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ANNUAL REPORT OF THE PUBLIC HOSPITAL FOR THE INSANE OF THE PROVINCE OF BRITISH COLUMBIA FOR THE YEAR… British Columbia. Legislative Assembly 1912

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 ANNUAL   REPORT
-OF  THE-
PUBLIC HOSPITAL FOR THE INSANE
-OF   THE	
PROVINCE  OF  BRITISH  COLUMBIA
—FOR  THE	
YEAR   1911.
THE GOVERNMENT OF
THE PROVINCE OF BHITISHGOUWBM.
PRINTED   BY   A VTMORITY   OF
THE  LEGISLATIVE   ASSEMBLY   OF  BRITISH   COLUMBIA.
VICTORIA,  B.C. :
Printed by William H.  Cullin, Printer to the King's Most Excellent Majesty.
1912.  2 Geo. 5 Public Hospital for the Insane. D 3
REPORT
ON  THE
PUBLIC  HOSPITAL  FOR THE INSANE,
1911.
To His Honour Thomas Wilson Paterson,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour :
The  undersigned  respectfully  submits  herewith  the Annual Report of  the   Medical
Superintendent of the Public Hospital for the Insane for the year 1911.
HENRY ESSON YOUNG,
Provincial Secretary.
Provincial Secretary's Office,
January, 1912. D 4
Public Hospital for the Insane.
1912
OFFICERS:
-:o:-
Medical Superintendent:
C. E. DOHERTY, M.D., CM.
Assistant Medical Superintendent:
JAMES G. McKAY, M.D., CM.
Analyst:
F. P. HUGHES.
Bursar:
GOWAN S. MACGOWAN.
Assistant Bursar:
T. H. CAMBRIDGE.
Matron :
MARIA FILLMORE.
Steward and Store-keeper:
R. REES.
R. LENNIE.
Chief Male Attendant:
GILBERT MATHEWSON.
Chaplains :
Engineer :
W. F. JOHNSTONE.
E. MAILLARD, O.M.I.
Matron and Chief Female Attendant:
MARIA FILLMORE.
Carpenter:
THOMAS CORMACK.
Plasterer and Mason :
EDWARD FITZGERALD.
Farmer:
E. B. STINCHCOMBE.
Gardener:
W. T. L. HOUSE.
Tailor :
Laundryman :
W. F. BEGGS.
Shoemaker:
J. HARGIE.
T. M. YEADON. 2 Geo.
5
Public Hospital for the Insane.
D 5
Medice
The Honourable
REPORT
OP   THE
il Superintendent of the Public Hospital for
New Westminster, B.C.
 :o:	
For the Year ending 31st December, 1911
the Insane,
ember 31st,  1911
Public Hospital por the Insane,
New Westminster, B.C., Dec
the Provincial Secretary,
Sir,—I have the honour to submit herewith the Fortieth Annual Report of the Public
Hospital for the Insane at New Westminster for the year 1911. The report embraces, as
usual, a full account of all operations of the institution, including a close record of all movements in Hospital population, as well as a detailed account of all revenues collected and
expenditures made during the year.
In order to facilitate a more ready comprehension of the data given in the tabulated
portion of the report, the following resume and summary is presented : At the close of the year
the number of patients under our care was 690, of whom 500 were men and 190 were women.
The admissions for the year were 332; of these, 259 were men and 73 were women, an
increase of admissions over the previous year of 52. Of the admissions, 145 were suffering
from a first attack, 50 were suffering from a second attack, and 11 from a third attack. In
110 cases it was impossible to ascertain the number of attacks, but it is more than probable
that a portion of these were cases recurring.
Of those admitted, 123 were married, 12 were in the widowed state, 179 had never been
married, while in 18 cases it was impossible to ascertain the civil state.
In religion, 211 were Protestants of various denominations, 90 were Roman Catholics,
18 were heathens, and in 13 cases the religion could not be ascertained.
The total number of discharged for the year was 181. Of these, 65 were discharged
recovered, 91 were discharged as improved, and 23 were discharged as unimproved. Two
were discharged as not insane. The percentage of recoveries, computed on the number
admitted during the year, is 19.57.
While no distinctive epoch marks the history of the institution for the year just elosed,
the policy of the Hospital along the lines of a progressive inquiry has been maintained, greatly
aided by the spirit of an earnest and zealous endeavour on the part of all officers and staff to
advance and enlarge its usefulness in the domain of the special branch of work for which the
institution was established forty years ago. The prospects of useful work in the treatment
of our mental cases in this Province were never so bright or so full of promise as they are
to-day. The Hospital is now receiving the closest attention of the many keen intellects of
our Provincial Cabinet and members of our Provincial Legislature, without whose assistance
in the supply of facilities all our efforts would be without avail.
The average outside practitioner may be of the opinion that the success of an institution
depends entirely upon the man directly in charge, and upon the rational methods adopted by D 6 Public Hospital for the Insane. 1912
him in his means of management, diagnosis, and treatment. True as this is to a certain
extent, for the fundamental principles on which the general treatment of mental cases is
founded are to some extent the same to-day as in the past, still there is an ever-changing routine
in the practice of all medicine, but particularly is this the case in the branch of psychiatry, and
even still more so in the methods of management and treatment of the dependent insane in
public hospitals; and it is just here where the Medical Superintendent and his assistants
find themselves entirely helpless, unless they have as superior officers men large-minded enough
to grasp the situation, and conscientious enough to see that the financial assistance is included,
in their yearly estimates.
While probably in Canada there is not yet an institution in which the equipment measures
up to all demands of the clinical service, as the different Superintendents would have it, still
this is no reason why our new Hospital at Coquitlam should not do so ; and thanks, sir, to
your great personal interest and energetic efforts, I am inclined to think that British
Columbia's new Mental Hospital, now rapidly nearing completion, will approach more nearly
the ideal standard than any other Canadian hospital yet constructed. Here we will have
buildings of the very best possible construction, absolutely fire-proof throughout, with separate
buildings for the chronic cases comprised of large airy dormitories and single rooms; with
day-rooms, all of which have natural light from three sides, are artificially ventilated, and each
of which opens out upon a comfortable solarium. The Acute buildings are splendidly adapted
for the reception, examination, and proper treatment of those acutely insane; while the
Hospital pavilions for the treatment, medieal and surgical, of those physically ill, I think will
compare with the most up-to-date general hospitals in this Dominion. Another feature worthy
of mention is the Isolation Hospital for tubercular and other cases, which is splendidly laid
out for the purpose for which it is intended, as also are the buildings for manual arts and
crafts training, with all the needs which experience has dictated.
Given such an equipment, it certainly behoves us all to form the highest ideals of the
particular part which each is to play in the carrying to success of his or her special duties in
this new Hospital. Now, by ideals, I do not associate my views with any slovenly or weak
sentimentalism or corrupting counterfeits ; I mean the real sentiment, the rational instinct for
service; no star-gasing or crystal-readings, but work. In our new Hospital, let our ideal be
application of imaginations to realities, the greatest of which will be the patient himself.
Treatment.
Before outlining our general routine of treatment for the past year, I wish again to assure
you that humanity has always taken the first place, both where the care and treatment of
those acutely insane, as well as where the happiness and welfare of those chronically afflicted,
were concerned.
Much mistaken sentiment exists, not only among laymen, but very often, also, even among
general practitioners and surgeons, that where a person recovers from insanity " he gets well
himself"; that is, unlike other diseases, medical interference has little effect in curing the
patient. How absurd, for, as a matter of fact, this is not a whit more true of mental cases
properly handled than it is of most physicial diseases in which recovery takes place. Let the
house surgeon from any general hospital go into the offices of a modern mental hospital, and
he will find that the diagnoses are not by any means haphazardly undertaken ; he will find the
alienist with his bacteriologist and clinical clerks diving into histories and making examinations
so thoroughly that he is astounded. When shown the charts of the Hospital's patients, he
will ascertain how thoroughly the family and personal history of each patient is secured; he
will notice that the history of the present illness shows step by step the patient's approach to
mental unbalance.    If he looks a little further, he will notice charts acquainting him of all variations of body-temperature and blood-counts, and variations from normal of all secretions
and excretions. Take him into the acute wards and let him see for himself the precautions
taken in feeding maniacal cases in order to support strength against exhaustion; let him see
the production of quietness of mind and sleep by baths and other proper sedatives; let him see
the upbuilding of nutrition by forced feeding and suitable tonics; and, if not yet satisfied,
take him into the shops, or, better still, out to the farm, and let him witness the arousing of
the sluggish and the diversion of the depressed mind by occupation, and he surely will be by
this time disillusioned and will recognize that our treatment is purely medical and surgical
treatment, just as much as that adopted in his hospital in carrying a patient over the crisis of
pneumonia, or that adopted by him in the application of splints in the treatment of a fractured
leg. In fact, if he has been properly shown through the mental hospital, I think he will admit
that here it requires, to a much greater extent, an insight and knowledge of the individual
and of human nature seldom called for in the conduct of a case of bodily illness.
