following careful study of some of the features of alcoholic insanity,
was prepared by Dr. C. G. Chaddock, Asst. Medical Superintendent:
The cases of mental disease admitted during the biennial period in which
alcohol played an unmistakable rdle of causation, while they give no
adequate idea of the relative frequency of this toxic agent as an excitingcause of alienation, are yet interesting and instructive.
The acute forms of alcoholic insanity, comprehending the nervous disturbances which characterize the condition of inebriety, and the more
prolonged and profound instability of function which we know as delirium
tremens, seldom come under observation on account of the comparatively
ephemeral nature of the mental anomaly, the prejudice against an asylum
per se, and the situation of the hospital in a rural district. It is after
confinement in jails has failed to induce a return to the normal mental
state that patients suffering with acute alcoholism, or a persistent train of
mental symtoms following it, are committed to the hospital for treatment.
The danger that delirium tremens, even when most carefully treated
may pass into a persistent form of alienation, should always be kept in
mind; and when the character of the treatment such cases frequently
receive is considered, it is not remarkable that the history of many of our
cases of chronic alcoholic insanity have an attack of the acute delirium set
down as having formed the beginning of the mental trouble. The desirability of treating such acute cases in hospitals for the insane is in no wise
overcome by the circumstance that such hospitals are comparatively
inaccessible for a large portion of the community. That the difficulty of
access to the hospital from the more distant counties of the asylum district
is not the most determining factor in relegating such cases to the jail, is
shown by the fact that cases of this kind rarely come from the immediate
vicinity of the institution. The real reason why these cases are not more

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NOETHERN MICHIGAN ASYLUM FOR THE INSANE.

frequently sent to the asylums, lies in the inadequate appreciation of the
dangers incident to the condition. Where possible, were such cases to be
given the benefits of asylum treatment, there would be fewer terminations
in incurable forms of insanity; and more than that, there would be an
opportunity to subject the sufferers to influences tending to the establishment of moral reformation. It is especially in the class of cases that are
at present kept in jails as the most available places of treatment, that the
substitution of treatment in an asylum is to be urged. In those cases
where means are sufficient to provide all the requirements of treatment at
home or in a general hospital, the advantages an asylum affords over the
latter places may possibly be outweighed by the stigma commitment to it
is sure to leave behind.
In these acute cases, when the delirium has quite exhausted the patience
of the jailor, or active excitement has become converted into an apparently
stationary state of hallucination and delusion, instead of the lucidity that
was so confidently expected, steps are taken to send the sufferers to the
asylum.
Thus our acute alcoholic cases are those in which the abnormal manifestations are such as belong to the psychoses as ordinarily conceived. But
even acute melancholias and manias due to alcohol, are not frequent in our
tables as compared with the numbers of the chronic forms of diseases due
to the same agent.
The acute insanities of alcoholic causation, as a rule, fail to present any
features beyond, perhaps, greater frequency of visual hallucinations, that
enable their differentiation from the same forms of disease resulting from
inanition due to other causes; in case, however, the form is that of acute
hallucinatory insanity, the intellectual perversion is more apt to present
characteristics which distinguish the anomaly as one in which alcohol has
exercised a causal influence.
In one case of melancholia (male, married, aged.32), had the history of
acute alcoholism been wanting, the mental symptoms would almost have
sufficed for a diagnosis of mental disturbance due to alcohol. The physical
signs of alcoholism were wanting, but the patient was profoundly neurasthenic. The fundamental mental state was one of profound depression
accompanied by the delusion of impending death, with annihilation of all
hope of salvation in the future life. There were also hallucinations (illusions ?) of sight of a terrific character, which changed in consonance with
the immediate sensory impressions; and ideas of marital infidelity,
expressed from the first, became more clearly defined as the hallucinations
began to fade. Amnesia for recent events, with memory quite intact for
remote occurrences, was an indication that the patient had passed through
a delirious state that had allowed no registry of impressions of time and
place. The persistence of amnesia for recent events for some time after
he had become rational and had begun to correct his delusions, was
another alcoholic feature. Depression continued after delusions had disappeared, the ideas of marital infidelity being the last corrected. In this
case, the depression immediately followed the subsidence of the active
symptoms of delirium tremens. T-he pi-ogress of the case was rapid to
complete recovery. There was comparatively perfect memory for the subjective mental phenomena of the time of his illness, but the objective
events of the same period could not be recalled, or were reproduced in the
false form in which they had been apperceived.
A case of hypochondriacal insanity, the exciting cause of which was

REPORT OF THE MEDICAL, SUPERINTENDENT.

47

prolonged over-indulgence in alcohol (patient was known to drink large
amounts of rectified spirits), becomes interesting on account of the predominating influence the constitutional neurosis exercised over the character of the mental symptoms.
X., male, married, aged 42. It was certain that a paternal uncle had
been insane. At the age of 27 the patient had an acute attack of insanity,
which is said to have terminated in recovery after treatment in a private
institution, the symptoms at that time being similar to those he presented
when admitted here, and likewise due to alcoholism. When admitted, he
had been manifesting insanity about a year. The outbreak of mental
symptoms followed prolonged excessive drink and loss of property by fire.
After the misfortune, he gave himself entirely to drink, and this continued
until he came here. One attempt at sxiicide had been frustrated. When
received, he was in a very feeble physical condition, but presented no
abnormality of the vegetative organs other than chronic gastro-iiitestinal
catarrh. This caused him much distress. Food was often refused, or taken
only to be regurgitated after a short time. Rheumatoid pains of an ephemeral kind were frequently the subject of complaint; a feeling of having the
nerves "stretched" and "pulled" was expressed, and unpleasant sensations
in the soles were described. Sleeplessness (not actual) was a chronic
complaint, as is so frequently the case in hypochondria.
Here, certainly, was a foundation on which the construction of delusions of persecution (poisoning, electricity, magnetism) would have been a
logical process. But the usual interpretation of the subjective anomalies
of sensations in alcoholism, was not the one made by the patient. He had
not even the beginning of an idea of persecution. The constitutional neurosis determined an interpretation, logical in its turn, of the visceral and
peripheral sensations in harmony with it. He believed himself to be
afflicted with an incurable physical malady. He even bemoaned his
physical improvement, because, as he said, it deceived others as to the
nature of his disease. The natural consequence of his firmly fixed delusion
was a desire to free himself from his irremediable misery, and an escape
nearly culminated in suicide.
Physical improvement was at last accompanied by something like a
remission of the symptoms, and, contrary to advice, he was removed by his
family. Some months after his discharge, probably under the influence of
a renewal of the suffering incident to a return to his former habits, he committed suicide.
Young men of neurasthenic constitution, that lead a life of pleasure,
and it is this class of individuals that shows an especial tendency to this
form of morbid indulgence, are prone to develop a form of hypochondria
approaching this. In one instance of this kind with the morbid subjectivity
of the mind, there were symptoms of folie du doute an occasional manifestation of agoraphobia. In such cases, it requires but the slightest favoring
circumstance to make commitment to an asylum absolutely necessary.
Treatment, in an ideal sense, should begin with the manifestation of the
constitutional vice, before it has insidiously led to the development of
an habitual gratification of morbid desire.
Another case of insanity, where the physical signs of chronic alcoholism
were unequivocal, presents an illustration of the genesis of primary
delusion with secondary depression, and forms an excellent example of the
value of psychological analysis in making a diagnosis.
At the time of admission there was much depression, and for some time

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NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

the emotional state might have been regarded primordial; but an analysis
of the delusions and hallucinations, with an estimation of the inter-relation
of the mental symptoms, as revealed by examination of the previous
history, and observation of the subsequent changes, served to establish a
more satisfactory diagnosis.
Y., male, married, aged 50. Lack of abilty to read was the most
obvious mark of the patient's low intellectual development. His mind had
not advanced beyond that stage in which iincoiiditioned credulity fosters
allegorical and supernatural interpretation of natural phenomena.
With failing physical health, came self-preoccupation and the syllogistic
association of subjective sensations and objective phenomena, and interpretation of their relation as supernatural. He began to see peculiarities
in his every day surroundings, which became signs of a supernatural kind,
and the step to a belief that these carne directly to him from God, was but
a short one. From this idea of heaven-sent signs to visual and auditory
hallucinations, in which the Deity was manifest, was another natural
transition. Inherent religiosity burst into flower and bore fruit in delusion.
He had led an irreligious life, and to prove the reality of his conversion,
God had tempted him as Abraham had been tempted. He was told to
sacrifice the members of his family with a knife. Change of surroundings
induced further elaboration of delusions, and a deepening of depression in
consequence. He believed that he was the only sane man in the world,
and that he had caused the insanity of the rest of mankind. A sexual
element was added in the belief that he had brought this about by a
youthful act of bestiality. God continued to communicate with him daily,
demanding the lives of his family as the price of redemption of the world.
Under tonic regimen, he gradually improved physically. Through a
special revelation, God at last informed him that he had thus far been led
by an evil spirit; his sins were forgiven, and he became a "sanctified" man.
All the blessings of earth were to be doubled, and happiness reign
supreme.
Here was an end of his depression. Bodily health improved, and
finally he learned to conceal all save the vestiges of his delusions.
It is only by study of the genesis, development, and termination of
insanities, that we can hope to gain the knowledge necessary for scientific
diagnosis and prognosis. Abnormal phenomena are natural phenomena
in sensu strictiori, and they, like normal phenomena, are manifested in
conformity with certain laws. Systematic treatment of the single case of
insanity, in the light of experience drawn from the observation of many,
is, in the absence of exact knowledge of the relations existing between
cerebral pathology and abnormal cerebration, the nearest approach to a
scientific method of procedure that is open to us. Whatever additions to
pathological knowledge of the brain improved methods of research may
hereafter make, the clinical (psychological) pictures of mental diseases
will continue to occupy the foremost place among the objective
phenomena which form the basis of diagnosis and prognosis.
The condition of a large number of insane patients sent to asylums is
such as to justify the view that the mental symptoms have reached their
acme; in another portion of them, that height has been passed for the
descent into terminal dementia; the unfortunately small remainder present
the active evolutional symptoms of insanity. We are fortunate if we may
attempt to stay the progress of a case during its period of evolution; but,

REPORT OF THE MEDICAL SUPERINTENDENT.

