Gentlemen: The tenth biennial report of the Fergus Falls State Hospital is herewith respectfully submitted. Table Showing Movement of Population For the Biennial Period Ending July 31, 1906. ADMISSIONS AND DISCHARGES. The statistical table showing forms of mental disease admitted during the biennial period continues to present the same discouraging Of the features as similar tables have done during the past six years. eight hundred and seventeen cases admitted only one hundred and fifty had any chance of making a permanent recovery. Many of the chronic cases will improve to such an extent as to be able to leave the hospital and become self-supporting for a longer or shorter period, but most of these patients will have to return to the institution at intervals and will finally become permanent wards of the State. The general health of the patients has been good during the period. An epidemic of diphtheria occurred during the winter of 1905. There were None of the cases twenty-nine cases among the patients and nurses. were of a severe type. One nurse died while in quarantine, but the cause of death was not primarily due to diphtheria. The origin of the first case was a mystery, as it occurred in a patient who resided on a ward not open to visitors and as far as we could learn no employe who visited the ward had been exposed outside. There were a number of cases in the neighborhood and some employe might have easily become exposed without his knowledge. However, two of the earlier cases among the employes were directly traced to exposure to the disease outside the hospital. Every case was strictly quarantined and the epidemic was finally stamped out. The death rate for the period has been about the average, five and five-tenths percent for the first year and five and seven-tenths for the second year. Thirty-eight percent of all the deaths were due to tuberculosis, an increase of three percent over the death rate for the same disease for the preceding period. CARE OF THE INSANE CLASSED AS DANGEROUS AND CRIMINAL. Every new state is met in the beginning with the problem as to the quickest way of housing and caring for its dependents. As the state grows in population and wealth and the necessity for haste becomes less urgent, the first crude efforts give place to more scientific methods, and one of the first steps taken is along the line of specialization or classification. Of late years considerable attention has been given throughout the United States to proper methods of classification of patients in institutions devoted to the care of the insane. No state has been more generous toward its dependent classes, or has made greater effort to attain the front rank in methods of care for its unfortunates, than Minnesota. But it has been considerably handicapped in this direction by the congregate plan of building which the State has followed until lately, a plan that lends itself but poorly to a proper classification of inmates. With the establishment of the two modern institutions at Anoka and Hastings on the cottage plan a beginning could now be made and a classification of patients started that would at once prove beneficial to all the institutions in the State devoted to the care of the insane. As a rule insane patients have a fair appreciation of what might be called their responsibilities towards society and are, broadly speaking, as law abiding as the majority of individuals of more stable mental equilibrium outside an institution. It is true maniacal outbreaks occur from time to time, just as ungovernable outbreaks of passion occur in persons outside, but such are never considered seriously, or prove to be a menace to the safety of others when properly controlled. The majority of insane people are as appreciative of the good things of this life and are as capable of enjoying pleasures as the sane. When they unfortunately have to come to the hospital for care or treatment, the endeavor is made to make the surroundings homelike and pleasant and to do away with everything, as far as possible, that may suggest the custodial or prison idea. There is in every hospital, however, a small number of patients who show a marked propensity toward crime, and this criminal tendency is almost invariably crime against person-attempts at homicide or rape. Patients of such characteristics, together with the so-called insane criminal of the penitentiary, form a class known as the Dangerous and Criminai Insane. In a hospital for the insane of the conventional congregate plan there iv very rarely a sufficient number of patients of this class to segregate on one ward and consequently no ward is properly constructed for their care and retention. Such patients do not respond to treatment, they are chronic from the beginning and require only custodial care; therefore, the only requisite is deprivation of liberty in the pleasantest manner possible, and to do this without detriment to the other patients is a problem impossible of solution unless some plan of segregation can be followed. No class of cases is so detrimental to the well-being of the other inmates, or to the discipline of an institution as the one under consideration. One patient of the criminal type is not only a source of danger and menace to the other patients, but he also deprives them of the care and personal attention of the nurses, a more serious matter. Every other patient in the ward should have every possible liberty and every privilege that may be granted, but the patient of criminal tendencies, not, for he, if at large, would be a menace to pic safety, so that he must be watched with the utmost care and every possible chance of escape must be guarded against. As a result the time of the nurses which should be devoted to the welfare of all the patients in the ward is given to the one, extra bolts and bars are gradually found necessary, the ward becomes prison-like and the patients become restricted of liberty. Certainly two or three patients on a ward should not establish the tone of the ward. It is unjust, that over ninety-five percent of the patients on any ward should be made to suffer and be deprived of the care and oversight due them because a small proportion of their number require such constant watchfulness. If there were a sufficient number of the dangerous and criminal insane class to fill a ward, it would be easy to select one ward and fit it up for the purpose, but at the present time there are probably not over fifty in all the institutions for the insane. The most feasible plan under the circumstances would be to collect all patients of this class in one institution. This institution should be one that is centrally located, so that patients could be transferred there from the other institutions without undue expense. Several of the eastern states have erected special institutions for the care of this class, New York has two, but certainly in the beginning a separate institution would be an unnecessary expense for the State. A cottage with a capacity of fifty inmates built especially for the purpose would be ample for present needs, and such a cottage could be built at very little additional expense to those the State is now erecting for the quiet, chronic class of patients. A cottage of this character at Anoka or Hastings would be ideal for the purpose. Either of these institutions is centrally located; they have already been established on the cottage plan for the care of chronic patients, and there would be no additional expense for administrative pur poses. The convict insane could be for the present, and possibly for all time, taken care of at Stillwater, as is now being done, and in time a cottage could be erected within the prison grounds so as to separate this class from the other convicts. REVISED LAWS OF MINNESOTA.. Before the passage of the revised laws by the legislature of 1905 a meeting of the Board of Control, superintendents and a legislative committee was held for the purpose of suggesting some changes and putting in some omissions from the old laws. In the opinion of the Board and superintendents such amendments as were suggested to certain sections of the revised laws covering State institutions were advisable, and the legislative committee expressed itself as in entire agreement with all the changes recommended, but as far as I can learn not one of the amendments suggested was introduced by any member of either house. I would, therefore, recommend the following suggestion to the consideration of the Board. Section 1866. The Board shall fix a compensation of all officers and other employes in such institutions, except those fixed by law, and shall classify the officers and employes, and the salaries paid to any class be practically uniform in similar institutions. Such compensation shall be included in the quarterly estimates, and be paid in the same manner as other expenses. Section 1880. On or before the first day of February, May, August and November of each year the chief executive officer of every such institution shall cause to be prepared triplicate estimates, in minute detail, of all expenditures required for the next three months, with estimated cost of each item. Two of said estimates shall be filed with the Board, and the other retained by the chief executive officer. Section 1881. Add thereto: On or before the tenth day of each month a statement in duplicate shall be prepared by each institution showing all revenues received during the preceding month and accounted for to the state treasurer on the first day of the month. Section 1890. The Board may transfer an inmate from one hospital or asylum for the insane to another, or to the school for feeble-minded, or from said school to any hospital or asylum for the insane and shall cause |