During the year 332 patients received such treatment as described above, while the
percentage of recoveries as a result was 19.57, those discharged as improved being 27.4.
Hydrotherapy.
A great deal of attention has been given during the past year to this most useful method
of treatment; more than ever am I convinced of the efficacy of continuous baths and wet
packs, and now hardly an acute case enters the Hospital who is not given a shorter or longer
course of this treatment. During the year we installed an additional hydrotherapeutic plant
in our refractory-female ward; and this, too, is giving splendid satisfaction, and is a great
assistance in the routine handling of subacute cases.
On the male side, Mr. A. G. Beaton has again had complete charge of our plant, and has
handled this department to our entire satisfaction. The following table will show exactly the
number of cases treated by him :—
3,634 warm full baths ;
607 steam cabinet-baths, followed by massage;
37 prolonged continuous baths in maniacal cases ;
4,187 rain and needle shower-baths ;
38 patients have been treated electro-therapeutically;
57 inunctions in syphilitic cases.
Amusements.
The attractive grounds and well-kept lawn, thanks to our Chief Gardener, Mr. House,
were a constant source of pleasure to our large household during the summer, and were taken
advantage of by us to hold fortnightly band concerts during the season. During the winter
months, concerts, dances, and other entertainments were held weekly and were much enjoyed
by all.
Occupation.
Under the guidance of their attendants, much of the actual work in the shops and upon
the garden and farm was intelligently performed by those of our number interested in the
quiet pursuits of outdoor life. The detailed report of the farm at Coquitlam, as elsewhere
presented, is abundant evidence of what patient labour can do; while if you refer to the table
on recoveries, you will then appreciate the advantage to patients of such labour.
Department of Pathology.
The pathological laboratories of the Hospital, established three years ago, did excellent
work during the past year, all work in this department having been conducted by Mr. F. P.
Hughes, late of the British Enteric and Dysentery Commission.    Appended is his report of
all work done in the laboratory during the year. D 8
Public Hospital for the Insane.
1912
Expenditure.
In the matter of expenditure, you will notice that the per capita cost has risen slightly.
"When you take into consideration, however, that our patients were supplied with clothing,
food, medicine, treatment, and nursing, and that all furniture and equipment where necessary
were replaced, and that the buildings were maintained, heated, and lighted at an actual cost
of 54.37 cents per day per patient, I think that you will readily recognize that no extravagant
waste could have occurred. Our previous year's cost was only 50.5.cents, but during the last
year much new furniture was required for the farm cottage and new temporary buildings at
Coquitlam, for which no provision had been made in the Estimates, and which accordingly
had to be charged to our general vote for maintenance.
Table A.
Showing the average number of patients in residence each year, the total amounts spent for
maintenance, and the per capita cost.
Year.
Average Number
in Residence.
Maintenance
Expenditure.
Per Capita
Cost.
1872 (81 days)	
16.57
16.07
16.76
27.42
36.41
34.61
36.52
38.17
45.42
47.18
47.86
48.73
4S.70
54.67
59.11
73.55
79.43
71.30
78.78
119.87
125.24
133 92
148.64
162.97
171.43
188.91
216.53
226.44
243.24
269.56
296.62
332.23
351.55
340.90
374.57
419.24
490.80
526.85
563.33
641.02
$ 2,265 25
7,841 94
8,232 41
9,892 38
12,558 18
12,917 17
13,985 05
10,253 72
10,552 18
10,691 76
11,343 65
11,829 11
11,843 94
15,555 87
15,334 43
15,945 22
16,261 06
15,657 79
17,577 80
21,757 03
23,518 37
25,904 98
26,495 S3
31,587 89
32,001 40
36,224 76
46,420 25
54,917 45
59,349 20
55,406 08
55,345 65
59,353 57
66,052 76
63,342 07
66,596 69
' 74,874 64
90,269 49
96,586 32
103,900 44
126,782 50
$616 00
1873	
1874	
487 98
491 20
1875	
360 77
1876	
1877 	
344 91
373 26
1878	
382 93
1879	
268 63
1880	
232 32
1881	
226 62
1882	
237 02
1883	
242 75
1884	
243 20
1885	
284 54
1886	
259 42
1887 	
216 70
1888	
204 72
1889	
1890	
219 60
223 13
1891	
181 50
1892	
1893	
187 80
193 36
1894	
178 25
1895	
193 83
1896	
186 67
1897	
191 75
1898	
214 38
1899	
242 52
1900	
244 00
1901	
205 54
1902	
186 59
1903	
178 65
1904	
187 89
1905	
185 80
1906	
177 79
1907	
178 59
1908	
1909	
1910	
183 92
183 32
184 43
1911	
197 78   2 Geo. 5
Public Hospital for the Insane.
D 9
Table B.
Showing analysis of the per capita cost.
Year.
1872.
1873.
1874.
1875.
1876.
1877.
1S78.
1879.
1880.
1881.
1882.
1883.
1884.
1885.
1886.
1887.
1888.
1889.
1890.
1891.
1892.
1893.
1894.
1895.
1896.
1897.
1898.
1899.
1900.
1901.
1902.
1903.
1904.
1905.
1906.
1907-
1908.
1909.
1910.
1911
Salaries.
$279 38
221 48
231 10
153 82
143 34
177 15
176 16
134 27
111 84
112 44
121 51
123 81
124 02
169 05
159 03
127 80
118 34
131 70
121 54
88 35
94 25
95 50
87 76
90 83
89 13
89 09
94 68
113 31
116 04
99 16
87 47
82 36
87 43
92 17
88 76
89 18
90 93
94 27
95 97
97 44
Provisions.
$184 03
166 81
152 10
113 40
114 45
126 75
124 23
95 10
87 71
81 14
84 52
92 56
90 64
84 33
69 35
59 10
60 47
59 11
62 77
54 79
56 74
53 55
57 07
61 15
55 93
58 18
69 43
72 91
72 62
66 65
61 13
57 86
60 01
54 09
53 15
48 47
49 17
53 41
48 43
58 08
Clothing.
$55 81
14 55
22 07
13 98
18 68
20 69
30 43
3 25
5 74
6 86
7 05
6 03
7 03
6 33
5 49
5 88
4 41
7 20
9 02
3 83
4 69
5 43
5 25
9 90
6 30
8 36
9 94
8 31
9 06
10 12
7 95
8 58
6 85
5 99
5 16
5 81
6 61
8 16
7 87
9 39
Fuel and
Light.
$22 44
23 65
23 98
16 S8
22 75
4 66
13 94
15 91
14 06
12 73
12 30
11 04
12 43
15 05
16 20
15 38
13 90
12 93
17 31
20 43
20 53
22 60
18 83
20 41
20 29
19 11
21 82
33 96
32 10
18 52
15 25
14 77
17 84
17 93
15 92
19 82
17 63
13 02
21 32
18 84
Furniture.
$15 55
21 59
28 36
25 45
17 90
20 75
7 20
6 39
6 00
5 55
4 54
4 26
4 14
3 90
3 72
3 88
3 11
4 13
4 00
3 40
3 35
3 39
2 98
2 51
2 56
2 95
2 76
2 50
2 15
3 25
4 13
3 24
4 48
3 83
3 57
3 02
4 56
2 78
2 02
1 12
Medicines.