49

fail as we must so frequently in this, we should not forget to make use of
all the data a history of this stage of the malady affords us.
Where the evolution has been complete, future change may be regarded
as involution, implying a return to the status quo ante; subinvolution,
the retrograde process stopping short of completion; and dissolution,
where the change is indicative of permanent mental decay.*
Thus in pure melancholias, the primordial state is one of emotional
depression (psychalgia). To this, in succession, are added delusion, hallucination, confusion, and even the graver state, stupor. Should improvement take place in such a case as this, and go on to recovery, the involutional process would consist of progress through the evolutional stages in
an inverse order: stupor gives place to confusion, confusion to unconscious
or conscious re-establishment of ideational associations, and delusion and
hallucination re-assume definition. Then delusion and hallucination fade
in turn, leaving at last the gloom of depression to be pierced and dispelled
by the dawning light of objective consciousness.
The case last described offers an illustration of this principle. Its practical use in determining other points of value in acute insanities, may be
briefly indicated.
In the psycho-neuroses, where the retrograde changes take place in an
order the reverse of that of their evolution, the prognosis would be favorable; should irregularity be manifested, it would at once suggest an
unfavorable opinion.
In other cases where preliminary history is meagre, the systematicobservation of the the sequence of mental phenomena will often serve to
establish a positive diagnosis of the form of alienation. The disappearance
of depression, with persistence of delusion or hallucintion, would indicate
some form of primary delusional insanity, or mark a step onward toward
terminal dementia. With an inverse relation of similar symptoms, the
originally favorable character of the disease would be at once apparent.
Cases of the mania gravis potatorum, of Krafft-Ebing, have been
admitted, but they have been of a type which deserves to be designated
mania ambitiosa, rather than mania gravis, Schiile's equivalent. Our cases
of this kind have coincided with periodical over-indulgence in alcohol, and
recurrence has been very frequent. The periodicity in such a case arouses
the suspicion of a degenerate brain. It is, of course, unnecessary to posit
constitutional psychopathia in every instance of this kind; the possibility
that a state of nervous instability may be induced by alcohol in an originally healthy brain, which manifests itself in periodicity, must still be kept
in mind. The prognosis of the single attack is good, but recurrence may
be confidently expected, and at least dementia of a pronounced type
becomes associated with the excitement, which then continues to manifest
itself with more well-defined periodicity, even without alcohol as an exciting cause. The grand and coherent delusions are reduced to incoherent
vestiges, and at last the mania is expressed in purely purposeless restlessness, destructiveness, and the most degraded perversions. One case will
serve as an example of this form of disease.
H., male, aged 53, native of Germany; no degenerative signs. Previous
history meagre. He was admitted for the first time in 1887, and again in
1889 after an absence of one year. In 1886 he was an inmate of an asylum
in Wisconsin. The facts of his previous life that have been obtained make
* This statement is not actually prejudicial to this conception of insanities as dissolutions.

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NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

the duration of his mental trouble five years. Up to that time he was
fairly industrious and prosperous, but habitual drinking gradually brought
financial ruin, and progressive moral decadence at last culminated in
desertion of his family. Then began a life of irresponsible vagabondage,
interrupted by spasmodic periods of industry. A portion of the winter was
usually spent in the woods, and when spring brought him out, he drank
and caroused until his money was gone.
It was after such a course, probably, that he was sent to the asylum
above mentioned, and his first admission here followed his escape from
that institution. His re-admission was the result of a similar series
of events. When he first came here, his mental symptoms were beginning
to show a remission, but he still lived in a world of grand religious
delusions, and went about convinced of his personal importance, wearing
grotesque ornaments which he would have others recognize as symbols of
his distinction by the Almighty.
He gave the following delusional account of his life:
God revealed to him the unfaithfulness of his wife, and this knowledge
made it necessary for him to abandon his family. He had to atone for her
sins, and while confined in jail he was crucified and decended into purgatory and hell in atonement, whence he came to earth again to fulfil a
mission as savior of the world. The stigmata inflicted in crucifixion were
removed by a miracle. A young woman became the subject of delusion.
He had been married to her in spirit, and she was about to give birth to a
child miraculously conceived. His confinement in jails and asylums he
explained as persecution arising by virtue of his consecration and divine
mission, and it was obligatory on his part to accept it in a spirit becoming
one having the most exalted relations with the Supreme Being.
A few months siifficed to establish an actual remission, with disappearance of delusions, and a fairly appreciative judgment of his malady; and
evincing a self-confidence and emotionality that betokened his exaltation,
he was discharged.
An absence of one year ended in a re-admission, and the same mental
symptoms were again manifested with the same termination, save that his
mental operations bore a more obvious impress of dementia.
Fifty per cent of the alcoholic cases admitted during the period are
classed as chronic, and by far the larger number of this percentage presented mental symptoms which entitled them to be further distinguished
as instances of persecutory insanity.
While persecutory delusions of alcoholic causation possess no absolutely
pathognomonic features, they are so frequent and characteristic of mental
perversion induced by alcohol that they deserve critical examination.
Delusions of persecution may be evolved out of the circumstances of life
affecting the individual; they may be secondary to pathological depression,
to hallucination, to illusion, to persistent morbid sensations; or, as is most
frequently the case, they may be the product of a combination of these
elementary anomalies.
But each of these modes of origin presumes a preceding or simultaneous
deterioration of the higher mental faculties of such degree as precludes
the possibility of normal adjustment between the objective and subjective
spheres.
The primary mental manifestation of the detrimental effect of the abuse
of alcohol on the most delicate and highly differentiated structure of the
nervous system, the cerebral cortex, is a progressive weakening of the

REPORT OF THE MEDICAL SUPERINTENDENT.

51

higher psychic powers inaugurated by deterioration in the moral sphere.
Inebriety presents, in an elementary and ephemeral way, many of the
abnormal mental phenomena which characterize the more stable perversion
of alcoholic insanity; even those which are apparently absent will be found
on critical examination to be represented by an equivalent or in an embryonic form.
When disease processes of gradual inception and progress affect the
cerebral cortex, and it seems evident that the changes in the pure
psychoses are of that nature, the symptomatic manifestation of them in the
psychic sphere is of like nature. The most highly differentiated (evolved)
structures suffer first, and of necessity their functions evidence the change,
which, expressed in the same terms, is failure, going on to absolute erasure
of the most highly evolved, the most circumferential realms of mind. In
the affective sphere, moral sentiment; in the intellectual, abstract ideation;
in the volitional, higher desire,—all evince, by their gradual erasure, the
progressive deterioration of the nervous structure of which they are functions. This shrinking of the mental horizon, progressing pari passu with
the structural change which causes it, continues, expressing itself more and
more definitely in subjectivity, until, in extremis, psychic action is reduced
to the circle of pure reflex action.
Evolution of mind is dilution of pure egoism; dissolution of mind is
reconcentration—a process resulting in increasing predominance of self.
In the mental sphere, it is dissolution and arrest of evolution that constitute insanity in its widest sense. The law of evolution fixes the law of
dissolution. The most striking characteristic of insane minds is the
universality of subjectivity (egoism), in which are seen the result of dissolution and the effect of arrest of evolution. Consideration of this law
explains the rise of subject consciousness (egoism), an inherent condition
in all insanities.
The gradual evolution of false ideas of persecution is typical of paranoia,
being here, so to speak, the normal psychic expression of a degenerate
brain. Consideration of the enviromental influences which attend the
persistence of habitual over-indulgence in drink, at once suggests a mode
in which primary persecutory ideas may be engendered:—
With the inception of habits of conviviality, moral decanence has been
insidiously inaugurated by the necessity of concealment over-indulgence
in drink brings with it. The victim leads a double life until indifference
has made his weakness known to all from whom he once wished to conceal
it. He meets with remonstrance from those to whom he is dearest; sees
his friends fall away one by one; feels the loss of confidence where he once
enjoyed it; and endures the distrust and contempt of society. All this soon
becomes the cause for continuance in the vicious course in which forgetfuliiess of any pang of remorse that may yet be felt is found; and at last, the
attitude of society suggests itself as the primary cause of degradation.
Driven on his way, as he thinks, the sufferer becomes a persecuted man.
Mind is a unit, but only so in the sense that a physical molecule is a unit.
It is a unit made up of faculties, just as a molecule is composed of atoms.
Integrity of the physical molecule depends on the maintenance of a certain
arrangement and relation of all its atoms. Disturbance of one atom, by
the consequent disturbance of relations of all, changes the chemical value
of the molecule. The integrity of the mind likewise depends on the maintenance . of the normal condition of each faculty and its normal relation to
all other faculties—the relation which characterizes the mind as an entity;

