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BOARD OF TRUSTEES.CHARLES FOSTER, President Fostoria.
S. A. BAXTER, M. D., Vice President Lima.
PARKS FOSTER-.. Elyria.
G. P. CAMPBELL, M. D Tedrow.
WILLIAM GEYSER Swanton.
Report of Trustees.
Hon. Wm. Mckinley, Governor:
The marked excellent condition heretofore prevailing at the Toledo State Hospital still continues. The reports of our executive officers will repay careful perusal. But little can be added to these comprehensive reports.
It will be noticed that our per capita cost, based upon current expenses and officers' salaries, is reduced to $120.11. This reduced cost has not been achieved by any diminution of provision for the table, or of any of the comforts and luxuries heretofore supplied our inmates. The quantity, quality, character and variety of food furnished; the equipment of our cottages, hospitals and amusement hall; the variety, character and number of entertainments given for the comfort and pleasure of our inmates, are not surpassed by other hospitals of like character.
There are in this Hospital district more than three hundred insane people in county infirmaries, while the Hospital is crowded to its utmost capacity. One of the most embarrassing duties of tbe superintendent is to be compelled to almost daily find an inmate who may be taken to the infirmary to give room for a new admission. In many instances applications for admission have to be denied, and under most distressing circumstances. The superintendent is criticised when he returns a patient to the county infirmary, and he suffers in the same way for refusing the admission of new applicants.
The Board of Trustees is asked to request the emergency board to allow us to use our surplus funds for tbe past and present years, together with seven thousand dollars appropriated for an industrial building, in addition to certain cottages, without increased cost to the State above appropriations already made. If our plans are approved, we will be able to accommodate from seventy-five to one hundred more people, and to that extent relieve the present distressing situation.
The Board of Trustees, in the most hearty manner possible, expresses its warmest thanks to the superintendent, steward, assistant physicians and employes generally, for their faithful and intelligent administration of the affairs of the Hospital.
Charles Foster, President.
S. A. Baxter, Vice President.
Parks Foster.
G. P. Campbell.
William Geyser.
To the Honorable Board of Trustees of the Toledo State Hospital:
Gentlemen: Again I have the honor and pleasure of presenting to you the superintendent's annual report of the institution under your control, this heing the eleventh annual report of the institution, and the seventh since it was organized for the reception of patients.
The following table exhibits the number of admissions, re-admiesions, discharges and deaths for the year ending November 15, 1894:
TABLE L—Showing Admissions, re-admissions, Discharges And Deaths During
Year Ending November 15, 1894
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There were remaining at the end of last year 1,182 patients, and 373 have been admitted, making the total number that have been treated 1,555. Of this number 79 have been discharged recovered, 81 improved, 106 unimproved, three not insane, and 91 have died, leaving in the institution at the date of this report, 1,195. The largest number in the institution at any time was 1,195, and the smallest number was 1,167. The average number in the institution: or the year was 1,183, which is nine more than the average for last year. There are thirteen more patients in the institution than a year ago, and thirty-two more have been admitted during the year than the previous year.The percentage of recoveries, calculated on the total number of admissions, was for males, 19.03; for females, 23.81; for both, 21.18.
The percentage of deaths, based on the total number under treatment was, for males, 5.43; for females, 6.29; for both, 5.87.
The per capita cost for maintenance, calculated on the average number of patients resident, including the total amount drawn from the State Treasury for current expenses and officers' salaries, was $120.11^, and including the receipts from all sources, was $127.97.
The average per capita cost for current expenses and officers' salaries for six years past, is $127.19.
The average death rate for the five preceding years has been 6.26 per cent., which is as low as institutions of the kind generally; therefore the death rate of 5.87 per cent, for this year is very gratifying.
Within the last year and a half many of the old water closets have been changed, the plumbing remodeled, the floors of the rooms tiled, new and tight floors put in buildings, and registers changed from the floors to the walls. No doubt the improved sanitary condition brought about by these changes has had something to do with lowering the death rate. It is to be hoped that there will be funds to go on with the good work until all the buildings occupied by patients are put in proper sanitary condition.
More than three years elapsed without a serious accident of any kind occurring, but within the last nine months five unnatural deaths have occurred—two by suicide and three by accidental drowning. A coroner's inquest was held in each case, and all the particulars given through the public press. As you are thoroughly familiar with all the circumstances connected with these accidents, it is probably unnecessary to reiterate them.