$10 18
7 74
7 7S
6 73
2 86
3 74
9 16
6 31
3 63
2 56
3
2
■2
2
1
2
2
1
1 89
1 80
2 69
1 43
49
24
77
93
59
93
09
07
29
1 07
1 20
1 91
2 10
2 03
1 21
1 57
1 79
84
1 15
1 87
Miscellaneous.
$49 30
32 16
25 81
30 51
24 93
19 52
21 82
7 40
3 34
5 34
3 61
2 82
2 18
2 95
4 04
3 81
2 40
2 46
7 19
8 81
6 42
10 20
4 93
5 93
8 83
10 20
10 62
8 80
10 32
6 77
9 46
9 93
9 18
9 76
10 02
10 72
13 23
10 84
7 67
11 04
Total.
$616 69
487 98
491 20
360 77
344 91
373 26
382 93
268 63
332 32
226 62
237 02
242 75
243 20
284 54
259 42
216 78
204 72
219 60
223 12
181 50
187 80
193 36
178 25
193 83
1S6 67
191 75
214 37
242 52
244 00
205 54
186 59
178 65
187 89
185 80
177 79
178 59
183 92
183 32
184 43
197 78 D 10
Public Hospital for the Insane.
1912
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COQ0GOCOQ0G000CO00C»0DO00DG0COO0GOCOQ0GOO0GOCCC/DGO00C0C^ 2 Geo. 5
Public Hospital for the Insane.
D 11
Revenue.
The amount of revenue collected at this office during the past year again sets up a new
record, and I wish to thank Mr. MacGowan, our Bursar, and his assistant, Mr. Cambridge, for
the very close attention given to this matter, as well as to all other matters pertaining to
their office.
1873   $1,440 99
1874        680 00
1875      1,342 60
1876	
1877	
1878	
1879	
1880      1,433 04
1881	
1882	
1883	
1884	
1885	
1886	
1887	
1888	
1889	
1890	
1891....	
730
31
799
91
479
42
867
38
433
04
614
99
505
18
298
24
98
35
50
00
720
59
750
00
220
00
599
24
761
15
1893.
1894.
1895.
1896.
1897.
1898.
1899.
1900.
1901.
1902.
1903  13,639
1904  15,004
1905    16,613
1906  19,058
1907  20,753
1908  25,807
1909 ,  25,845
1910 .  26,137
1911.
1892     2,418 43
Garden Produce—Fruit.
Apples.
Blackberries	
Cherries	
Currants, black	
ii red    . ,	
Gooseberries	
Plums	
Pears        1,039
Raspberries	
Strawberries	
40
53
23
71
80
j5 1,585
2,709
4,409
3,741
3,816
4,003 79
4,769 04
6,893 33
12,800
10,926
76
23
64
22
18
42
35
83
65
38
30,100 20
693
boxes $866 25
17
lb.    1 70
450
45 00
125
10 00
1,165
93 20
254
25 40
542
43 36
1,039
32 50
139
19 30
2,502
375 30
Total $1,512 01
Home Farm Produce.
Pork, dressed, used at institution  13,567
ii     sold alive	
ii        ii    dressed	
Chickens, dressed  50 @ 5
Ducks, ii   111@
Eggs, dozen  927 @
Total $3,441 67
ft. i
51,853 57
246 00
730 10
0.75
37 50
1.00
111 00
0.50
463 50 D 12 Public Hospital for the Insane. 1912
Garden Produce—Vegetables.
Beets  7,680 ft    $76 80
Beans, French  382 „ 19 10
Carrots  3,900 „ 39 00
Cabbage  14,226 ■■ 142 26
Cauliflower  42 n 6 30
Celery    59 doz. bunches 2  90
Corn, sweet  426 ft 105 50
Cucumbers ,  9 n 3 60
Leeks  360 „ 18 00
Lettuce  373 dozen   130 55
Onions  1,500 ft 60 00
Parsnips  10,529 ,. 105 29
Peas, green  2,993 ,. 179 58
Potatoes  5,357 n 80 35
Radishes  630 bunches 63 00
Rhubarb  1,728 ft 86 40
Spinach  1,656 „ 82 80
Tomatoes, ripe  354 n 53 10
.,        green  929 n 27 87
Turnips  8,785 „ 438 75
Total $1,721  15
Colony Farm.
The results obtained at Colony Farm during the past year have been most encouraging,
the crops raised exceeding even our most sanguine expectations ; some 230 tons of hay, 130
tons of potatoes, 125 tons of oats, and over 100 tons of mixed roots comprising our crop, to
say nothing of green feed obtained for dairy cattle and young horses. The appended table
will give you an exact idea of the amount of crop, together with value of same. You will
also note table on dairy production.
The farm buildings have been completed, and the group, as now composed, is conceded
to be the best in Western Canada. Some idea of these buildings may be gained from
accompanying cuts.
With the permission of your Department, in order to obtain an unquestionable opinion
as to the exact quality and standing of our stock, some fifteen head of stallions and brood
mares and some twenty head of dairy cattle were shown in competition at the Dominion Fair
held at Regina, Saskatchewan, early in July. For results, I refer you to the different
Canadian and American stock and farm journals, all of which agree that British Columbia,
represented by Colony Farm, furnished the surprise of the year, winning over twenty prizes,
including five championships and three grand championships. I am enclosing a few cuts of
the winning animals.
Work done by Colony Farm Patients during the Year 1911.
Work on farm	
Cutting wood and clearing land.
Work in kitchen	
it      dining-room	
n      stables	
Ward or house work	
Work with Engineer	
n        Carpenter	
a        Surveyor 	
n       Plasterer 	
ii        Teamster	
Days.
13,071
1,919
1,007
2,145
1,073
5,423
424
266
359
906
482 2 Geo. 5 Public Hospital for the Insane. D 13
Colony Farm Statement of Produce for the Year ending December Slst, 1911.
Grain—
125 tons Oats   @ $28 00 $3,500 00
25    h    Barley         28 00 700 00
5    ii    Wheat         25 00 125 00
$4,325 00
Roots—
130 tons Potatoes @ $20 00        $2,600 00
50    h    Turnips         12 00 600 00
40    ,i    Carrots         15 00 600 00
30    ,i    Mangolds         12 00 360 00
$4,160 00
Dairy—
19,600 gallons Milk @ $    0 30        $5,880 00
24 head Calves         100 00 2,400 00
$8,280 00
Horses—
8 head Colts @ $125 00        $1,000 00
Miscellaneous—
600 cords Firewood @        3 00 $1,800 00
200 tons Hay           20 00 4,000 00
Garden stuff  200 00
1000 bales Straw @    $ 0 30 300 00
$6,300 00
Total-
Grain  ,  $ 4,325 00
Roots  4,160 00
Dairy  8,280 00
Horses  1,000 00
Miscellaneous  6,300 00
$24,065 00
Before closing this report, I not only wish to thank personally, but to commend to your
favourable consideration, the Assistant Medical Superintendent, Dr. J. G. McKay, and all
other officials who, without exception, have laboured diligently and conscientiously to promote
the administration of the Hospital throughout the year; the efficiency and untiring zeal at
all times rendered by my officers have made my duties indeed very light.
I wish also, sir, to express to yourself and to the other honourable members of the
Cabinet my sincerest appreciation for your uniform support in all matters pertaining to the
promotion of this Hospital's best interests.
I have the honour to be,
Sir,
Your obedient servant,
C. E. DOHERTY,
Medical Superintendent. LABORATORY    REPORT.
Laboratory op Hospital foe Insane,
New Westminster, B.C., 31st December, 1911.
The Medical Superintendent,
Public Hospital for Insane, New Westminster, B.C.
Sir,—I have the honour to submit herewith the Annual Report of this Laboratory for
the year ending 31st December, 1911.
During the year there has been fifty-nine deaths in the institution, but we have only been
able to submit thirteen bodies to autopsy, a summary of the report on each of which ia included
in this report.
This year there have been 332 admissions to the Hospital, consequently the work of this
department is constantly on the increase. Heretofore we have, on the admission of each
patient, made a red, white, and differential enumeration of the blood-cells, also a urinalysis.
From the early part of the year, however, it has been found necessary to drop the blood-work,
except where specially indicated, owing to the amount of time it required ; moreover, we have
only been corroborating our findings in this study, the results of which were given in the
Annual Reports for the years 1909 and 1910. The urinalyses, however, are being continued,
and the table appended gives the number and nature of these examinations.