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NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

and primary disturbance of one faculty, by virtue of the consequent disturbance of normal relation, alters the mental value of the unit, and the
mind is deranged,—altered as a whole. Therefore, though the mind is one,
mental disturbance may be primary in one faculty or more, but the mind
suffers in its entirety as soon as the disturbance has passed beyond normal
limits.
Primary states of emotional depression are especially prone to evolve
ideas of persecution, and while these may be present in melancholia of any
causation, they are especially apt to manifest themselves where the original
alienation is due to alcohol. Selfishness and suspicion, the most vigorous
of the progeny of alcoholism, are the natural forerunners of persecution.
In melancholia, there is a retardation of the normal mobility of emotion;
the mind harps on the dismal chord of sadness, and the whole gamut of
feeling vibrates in harmony with the fundamental tone. This inhibition
involves the intellectual sphere, expressing itself there in conscious difficulty
of thought and volition, and in immobility of idea. These are conditions
ultimately favoring the evolution of delusions; but their construction implies
that inhibition of intellection is not so absolute as to amount to prohibition.
The delusions vary in content in consonance with the previous mental
peculiarities and endowments of the individual. A selfish and suspicious
mind finds in this inner inhibition an involuntary restraint which is logically attributed to external influence, and the further elaboration of the
false inference to definite persecutory delusions, varies with the accident of
previous mental acquirement, and residual mental power.
The role played by hallucination and illusion in the genesis of delusions
of persecution in alcoholic insanity, is most important, and a short
consideration of it must be prefaced by a review of those elementary
anomalies in general.
There is somewhat indiscriminate use of the term hallucination.
Hallucination is frequently made to include pure hallucinations, illusions,
and the sensorial anomalies which combine in varying degrees characteristics of each of the elementary phenomena.
Hallucination is primarily central and exclusively representative;
illusion is primarily peripheral and exclusively presentative. A combination of these may be designated hallucinatory or illusional in accordance
with the predominance of either factor.
An hallucination exists when a memory picture is spontaneously represented in consciousness, and so vividly projected in presentative terms
that the image acquires the intensity that characterizes an actual presentation.
Presentation is essentially involuntary and sudden; representation is
voluntary and relatively slow. This difference and variation of intensity
are the criteria by which presentations and representations are differentiated in consciousness. The voluntary representation (visualization) of
images is the physiological antecedent of hallucination. It is where a
voluntary representation has been intensified by repetition, and volition
has, for the same reason, come to be but a small causative factor in its
production, that the domain of hallucination has been reached, where
representations are spontaneous and possess presentative intensity as a
result of pathological conditions. When the individual ultimately becomes
unable to differentiate the representation from actuality there is an
anomalous element in consciousness that is indicative of mental disease.
An illusion is an actual percept which, either by virtue of physical

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53

conditions outside the organism or because of anomalous conditions of the
perceptual mechanism, differs from what the percept would have been
under normal external and internal conditions; and in a strict sense are
included false percepts arising in consequence of conditions affecting the
perceptual mechanism in the absence of external stimuli. Thus, beyond
physiological limits, false percepts may be induced by disease of sensory
nerve endings, of afferent tracts, of perceptual centers, or by a multiple
involvement of these. Here again, in order that the anomaly be symptomatic
of insanity, there must be simultaneous and enduring inability to form a
correct judgment concerning it.
It is often difficult to differentiate hallucinations and illusions of the
insane, owing to the accompanying mental enfeeblement or the affective
reaction to the elementary anomaly; but a consideration of their relation
to normal and abnormal mental states will show the importance of making
the distinction where it is practicable, and possibly afford some generalizations which may be of value in determining a decision in the single case.
Sensation marks the first step above reflex action in the evolution of
mind; perception the second; and subsequent acquisition of the power of
representation is the sine qua non of higher mental development.
Illusions which depend on presentation, are of a lower order than
hallucinations, which depend on representation. Illusions, in that they are
presentative, are subject to a narrower limitation of elaborateness, than
hallucinations, which, by reason of their dependence on imagination in its
strict sense, present degrees of complexity extending from the representation of elementary percepts (sensation) through an ascending series to the
hallucinatory reproduction of the most complex concepts.
Thus, in themselves, hallucinations, by reason of variation in elaborateness of content, afford evidence of mental (brain) power; and observation
of their variations in the individual is productive of knowledge concerning
the subsidence or progress of underlying pathological processes. Their
occurrence in complex forms in simple insanities must be coincident with
retention of a relatively considerable amount of brain power. As might
be expected, it is in the "primarily chronic" forms of alienation that
hallucinations are most elaborate and complex; so that in the absence of
positive antecedent history, their presence in a highly developed form
would almost justify a diagnosis of a "degenerative" form of disease.
As has been shown, illusions belong to a lower level of mind, involve
less mental activity than do hallucinations; and this fact, were it unsupported by direct evidence, would lead us to expect them to be more frequent
in mental disease than hallucinations. In those forms of insanity which
are associated with bodily disease, among which chronic alcoholism holds
a prominent place, this elementary anomaly is especially frequent, and in
the secondary insanities, it is one of the most prominent active
symptoms. Here the brain is too far deteriorated to allow much active
representation, and the possibility of hallucination is minimized both
quantitatively and qualitatively; the individual lives almost absolutely in
percepts which undergo frequent falsification by reason of decadence of
the higher mental faculties. The frequency of illusions in the inmates of
asylums for the insane, where there is always an accumulation of cases of
advanced dementia, and the failure to strictly differentiate illusions and
hallucinations, especially in the domain of the acusticus, is in part responsible for the diversity of opinion with regard to the relative frequency
of visual and auditory hallucinations.
There is little doubt that

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hallucinations of sight are qiiite as freqiient as those of hearing, owing
to the fact that physiological reproduction of mental images is almost
invariably accompanied by visualization, but visual, like all hallucinations, belong to the earlier stages of alienation and to those forms of
disease where dementia is comparatively slight. While hallucinations of
hearing are frequent in the early periods of mental disease, they are certainly more characteristic of its chronic stages. The reason for this variation and apparent contradiction lies in the fact that representation of sound
is a process of less complexity than visualization of images, and, therefore,
the possibility of hallucinations of hearing endures longer in progressive
forms of mental disease. Here again the order of dissolution is determined
by the law of evolution; the earliest voluntary representation, having its
beginning in imitation, is the reproduction of sounds (language), and,
therefore, their representative images are among the last to be eradicated.
An uncorrected hallucination may be the starting point of delusion. The
hallucination may occur but once, and yet, by virtue of memory, lead to
continuance of morbid ideation, or, it may be frequently repeated and even
come to be a comparatively constant element in consciousness. Delusions
of persecution may be secondary to hallucinations as a direct result of their
terrific or threatening (persecutory) content; or, where the hallucinations
are of an exalting character, affecting the individual's social relations, persecutory delusions may result from the paradox of actual environment and
hallucinatory content.
Hallucination is a very frequent phenomenon in acute alcoholism, owing
to both the direct and the indirect effect of alcohol on the psycho-sensory
regions of the cerebral cortex; and in chronic alcoholism, where progressive
irritative (inflammatory) changes have been induced in the same cortical
realms by an habitual abuse of the intoxicant, the conditions favoring
the occurrence of hallucination are given in a pre-eminent degree, at least
before the degenerative process has advanced so far as to actually reduce
the specific energy of the nervous sub-stratum of ideation.
The elaborateness of hallucinatory content is necessarily a measiire of
the active energy in the psycho-sensory centers of the cortex, and relatively
indicates the degree of functional or structural alteration these centers have
undergone, just as systemization of a subsequent delusion is the measure
of the active power of reasoning that constructs it.
Objective (abstract) ideation, both in the individual and in the aggregate, is quantitatively infinitesimal in comparison with ideation that is
siibjective (egoistic). Egoistic ideation in its absolute nature can be of
but two kinds; that which exalts (pleasurable); that which debases (painful). Therefore, insane hallucinations are in the vast majority.of instances
egoistic, and must then in content be either exalting (pleasurable), or
debasing (painful) to the individual, and, as has been shown above, conditioned by the logical powers of the individual affected, hallucinations of
either bind lead to delusions of persecution.
The persecutory reaction in ideation to hallucination is primary where
hallucination and delusion are congruous; secondary, where these elements
are incongruous. The direct sequence is the more frequent from the fact
that the indirect evolution often lies beyond the residual power of the
mind affected.
Abnormal sensations, as primary factors in the morbid ideation of
chronic alcoholic insanity, give the malady many of its striking features.
They are most frequently referred to the skin, the viscera, and the mus-

REPORT OF THE MEDICAL SUPERINTENDENT.

