the family mansion on fire, and makes no secret of the delight with which he sees it burn to ashes. He is arrested by the officers of the law, and had he burned a neighbor's house instead of his father's, he would exchange the kindly minis trations of a hospital for the stern rule of a prison. The sight of the physician whose skill and pains they have so poorly rewarded would be a reproach to the awe-stricken parents, and they take the poor victim of their folly to another hospital. Though every care and skill are bestowed upon him he never fully recovers his reason, but lives on year after year, wretched and dreaded, till appetite, passion, and delusion subside into fatuity. The most that can be said against this picture is that it is a strong one. It is not in any particular untrue to nature. No real patient will kill himself because he is compelled to remain in a hospital till he is fully restored, no more than our supposed one would have done; and criminal acts more frightful than arson are committed nearly every week by insane persons who are at large by the indul gence of friends and against the warnings of competent professional counsels. Now the terrible evil whose existence and character we have endeavored to demonstrate, is a palpable violation of the plainest and most solemn duty of intelligent and accountable beings. It exists to a fearful extent, and no subterfuge of reason can possibly reconcile it to an enlightened conscience. When a fellow-being is deprived of reason and unable to act for himself, it is the obvious duty of his nearest friends to act for him, and the closer the ties of blood or affection the more sacred and imperative the duty to so act as to promote his highest welfare; and in what does the highest welfare of the patient consist? First, certainly, in promptly adopting and patiently persevering in the means most likely to secure the complete and permanent restoration of his reason. The only way in which present safety and sound recovery can be most certainly effected are demonstrated by the experience of the enlightened world, and the lessons of experience are skilfully applied to the circumstances of the individual case; and what a lamentable paradox it is that diminishes the unfortunate patient's chances of recovery in proportion to the ability of his friends to provide every agency calculated to secure it! More persons become insane between the ages of twenty-five (25) and thirty (30) years than in any other equal period of human life, and at the latter age the average duration of life is about twenty (20) years, and the individual may live beyond the allotted age of man; and how utterly insignificant is the devotion of a whole year's time, if so much be necessary, to the use of the means most likely to insure twenty (20) years, possibly forty, (40) of reason and health, occupation and usefulness, and respect and happiness! How inexpressibly foolish the common plea for cutting short the treatment of a patient before a full probable recovery, that the busi ness is suffering, or the opportunities of pleasure are passing by, in which he is utterly incompetent to engage, and which, when he does engage in them, hurry him back to irrecoverable madness! Recovery from insanity is uncertain under the earliest and best treatment sufficiently persevered in, and no modes of management that are painful or dangerous to the individual could be justified for one moment. Happily, tenderness and sympathy constitute an important part of the most effective curative treatment. It is deemed so essential to the welfare of the insane that all their innocent domestic and personal comforts while in a hospital should correspond to those to which they have been accustomed in health, that when civil patients of refinement and liberal education—who “have seen better days"-are sent to us by the department, as they often are under that generous provision of national law which secures to all persons who become insane in the District and are unable to support themselves under the visitation of insanity "the most humane care and enlightened curative treatment," we, as far as practicable, make the food and clothing and all the personal relations of such patients conform to their previous habits. We believe this to be the practice of most of the State institutions, and that in them it is found, as it is with us, that humanity and public economy here accord, because the liberal care promotes the earliest and most certain recoveries and soonest relieves the authorities from the expense of maintenance. It would be unjust to suppose that the treatment of every patient of the independent classes is embarrassed in the manner we have indicated, or in any manner; but that some degree of some such embarrassment is encountered in the management of the majority of such patients, if not proven, is at least illustrated by the fact that a hearty, uniform, and unflagging support on the part of the friends of a pay patient is a sufficiently marked event in the experience of most hospital physicians to be gratefully recognized whenever it occurs. It hardly need be said to any one who has much knowledge of himself that the mental physician, however conscientious and devoted he may be in the discharge of all his duties, can, and therefore will, do more and better for the patient whose friends appreciate his skill and care and confide in his judgment than he can possibly do for one whose fickle friends may any day disconcert the best laid and most promising plans of treatment. The evil of which we are speaking is believed to be not exclusively, though peculiarly, American, and, viewed in the opposite lights of self-interest and