The work of this department may be divided into two sections—clinical and post-mortem
pathology—having as their objects : (1.) The microscopical and chemical examinations of
excretions and secretions of all patients admitted to the institution, in order that any
abnormality in this respect, not exhibited by the usual symptoms, may be observed and proper
treatment administered. (2.) The microscopical examination of sections made from the nervous
system and organs, as well as chemical, bio-chemical, and bacteriological experiments with the
fluids taken from the cadaver.
It is only from untiring efforts along these various lines that we can ever hope to elucidate
the cause of some of the forms of insanity. Also these examinations serve as protection to the
patients as a whole from zymotic diseases which might be introduced in our midst by a patient
on admission. The analysis of the water, milk, and food supplies of the Hospital tends to
protect the health of the patients, by ascertaining whether or not such articles are fit for
consumption.
An important point which seriously interferes with our work, and which is merely
prejudice, is the unreasoning sentiment against permitting autopsies on the body of a relative.
It is needless to say that be the study of a case, historically and clinically, ever so exhausive,
the value of the painstaking labour and opportunities of thorough study of often vastly
important cases are lost by the stubborn resistance, against every appeal to reason, for permission to examine the body, without visible mutilation, for causes of death and disease.
This is one all-important source of impediment to more rapid progress in our search for truth
and the means of freeing the race from an awful disease. Much has been done by legislators
and other enlightened members of society in the way of dissipating this chimera of the
conscience, and much more is hoped for to gain universal recognition of the beneficent results
of opportunity to search the cadaver for the effects of disease. 2 Geo. 5                        Public Hospital for the Insane.
D 15
At the time of admission of each patient, as complete a case record as possible is made,
and  during his residence in Hospital notes are added from time to time when any physical or
mental change is noted.    (See article following.)    Also a laboratory chart is attached to each
file, on which is noted the result of any examination made in connection
with the patient
concerned;   consequently,  our   method of   systematically compiling   records of this nature
enables each case to be studied according to its merits; but should death end the case, unless
we can hold an autopsy and attach the report on the macroscopical and miscroscopical findings
to this file, the case is incomplete, and the effects of the disease more or
less a matter for
conjecture.
A brief summary of the work done during the year in the laboratory is
here tabulated:—
Sputa	
...     31
Faeces	
5
Blood examinations—
...     87
...    87
...     88
49
...       2
6
Typhoid	
3
Tetany...   	
2
Cultures—
From throat	
...     12
From fluids	
...     23
...     17
Fluids—
...     16
8
Smears—
...     28
...     15
2
4
Miscellaneous—
...    69
9
...     14
5
...   240
...     13
Analyses—
Milk                   	
...     31
...     17
3
Coffee                   	
2
Tea                 	
2
2 D 16 Public Hospital for the Insane. 1912
Sputa.
B. Tuber- Diplococcus
culosis. Pneumonia;.
Slides examined  87 •    12
Number of cases  17 2
Found in  7 1
Not found in  10 1
Urinalysis.
Total number of specimens examined   240
Albumen        6                  Sugar  3
Phosphates        6                 Urates i  72
Calcium oxalate      11                  Mucin  8
Urobilin    187                  Bile pigments  1
Cells— Casts—
Blood  2                 Hyalin  63
Pus  3                 Epithelial  8
Epithelial  47                  Granular  37
Fatty  2                 Blood  1
Hajmoglobin    2                 Fatty     .... 1
Molds  1         Spermatazoa  3
Leucin  1         Hippuric acid  3
Tyrosin  1        Indican  3
Blood Examinations.
Estimation of haemoglobin      87
ii colour index        9
ii blood-coagulation time        4
n specific gravity        2
n alkalinity        2
Enumeration of red cells      87
ii white cells      88
Differential enumeration of white cells      49
Malaria        2, both positive.
Tuberculosis        6,  all negative.
Typhoid        3,  all negative.
Tetany        2, both negative.
In addition to the above, gross specimens from cadavers submitted to autopsy, where
considered of sufficient interest, have been preserved by the Kaiserling method for addition to
our embryo museum.
Summary of Autopsies.
2865. A. G., male, set 45, single, prospector. Admitted 8th March, 1911. Died 16th
March, 1911.    Cause of death, diphtheria.    Form of insanity, manic depressive.
From history received and mental condition presenting at time of admission, the psychosis
of this case must have extended back for some time previous to admission. Physical examination, patient very poorly nourished; chest negative; eyes sunken and pupils irregular;
expression pinched; lips and teeth covered with sordes; tongue dry, very heavily coated, and
tremulous; breath very offensive. After admission patient's restlessness continued and he
refused all food, and accordingly had to be fed per tube. This condition of mania gradually
became worse until the fifth day, when throat symptoms were noticed; smears prepared and
culture made, both being positive for B. diphtheria?. Patient immediately isolated, 4,000
units antitoxin administered, repeated in eight hours, but patient never rallied, dying on the
ninth day. " Minnie  Rocker's Poem,"  Holstein  Cow.
(Grand  Champion   at  the  Dominion  Fair,  Regina,   1911.)
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WP-0-
Farm  House.  2 Geo. 5 Public Hospital for the Insane. D 17
Patliological Report.—Considerable "Pusy" looking mucus in nares ; ecchymosis and some
oedema, right orbit and eye somewhat protruding. Scalp thickened and cedematous, more
especially over occipital region : cranial bones compact; dura firmly adherent over the frontal
and parietal bones; diffuse thickening and opacity of the arachnoid ; dura adherent to pia
over parietal; marked decrease of subdural and subarachnoidean fluid, while the right subdural
cavity contained some 30 to 40 cc. of creamy pus; also a little pus over frontal lobe of left
hemisphere; small foci of softening in posterior portion of the superior frontal posterior part
of the collasal, paracentral, quadrate, upper half of the ascending frontal, ascending parietal,
superior parietal, superior and middle occipital convolutions, the external capsule and adjoining claustrum and lenticular nucleus on the right side ; pia mater firmly adherent throughout;
in the fissures of three of the convolutions of the right frontal lobe are small masses of a
creamy gelatinous matter. Brain—weight, 1,120 grms. Pharynx and larynx show typical
diphtheritic membrane.
Microscopical Examination.—Diphtheria bacilli in Loeffler's blood-serum media after
twenty-four hours' incubation, and also some in smear direct from pharynx. Subcutaneous
inoculation of 1.10 cc. into guinea pig killed it in forty-eight hours; cedema, hsemorrage, and
fibrino-purulent exudation around seat of inoculation and in subcutaneous tissue; hsemorrhagic
enlargement of lymphatic glands; cedema of lungs and some congestion. Histologically
" fragmentation" of the nuclei of the cells of the lymph glands, with deeply staining globules
of chromatin scattered throughout them. No organisms found in pig's liver, spleen, or kidneys,
but smears made from fibrino-purulent exudate around seat of inoculation showed many.
G. S., male, set. 55, occupation unknown. Admitted 14th December, 1910. Died 30th
March, 1911.    Cause of death, asphyxia by hanging.    Form of insanity, paresis.
On admission of this patient it was impossible to obtain any definite personal or family
history, as patient could not speak a single word of English, and was too confused mentally
to make any statements, which otherwise might have been obtained through an interpreter.
Patient continued in more or less confused and depressed mental condition until, on March
30th, he committed suicide by hanging.
Pathological Report.—Well nourished. Band of constriction encircling the neck, somewhat depressed and more or less abraded. Abrasion on left shin and below right knee. Scalp
thick and cartilaginous; temporal muscles large. Brain weight, 1,190 grms.; dura firmly
adherent to skull; calcareous deposit in the walls of the superior longitudinal sinus over the
parietal eminence and extending along the falx cerebri for some distance; general atrophy of
the convolutions; basal vessels moderately atheromatous; slight increase of subdural and
subarachnoidean fluid ; ependyma granular throughout. Heart—weight, 435 grms.; moderate
arterio-sclerosis; marked dilatation; large veins of the thorax distended with blood; fatty
infiltration. Lungs—weight, left, 450 grms.; right, 475 grms. ; extensive, firm pleuritic
adhesions on the right side and a few on the left; some marginal emphysema more or less
lobular ; venous engorgement of both lower lobes ; extensive subpleural blackish pigmentation.