55

cular system, but they may be found in connection with any of the higher
senses. The frequency of anomalous general sensations is due to the
insidious and widespread disease of the peripheral nervous system resulting from abuse of alcohol. Should the intellect be comparatively intact,
these sensations receive a relatively correct interpretation; but their persistence until the higher mental faculties begin to show the effect of the
poison, is almost certain to lead to persecutory delusion, either directly or
through the shadow of illusion and secondary hallucination.
Instances of delusion arising directly from these abnormal sensations
are shown where they are attributed to the effect of poisons secretly administered, or where they are held to be the result of some intangible influence. Here the popular ideas concerning electricity, magnetism, etc., find
delusional expression. Under these circumstances, with only few exceptions, the delusions assume a persecutory form, the content varying with
variation of previous and retained mental acquirements.
The transition from persistent anomalous sensations to illusions is but a
step. Soon they give rise to illusional percepts of an endless variety;
sharp pains become stabs, dull ones blows; sensations of scratching become
evidence of the presence of the lower forms of animal life on the skin or in
the body. Feelings of weight or pressure and tearing pains, receive their
appropriate illusional interpretation.
These illusions may be accompanied by secondary hallucinations of
other senses. The victim sees the active cause of his suffering, or hears
the sounds that should accompany such operations.
Of the higher senses in alcoholism, the auditory isi?that most frequently
implicated. Aside from pathological conditions of the organ itself, the ear
is, of all the higher sensory mechanisms, most frequently subjected to the
influence of inadequate stimuli, which accounts for the great frequency of
auditory illusions in insanity. As a primary anomaly in chronic alcoholism, auditory illusion is very frequent, owing to the frequency of peripheral disease.
A differential index for determining the hallucinatory or illusional
character of a seiisorial anomaly is found when the abnormal manifestation
is studied with respect of its elemental character and the frequency with
which its essential factors are found to occur independently in a large
number of individuals.
An illustration of this is found in a consideration of the hallucinatory
phenomena of acute alcoholism. There is no doubt as to the actual illusional character of the percepts (of insects, etc.) arising from affection of
the cutaneous nerve endings in delirium tremens, they always have the
same distinctive character, but it is usual to designate the visual
phenomena as hallucinations, notwithstanding the fact that here also there
are quite as distinct marks common to all cases.
The common feature of the cutaneous illusions is a subjective perception
of motion on the skin; the common and fundamental feature of the visual
phenomena is motion, and, with a common cause and anatomical homology,
simple analogy suggests that they too are due to affection of the retina.
The cause of the peripheral impression of motion is at once suggested by
the rhythm of the circulation, and in the case of the retina, also by the
fact that a hyperaesthetic condition of it favors the persistence of
after-images which are always accompanied by a sense of objective movement. Latent memory-pictures in which movement is the primordial
element, are images derived from the animal kingdom, and visions of

56

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

animals constitute the distinctive element of the hallucinatory phenomena
of delirium tremens. Thus, in the strictest sense, these anomalies are illusions. It is almost unnecessary to point out the possibility of actual
hallucinatiora ultimately arising secondarily.
By the side of persecutory delusions in chronic alcoholic insanity, often
flourish others of a sexual nature, and those of marital infidelity have been
regarded as pathognomonic of an alcoholic basis. The combination is certainly very frequent, though not constant, and it is interesting to trace
the law of the association.
The frequent anomalies of genital functions and sensation in alcoholism
have their organic basis in the frequency of disease of the peripheral
nervous system, and here lies the cause of the comparative frequency of
sexual delusions per se; but those of marital infidelity and the corresponding
ones of jealousy, have a purer psychic origin.
Delusions of marital infidelity are, in their ultimate nature, persecutory,
but this fact alone does not account for the frequency of the conjunction
of these ideas with other delusions of persecution. The cause lies deeper
than mere likeness in kind.
Sexuality is the most powerfully determining factor in all social relations.
In all its forms, from the coarsest fibre of procreative instinct to the silken
floss of altruism, it is woven into the fabric of society. To sexuality,
society owes all its coarseness and all its refinement.
The closest of social relationships (marriage) has its origin in this primordial instinct, and about it cluster the multitudinous human interests
that mould inexorably the life of the individual. Persecution implies
that these interests are assailed, and the primary or ultimate implication of
the radical is almost a necessary result of the persistence of the subjective
feeling of persecution.
In the developed case these anomalies are met with in all varieties of
combination; indeed, it would be remarkable if the sensorial perversion of
chronic alcoholism were to manifest itself in but one domain. The following note of a case illustrates the frequent combination of pathological sensation, illusion, and hallucination, and is an example of remarkable delusional elaboration of them.
X., male, aged 47, married, Sweden, railway roadmaster; no heredity; no
degenerative signs. He has been married 16 years; no children. Leading
a rough life as a railway contractor, he drank excessively for years. Some
months before admission he had an attack of delirium tremens, and a short
time before commitment he threatened his wife with a knife. When
received he was in excellent physical health apparently, with no demonstrable organic lesions; no tremor. His face had a sodden look, and there
was slight acne rosacea. In manner he was reticent and suspicious, but he
soon became more communicative, and talked with freedom on all topics
that were personally indifferent. Concerning his delusions he could not be
induced to talk, but finally he wrote the following description of his persecution, without request or promptings. The persons referred to are those
that were about him at home:
"Mar. 10, 1890. A good deal has been said about electricity in my paper
left with J. I have since then discovered more about it, and can say with
iny hand on my heart and swear to Almighty God, that it is true. I have been
(and hundreds besides me) ill treated by Dr. X., by having a stream of
electricity on my body. I have not seen the battery or instrument that he
uses, but suppose it is the same as that used in the telegraph system: but

REPORT OF THE MEDICAL SUPERINTENDENT.

57

I know for sure that there are ingredients in it that are not used in the
telegraph, and that electricity can be sent into a person at a distance of one
or two hundred miles without any negative in the body, because the negative is mixed in with the stream in the instrument, and is magnetism.
(The magnetism is put separate in the instrument and the stream of
electricity runs through it and becomes magnetized.) The instrument must
be a small one so it can be carried in the pocket. (I think Dr. X. in M. has a
large one and has it taken care of by F., the hustler, and that is the one
used on me.) The electricity is sent through the body at the navel to
begin with, and after that it can be shot through the body anywhere, on
account of the mixture of magnetism with the stream. As an example of
its danger, I will take myself. When leaving I., I was filled with streams
of it mixed with magnetism. Any person I came near was shot through.
I am in the asylum, and everybody in the whole building is shot through
with it. We walk twice a day in a body, and there is the best chance to
fill everybody. Some will say: How can it be done when there is no negative? The negative is mixed in the stream and I am full of it. Anyone
coming opposite of me is shot through. You may ask, how does Dr. X. in
I. know when I am opposite a person. In this way: Dr. X. has a stream
through his body and brain as I have, and anything I am thinking or talking goes through a tube (the size and shape of it I don't know) into his
head and stomach and makes a perfect language of it. He has the same
feelings I have. Anything I see, he sees. If I think of California, San
Francisco, Oakland, the Golden Gate Park, the Shoal Bocks, Cliff House,
etc., or of any place I have been, he sees the same as I do. In this way
Dr. X. has the control of everybody in M. County and can kill any man he
wants to. For the last five months he has tried to kill me. I would have
been dead long ago if it had not been for F. He did this to get my wife.
When he could not kill me he got me sent to the asylum as crazy, by making
my wife swear falsely, also done by having streams of electricity in her,
closing up some of her feelings and holding out others. It is done by magnetic glasses. When he got me in the asylum, he first took my wife (after
three days' stay in the house) to V. and kept her locked up in his room for
three or four days. From there Dr. X. and F. moved her to the hospital
and kept her in the basement for a few days, then moved her up to F.'s
cellar, from there to the hospital again, and from there to the stable belonging to the hospital, where she is at present. During this time she has
been punished in the worst way. Her body has been striped until it has
grown yellow and blue. [Here follows a description of the torture to
which his wife was subjected, which cannot be given in his own words. |
She is in a terrible state today in the barn (this is the 10th of March),
and she is liable to be killed. When killed she will be buried under the
floor in some of the outhouses or in some manure pile in this city.
Through the talk that is going on between Dr. X., F. and myself, I know
what disposition has been made of my furniture. My wife is not dead
yet, but is now in the barn at the hospital. Dr. X., F. and his wife,
know about it. While torturing my wife, F, has been dressed in my
clothing, and used my voice. Everybody would say; how can F. use my
voice when I am at the asylum and he in I. The answer is: we are all connected with a stream of electricity through the breast and the navel, and in
that way can use each other's voices. What I mentioned about blocking
up the feelings in a person is done by having the inside washed in spots
with magnetism, and by holding the stream of electricity on it these spots
8

58

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

are so blocked up that one has no feeling except where one doesn't want it.
It can be pulled out with a magnetic steel (it can be done just as easily
two thousand miles away as twenty feet; it only requires practice). For that
reason everybody ought to have a magnetic steel that goes near Dr. X., or
near any person that has come from his vicinity. I have noticed that Dr.
X. has a stream of electricity on all the doctors here at the Asylum. When
they talk, he braces them up more or less so they can hardly speak, and
don't know what they are doing. I would advise everyone to get a magnetic steel with a glass handle, and they will find that I speak the truth.
Talking about robbing, Dr. X. is the biggest robber, I may say lowest
robber, in the U. S., and as an example of his operations I may say that
when I was roadmaster on the
Railway, I had $1,500 or $1,600 lying
in my trunk. He went there to see my wife probably five or six times.
After doing his dirty work, he narcotized her, took the trunk key from her
pocket, opened the trunk and took as much as he thought would not be
noticed; then he woke her up and went away. I didn't know anything
about it, and she didn't. In the fall of '83 I went to California, and, counting my money, I found that a good deal was spent, but could not imagine
how. My wife said she hadn't taken any. I did'nt know at that time that
electricity was used on me, but it was, and had been used on both of us for
years. When Dr. X. came from H. in the fall of '79, his intention was to
kill me, and I was told the whole story by F. In killing people, Dr. X.
uses electricity and poison sent into the body by means of the electric
stream. It is sent through in the same way as the magnetism is sent.
The stream goes through the poison and into the body at the navel, and
then he moves the poisoned stream with his magnetic steel to any part of
the body he likes. I expect to be killed any time in some way by Dr. X.,
or be made crazy by means of a poison stream of electricity or a negative
stream like that used in the silver bath in photography. It was for this
purpose that Dr. X. had me sent to the Asylum and had my wife swear to
the effect that I had used a knife on her, which I never did. The reason
that I am not made crazy is on account of F.'s unwillingness to use the
stream as directed by Dr. X. Sometimes Dr. X. says that he has made oni
false papers and is going to have me arrested und sent to the State prison
for stealing. At other times he says he will not kill me until I get out of
the Asyium, and if he don't kill me he will make me crazy on the road
and have me sent back to the Asylum. I didn't mention some things
about Dr. X.'s robbing. He can go in anywhere he has a mind to and
open any safe and any door and take what money he wants. It is clone in
this way: (I have his word for it through a second person, and it is true,
too) He takes the combination from the man when he is asleep by a
stream of electricity, getting it letter by letter, and also he ascertains how
much money there is. If it is in a drawer, he finds out where the key is.
I heard him say that he took $5,000 out of V.'s safe in I, night before last.
Of course, he hears every word I am saying, and may return it, but people
in I. would do well to look out for their money, because nothing will keep
him from stealing it if he wants to. He is a woman destroyer. He can
make any woman come to him by putting a stream into her and making
her crazy, and then, while the stream is running through her, he says
or thinks, ' Come to Dr. X.,' and it goes to her in just the same way a
telegram goes from one station to another, only the woman does not
hear anything but has that feeling, and if she can, she will start right

EEPORT OF THE MEDICAL SUPERINTENDENT.

off. I may be taken away by Dr. X. to some other place.
track of where I am taken."