The percentage of recoveries reported last year was 24.51, and this year but 21.18, and yet it is my belief that there has been a larger per cent, of recoveries this year than last, because there has been more admissions, and more acute cases received. This year, as heretofore, we have followed up each patient after leaving the institution, with letters of inquiry, and have based our judgment of the patient's condition largely on the reports we have received of them from their friends; and yet with all these precautions it is my opinion that we have constantly erred in discharging too many persons as recovered, because it so frequently happens that within a short time they are returned in as bad condition as when first admitted, which proves that in such cases the mental disease was not cured, but only remained dormant or quiescent, and ready to be excited into activity by tbe sligbtest cause. It is unfortunate that a more uniform standard of just what condition or what degree of improvement should be considered recovery, cannot be agreed upon by the physicians in charge of hospitals for the insane. Then there would not be that wide difference we now find in the reports of the various institutions, varying in some instances from twenty to fifty per cent, of reported cured. If every one who leaves the institution apparently restored, was discharged recovered at the time of leaving, the percentage of our reported recoveries would be much larger than it is; while, on the other hand, if no one was reported recovered until he had been away from the institution a year or more, and had been subjected to the ordinary trials of life—and then not until after corresponding with the person himself and with his friends— I am confident that our recoveries would be even much less than reported. I do not want to be tedious on this subject, but I feel that reliable statistics as to the curability of insanity are of importance both to the medical profession and to society in general, and therefore the matter should have eareful and painstaking consideration.
The year just past has been one of the most successful and satisfactory in the history of the institution. The officers and employees almost without exception have worked earnestly and zealously for the best interests of the institution and for the welfare of its unfortunate wards, and the financial management has been careful and economical, as is shown by the low per capita cost and the detailed statement of the accounts in the steward's report.
Our first obligation, of course, is to the patients confined to our care; to see to it that they are well fed, comfortably clothed, kindly treated, and all their physical wants supplied, and also that every effort is put forth, both medical and moral, for their betterment, or that tends to bring about their restoration. Next in importance is our duty to the State, or, in other words, the people, whose philanthropy supports the institution.
As civilization advances the customs of society become more complicated and intricate and are more strictly enforced; ambition is more excited, wants are increased, desires less easily satisfied; and thus the struggle for existence becomes greater. The luxuries of wealth and the privations of poverty are each recruiting stations to the ranks of the insane, and are entailing to posterity enfeebled bodies, weakened minds, perverted moral instincts and unstable mental organizations. That insanity and kindred neuroses are increasing, there is no question; and, therefore, year after year the number that society must be protected from and that must be protected is being surely and steadily augmented.
The economic problem of asylum management, therefore, has become an important one, and that it is being more carefully studied is shown by the fact that the per capita expenses of institutions throughout the country generally are decreasing; especially is this true of the asylums in this State. I cannot but believe that the patients of the asylums that have lowered their rate of maintenance are as well cared for and have as many comforts as before. In some instances, I am satisfied that they have even more comforts, for they have been given more employment, which has necessitated giving them more privileges and greater freedom. Until within a few years past the insane, as a class, were regarded as entirely different from the rest of mankind; not possessing any capabilities nor capable of having any responsibilities, and consequently were kept behind bolts and bars and under the constant surveillance of keepers. This mode of treatment, keeping them in enforced idleness, required that all the labor of the institution be done by hired help, and also required a large ratio of attendants in order to give the patients proper protection and keep them under proper subjection, and therefore their care was necessarily expensive. Under the light of a broader civilization, with improvements, inventions and advanced scientific knowledge, we are learning that all things depend upon natural laws and that nothing can be attributed to supernatural intervention; that neither good nor bad spirits possess mankind; and, as people of all stations, all nations, all customs, all religions and all religious sects meet and mingle in daily contact, our prejudices are passing away and we are beginning to learn that we are all children of "The Heavenly King," and that "a man's a man for a' that," and that if we would have our rights respected, we must have a proper regard for the rights of others. The lesson thus learned has extended to men and women of all classes and conditions, until even the insane, whose rights in the past have been more disregarded than those of the people of any other class, are beginning to feel its beneficent influence.