Spleen—weight, 145 grms.; engorged. Pancreas, weight, 210 grms. Liver—weight, 1,890
grms.; moderately engorged. Kidneys—weight, left, 160 grms.; right, 135 grms. ; considerably engorged; glomeruli prominent; considerable pelvic fat; cortico-mudullary junction
pale in color. Stomach—considerable hemorrhagic extravasation most marked about the
cardiac orifice; mucosa thickened and covered with a thick, viscid mucoid secretion. A
similar condition scattered throughout the small intestine.
Microscopical Report.—Diffuse staining of the nerve-cells; blood-vessels of the tissues
well filled ; perivascular spaces prominent; numerous concentric hyaline bodies in the choroid
plexus ; epithelium of the pineal glands more or less alveolar, and the gland contains numerous
B D 18 Public Hospital for the Insane. 1912
hyaline bodies and irregular calcareous masses; thyroid gland vesicles irregular in size and
shape, many of the smaller more or less filled with desquamated and proliferated cells. Fatty
infiltration of the right ventricle of the heart; moderate endarteritis of the arteries. Intense
engorgement of the pulmonary capillaries; some chronic pleuritic thickening. Intense
engorgement of the spleen. Liver shows intense engorgement and small foci of round-cell
collection and slight increase of fibrous tissue in the portal fissures. Intense engorgement of
the kidneys and extensive diffuse nephritis. Intense engorgement of the stomach and
intestines ; some proliferation of the mucosal epithelium; hyperplasia of the lymph follicles ;
foci of submucosal round-cell infiltration.
2683. S. N., male, jet. 45, labourer. Admitted 2nd September, 1910. Died 16th
April, 1911.    Cause of death, general debility.    Form of insanity, paranoia.
At time of admission patient appeared to be fairly well nourished ; shows no facial or
cranial stigmata of degeneration; physical examination negative; mental examination,
although patient could not speak English, he gave every indication of the existence of delusions
and hallucinations, those of hearing being most marked. Patient gradually became more and
more resistive, taking food badly, and as a result of this soon began to drop off in weight. This
physical failure became more and more marked until the time of his death.
Pathological Report.—Small abrasion of either knee; old scars on shins. Cranial bones
thin but compact; diffuse opacity of the arachnoid ; great increase of subdural and subarachnoidean fluid. Brain—weight, 1,280 grms.; general atrophy of the convolutions; consistency
firm ; ventricles dilated; ependyma granular throughout; choroid plexus cystic. Heart—
weight, 220 grms.; patent foramen ovale; moderate sclerosis of the mitral and cortic valves;
muscles firm and numerous; whitish streaks throughout the substance; extensive arteriosclerosis and atheromatous degeneration of the arteries. Lungs—weight, left, 230 grms,;
right, 410 grms.; right pleural cavity obliterated by pleuritic adhesions; right lower lobe semisolid in consistency and of a cyanotic-red colour ; pleura thickened; a few pleuritic adhesions at
base of upper left lobe ; considerable subpleural blackish pigmentation of both lungs. Spleen
—weight, 180 grms. Liver—weight, 1,315 grms.; nutmeg in appearance. Kidneys—weight,
left, 130 grms.; right, 150 grms.; pale in colour; numerous cortical cysts; considerable pelvic
fat; capsule strips readily. Pancreas—weight, 110 grms. Appendix 15 cm. long lying beside
the csecum and extending to the under-surface of the liver, and is attached to the omentum
at the hepatic flexure of the colon; full of fsecal matter.    Other abdominal organs normal.
Microscopical Report.—Extensive chromatolytic changes in the nerve-eells ; proliferation
of the ependyma epithelium ; chronic myocarditis; extensive arterio-sclerosis and irregular
atheromatous degeneration of the arteries; extreme fatty infiltration of the liver; extensive
diffuse nephritis, the arterio-sclerotic and parenchymatous changes predominating; fatty
degeneration of the pancreas.
2900. F. J., male, white, eet. 45, single, coal-miner. Admitted 21st April, 1911. Died
22nd April, 1911.    Cause of death, brain-tumour.    Form of insanity, Brain-tumour.
Patient admitted in a very confused condition mentally, seemed almost perfectly oblivious
to his surroundings, while he also appeared to be very weak physically and very unsteady in
gait. The attendant who accompanied patient to the Hospital at the time stated that he had
refused all food for some days. Was immediately fed with tube, no vomiting occurring.
Physical examination at this time showed patient to be in poorly nourished condition;
examination of chest delayed on account of his very weakened physical condition. On second
day after admission patient died suddenly before proper examination could be made. 2 Geo. 5 Public Hospital for the Insane. D 19
Pathological Report.—Dura firmly adherent to the arachnoid over the anterior surface of
both frontal lobes; thickening of the arachnoid over the anterior surface of both frontal lobes,
over the lower part of the Rolandic area on the right side, involving the ascending frontal, the
ascending parietal, and the anterior inferior part of the supramarginal convolutions ; beneath
the pia in these places is a gelatinous mass; general softening of the brain-substance.
Brain—weight, 1,180 grms. Heart—weight, 350 grms. ; small quantity of serous fluid in
the pericardial cavity ; left side hypertrophy ; right side dilatation ; moderate sclerosis of the
mitral and aortic valves ; some atheromatous patches in the body of the mitral; marginal
fenestration of the aortic valves; moderate sclerosis and irregular, patchy, atheromatous
degeneration of the arteries. Lungs—weight, left, 250 grms. ; right, 345 grms. ; a few firm
pleuritic adhesions about both apices; considerable subpleural blackish pigmentation.
Liver, weight, 1,110 grms. ; capsule thickened ; surface rough and irregular; firm on section.
Spleen—weight, 85 grms. Kidneys—weight, left, 120 grms. ; right, 135 grms. ; surface
uneven and irregular; firm on section ; striation fairly marked; large quantity of pelvic fat;
capsule adherent.    Other abdominal organs normal.
Microscopical Report.—The brain-tumour consists of hyperplastic neuroglia and glia
cells; a network of delicate, glistening fibrellae in which are embedded numerous short oval
nuclei; some areas of apparent granular degeneration.
2816. H. B., male, white, set. 60, labourer. Admitted 27th December, 1910. Died
30th April, 1911.    Cause of death, interstitial nephritis.    Form of insanity, paranoia.
Patient was very confused mentally at time of admission, also suffering with hallucinations
of hearing and fixed delusions of persecution. Examination of urine soon gave evidence of
existing kidney-disease. Patient suffered with fixed delusions of persecution until the end of
the fourth month, when suddenly, without warning, he suffered a urjemic convulsion, and, never
rallying from comatose condition, he died on April 30th.
Pathological Report.—Cranial bones compact; dura firmly adherent; diffuse opacity of
the arachnoid ; slight increase of subdural and subarachnoidean fluid. Brain—weight, 1,220
grms.; convolutional atrophy of the frontal lobes; moderate arterio-sclerosis of the basal
vessels. Lungs—weight, left, 240 grms.; right, 315 grms. ; slightly doughy in consistency;
ooze considerable frothy fluid on section; extensive blackish subpleural pigmentation.
Heart—weight, 320 grms. ; left ventricle hypertrophied ; right ventricle dilated and contains
a pinkish coagulum more or less firmly adherent to the endocardium ; slight sclerosis of the
mitral and aortic valves ; extensive arterio-sclerosis with more or less patchy atheromatous
degeneration. Spleen—weight, 95 grms.; capsule wrinkled; tough on section. Liver—weight,
1,570 grms. ; nutmeg; tough on section ; capsule adherent and leaves a rough surface, tearing
the substance on removal. Kidneys—weight, left, 145 grms.; right, 120 grms.; tough on
section : pale in colour; two small pockets of pus in pelvis of right kidney; pelvis dilated ;
pelvic mucosa congested; striation poorly marked; considerable pelvic fat; capsule adherent
and tears the kidney-substance on removal. About a half-inch layer of fat in the abdominal
wall which has a half-cooked appearance and is quite greasy to the touch.