59

Please keep

EPILEPSY.

The following observations concerning epilepsy were prepared by Dr.
W. A. Stone:
There have been admitted during the years included in this report, 30
cases of epilepsy. This is only a slight increase of the percentage of cases
received during the preceding years. The degree of mental impairment
extends from a slight confusion of the mental faculties to dementia verging
on idiocy. Three of the cases have followed infantile hemiplegia. Of the
1,130 patients admitted since the opening of the institution, five have been
hemiplegic epileptics, and in all has the paralysis been on the right side.
In two, aphasia followed the acute attack and has continued for years,
(one being motor and the other sensory).
Convulsions began in two of the cases one year after the paralysis, in one
two years, in one seven years, and in one nine years after. The seizures in
these cases are very severe, and are always followed by an unusual amount
of mental confusion and distiirbance. The following history shows a rather
unusual termination of a case of this class in so young a patient.
P. A., 24 years of age, native of Michigan, of German parentage, became
Lemiplegic at about two years of age and at four was subject to epileptic convulsions. In his 24th year he developed homicidal and suicidal tendencies,
and it became necessary to remove him from his home to the asylum. He
was a large, muscular young man, the left side of the body being excessively developed. Right chest from middle of sternum to 6th dorsal vertebra measures 44 \. Left 49 cm. Circumference of right arm at middle
'29 cm. Left 31. Bight forearm 26 cm. Left 29-| cm. Left thigh 57 cm.
Right 50^ cm. Left leg 42 cm. Right 35 cm. The superficial and deep
reflexes of the right side were much more active than those of the left, and
there was quite marked anaesthesia of the anterior surfaces of the right
half of body, arm and leg. Although the right arm and leg were useless
save for mere acts of motion, involuntary associated movements of them
were observed. There was facial asymmetry. Hearing impaired.
His mind was much impaired, and he had hallucinations which greatly
frightened him. A few days after his admission he began to have two or
three severe convulsions daily, and his mental confusion increased. He
made several attempts to break out windows and doors. The last seizure
was very severe and was followed by coma which lasted eight hours, and
until death ensued from failure of the respiration. A post-mortem examination revealed a right meningeal hemorrhage, and a clot of blood in the
sub-dural space which extended from the vertex to the tentorium. A small
hemorrhage was also found in the floor of the 4th ventricle. The brain
weighed 43 1-2 oz. Right hemisphere of cerebrum 19 1-2 oz. Left 17 1-2.
The convolutions were flattened and poorly developed, especially on the
left side.
Fifteen of the cases of epilepsy began under the age of 10, and among
this number are found all of the cases of extreme dementia and degradation. Seven began between the ages of 10 and 20, and among these the
mental impairment is not so great, and their early training in regard to
personal habits and dress has not been entirely lost. Only one case, a
syphilitic, began between the age of 20 and 30. Seven cases developed

60

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

after 30 years of age, and in only one of these was there any history of
inherited epilepsy.
In ten of the cases which began before 20 there is a history of insane
ancestry, six are free from any hereditary taint, and of four the history is
not known.
One case which developed at the age of 40 was undoubtedly due to persistent and excessive indulgence in alcoholics. Previous to his admission,
his friends had not yet recognized that he was an epileptic, yet they had
observed his mental failure. When first he came to the asylum he was far
more bright and intelligent than is the usual epileptic, and the convulsions
occurred only once or twice "in three months; now, after one and a half
years, his mind has failed, the seizures have increased in frequency, and he
has taken on the characteristics in gait, speech and mental action, of an
advanced case of epilepsy, medical treatment having little or no effect.
Another case developed at the age of 57, after a severe attack of acute
rheumatism. The disease has now lasted for six years, and the administration of potassium bromide has a very pleasant effect. He is made comfortable, and usually stays in the asylum but a few months at a time.
The following case of Jacksonian epilepsy is probably of syphilitic origin.
The preliminary history is rather meager, but cicatrices, previous treatment, and the development and progress of the disease, point to gummata:
T. M., 28 years of age, miner, native of Ireland. No hereditary taint,
was a temperate and industrious man. About six months previous to his
commitment to the asylum, he had a series of epileptic fits, and for a time
afterwards was confused and excited. Since that time the convulsions
have been frequent, and by reason of his mental disturbance which quite
often extended to furor, it became necessary to remove him from his
family. On admission, he was found to be a large, fully developed man,
and well nourished. His gait is shuffling and staggering at times. Speech
measured and hesitating. Not coherent in thought. Has a fair memory
for remote events, but poor for recent ones. Is very delusional; believes
that he has been sawed into several pieces; and that he has been shot
through and through. The tendon reflexes at the knees were equal but
excessively exaggerated. Pupils re-act slowly to sensory stimulus, other
reflexes normal. Perciission over right side of vertex reveals a tender
point. During the first week of his residence in, the^asylum he had no convulsions, much of the mental confusion disappeared and he was able to
some extent to realize his condition. His first convulsion was noticed by
his attendant, who stated that the spasm was confined to the left side, and
for some time afterward he was unable to exercise full control over the leg
and arm. Complete power was regained in a few hours. During the next few
weeks he had but one convulsion, and his mind improved in a remarkable
way. He states that during the convulsion he does not lose consciousness,
and if where he can support himself he can take out his watch and time
the fit. The spasms always begin in the hand and extend upwards, and
then begin in the leg. One night after having been as well as usual, he
had. several convulsions, and from this time gradually in two days sank
into status epilepticus. The convulsions increased in frequency from ten
on the first day to twelve every hour during the last day and night. The
seizures were very severe, and, although they began on the left side, the
spasms spread to the right, but with less severity. The head is turned to
the left, there is conjugate deviation of the eyes to the left during the fit,
but in the interval between the seizures there is conjugate deviation to the

REPORT OF THE MEDICAL SUPERINTENDENT.

61

right. The right pupil moved to the stimulus of light, but the left was
rigid. The convulsions continued with increased severity, the temperature
arose to 105, and on the fifth day after the onset of the storm, he died from
failure of the respiratory center. No post-mortem allowed.
One case of idiopathic epilepsy followed an attack of scarlatina with
nephritis and optic neuritis.
A gunshot wound in the left anterior temporal region, causing depressed
fracture, was followed after the lapse of eleven years by general convulsions, which have continued for twenty years. There is neither aphasia
nor muscular weakness.
Another case, where the mother was epileptic, did not show any indications of the malady during childhood, but at the age of 18, after an abortion produced by the administration of an unknown quantity of oil of
wintergreeu, general convulsions made their appearance and have since
continued for seven years.
The following is an interesting case, illustrating an example of idiopathic
and Jacksonian epilepsy in one subject, and an excessive number of convulsions within a short period of time.
E. H., age 21, subject to general convulsions since the age of one year.
He resided in the institution one year and three months. Severe convulsions and attacks of petit mal occurred about three or four times per week,
notwithstanding active treatment with potassium bromide. After a seizure
he often performed automatic acts of destructiveness, and was astonished
after a few hours when told what he had done. Three months after his
admission, under the advice of a relative with whom he had lived for years,
the bromide was discontinued, and in about ten days a rapid succession
of fits occurred and he soon passed into statiis epilepticus. Hypodermic
injections of ergotin and potassium bromide in large doses relieved him in
a few days and he continued the bromide until about a year afterwards
when he was taken home for a visit by his father, who lived in a cottage
adjacent to the asylum.
On the twelfth or thirteenth day after the discontinuance of the bromide, a repetition of severe convulsions began. During the first two days
the seizures were general, but began in the left arm and gradually
extended to the whole muscular system. During these severe general convulsions, consciousness was lost. On the evening of the second day the
spasms became limited to the left side, and began to occur with greater frequency. For twenty days left-sided convulsions ensued at an interval of
from two minutes to not longer than ten. The left limbs were strongly
convulsed with conjugate deviation of the eyes to the left. The consciousness was not lost, as was proven by the fact that the patient could repeat
words uttered by the nurses during the convulsion and could also perform
certain movements with the right hand whenever directed.
At intervals of three or four days, a general idiopathic convulsion
would occur, as had been usual for several years.
The patient complained of a painful spot on the right side of the head
and over the motor region for the arm and leg, and percussion at this
point was distressing.
His family and friends estimate that 7,000 fits occurred in three weeks;
but a careful estimation, allowing for an interval of six hours during one
night, would place the number, without exaggeration, at about 3,200. The
spasm gradulally became less severe, and finally ceased from muscular
exhaustion.