Scarcely twenty-five years have elapsed since the illustrious Dr. Richard Gundry, who spent twenty-three of the best years of his life for the asylums of Ohio, and shaped their character, and who was driven out of the State by the baneful influence of partisan politics, was the first man in America to raise his voice in behalf of the insane confined in asylums; advocating enlarged liberties and the abolition of mechanical restraints and the use of continued solitary confinement, or, to put it more mildly, seclusion. He suffered the severe criticisms, and almost ostracism, of many of his most influential compeers, although the logic of his arguments could not be refuted, or the results of his treatment controverted. The seed sown by this great, good and brave man has borne fruit until there is hardly an asylum in the land where you will not find a considerable number of the patients who enjoy the liberty of the grounds, and a larger number who are engaged in useful occupations. The number, too, who are tied, strapped, caged in cribs or kept in solitary confinement have become a very small per cent, of the number composing the household. Next to the love of life is the love of liberty, and a palace becomes a prison if the windows are barred and the doors bolted. Solitude is the most venemous worm that can gnaw at a heart, and enforced idleness is a pestilence to the soul. "Of all the cankers of human happiness, none corrodes with so silent, yet so baneful an influence as indolence. Body and mind both unemployed, our being becomes a burden and every object about us loathsome, even to the dearest." Insane men and women are still human, and if a remnant of their former self remains, are still moved by the same instincts and influences that affect the rest of mankind. Therefore, is it not better that their physical energies be expended in natural and useful employment than in tugging at straps or the bonds that may confine them; and their mental activities engaged in intelligently directing their labors, rather than in bewailing and lamenting their unfortunate condition, or resenting the injustice they may feel has been done them? To answer this question it is not necessary for one to be able to count the number of the brain cells, or to point out the exact area of a convolution that, if irritated, would cause the contraction of a certain muscle; but common sense, common justice, says: "Put yourself in his place," and the question is easily answered.
A more enlightened and humane method of caring for the insane has not only resulted in blessings to them, but has benefited the tax payers as well, by lowering the rate of maintenance. To a considerable extent the insane have practically been made their own keepers, and cheerfully contribute their labor toward lessening their burden to the commonwealth. Even the projectors of this institution, who formulated the plans, admitted that it would be more expensive to conduct than asylums built on the older wing plan, because two-thirds or more patients would occupy buildings without screens to the windows, and it would be necessary for almost as large a number to go out into the open air in order to reach the dining rooms; and, therefore, it was reasoned, a much larger force of attendants would be required than where the patients are kept all in one building, with the windows guarded and the doors locked. They justified their action, however, with the argument that the expense of construction would be so much less that a fair rate of interest on the difference in cost would pay the increased running expenses. They built better than they knew; for instead of the institution being more expensive to conduct, it has reached so low a rate of maintenance that honest doubts have arisen in the minds of some people as to whether or not our patients are receiving good care.
This being the case, perhaps some explanation should be given of the manner in which the institution has been conducted, and how so low a per capita cost has been attained.
First. As has already been intimated, the patients have been allowed to contribute largely to the support of the institution by their labor, as is shown by Table XIII and the list accompanying the steward's report showing the products of the farm and garden and receipts from various sources which, at a low estimate, would be worth $10,000, and have not cost the State to exceed $1,300, including $400 for rent of land.
Second. By a most careful and business-like financial management and by carefully guarding every avenue of waste.
Third. By the selection of employees and officers, having only in view their qualifications for the positions they occupy.
Fourth. By an effort to stimulate everyone (officers, employees and patients) to feel that we are all members of one large family, one common household, and that we are here for each other's good and all harmoniously to work together for the welfare of the institution.
Each hospital building is provided with a kitchen, ice box and cupboard, where at all times delicacies are kept that might tempt the appetite of a sick person, and that can be prepared at any time, day or night. Each hospital has always five attendants in the day time (and the greater part of the time six), and two night attendants. Each building also has a room fitted up with modern appliances for aseptic surgery. During the year Dr. C. A. Kirkley, of Toledo, an eminent specialist in female diseases, has performed thirty-one operations, a detailed list of which accompanies this report, and has also examined and directed the treatment of many other patients. Besides what has been done in this line, two cases have been trephined; there have been four operations for hemorrhoids; one operation for removal of large stones from the bladder, median lithotomy; external operation for stricture of the urethra, without a guide; removal of foreign body low down in male urethra; enucleation of two eyes; amputation of a toe, with portion of phalange; three operations for necrosed bone; two operations for removal of enlarged tonsils; operation for correcting deflection of the septem of the nose; amputation of a thumb; removal of a large mass of tubercular glands from the neck just below the angle of the jaw; three circumcisions; one operation for removal of cancerous mass from the leg; one tracheotomy for removal of food from the air passages; reduction of two cases of strangulated hernia; reductian of two cases of dislocated shoulder; treatment of two fractures of the leg; three cases of fracture of the arm, and one fracture of the collar bone, besides a number of other minor operations.