Microscopical Report.—Extensive sclerosis of the blood-vessels; hyperplasia of the
malpighian bodies of the spleen; chronic diffuse nephritis.
2905. A. J., male, white, jet 32, labourer. Admitted 24th April, 1911. Died 30th
April, 1911.    Cause of death, acute mania.    Form of insanity, acute mania.
Patient admitted in an extremely maniacal condition, and was so confused and incoherent
that it was impossible to obtain either personal or family history.    Continuous baths and hot packs used without result. On the second day patient became very maniacal, and began to
show so many signs of rapidly weakening in physical condition that the continuous baths were
stopped.    Patient gradually sank until the time of his death on the 7th day.
Pathological Report.—Sordes on teeth and lips ; numerous discolorations from bruising
scattered over whole body. Scalp thick; cranial bones thickened hard and brittle.
Brain—weight, 1,340 grms.; slight decrease of subdural and subarachnoidean fluid ; general
cedema of the convolutions most marked in the frontal lobes; slight opacity of the arachnoid
along the Sylvian fissure. Heart—weight, 315 grms.; sclerosis and some atheroma of the
mitral valve ; moderate sclerosis of the arteries. Lungs—weight, left, 250 grms. ; right, 280
grms.; considerable subpleural blackish pigmentation. Liver, weight, 1,230 grms.; some
thickening of the capsule ; firm on section ; diffuse pale red in colour ; oozes considerable blood
on section. Kidneys—weight, left, 125 grms.; right, 120 grms.; fairly adherent to the perirenal
fat; firm on section ; ooze considerable blood. Spleen—weight, 85 grms; hard faecal matter in
transverse and ascending colon. Other abdominal organs normal. Collection of pus-like
mucus on pharynx, but no obstruction in oesophagus or larynx ; no diphtheritic membrane
and no marked cedema of larynx or epiglottis.
Microscopical Report.—Cloudiness and swelling of the nerve-cells; vascular engorgement
of the pituitary body, with an alveolar arrangement of some of it, some of the alveoli being
filled with hyaline material, others with granular debris.
2792. J. D. H. B., male, white, set. 33, single, labourer. Admitted 19th November,
1910. Died 18th May, 1911. Cause of death; intestinal obstruction (sarcoma of pancreas).
Form of insanity, manic depressive.
Patient admitted in fair condition physically; mentally his manner was restless, attention
fairly easily obtainable, orientation fair, auditory and visual hallucinations present and
delusional trend of a persecutory character. Physical examination negative; no congenital
stigmata present except a very highly arched palate and rather irregular teeth. Soon after
admission patient began to exhibit hallucinations of taste and delusions of poison, as a result
of which he refused to take food, and accordingly tube feeding was restored to. This condition
existed for about one month, when patient began to eat voluntarily. About six months after
admission he began to complain of pain in region of stomach, a few days afterwards vomiting
several times throughout the day. Solid food stopped and put solely on milk diet; vomiting
continuing, lime-water was added, but vomiting still continued; otherwise no evidence of
intestinal obstruction was shown, as bowels were moving regularly. Patient died eighteen
days after going to bed, vomiting continuing until the end.
Pathological Report.—Permission for full autopsy could not be obtained, but on opening
up the abdomen to ascertain the cause of obstruction, a hard mass was found, including the
pancreas and duodenum, which had caused a constriction of the duodenum with consequent
obstruction.
Microscopical Report.—Sections from pancreas show large spindle-cell sarcoma.
383. E. T. M., male white, set. 70, single, labourer. Admitted 4th September, 1890.
Died 16th June, 1911. Cause of death, Carcinoma of larynx. Form of insanity, terminal
dementia.
This patient, who had been an inmate of the Hospital for about twenty-one years, and
who had become very advanced in dementia, suddenly began to give evidence of laryngeal
trouble; casual examination of pharynx showed no evidence of congestion, and as patient
seemed to improve no further notice was taken of this case until about a month later, when he 2 Geo. 5 Public Hospital for the Insane. D 21
again began to show same symptoms, with rapid loss of weight; breathing became more and
more interfered with and dyspnoea more and more exaggerated, until the patient died three
weeks after going to bed.
Pathological Report.—Costal cartilage of the fourth and fifth ribs abnormally prominent
on left side, some dural adhesions; extensive diffuse opacity of the arachnoid with increased
thickness; excess of subdural and subarachnoidean fluid. Brain—weight, 1,250 grms.;
general atrophy of the convolutions ; more or less granulations of the ependyma throughout.
Heart—weight, 510 grms.; extensive hypertrophy; large quantity of epicardial fat; fibroid
nodular thickening of the margin of the mitral and calcareous deposit in the body of the valves ;
chordse thickened and shortened; aortic valves thickened, with calcareous deposit in the bases ;
general dilatation of the aorta ; extensive atheromatous degeneration of the arteries, the
coronary, carotids, and the vertebrals extremely so. Thyroid gland—weight, 50 grms.; right
lobe enlarged and somewhat cystic. Lungs—weight, left, 490 grms.; right, 540 grms.; firm
adhesions between the left lung and the pericardium ; left pleural cavity obliterated by dense
firm adhesions; a few adhesions at apex of right lung ; lower lobes and posterior portion of
the upper lobes cyanotic red in colour, doughy in consistency, and ooze an abundant frothy,
bloody fluid on section, the right side more extensively than the left. Larynx contains a
cartilaginous growth, almost completely filling the cavity, and including the thyrohyoid and
cricothyroid membranes. Firm perihepatic and perisplenic adhesions. Appendix hanging
wholly into the pelvic cavity. Spleen—weight, 75 grms.; malpighian bodies prominent. Liver—
weight, 1,130 grms.; firm on section ; rough appearance on the surface. Pancreas—weight, 95
grms.; more or less nodular and occupied by fatty tissue. Kidneys—weight, left, 145 grms.;
right, 145 grms.; firmly adherent to the perirenal fat; firm on section; pale in colour; striation
indistinct; considerable pelvic fat; capsule more or less adherent, leaving a rough surface.
Microscopical Report.—Diffuse staining and extensive chromatolytic changes of the
nerve-cells; proliferation of the ependyma epithelium ; thickening of the walls of the cerebral
vessels. Chronic myocarditis; moderate fatty infiltration of the heart and considerable
perivascular fibrous tissue increase ; extensive proliferation of the intima; thickening of the
media and adventitia, with considerable atheromatous degeneration and focal infiltration of
round cells in the outer coats. Considerable subpleural blackish pigmentary infiltration of
the lungs. Splenic capsule thickened by dense fibrous tissue formation; malpighian bodies
prominent; some increase of splenic corpuscles. Moderate engorgement of the liver, with
extensive cirrhosis. Capsule of the kidney thickened; extensive diffuse interstitial nephritis.
Carcinoma of the larynx.
2151. D. B., male, white, set. 47, single, teamster. Admitted 18th April, 1908. Died
27th June, 1911.    Cause of death, chronic nephritis.    Form of insatity, paresis.
This patient, who was apparently well advanced in the second stage of paresis, and who
had also from the time of admission suffered with incontinence of urine and marked albuminuria, gradually failed in physical health, until a few days before death he became comatose;
this condition, however, at this time did not resemble the usual congestive seizure of paresis.
Patient gradually sank until the time of his death.
Pathological Report.—Emaciated. Dura adherent. Diffuse opacity of the arachnoid;
moderate increase of subdural and subarachnoidean fluid. Brain—weight, 1,270 grms.; more
or less convolutional atrophy of the frontal lobes; basal vessels moderately atheromatous;
ependyma granular; brain-substance softened. Heart—weight, 350 grms.; moderate sclerosis
of the aortic valves; moderate atheromatous degeneration of the arteries. Lungs—weight,
left, 470 grms.; right, 430 grms.; lower lobes of a cyanotic-red colour; doughy in consistency,
bleeding freely from the  doughy portions on  section; hsemorrhagic  infarcts  in  both lower D 22 Public Hospital for the Insane. 1912
lobes; apex of left lung more or less nodular. Omentum and about a foot of small intestine
above csecum congested. Spleen—weight, 150 grms.; friable ; malpighian bodies prominent.