62

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

Five months now after the cessation of the convulsions, there is yet
partial loss of power and lack of co-ordination in the muscles of the left
arm and leg.
The medical treatment of epilepsy is with us largely confined to the
administration of the bromides of potassium and sodium and biborate of
sodium. In a few cases the latter remedy has succeeded most admirably,
but in others, gastritis, psoriasis, otorrhoea, have followed a prolonged use
of the drug.
In cases in which a series of convulsions occur periodically, comparatively
small doses of potassium bromide given regularly and supplemented by a
few large doses at the approach of the seizures, have produced a most
excellent result, the number of convulsions being lessened and the mental
disturbance and confusion much modified.
The general care of the epileptic after it becomes necessary to send him
to an asylum is, in the majority of cases, largely custodial, and the
desirability of a separate ward or building, specially constructed, cannot be
too strongly xirged. To a person who is not accustomed to seeing a fellow
being in the throes of a convulsion, the cry, the fall, and the distorted
features, produce on a sensitive mind an impression not easily erased.
One of the essentials to the well being of epileptics is a careful regulation of their diet; but any attempt to restrict or to modify their dietary in
a ward with others is simply impossible.
The extreme violence, the homicidal assaults, and much of the general
irritability and disturbance in asylums are directly traceable to the epileptics.
With segregation in a properly constructed building, their lot would be
a far more comfortable one, and a very disturbing element would be
removed from our wards.

REPORT OF THE MEDICAL SUPERINTENDENT.

63

TABLE IV.--Nativity of Patients Admitted.
For the Biennial Period.
Males.

Canada
Connecticut.

_ . . _ ,-_

..

4
25
8

England.

8
1
5
16
1

FinlandHolland ..
Italy
Indiana. .
Illinois

-. .. ..

.

14
8
5
3
1

_

Females.

9
88

6

fl
1

4

12

10
1

12
26
2

6
4
1

New Hampshire
Nova Scotia.- ...
New Jersey

....

.

9
148
2
17
1

29
1
22
62

22
1
14
54
4

SI
2
36
116
8

20
3
9
3
1

39
6

35
1

74
7
16
6
1

1

.__---

1

2
26

2
55

2

5
1

7
1

New York..

21

11

32

Newfoundland
Ohio
•'..
Pennsylvania .

11
4

5
2

16
6

1

1

2

12
1
1

Poland
Russia

.. ... ..

Scotland. .
Switzerland.

25
g

...

Virginia

__

West Virginia
WisconsinWales
Unascertained
Total

.
.

_ ..

Total,

2
8

1

29

_.

Males, i Females.

4
51

28
1
3

1

Michigan

Total.

From the Beginning.

3
1
3

76
1
14
3
3

60

g

3

1
1
]

1

4
83

4
4
159

18
1

1
27
1
8
3

72
1
1
25
16

51
1

8

87
4
1

6
2
69
11
3

45
7
5

9
2
114
. 18
8

3
1
8

1
4
1
8

1
2
2
1
12

8
6
2
20

1
19

18

1
37

3
1
3

5

9

7

16

202

142

344

622

31
12

508

123
2
1
56
28

1

1,130

RECAPITULATION :

Native born..
Foreign born

Total .

140
188
16

-440
653
87

344

1,130

64

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
TABLE V.—-Civil Condition of Patients Admitted.
For the Biennial Period.
Males.

Married.
Widowed

.„

.

Unascertained
Total

Females.

From the Beginning.

Total.

Males.

Females.

Total.

80
107
18
2

96
31
12
8

176
138
25
5

240
329
26
B
21

348
10B
40
12
2

B88
435
66
18
23

202

U2

341

632

508

1,130

TABLE VI.—Occupations of those Admitted.
For the Biennial Period.
Males.
Baker.

-

Butcher
Baker
Carpenter .

.

r__.

_

-

, ._-

None
Printer
Painter
Physician
Sailor
Soldier
Salesman
Teacher
Telegrapher .
Tailer
Unascertained
Weaver
Total

--

-.

Total.

1
25
6
6
29

7
1
87
1

7
3
S9
1
2

8
151

45
9
121
2
35

45
17
272
2
35

42
2
3
1

118
8

121
2
8
2

3
889
3
13
9

5

2
1
1

2
1
6

2
1
7

13

6

19

40

3

11
1
1
3

18
2
3
7
1

77
1
1

Miller
Minister
Miner

Females.

9
1
3
15

2
52

_„_

Males.
1
16
5
•3
14

i
2
1

2

Lawyer

Total.

5
2
2
7

4
2
6

Farmer

Females.

From the Beginning.

8
I
1
2

1

1
4
5
4
1
1
8
1
202

1
4
)
g

3

3
268
j

1

2

5
9
5

6
11
7

3

2
1
2
26
2

20

1
28
1

142

844

622

3
2
7
3
22
18

.._
3
1
1

11
0

7
6
42
2
508

5
3
14
8
62
36
2
3
10
1
3
I
8
22
12
B
1
8
B8
4
1,130

EEPORT OF THE MEDICAL SUPERINTENDENT.

65

TABLE VII.—Duration of Disease Previous to Admission.
From the Beginning.

For the Biennial Period.
Males.
Under two months
One year and under 2 _ Two years and under 5
Five years and under 10

- . _. .

Twenty years and over
Unascertained _
Total

.

Females

Total.

Males.

Females

Total.

33
20
16
5
27

26
19
14
2
23

59
39
30
7
50

77
48
34
18
81

65
43
29'
8
51

142
91
63
21
132

30
32
22
12
15

22
16
7
7
6

'52
38
29
19
21

132
82
76
27
52

96
84
73
34
25

228
166
149
61
77

202

142

344

622

508

1,180

TABLE VIII.—Probable Exciting Causes.
For the Biennial Period.
Males.
Anxiety and grief
Brain disease
Business reverses
Congenital defect
Climacteric

-

6
4
4
14

.

Disappointed affections.Epilepsy
Exposure
Fever...

_

..

Total.

Males.

16
6
4
17
8

8
8
13
21

33
5
9
8

41
13
IS
30
8

4
3
59
2
10

3
20
35
5
6

7
23
94
7
16

2
41
33
2

4
51
96
5
1

9
90
1
1

13
141
97
6
1

1
31
1

6
1
2
31
1

5
1
1

6
2
5
108
3

11
3
6
103
3

2
1

5
1

3

5
1
4
10
21

3

Females.
10
2
3
8

1

2

3

21

10

31

6

Fright.
Ill health
Intemperance-

13
83
1

Nostalgia
Overwork..
Pubescence

3
1
1

._

Prolonged lactationPrivation .

3

Previous attacks
Religious excitement..
Syphilis

.. -

5

6
2
28
1
3

Total .

..
..

.

8
2
48
28
202

Females.

Total.

2

2
5

18

2
1
1
6
3

5
1
26
3

13
3
74
31

3
16
10
171
102

11
2
127
8

3
3
27
12
298
110

844

622

508

1,130

Seduction..
Senility.
Traumatism - .
Unascertained.
Vicious Habits. _ .

From the Beginning.

142

8
4

66

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
TABLE- IX.—Residence of Patients Admitted.
For the Biennial Period.

From the Beginning.

'

County.
Males.

Females

Total.

7
5
1
2

6
2
1
1
1

13
7
2
3
1

20
8
1
3

16
14
2
2
1

86
22
3
5
1

6
1
11
9
5

1
3
11
2
5

7
4
22
11
10

10
6
18
13

11
4
6
6
1

21
10
24
19
1

Males.

Females.

Total.

1

1

2

Charlevoix _
Clare
Crawford..

2
3
1

4

3

6
3
4

Cheboygan

3

3

6

Delta -

5
7

1
3

6
10

4
6
4
19

1
7
6
8

5
13
10

6
20
19
53

3
19
26
34
1

9
39
45
87
1

Isabella .

2

4

6

Kalkaska..

1

2
3
2

12
1
13
3
7

6

2
2
2

7
1
2

18
1
20
4
9

Keweenaw

1

2
1
1
2
7

6

1
2

1
1
1
1
5

6
8

5
1
1
2
18

11
1
1
8
21

1
11
13
4
10

3
3
14
1
9

4
14
27
5
19

4
25
48
9
24

7
16
35
8
26

11
41
88
17
50

_. ..

11
3

7
5

18
8

42
8

._. _.

1
11

1
9

2
20

4
41

15
17
1
3
47

57
25
1
7
88

10
3
6
2

9
4
1
2

19
7
7
4

34
10
13
6
2

32
20
12
4
6

66
30
25
10
8

Osceola

4
2

2

6
2

21
3

Presque Isle
Boscommon

1
1

1

1
2

12
5
1
2
4

33
8
1
2
7

1
7

2
4
10
1
18

2
10
15
3
33

18
7

2
11
33
3
40

622

508

1,130

G-ladwin
Gogebic .
Gratiot .
Isle Royal

Kent .
Lake
Leelanaw,

.. ...

.

.. ..

Mackinac
Marquette
Mecosta
Menominee ..
Midland _
Monroe
Missaukee
Muskegon
Montcalm

_.

Ontonagon .

Shiawassee _.
Schoolcraft
Wexford._
Wayne.
No legal settlementTotals

2
3
3
1
17
202

1
142

27

344

3

i

67

REPORT OF THE MEDICAL SUPERINTENDENT.
TABLE X.—Age of Patients Admitted.
For the Biennial Period.

From the Beginning.

Males.

Females.

Total.

Males.

2
14
20
30
23

1
7
16
25
23

3
21
36
55
46

7
29
67
88
82

3
23
51
80
70

10
52
118
IBS
152

40
45
50
55
60

26
24
13
13
8

18
12
13

44
36
26

I

"?