patriotism, it assumes proportions even more formidable than those it derives from a violation of reason and conscience, for in no other enlightened country of the globe can it be so destructive of the individual interests of those most affected by it or of the public weal. Here self-indulgence is inevitable selfdestruction. Here individuals and families rise to honor and usefulness by their own energy and self-denial, and, unsupported by the artificial props of rank and privilege, they sink into imbecility and insignificance by the dead weight of sloth and pleasure. Self-indulgence not only neglects education of every kind and invites the invasion of disease, but, in the case we have considered, it clings to the ruin of its victim. On the other hand, as it is obvious that republican government rests upon individual self-government, the prevalence of sloth and luxury among the people must sooner or later sap the foundations of our cherished institutions. The independence of the national hospital for the insane of private patronage, either for support or a wide field of usefulness, which enables it to bear a testimony as disinterested as it is earnest against the evil in question-an evil which lacks only the intent to make it a crime-does not diminish our obligation to raise our voices against it; and we would solemnly adjure every responsible friend of an insane person into whose hands these pages may fall to reflect seriously upon his duty to his afflicted ward-to resolve to be governed in all things by competent counsel-to do what will promote the recovery and thus the highest ultimate welfare of the patient, and not what will momentarily grat ify his appetite or relieve his impatience, but in the end confirm his ruin. Classified abstract of the receipts and expenditures of the hospital during the year ending June 30, 1866. EXPENDITURES. Balance from last year due superintendent from United States... $22,555 71 Expended for flour.. Expended for butter and cheese. Expended for meats, including hams 8,827 83 7,921 71 4, 434 30 1,342 59 Expended for feed for stock, including pasture. 1, 188 93 6, 129 51 1, 349 83 5,036 63 552 23 Received from treasury United States... Received from naval hospital fund for supplies furnished.. Total..... $100, 000 00 5,017 16 5, 156 68 987 00 111, 160 84 The visitors respectfully recommend that ninety thousand five hundred dollars ($90,500) be asked of Congress for the support of the hospital during the year ending June 30, 1868. This sum is the same as that granted for the current fiscal year. Congress at its last session passed an act extending the privileges of the institution to all men who had served as Union soldiers in the late war and should be found insane within three (3) years after their discharge, by reason either of the continuation of the disorder, of relapse after recovery, or of original invasion of mental disease from causes growing out of their military service. As it is not possible so soon after the passage of the act to make even an approximate estimate of the number of patients that will be sent to the hos pital under its provisions, nor how rapidly they will come in, no addition is made on account of it to the sum asked last year for the support of the establishment, not doubting that, should the number of former soldiers received materially swell the population of the house, Congress will not hesitate to make up a deficiency in the regular appropriation occasioned by legislation that it deemed just and proper. It is thought that the number of the several classes of inmates provided for by previous legislation and the cost of their maintenance will not materially vary from the estimates of last year. The lodge for colored men, occupied as a general naval hospital since the spring of 1861, was vacated on the day of the date of this report, (October 1,) by the transfer of the seamen then under treatment to the handsome new naval hospital building, just completed in Washington. As soon as some needful repairs can be effected the colored men will be transferred to it from the first story of the lodge for colored women, and the welfare of both sexes will be promoted by their entire separation, and the additional room and freedom each will enjoy, We were much pleased with the manifestation of good will by the steward and nurses of the naval hospital at the breaking up of its organization here, by giving to this institution their pretty boat, completely furnished with oars, cushions, and awnings. No change in the medical staff of the hospital took place in the course of the year, and the physicians have been active and skilful in their efforts to promote the comfort and restoration of individual patients, and the general discipline and good order of the establishment. Individuals among the under officers, and among the attendants and other employés, have done themselves great credit by their earnest, self-denying efforts to relieve pain and sickness, and to render the institution not only a good hospital, but a kind and sympathizing home. Divine service was held in the meeting room on every Sabbath afternoon of the year; and on every other evening of each week, from the 1st of November to the 1st of May, one of the physicians conducted a general entertainment, usually consisting of the popular treatment of some scientific subject, illustrated by drawings or experiments. We were indebted to Colonel John H Wheeler for the delivery of several lectures in the course of last winter, which were much appreciated by the patients; to Miss D. L. Dix, for the gift of a melodeon and several smaller musical instruments, and to Messrs. W. G. Metzerott & Co., and J. F. Ellis, of