Liver—weight, 1,380 grms.; capsule strips readily. Kidneys—weight, left, 230 grms.; right,
230 grms.; multiple abscesses in both and considerable quantity of a bloody purulent fluid ;
ureters distended and filled with bloody purulent fluid. Bladder more or less injected and
congested; prostate dilated.
Microscopical Report.—Extensive chromatolytic changes in the nerve-cells; proliferation
of the ependyma epithelium. Moderate arterio-sclerosis jind irregular atheromatous degeneration. Intense alveolar engorgement of the lungs. Engorgement of the liver. Hyperplasia
of the malpighian bodies of the spleen. Hyperplasia of the lymph follicles of the intestines.
Foci of round-cell infiltration in the adrenals.    Chronic diffuse nephritis.
2984. A. R., male, white, a?t. 30, single, clerk. Admitted 15th July, 1911. Died 29th
July, 1911.    Cause of death, tubercular peritonitis.    Form of insanity, dementia praecox.
Patient admitted in very poor physical condition, having undergone an operation in a
Chicago hospital six months previously for empyema, and having spent three months in this
Hospital. Abdomen gave evidence of tubercular condition existing, bu,t examinations of
sputum were negative. Patient immediately put to bed, marked hallucinations and delusions
being present in the case. Temperature at time of going to bed, 99.2° ; pulse 80. Consultation with city surgeons held, when diagnosis of tubercular peritonitis was made, and a decision
not to operate on account of extremely low condition of the patient. He gradually sank, and
two days before death began to vomit considerably ; from this time there was a rapid failure
until time of death.
Pathological Report.—Emaciated. Abrasions on both knees and nose; ecchymosis right
eye; phymosis ; scar (operative) under right scapula and partial excision of seventh and
eighth ribs. Brain not examined. Heart—weight, 240 grms. Lungs—weight, left 200
grms.; right, 220 grms.; middle and lower lobes and base of upper lobe of right lung firmly
adherent to costal pleura, and cavity obliterated by these adhesions ; middle and lower lobes
adherent to each other; a few adhesions at left apex. Ninth, tenth, and eleventh ribs on
right side fractured, but periosteum intact; ecchymosis of diaphragm immediately beneath
fractured ribs. Peritoneum, walls of intestines, mesentery and omentum congested, and the
whole of the abdominal organs more or less massed together with vascular tissue, and the
whole covered with numerous typical white tubercular spots ; mesenteric and retroperitoneal
glands more or less enlarged ; lumen of small intestine and rectum small; numerous adhesions
of liver to diaphragm, colon and stomach. Liver—weight, 1,170 grms.; capsule strips readily,
but leaves a rough surface. Spleen—weight, 110 grms.; malpighian bodies prominent.
Kidneys—weight, left, 110 grms.; right, 120 grms.; adherent to the perirenal tissues; small
amount of pelvic fat; capsule strips readily. Stomach dilated, and a large abscess, walled off
from peritoneal cavity, about 2J inches in diameter, lying between the cardiac and pyloric
ends of stomach in the lesser curve, with several sinuses running down into the mesentery,
this cavity being filled with a thin, purulent, foul-smelling fluid.
Microscopical Report.—Tubercle bacilli found in pus from abscess and in sections from
mesentery and omentum.
2033. D. B. S., male, white, set. 55, single, earpenter. Admitted 26th October, 1907.
Died 22nd August, 1911.    Cause of death, endocarditis.    Form of insanity, paranoia.
Patient, who was a paranoiac with fixed delusions of persecution, and in whose case no
suspicion of endocarditis had ever been entertained, without any warning dropped dead while
out with walking-party. 2 Geo. 5 . Public Hospital for the Insane. D 23
Pathological Report.—Marked cyanosis ; old scars on left knee and shin ; pupils dilated.
Cranial bones thick and heavy; increase of subdural and subarachnoidean fluid. Brain—
weight, 1,290 grms.; basal vessels atheromatous. Heart—weight, 330 grms.; general hypertrophy and dilatation; sclerosis of the mitral and tricuspid valves ; moderate dilitation of the
aorta; moderate arterio-sclerosis. Lungs—weight, left, 420 grms.; right, 510 grms.; some
subpleural blackish pigmentation. Liver—weight, 1,360 grms.; more or less nutmeg
appearance; firmly adherent to the colon in the region of the gall-bladder. Pancreas—
weight, 120 grms.; rather firm and considerably infiltated with fatty tissue. Kideys—weight,
left, 180 grms.; right, 185 grms.; firmly attached to the perirenal tissue; firm on section;
large quantity of pelvic fat; capsule strips readily. Spleen—weight, 235 grms.; moderately
firm.    Thyroid gland—weight, 40 grms.; slightly cystic.
Microscopical Report.—Intense engorgement of the brain-tissue; some round-cell infiltra
tion of the perivascular spaces; moderate chromatolytic changes in some of the nerve-cells.
Intense engorgement of the alveolar capillaries in the lungs ; diffuse alveolar pigmentary
infiltration. Parenchymatous enlargement of some of the vesicles of the thyroid gland.
Chronic endocarditis ; moderate arterio-sclerosis. Chronic interstitial and fatty pancreatitis.
Venous congestion, cirrhosis, and foci of fatty necrosis in the liver. Intense engorgement of
the spleen, with hyperplasia of the malpighian bodies.
3039. H. M., male, white, set. 44, sailor. Admitted 5th September, 1911. Died 10th
September, 1911.    Cause of death, general paralysis.    Form of insanity, general paralysis.
Patient admitted in an extremely poor physical condition; immediately carried to the
infirmary ward and put to bed. In an attempt to take family and personal history, it was
ascertained that confusion was so great, orientation and memory so bad, that anything reliable
could not be obtained. Physical examination made at that time showed tongue coated, moist,
and tremulous and slightly deviated to left; chest normal; liver atrophied and tenderness
over • gall-bladder ; pupils did not react to either light or accommodation; patellar reflexes
were much diminished or absent; marked Rhomberg present; everything pointed to patient
having suffered a stroke of hsemaplegia some time previous to admission, although no definite
history of this could be obtained. Five days after admission patient suffered a seizure
(apoplectic), quite severe, completely losing the use of left side; during the same night patient
was reported as having suffered another attack, and being in comatose condition with
breathing much affected ; died four hours later.
Pathological Report.—Cranial bones heavy and dense. Diffuse opacity and increased
thickness of the arachnoid ; increase of subdural and subarachnoidean fluid. Brain—weight,
1,130 grms. ; general atrophy of the convolutions; pia rather firmly attached ; basal vessels
atheromatous ; extensive dilatation of the ventricles ; granulations of the ependyma throughout.
Heart—weight, 210 grms.; sclerotic patches in the epicardium ; atheromatous patches in the
body of the mitral and aortic valves; moderate arterio sclerosis of the arteries. Lungs—weight
left 470 grms.; right, 640 grms.; scattered pleuritic adhesions in both cavities; lungs
doughy, areas deep red in colour, and firmer in consistency than the intervening tissues;
oozes considerable bloody fluid. Spleen—weight, 120 grms.; moderately firm on section.
Liver— weight, 1,360 grms.; somewhat nutmeg in appearance. Kidneys—weight, left, 120
grms. ; right, 125 grms.; firm on section; pale in colour; no pelvic fat; capsule adherent.
Ureters dilated ; pelvis dilated.    Pancreas—weight, 70 grms. ; rather firm on section.
Microscopical Report.—Extensive degenerative changes in the nerve-cells; perivascular
spaces prominent; areas of round-cell infiltration of the pia and surrounding the pial sheath
into the brain substance; central canal of the cord filled with cells; engorgement of pituitary body; numerous hyaline bodies in the choroid plexus. Moderate arterio-sclerosis. Chronic
parenchymatous hyperplasia of the thyroid gland. Hyperplasia of the malpighian bodies of
the spleen.    Chronic venous congestion and slight cirrhosis of the liver.
2156. J. R., male, white, set. 53, married, bartender. Admitted 25th April, 1908.
Died 4th December, 1911. Cause of death, general paralysis. Form of insanity, general
paralysis.
Patient admitted well advanced in the second stage of paresis, with well-developed
delusions of grandeur, unsteady gait, scanning speech, and fine lingual tremors. For first year
he gave very little trouble and was more or less engaged in light ward-work before passing into
the third stage of this disease, after which he suffered many congestive seizures, the last
occurring about twenty-four hours previous to death.
