Of the 260 first admissions during the year, 54 were discharged as recovered.

The daily average of patients was 823. The largest number present at any one time was 867; the smallest, 774. In addition to the 66 discharged as recovered, 34 were discharged as much improved, and 30 as improved. Of the recoveries, 10 had acute melancholia, and 14 acute mania; 1 of them had been insane less than one month before admission, 13 less than three months, 17 less than six months, and 13 less than a year. Among the deaths 19 were from general paralysis, 19 from senile dementia, and 7 from phthisis. Among the probable causes of insanity in persons admitted during the year, intemperance is assigned in 52 cases, heredity in 39, senility in 36, and epilepsy in 8.

Although not the first Institution in the State to use a congregate dining-room, this Hospital is the first to use one for both sexes on so large a scale. It has now been opened for about eight months, and 522 patients and 64 employees are reported as taking their meals there at the end of the official year. The room is 120 x 180 ft. in size, and the tables occupied by the men and women are separated by a wide passage-way. There are no partitions, but rows of ferns and other plants, in boxes, cross [the room in several places between the tables. A small orchestra furnishes music during all the meals, the patients remaining in the room a full hour for dinner, and from thirty to forty minutes for breakfast and supper. There is no other Hospital in the State which, in its general form, lends itself so readily to such a plan. The dining-room being central, the approaches are so arranged as to make the ingress and the egress of the inmates comparatively easy.

Another important step taken by the Trustees is the erection of a nurses' home, the second under construction among the State Institutions. This house is 400 ft. from the main building and has 45 rooms. It will accommodate all the female nurses excepting those who must remain on the wards at night; having a single room for each nurse, a general parlor, a class room, and a basement laundry. The training-school for nurses was opened eight years ago, and with each year the standard of requirements is raised.

The absence of mechanical restraint continues a marked feature here, no male patient having been submitted to such restraint for the past twenty months, and no female patient for about six years. This system is regarded not only as directly beneficial to the inmates, but as strengthening the hands of the nurses, while, at the same time, developing in them a kindlier spirit in the management of the patients. It must be confessed, however, that it results in considerable noise and confusion in the wards.

Some much needed changes are being made in the plumbing, and a large and elaborately fitted bath room has been put in, in many respects far superior to any in the State. From this the Institution expects excellent results in hydrothereapeutics.

Under the appropriation made by the last Legislature of $30,000, plans have been made for extensions to the excited wards. There will be fifteen rooms in each ward. The Board is of the opinion that the recent closing of two wards upon the men's side, and the over-crowding of others, is a mistaken policy. The measure may be an economical one, but in many other respects it cannot but be regarded as unsatisfactory.

The Trustees estimate the expense of a desired new cottage for female nurses at $2,500; for laying tile or asphalt floors in the bath-rooms $1,500; for land for sewage plant and expenses $2,550, and should a new water supply be needed, in consequence of the failure of pending negotiations with the town of Danvers, they estimate the cost of it at a figure varying from $11,000 to $25,000.

THE WESTBOROUGH INSANE HOSPITAL.

(Opened, 1886.)

Trustees: Charles R. Codman, of Barnstable, Chairman; Emily Talbot, of Boston; George B. Richmond, of New Bedford; Eliza C. Durfee, of Fall River; Benjamin W. Childs, of Worcester; Alden Speare, of Newton; John M. Merriam, of Framingham.

Balance in favor of Hospital,

Average weekly cost per capita, $3.91.

fer, 115; Other removals, 79; Total, 318.

Classification of discharges: Recoveries of Insane, 73; Deaths, 51; Discharged by trans

$20,786 94

Total.

Of 224 first admissions during the year, 25 were discharged as recovered.

The daily average of patients was 546.57. The largest number present at any one time was 590; the smallest, 506. In addition to the 73 discharged as recovered, 40 were discharged as much improved, and 32 as improved. Of the recoveries, 43 had acute melancholia, and 23 acute mania; 23 of them had been insane less than one month before admission, 21 less than three months, 5 less than six months, and 3 less than a year. The whole duration of insanity in 71.23 per cent of those who recovered did not exceed one year. Among the deaths 9 were from general paralysis, 11 from senile dementia, and 5 from phthisis. Among the probable causes of insanity in persons admitted during the year, intemperance is assigned in 35 cases, heredity in 19, senility in 37, and epilepsy in 11.

This Institution continues to present a greatly improved appearance throughout its wards; the discipline is good, the ventilation generally excellent, and the relations between the Superintendent and his patients appear to be very pleasant. Increasing and successful efforts are made to employ and interest the inmates. The work of the training-school is making good progress. There has been an increase in pathological work and clinical study during the past year, with gratifying results.

Several structural changes have been made in the Institution, and, under the appropriation passed by the last Legislature, there is now in process of erection a building for the reception and treatment of acute cases, which is to cost $50,000. It will accommodate fifty patients, besides rooms. for a physician and his family, and will be provided with a Turkish bath, the first of its kind in any of the State Institutions.

Further consideration of the subject of recoveries of the insane at this Institution seems inadvisable. The Trustees and Superintendent, in their last Annual Report, appear to misunderstand the position of the Board in the matter.

THE MEDFIELD INSANE ASYLUM.

(Opened, 1896.)

Trustees: John G. Park, M.D., of Groton, Chairman; Elizabeth Thurber, of Plymouth, Secretary; Ira G. Hersey, of Hingham; William O. Blaney, of Boston; Edwin V. Mitchell, of Medfield; Benjamin S. Atwood, of Whitman; Florena G. Wellington, of Roxbury.

Average weekly cost per capita, $3.08+.

$51,582 06