93
75
35
36
20

71
64
50
29
14

164
139
85
65
34

61 to 70

13
4
17

6

lit

11

28

32
13
45

23
5
25

55
18
70

202

142

344

622

508

11,130

Ifi to 20
21 to 25
26 to 30
31 to 35
36 to
41 to
46 to
51 to
56 to

.

Unascertained

-

__

Total

Females.

Total.

TABLE XL—Degree of Heredity.
•

From the Beginning.
Males.

Paternal immediate-

-- -

- -_

Maternal immediate-

- -_-

,

-.

.

Dissolute ParentageUnascertained. Total

.
.

- -„

Females.

For the Biennial Period.

Total.

Males.

Females.

Total.

1
15
10
9
4

7
8
19
6

1
22
18
28
10

80
20
37
14

9
30
15
51
19

14
60
35
88
33

7
2
47
107

13
3
43
43

20
5
90
150

31
10
131
344

47
19
151
' 167

78
29
282
511

202

142

344

622

508

1,130

DIVINE SERVICES.

These services have been regularly conducted, and have afforded much
comfort to all those able to attend. To Rev. Mr. Cochlin, acting chaplain,
and to Revs. Mr. Lee, Mr. Powell and Mr. Elbridge, we are grateful for
kindly efforts to promote the welfare of patients, and feel assured they
have brought help and blessings to many.
The death of Rev. Dr. Van Alstine was a painful affliction to all. His
many noble qualities of mind and heart endeared him to us, and his
memory will be long cherished.
»In closing this report, I would especially call attention to the value of
the work the institutions of the State have accomplished for our insane
citizens, and urge a continuance of the present system, by which not only
added comforts have been brought to the insane, but a check has been
placed upon the increase of insanity.

68

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

This Asylum district is much in the same position, so far as need for
additional accommodations is concerned, as it was two years ago. The
statistics and estimates presented to the last legislature, in reference to the
increase of the insane and the requirements of this district to meet the
same, are found to be not far from what has actually occurred. It is
imperative to either enlarge the Asylum, or take steps for the construction
of another institution.
ACKNOWLEDGEMENTS.

We are especially indebted to the attendants for the kind and intelligent
manner in which they have performed their delicate duties, and for their
willing and zealous co-operation in carrying out every measure directed
for the comfort and care of patients.
Our thanks are due to Mr. F. Hamilton and Mr. J. "W. Milliken, of Traverse
City, f©r donations of periodicals, and especially to Mr. C. L. Lockwood,
General Passenger Agent of the G. R. & I. R. R., for weekly donations of
a large number of papers, magazines, etc., for the use of patients. It may
be gratifying to these gentlemen to know by their generous remembrance
of patients they have brought to them many pleasant hours.
We are also under renewed obligations to the proprietors of the following papers for gratuitously sending to our household copies of their publications.
*
Triumphs of Faith.

The Hamlendet.

Traverse Bay Eagle.
Cheboygan Tribune.

The Transcript.
Pontiac Gazette.

Saturday Express.
Cadillac Democrat.

Pontiac Democrat.
Deaf Mute Mirror.
Negaunee Iron Herald.
Three Rivers Tribune.
The Menommee Democrat.

Big Rapids Herald.
Grand Traverse Herald.

Alpena Argus.
Charlevoix Journal.
Iron Port.
The Republic Sun.
Lake Linden Times.
Mancelona Herald.

On behalf of the lady patients of the north infirmary, I would gratefully
tender thanks to Mr. P. O. Partridge, of Mikado, Michigan, for the
presentation of a beautiful picture.
I would also in this' connection thank Dr. W. P. Manton, of Detroit, for
skillful medical services in behalf of two female patients.
I would especially express my appreciation of the high value of the
medical and executive ability of the Assistant Superintendent, Dr. C. G.
Chaddock, and to him, and to Drs. W. A. Stone, I. L. Harlow, and G. C.
Crandall, members of the Staff, I would acknowledge the unselfish assistance
they have rendered in their respective departments, and also my indebtedness to them for many personal kindnesses.
Mr. J. P. C. Church, the Steward, continues to discharge his duties with
accustomed tact and fidelity.
To Mr. C. M. Prall, superintendent of constructions and Mr. W. H.
Bauld, engineer, I am under many obligations for the untiring efforts they
have put forth in their work, and for the careful oversight they have given
their respective departments.
I would express my appreciation of the unselfish devotion to work that
has been given by all connected with the farm, kitchen, bakery, laundry,
and shops, and especially to Mr. T. H. A. Tregea, accountant, Mr. H. S.

EEPORT OF THE MEDICAL SUPERINTENDENT.

69

Barnabee, storekeeper, Miss Sarah Graham, and Miss Florence Mulrine,
clothing clerks, Mr. C. E. Kenyon, stenographer, and to Mr. E. C. Kent
and Miss May Botsford, general supervisors.
To you, gentlemen of the Board of Trustees, and to the resident trustees
in particular, whose advice and instruction have often been solicited, I
would return thanks for the uniform kindness and courtesy always
extended to me. The period just closed has been without accident, and
there is nothing in the immediate outlook of the institution unpropitious
of a continuance of its useful work.
Respectfully stibmitted,
JAMES D. MUNSON,
Medical Superintendent.
Traverse City, June 30, 1890.

PLANS OF INFIRMARIES, ETC.

As required by law, the plans of the infirmaries and cottage were submitted to the State Board of Health and the State Board of Corrections
and Charities, for approval, and the following are their reports on the
same.
BOAKD OP CORRECTIONS AND CHARITIES, /
Lansing, July 13, 1889. )

JAMES D. MUNSON, M. D.
Medical Superintendent, Northern Michigan Asylum,
Traverse City, Mich. :
DEAR DOCTOR—The Board of Corrections and Charities, after its thorough examination at your Institution on the 10th inst., of plans of the detached cottage and of the
infirmaries to be erected there, voted that such plans were entirely satisfactory to it,
and instructed me to certify such fact to you, which I take great pleasure in doing.
Yours very truly,

L. C. STORES,

Secretary.

MICHIGAN STATE BOAED OP HEALTH, ~\E OF THE S
Lansing, Michigan, August 3, 1889. }
JAMES D. MUNSON, M. D.
Medical Superintendent of the Northern Michigan Asylum,
Traverse City, Michigan:
DKAR DOCTOR—I transmit herewith the report of the committee appointed to examine
the plans for the cottage and two infirmaries at the Northern Asylum. Accept kind
regards for you and yours.
Very respectfully,
HENRY B. BAKER,
Secretary.
PLANS FOR A COTTAGE AND TWO INFIRMARIES AT THE NORTHERN MICHIGAN ASYLUM FOR
THE INSANE AT TRAVERSE CITY.

The undersigned, constituting a committee of the State Board of Health, appointed
to examine the site, ground plans, and proposed ventilation, house drainage and sewerage of a cottage for males, and of two infirmaries at the Northern Asylum for the
Insane, at Traverse City, Michigan, respectfully report, having visited the location, and
examined the sites and plans, and listened to the explanations given by James D. Munson, M. D., Medical Superintendent of the Asylum.
The cottage is to be near the cottage for which plans were examined by this Board
last year, and which on our recent visit to it we found in excellent condition, and the
ventilation of which was excellent, even though at the time of our visit the difference
in temperature between the indoor air and the outdoor air was very little. The design
is to have the ventilation of the proposed cottage similar to that of the one already
built, the rooms being warmed by indirect steam heating. The foul air conduits will
start from underneath windows, and from each room will be separate from those of any
other room throughout the outer air above the building. This was approved by the
undersigned. It was suggested by us (and the suggestion was kindly received) that it

PLANS OF INFIRMARIES, ETC.

71

is desirable to have provision for the ingress of fresh air from out of doors aside from
that which passes over the heated radiators, and in such a way that when a room would
otherwise be top warm, registers shall shut out some of the heated air, and admit cold
air to mingle with that which has been heated, and thus lower the temperature without
shutting off any of the needed supply of fresh air.
The sites and the plans for the house-drainage and sewerage for these three buildings
were approved.
HENRY B. BAKER,
ARTHUR HAZLEWOOD,
DELOS FALL,
Committee.

NAMES OF THE OFFICERS
AND OTHER EMPLOYES OF THE NORTHERN MICHIGAN ASYLUM, AND
THE WAGES OR SALARY PAID TO EACH, JUNE 30, 1890, AS
REQUIRED BY SECTION 2, ACT 206, LAWS OF 1881.

Names.
James D. Munson
C G Cliaddock
Wm. A. Stone
..

Service.
_._ _ _ Medical Superintendent- ...
Assistant Physician.
..

G. C. Crandall.
Rev. D. Cochlin
J. P. C. Church
C. A. Crawford
T. H. A. Tregea
Wm. H. BaulcL
C. M. Prall
Chas. E. Kenyon
H. S. Barnebee
C. G. Huntley
W. Pennington.
E. C. Kent
Florence Mulrine
Rob't Rattray
Geo. B. Donelley
Hattie AllenWin. Appleman

Philip Blue
Clara Buskirk .
Mary Campbell
Eva Chaney

U

It

Acting Chaplain
Steward
Treasurer

..

Engineer .

Storekeeper
Telephone Operator .

_ . ._

00
00
00
00
00

5000
45 00
35 00
15 00
40 00

Watchman .
General Supervisor
Attendant
"
"
n

20
32
24
15
22

00
00
00
00
00

„
"
"
"
"

27
13
12
15
18

00
00
00
00
00

26
30
21
13
22

00
00
00
00
00

29
30
18
18
25

00
00
00
00
00

12
22
22
22
15

00
00
00
00
00

c
"
ti
"
tt

O. J. East
K. Elwell
C. D. Edwards

"
"
"

Anna Evans
Fred Flanders
Chas. Fletcher.

