Tabular statement of the time of life at which the 9,588 cases treated since the opening of the institution became insane.

Recovered.

Year.

Improved. Unimproved. Died.

Admissions, discharges, and deaths, with the mean annual mortality and proportion of recoveries, per cent of the discharges, including deaths, for each year since the opening of the hospital.

Admitted.

Discharged.

Total.

ToM. F. tal.

M. F.

Total.

To

M. F.

To

M. F.

M.

tal.

tal.

235 2,283 604 2,887 1,318 384 1,702

The number of admissions, 371, an average of more than one a day, has never been exceeded within the hospital history, except during the last two years of the war, while the whole number under treatment, 2,052, is in excess of that of any previous year, and the daily average number is nearly 50 more than ever before. The recoveries, 98, just 28 per cent of the discharges, make a favorable showing, when the chronic character of the great proportion of cases at the time of admission is taken into account. The deaths were 179, showing a mortality of 10.73 per cent on the average number and 8.72 per cent of the whole number under treatment. Ninety-three of the deaths were of soldiers and sailors. The increasing age of the veterans each year swells the ranks of those called up higher.

The insalubrity of the flats of the Eastern Branch of the Potomac, in a great measure due to the abortive attempts of the United States Government to fill them, is every year increasing and is the probable cause of more than one-half of the sickness occurring at St. Elizabeth. Is there no remedy for this?

Competent engineers and sanitarians who have studied this problem of the river say that by filling the flats, so as to confine the Anacostia within its proper channel, the current will be quickened, hundreds of acres of ground along the river banks, valuable for parks, many acres of which would seem to belong with the riparian rights of the hospital, will be reclaimed, and the malaria will in a great measure be at an end. It seems proper to ask in behalf of the afflicted inmates of St. Elizabeth, What has the Government done to bring about this most desirable result? With an insufficient appropriation mud bars have been thrown up so as to impede the motion of the water in the swash channel, and with each ebb and flow of the tide broad reaches of the river bottom are alternately flooded by the half-stagnant water and then exposed to lie festering under the August sun, breeding microbes and germs. Then, the limited appropriation exhausted, the Government has waited supinely for the river by depositing its silt to fill these noisome flats with the slow accretions of ages. As compared with the date of final completion of such work the millennial year seems near, and this generation will die of malaria without the sight of relief.

Despite all these preventable causes of disease and the shortened tenure of life that brain disorder is supposed to confer, it is pleasant to note that after forty years of continuous hospital life two men and two women of the 63 persons admitted prior to June 30, 1855, during the first six months after the hospital was opened, are still among its contented inmates. One styles himself" king;" the other, "high priest of nature." Here for forty years one has reigned with no revolt among his subjects; the other, long past fourscore, who has seen a village of the simple grow up among oaks remembered by him as acorns, and under whose shadows he has silently worshiped, may well be accounted worthy of recognition as both Nestor and Druid of St. Elizabeth. Long cloistered in these peaceful shades, may their lives come at last to broader horizons.

The problem of finding accommodations and providing for 1,700 insane in one village-for this is what St. Elizabeth has become-is somewhat complex and one beset with many difficulties. At the risk of repeating some things that have been said in past reports, notably in those of 1887, 1891, and 1893, it seems advisable to state concisely what we have now or have in process of development, and what we should strive for in the near future to keep this hospital a model institution under the Government for the care of its insane.

Many of the buildings are now overcrowded, but with the appropri ation of $25,000 for additional accommodations made at the last session of Congress buildings have been projected, some of which are already being constructed, which will afford relief, even if they do not wholly do away with the difficulty in this respect.

The Government Hospital for the Insane is under the charge of a resident superintendent, whose entire time and energies are devoted to the work. He is the responsible head of the whole-medical, financial, and executive. In this arduous position, while under the general supervision of the Board of Visitors, he has their friendly counsel and cordial support. In the several departments he is assisted by an ample staff of subordinate officers, each officer being under his direct control. Where the responsibilities are so vast, unity of head becomes an absolute necessity, and on the judicious exercise of such individual respon sibility much of the success of a hospital depends.

The Government domain here devoted to the care of the insane comprises three tracts, viz, St. Elizabeth, Stevens farm, and Godding croft. They contain nearly 800 acres and have a population of more than 2,300. Counting three buildings which are projected, but as yet only in proc ess of erection, there are seventeen buildings occupied by patients, with an average population of about 100 each. These naturally subdi vide into six groups, looking to the segregate classification of the inmates, in addition to which groups there are two cottages for special cases entirely distinct. The main hospital consists of a male and female department, kept distinct by an administration building. Here all patients are received on admission and kept for a time under observation. Each department is under charge of its respective physician. The central male group comprises the west wing of the main hospital edifice, with its Dawes and Garfield extensions and the west lodge for colored males. This division has 19 distinct wards and provides for 400 inmates. This number of wards admits of considerable classification in itself, but it is from these wards that most of the transfers to the different groups for males are made after the cases have been under observation for a sufficient time to permit of an intelligent diagnosis.

The female department makes the second group and comprises the east wing of the main hospital building, the east lodge for colored females, and Dix Building Nos. 1, 2, and 3 for the female epileptic insane. Here 375 inmates are provided for with classification in 20 distinct wards, 5 of which admit of subdivision. This group has its own distinct grounds. The third or west group, also with distinct grounds, is for the criminal and homicidal male patients. It consists of the four wings of Howard Hall, which, being built in the form of a square, inclose a court. They are also provided with grounds lying outside the building. Howard Hall cares for all its inmates, 120 in number, in single rooms, divided into 8 wards. There are also work rooms, dining rooms, amusement room and smoking apartment. A physician is in charge of this criminal department.

The fourth or eastern group is for male patients, for the most part of the quiet chronic class. The largest number of the veterans from the National Home for Disabled Volunteer Soldiers are provided for here. The group consists of Atkins Hall, the Relief, the Home, together with a large building for a common dining hall, workroom, bowling alley, and smoking apartment, the latter being fireproof. Provision is here made in 13 wards for 500 inmates. This department has its own physician and distinct grounds, comprising about 8 acres, that are lightly inclosed to afford greater freedom to its occupants. These