Washington, for handsome discounts, on account of the benevolent character of the institution, in the prices of several pianos and music books bought of them. We were also, as before, much indebted to the War and Navy Departments proper, and to several of their bureaus, for valuable facilities which evinced a gratifying interest in the objects of the institution. We have the honor to be, very respectfully, your obedient servants, President of the Board. C. H. NICHOLS, Hon. O. H. BROWNING, Secretary of the Interior. Secretary of the Board. GOVERNMENT HOSPITAL FOR THE INSANE, Office of Construction, November 1, 1866. SIR: All the estimates submitted in my last annual report, and approved by your predecessor, were appropriated by Congress. None of the improvements, nor the purchase of land contemplated by those estimates, have yet been completed; but most of the former are in progress, and are being urged forward with as much rapidity as is thought to be compatible with the careful maturity of details of design, and with economy and durability of construction. One large ward for women, the locust, has just been finished, and the furniture for it is now being made of the same wood. I hope the furniture will be completed and the bedding made up in time for the occupation of the ward by or before the end of the year. The stone for the extension of the abutment of the hospital wharf has been delivered, and most of the additional wall laid. Upon examination, it was found that all the old piles were too much decayed for further use, and entire new white-oak piles, forty (40) in number, have been cut on the grounds of the institution, and just been driven by a steam pile-driver courteously furnished from the navy yard. The stone for the wall enclosing the grounds is quarried at a point on a neighboring property about one mile distant, by a party of out-door attendants and patients, and hauled by the hospital teams; and, on account of the farm improvements and cultivation, both of which have been more extensive the past season than in that of any one previous year, it was necessary to defer the devotion of any considerable force to this work till the first of October. Two parties of stone masons are laying the wall by contract, and are making good progress. But little progress has been made in building the contemplated cottages for the occupation of the employés of the hospital having families. At the breaking up of the Giesboro cavalry depot, last summer, there was an opportunity to purchase, at cheap rates, lumber suitable for greatly needed internal or subdivision fencing; and it was deemed most advantageous to the interests of the institution to obtain the lumber from that source, and, under the support account, proceed at once to employ all the carpenters that could be conveniently engaged in making the improvement indicated, and put off the erection of the cottages till early another spring. The title of the land, for the purchase of which an appropriation was made at the last session of Congress, is being examined, and I hope the institution will, in a few weeks from this time, come into full possession of the property, In making the survey necessary to perfect the title, it was satisfactory to find that there are between three (3) and four (4) acres more of this land than was supposed when it was bargained for as a whole piece. The following estimates for the year 1867-'68 are respectfully submitted: 1. For finishing, furnishing, lighting, and heating additional accommodations in the east wing of the hospital edifice, (occupied as a general army hospital during the late war, and still, in part, unfinished,) seven thousand dollars, ($7,000.) 2. For continuing the wall enclosing the grounds of the hospital, ten thou sand dollars, ($10,000.) 3. For building a coal-house near the wharf, two thousand dollars, ($2,000.) The estimate for the continuation of the finishing, furnishing, and fitting up of the unfinished interior eastern extremity of the east wing is two thousand dollars ($2,000) in excess of what was asked and appropriated last year. The house is now over-crowded, and a somewhat larger expenditure than can be made with the last appropriation is needed, in order that the completion of additional accommodations may keep pace with the increase of patients. The sum asked for continuing the wall enclosing the grounds is the same that Congress has granted each year for three years past, with the understanding that the entire expenditure necessary to complete this important work will be less felt by the country by being granted in several annual instalments than it would should the whole amount be drawn from the treasury at one time. The fourth item is the estimated cost of building and fitting up a coal-house at the river. The hospital consumes about one thousand tons of coal each year, and it has heretofore been necessary to haul all of it up the hill-a horizontal distance, by the road, of about three thousand (3,000) feet, and a rise of about one hundred and seventy (170) feet-and stow it away in the coal vaults, in the hottest months of summer, when coal can be bought at the lowest price. This is the dreaded job of the year, because the work is oppress ive to both man and beast, and because it occurs when agricultural operations are most pressing. If a coal-house is built and properly fitted up upon or adjacent to the wharf, the coal can be hoisted directly from the vessels into it, and then drawn up as it is consumed in winter, when animal vigor is highest and its exertion least felt, and when agricultural operations are or can be suspended. I have the honor to be, sir, very respectfully, your obedient servant, |