,
•

..
.

1,500
500
1,200
110
110

00
00
50
00
00

u

H. L. Crittenden
L. Drainer,
L. E, Deal

$3,000 00 Per annum. Resident.
1 200 00
a
i
1,000 00
«
*
800 00
K
i
800 00
n
i
250 00

27
15
37
35
24

-.. . . Ass't Clothing Clerk.

„ _ . _ ._-

Time.

Rate.

1

i
•

Non-resident.
U

11

Per month.
„
it

U

It
U
"

(j

"

"

Non-resident.

"
[(

^
"
si
ii
((

i«
"
'*
"
l(

"

"
"
"
u

'I
I'
"
ts

u

"
"
"

",

73

NAMES OF OFFICERS AND ATTENDANTS.
OFFICERS AND OTHER EMPLOYES.—CONTINUED.
Names.

Service.

'i
it
"

Sarah Houghton

4t

Cora Hickok
Ida Hickok_ I II" II

»
"
it
t*

Wm. Hollister
E. J. Hutchinson .
Chas. James
D. W. Kelley
Libbie Kelley
Louie C. KentNellie Kent

Rate.

„
"
»
*«
't

._ .

„
tt
"
tl
it

ft

it
i'
K

00
00
00
00
00

„
"
K
tt
u

16
21
22
13
12

00
00
00
00
00

u

Laundry Assistant
ti

u

It

It

It

U

Cook,
Assistant CookKitchen Assistant
,(

,

U

I

ti

I

tt

4

«

Attendant
i.
t*
n

tt
It

It
11
it

1

tt
tt
tt
"

it
t

'
t

,

t
t
t
t

00
00
00
00
00

(4

14
13
13
12
13

00
00
00
00
00

(i

45
25
25
18
15

00
00
00
00
00

15
15
15
15
12

00
00
00
00
00

20
60
50
25
25

00'
00
00
00
00

25
28
25
12
10

00
00
00
00
00

18
18
28
34
15

"
K
«
u

,,

10

00
00
00
00
00

u
'!

19
13
18
U
28

I

Ira Patterson.
N. Gr. Perry

15
18
26
18
26

"

00
00
00
00
00

C E Hilton

J McPhee
Elsie Middleton.
W. E. Mulrine
Fred North
Geo. O'Dell

00
00
00
00
00

18
19
22
22
30

<•<•

Wm. Sweet
H.WilMnsIII
A. Hesley
L. Revolt
K. Revolt
E. Revolt

.$14
18
18
15
20

t(

„

Maud Lambert _ _
F. Lambert
John Leitch
Sarah Little
M. Marshall
J. Magill
A. P. McBride._
Sarah McLarty_ __
E. Stigar ..
M. Wiedoft
M. Frankie
M. Woods
A. Basch
C. Egbert
Chas. Moult-on
F. Wilhelm
H. Butler
H. Stiles
E. Keefe
F. Schroder

Time.

10
10
28
16
16

00
00
00
00
00

18
26
26
22
26

00
00
00
00
00

19 00
22 00
14 00

"
t'
'»
tt

"
t-t
t'
tt

,,
tt
't
«
It

u

>(
't
tt

'*

„

It
tt

tt

4i

t'

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(,

it
tt
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l(

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tt
"
tt
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74

NOETHERN MICHIGAN ASYLUM FOR THE INSANE.
OFFICERS AND OTHER EMPLOYES,—CONTINUED.
Names.

Service.
Attendant

L. C. Perkins
H. Reahm
F. D. Sturtevant
B. Shriner
E. Sargent
S. C. Smith
E. Walsh
H. Walsh
I!
Fred Williams
S. White

I"II-I.

C. Wiser
D. Ward
8. Parker
S. H. McMichael
John King.
E. H. Wood
S. Holmes
C. Getchell

Carpenter
Painter
Laborer

Hate.

Time.

$22
12
30
15
16
24

00
00
00
00
00
00

IS
26
23
19
28
22

00
00
00
00
00
00

15
18
19
25
18

00
00
00
00
00

Per month.
*
'
*
»
'
*
'
1

'
,
*
'
i

2 50 Per day.
2 00
"
1 75
ii
1 75
"
1 50

Non-resident.
ii

is
"

APPENDIX.

LAWS GOVERNING THE ASYLUM.

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

SEC. 10. Each board of trustees is hereby directed and empowered to establish such
by-laws as it may deem necessary and expedient for regulating the appointment and
duties of officers, attendants and assistants; for fixing the conditions of admission,
support, and discharge of patients, and for conducting in a proper manner the business
of the institution under its charge; also, to ordain and enforce a suitable system of rules
and regulations for the internal government, discipline and management of the
asylum.
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 ammended
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 bondsman 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 jxidges 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
discretion of the judge of probate any relative, or other person having said alleged

78

NOBTHERN MICHIGAN ASYLUM FOR THE INSANE.

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 his 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 supervisors 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 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 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,-!, 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 be
insane; 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

APPENDIX.

79

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, \

l ss'

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
I hereby appoint and direct
said

Judge of Probate.
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:
SECTION 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
empanelled in accordance with the few 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

80

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

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, subpcena
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.
SECTION 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 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.
[L. s.]

County Clerk.

The following blanks have been adopted for the admission of private
patients:
JUDGE OF PBOBATE'S OKDEB.
STATK OF MICHIGAN, i
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.

APPENDIX.

81

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.
STATE OF MICHIGAN, ^ j gs_

p?,o&afe Oouft

fof

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 Hoii_________......______________________________________Judge of Probate for the
County of______________________________________,in the State of Michigan:
The Application of_________________________________________________________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

18

STATE OF MICHIGAN, \ of

\u'

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 5
A. D. 18...
Judge of Probate.
APPOINTMENT OP MEDICAL EXAMINEES.
STATE OF MICHIGAN,
j?
r SS.
County of.
At a session of the Probate Court for said County of
held at the Probate Office, in the
of
^y

day of

on the

, 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.

11

82

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.
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
[i.
[L.
Signed and sealed in the presence of
I HEREBY CERTIFY, That I am personally acquainted with
and
, signers of the above bond, and consider either of them fully
responsible for the prompt discharge of its obligations.

PHYSICIAN'S CEBTIFICATE.
^ICHIGAJI' | ss.

In the Probate Court for said County.

In the matter of the application of
in behalf of
an
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
,a '
aged
years, by
occupation a
and 2
, 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 conductor other evidences of insanity.]

And I further certify and declare, That I am not related by blood or marriage to said

APPENDIX.

83

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
Insanity* have been duly attested and certified by
Clerk of
County.
(Signed)
_M. D.
Sworn to and Subscribed before me, This
day of
18
Judge of Probate.
1 Male or Female.
2 Married, single, widowed or divorced.

COUNTY CLEHK'S CEBTIFICATE OF QUALIFICATION.*
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. 136, 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.
. __Countv Clerk.

*See Public Act No. 220 Laws of 1889.

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
superintendent 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 EEMOVAL 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 ivhen the patient is
much prostrated or laboring under severe bodily illness, and care should,
be taken that the excitement attending acute mental disease be not mistaken
for physical strength.
The attention of county officers is particularly directed to the requirements of the following section in reference to a female attendant,
< othing, etc.:

84

NORTHERN MICHIGAN ASYLUM FOR THE INSANE.

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 wilfully
leave, abandon, neglect, or abuse such patient, either in going to or returning from the
iisyliim, 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 OF UNEECOVERED PATIENTS.

An imrecovered patient may be removed from the Asylum in accordance
with the folowiiig by-law adopted by the Board of Trustees, Jan. 18, 1888:
An niirecovered 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, 8 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 promptly advised
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. Iiifor-

APPENDIX.

85

matioii concerning inmates will not be given to casual visitors, except aV
tlie 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 arid tastes; the
success in business; if addicted 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 emaciated; 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 under any circumstances be received.
All correspondence in reference to patients may be addressed to Dr.
James D. Munson, Northern Michigan Asylum, Traverse City.

INDEX.

INDEX.

PAGE
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
Alcoholic insanity, a study of
._
Cottage for male patients
Civil conditions. Table
.
Care of the insane
_
.
"
"
" —need for Asylum
Clinical groups. Table
Classification
v
Classification, change of
..-.
Divine service
Duration of disease. Table
Deaths, causes, etc.
Epilepsy
__
Exciting causes. Table
Fire protection, recommendation for
Farm and garden products
Farm, garden, and grounds
Form of disease. Table
Government of the asylum
_..
Heredity. Table
Inventory, summary of
Infirmaries
Infirmaries, plans of
Katatonia..
_
Melancholia
Melancholia, simple
Melancholia, hypochondriacal
f
Melancholia, general
Movement of population. Tables
Nativity of patients. Table
Names of officers and employes
Occupations. Table
Report of Trustees
Report of Treasurer

12

J
-

.
.
___

...

...

-...

.'
„

17
68
-_
12
79
77
29
67
75
79
45
9
64
12
14-15
38
36
35
67
65
30-31
59
65
11
27
9-10
-36
77
.-- 67
28
7-8
70
44
38
41
42
42
29
63
72
64
5
17

90

INDEX.
PAGE.

Report of medical superintendent
Eeport of steward
Report of auditing committee
Report of State Board of Charities and Corrections
Report of State Board of Health
Roofs, condition of
Receipts and disbursements
Residence of patients. Table
Special appropriations
Support of patients by counties

,

29
25
24
70
70
10
10
66
7-9
7