SUPERINTENDENT'S REPORT.

MEDFIELD, Sept. 30, 1897.

To the Board of Trustees of the Medfield Insane Asylum.

LADIES AND GENTLEMEN:- The first annual report of the Medfield Insane Asylum covered a period of five months only, and consequently did not demonstrate all of the problems met with in the management, and expenses attending the running, of this institution. This, being the second one, is for the full year, ending September 30, and shows more fully the results of one year's management.

The asylum year of 1896 closed with 563 patients in the institution. There have been received since then, by large transfers from the State hospitals, 499, making 1,062 patients received since the opening of the asylum, May 1, 1896. The largest number in the asylum at one time was 999; the smallest number, 557; the daily average for the year has been 741.95. This would have been larger, but some of the heaviest transfers were received quite late in the year. The total expenditures of the year, minus money received for cash sales and extraordinary expenses, mostly for construction, gives a weekly per capita cost of $3.08.

All of the buildings are now occupied, and the classification has been made as perfect as possible, considering that there is very little difference in the character of the patients received. The cottage plan of construction gives the best possible facilities for classification, and, if the patients were acute cases, classification could be made well nigh as perfect as it is possible to do. About 575 patients are able to go to the general dining rooms in the centre of the square; the remaining patients eat in the small ward dining rooms in the buildings in which they are located.

The general character of the patients received by transfer during the past year has not changed from that of the previous

year. A large number are cases of terminal dementia, — patients that are difficult to care for, because of their untidy habits and their tendencies to destructiveness. A large number of old and feeble cases have been received, so that the number of bed cases has been large, and has varied from 50 to 85 at a time; most of these are in bed from feebleness or exhaustion from organic brain diseases. There have been discharged 28 cases; 7 of these were recovered, 1 much improved, 6 improved and 14 not improved. There have been 73 deaths, mostly from exhaustion following organic brain diseases, principally terminal dementia. The general rule that many patients die immediately following their transfer has proved itself during the past year.

With a full year's experience in the management of an asylum built upon the cottage plan, several practical facts have demonstrated themselves. Apart from the advantages obtained by giving more air and sunlight, has been the increased opportunity for getting patients out of the wards, and breaking up the daily monotony of sitting continually in the ward rooms of the different buildings. Great use has been made of the piazzas, and, in addition to the daily walks, patients have had the short walks to the dining rooms to and from each meal. On the other hand, the cost of repairs and the expenses of maintenance are larger than in buildings built on the block plan. The distribution of supplies and the necessity for more outside clothing and more help are the largest expenses. The patients were able to go to the general dining rooms during every day in the year but on two afternoons, when food was distributed to the ward buildings.

The chapel was completed and occupied in September, religious services being commenced at that time. The lack of a hall for amusements prevented anything of that sort during the past winter, but this winter the usual entertainments furnished at the other State institutions will be given in the chapel for the benefit of the patients. The base ball games have been continued throughout the summer and have been quite popular, especially the match games with outsiders. As many patients as possible have been employed both outside and inside the buildings, in accordance with the original plan of the institution. While their labor so far has not been very productive,

still, as large a number has been employed as possible, principally for the benefit the patients would derive from it by being constantly in the open air. With a class of patients less demented and stronger physically, much more could have been done. Considerable grading, road building, rough labor and stone work has been accomplished, and there remains very much more similar work. The ice pond was excavated, and a good supply of ice for the year's use was put in at an average of 29 cents per ton, allowing interest on the investment in tools. and ice house. Progress has been made in improving the farm; stones have been dug up and taken away. and trees and bushes grubbed up. The farm has been reasonably productive, and has produced an abundance of vegetables in season and enough for use during the coming winter. In addition to the regular farm work, the coal has been drawn by the farm teams and considerable work done upon the grounds. In February last the stock barn was completed, so that cows were bought. Since then we have had our own milk, which is of better quality and less in price than it could have been bought for.

Among some of the necessities made apparent during the past year is the need of a building for a carpenter's shop and machine shop. Some sort of a recreation room should be furnished the help, where they can play games and read when off duty. This is the more necessary because of the distance of this institution from populous centres, and consequently requiring time and money for them to reach a place of entertainment. Sick employees should be provided with some quiet place removed from the noise of the wards. At the present time there are no facilities for such removals, and the sick person is often surrounded by a noisy and turbulent class of patients.

Several changes have taken place in the official staff during the past year. Mary Satterthwait, the first matron, resigned Oct. 14, 1896. Mrs. Satterthwait began her duties before the asylum received any patients, and went through the hard work of organizing and the troubles and perplexities of starting a new institution. She left to engage in similar work in Pennsylvania. She was succeeded by Miss A. L. Fletcher, who left March 22, 1897, to take a similar position in a large hotel, with increased salary. Miss Bessie Hazen, the third incumbent, is

still with us, and doing valuable service. Dr. Harriet M. Doane, from the Memorial Hospital, Worcester, was appointed on the staff last March. Dr. Thomas Howell, assistant physician, resigned to engage in private practice last May. He had been an efficient officer, and was a loss to the institution. Dr. Lawrence F. Patton, from the Brattleboro Retreat, was his successor, a gentleman well qualified by personal attributes and training for this responsible position. About fifty of the attendants and employees who began work with the opening of the institution are still here, and doing good service.

As to my officials and employees, I take pleasure in publicly approving their faithful service to the asylum. The thanks of the management are extended to all friends of the asylum who have donated reading matter for the use of the patients. This is a real charity, and is much appreciated by the patients, who get many interesting hours from the old books, papers and magazines so received.

Thanking your Board for your co-operation and advice during the past year, this report is respectfully submitted.

EDWARD FRENCH, M.D.,

Superintendent.