The average number of patients for the year ending Sept. 30, 1897, was 546.57, and the average weekly cost $3.913. For the previous year the number was 564.35, and the average weekly cost was $3.894. Unless the number of patients be considerably increased during the coming year, it will not be possible for the hospital, as at present conducted, to meet its expenses, and there will be a deficit at the end of the fiscal year. There is already a very considerable increase in the cost of such necessary supplies as flour and potatoes, sugar, clothing and cotton goods; and it is estimated that it will cost $5,000 more to carry on the hospital this year than last year. The number of cases considered curable, admitted during the last hospital year, was 65; 44 such cases were discharged as recovered, being a percentage of 67. The trustees were authorized by chapter 276, section 1, Acts of 1897, to consent to the relocation of the highway which now runs close to the hospital buildings; and by the same act the State Highway Commission was authorized to lay out a new State highway during the present year. The trustees have conferred with the State Highway Commissioners, and the new highway has been located in a manner perfectly satisfactory to the trustees. The trustees have deemed it wise to obtain the right to purchase certain lands through which the new road is. to pass. These lands are adjacent to those of the hospital, and, by becoming its property, the State Highway Commission will be saved the necessity of adjusting the land damages which the State would be called upon to pay. The land to be acquired will be very useful as an addition to the hospital farm, and in providing a filtration bed for sewage, when needed. The discontinuance of the present public road, which is much too near the buildings occupied by patients, will give to the hospital buildings a very desirable and much-needed seclusion. The trustees will ask for an appropriation to pay for the land to be acquired, consisting of about sixty-one acres, all but one acre of which has been bonded to the hospital, contingent upon an appropriation by the Legislature. The remaining acre has been purchased for $142 31. The trustees will also ask for an appropriation for furnishing the new building for acute cases. The reports of the superintendent and treasurer are appended, and the trustees would call special attention to the discussion by the superintendent of the subjects of "treatment” and statistics." CHARLES R. CODMAN, EMILY TALBOT, GEORGE B. RICHMOND, ELIZA C. DURFEE, BENJAMIN W. CHILDS, ALDEN SPEARE, JOHN M. MERRIAM, Trustees. REPORT OF THE SUPERINTENDENT. To the Board of Trustees of the Westborough Insane Hospital. I respectfully submit the twelfth annual report of the superintendent for the hospital year ending Sept. 30, 1897. The following table shows the movement of population for the past year: Recoveries to admissions (per cent ), Recoveries of curable forms admitted (per cent.), 22.74 67.00 5.86 There were 321 patients admitted during the present hospital year,- 45 more than in the previous hospital year. Of those admitted, there were 286 direct commitments by the courts, 14 transferred from other hospitals and from boarding out by the State Board of Lunacy and Charity, and there were 21 voluntary patients. The admissions from Suffolk County, contained fewer curable cases than in previous years. There was a large propor tion of old men and women, many of them from the Long Island Almshouse, and these paupers, while insane and proper subjects for asylum care, are not at all desirable additions to a hospital. There were 318 discharges, -23 more than in the previous year. Of these, 145 went to their homes and friends and 115 were removed by order of the State Board. Of these transfers, 90 went to other institutions, 23 to their places of settlement outside the State and 2 were boarded out; 3 town patients were discharged to overseers of the poor, and there were 6 successful elopements, all men. There were 51 deaths during the year. In but 2 of these was the mental condition acute, and in both death resulted from advanced physical disease, which no doubt was also the cause of the mental condition. Notwithstanding the sending of 74 patients to the asylum at Medfield, our numbers at the end of the hospital year are 3 more than a year ago, and it seems probable that when our hospital building for the accommodation of 50 acute patients is ready for occupancy there will be abundant need for it. TREATMENT. The careful chemical and microscopical examination of the urine of all cases admitted has shown that serious affections of the kidneys, as evidenced by albumen and casts found, are not uncommon; and the remedy which has most promptly improved these cases, and caused the disappearance of the casts from the urine, has been cuprum arsenicosum, third x trituration. Mental improvement usually follows such a restoration of the bodily health. Mental improvement and also complete recovery, following changed physical conditions, is shown by our use of thyroid feeding in certain cases of insanity. There appeared in the January, 1895, number of the "Journal of Mental Science" (British) an article by Dr. Lewis C. Bruce, upon the results of thyroid feeding, to which my attention was called. I had previously found this treatment a specific for myxedema, a disease often accompanied by mental derangement, and I began thyroid feeding for insanity in March, 1895. Some unexpected recoveries followed, and after waiting two years since the first cases were discharged, and keeping them under observation, I can say that up to the present time there has been no relapse. I will epitomize our results by saying that this treatment has not been of any value in curing the recognized chronic forms of insanity, but in cases apparently curable when admitted, which have not done well, and which appeared to be passing into dementia, it has done good; and in protracted cases of the puerperal forms of melancholia and mania it has been almost a specific. We continue to use thyroid feeding, and value this treatment so highly that we give it in all suitable cases. I agree with what Dr. Bruce says in his article: "The exhibition of this drug is certainly worth a trial in that class of patients, so commonly seen in every asylum, in whom a certain improvement has occurred, but beyond that point they never advance." Hydropathic measures have received extended use in cases of acute mania, and in all other cases in which there was a marked rise of temperature. I believe that continued high temperature in the insane, while seriously threatening life, also causes damage to the brain and increases the probability of dementia following the acute condition. The nurses are instructed, whenever the temperature of an acute case of insanity rises above 100°, to give a cool sponge bath every four hours; or, when directed by the physician who decides if the condition of the patient will warrant it, to give a graduated spray bath, beginning with water at 100°, and running down in five minutes to 550 or 60°. The results of this treatment have been satisfactory, and in cases of acute alcoholism it has become our entire treatment for the tormenting hallucinations that come on at night; a five minutes' graduated douche making a patient entirely rational, and giving him a quiet night. Sometimes second spray is needed and in one case a third bath was necessary. STATISTICS. The State Board of Lunacy and Charity, in their last annual report, January, 1897, devote two or more pages to unfavorable and unjust criticism upon statements of statistics made in your last annual report. The State Board have several times. before made similar criticisms, yet in all these years they have never come personally or sent any one to the hospital to |