Pathological Report.—Well-nourished but general jaundiced appearance ; pigmentation of
lower half legs above malleoli over whole circle; operative scar right leg. Dura thickened
and tough ; decrease of subdural and subarachnoidean fluid. Brain—weight, 1,340 grms. ;
calcified spine in median line between frontal lobes and adherent to dura; marked capacity of
the arachnoid over the whole convexity of cerebral hemispheres; sclerosis of basal vessels;
some convolutional atrophy of frontal lobes; cerebellum adhererent to dura of post-fossa.
Heart—weight, 520 grms.; large calcareous patches in aortic arch; tricuspid valves show
fatty infiltration of segments; mitral valve shows thickening of edges; coronary orifices
gaping ; milk-spots in epicardium. Lungs—weight, left, 970 grms. ; right, 900 grms.; lower
left lobe congested, and on section oozes blood and shows mottled appearance, with many
irregular, greyish, firm, granular, dry areas ; right lung in similar condition. Spleen—
weight, 140 grms. Liver—weight, 1,840 grms.; capsule adherent and leaves a rough surface
on stripping; deeply congested ; mottled surface; lobules marked out by deep-red tracery ;
normal in consistency. Kidneys—weight, left, 190 grms.; right, 170 grms. ; cortex narrow
but regular ; increase of pelvic fat; capsule strips readily.     Other abdominal organs normal.
Microscopical Examination.—Not completed.
I have the honour to be,
Sir,
Your obedient servant,
F. P. HUGHES. o.
s
o
w
o  2 Geo. 5
Public Hospital for the Insane.
D 25
STATISTICAL    TABLES.
Table No. 1.
Showing the operations of the Hospital for the year 1911, in summary form.
Movement of Population New
Westminster, asylum.
Remaining in residence here, Dec.
31st, 1910	
Discharged on probation, and still
out. Dec. 31st, 1910	
Escaped but not discharged,  Dec.
31st, 1910	
Total under treatment here, Dec.
31st, 1910 	
Admitted during' the year :—
By ordinary forms	
By urgency forms	
By order of Court	
By return from escape, 1911...
From Yukon Territory	
Total  under treatment   for  year
1911 at New Westminster	
Discharged during the year :—
As not insane	
As recovered	
As improved...	
As unimproved	
Total
Other discharges:—
Transferred to Vernon	
Discharged  on  probation and
still out, Dec. 31st, 1911	
Escaped but not vet discharged
Died	
Remaining  under treatment Jan.
1st,1912	
427,168
9
259
Movement of Population
at Vernon.
Remaining in residence at Vernon,
Dec. 31st, 1910	
Discharged on probation and still
out, Dec. 31st, 1910	
Escaped but not discharged, Dec.
31st, 3910	
Total under treatment at New
Westminster, Dec. Slst, 1910	
Total under treatment, New Westminster and Vernon, Dec. 31st,
1910	
Admitted during the year    	
Total under treatment New Westminster and Vernon for year 1911
Admitted to Vernon from New
Westminster	
Total  treated  in Vernon for vear
1911	
Discharged on probation, Vernon .
Discharged, improved, Vernon...
Died at Vernon	
Less Vernon patients in residence
Dec. 31st, 1911	
Remaining   in   residence at   New
Westminster, Dec. 31st, 1911	
75
627
702
332
1034
271
766
Total number of cases admitted since opening .
ii ii ii       discharged	
it tt ii       died	
Remaining under treatment January 1st, 1912
Male.  Female.   Total
1,695
1,270
548
425
119
667
Male. Female. Total.
2,410 743 3,153
1,818 544 2,362
592 199 791
Daily average population during the year     641 03
Maximum number present any one day, Slst December, 1911  690
Minimum h u n 1st January, 1911    595
Percentage of discharges on admissions (deaths excluded)     54.52
i r recoveries on admissions      19.57
, i deaths on whole under treatment.. ■       5.83 D 26
Public Hospital for the Insane.
1912
Table No. 2.
Showing in summary form the operations of the Hospital since its inception.
Year.
1872
1873
1874
1875
1876
1877
1878
1879
1880
1881
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
03
a
o
Discharges.
-a
03
03
»3
to
u
03
>
o
o
03
K
EC
CO
18
1
1
15
10
2
5
12
4
3
29
3
3
10
22
11
3
5
14
4
4
3
16
7
3
8
18
4
1
8
17
5
5
13
5
3
5
7
3
1
2
8
4
1
3
10
2
4
2
20
5
5
27
10
6
6
36
15
5
5
26
12
6
3
41
14
5
4
52
17
6
12
49
19
4
20
52
17
10
13
44
14
18
14
80
13
19
19
62
29
11
20
64
23
25
9
74
20
8
14
81
27
13
19
101
31
32
21
113
38
27
29
115
40
20
25
121
30
31
25
139
38
37
26
115
46
26
26
123
43
33
27
150
36*
43
28
221
48
43
39
230
68*
56
57
232
73f
77
40
280
84
82
41
332
67J
114
60
*> g
§ 03
'S o
03
A i
U   O
S 03 £
1^
16
14
19
32
35
38
36
41
48
48
49
49
51
61
66
77
82
100
117
123
135
133
162
164
171
203
221
234
258
284
311
349
321
348
388
461
507
536
595
690
13
3
3
2
10
5
11
5
18
17
6
12
29'
2
7
32
18
13
24
26
27
38
27
43
73
46
29
48
105
28
&T3
18
31
26
48
54
49
54
54
58
61
55
57
59
71
88
102
103
123
152
166
175
179
213
224
228
246
285
327
356
377
413
466
480
505
552
666
765
816
896
1,034
Kr
Hh
5.55
66.66
33.33
10.34
50.00
28.57
43.75
22.22
29.41
38.46
42.85
50.00
20.00
25.00
37.03
41.66
46.15
34.15
32.69
38.77
32.69
31.81
16.25
46.77
35.93
27.03
33.33
30.69
33.63
34.78
24.79
27.34
40.00
33.33
23.03
21.30
28.30
31.00
30.00
19.57
m  2   «
« a °>
•o   CO
0.05
80.00
33.33
26.89
63.63
78.57
62.50
27.77
29.41
61.54
57.14
62.50
60.00
25.00
59.25
55.55
69.23
46.34
44.23
46.94
51.92
72.72
40.00
64.51
75.00
37.83
49.38
62.37
57.52
52.17
50.41
53.96
62.61
61.78
52.06
41.20
53.90
64.60
59.28
54.42
S   03   g
03  4^    3
_Pm	
5.55
16.12
11.53
20.83
9.35
6.12
16.16
14.81
8.62
8.19
3.63
5.26
3.33
6.94
6.81
4.80
2.87
3,25
7.64
11.69
6.95
7.60
8.92
8.92
3.94
5.69
6.66
6.42
8.14
6.63
6.06
5,57
5.42
5.34
5.04
5,08
7.44
6,40
4.57
5.83
* Three not insane.
t One not insane.
X Two not insane. 2 Geo. 5
Public Hospital foe the Insane.
D 27
Table No. 3.
Showing the number of admissions, discharges, and deaths in 1911.
Mouths.
January.. ..
February ..
March .   ...
April	
May	
June	
July	
August ....
September .
October	
November..
December..
Total
Admissions.
DlSCHAKGES.
Deaths.
Male.
Female.
Total.
Male.
Female.
Total.
Male.
Female.
17
5
22
1
2
3
5
16
4
20
2
21
6
27
8
8
4
1
15
6
21
7
3
10
5
24
10
34
5     .
5
5
1
27
2
29
6
1
7
6
2
19
7
26
5
1
6
5
1
31
6
37
11
11
3
21
5
26
5
5
4
3
31
9
40
7
7
3
1
17
5
22
52
23
75
2
2
20
8
28
36
8
44
4
1
259
73
332
143
38
181
48
12
Total.
6
8
6
3
7
4
4
5
60
Table No. 4.
Showing the civil state of patients admitted during 1911.
Civil    State.
Male.
Female.
Total.
164
70
7
18
259
15
53
5
179
123
12
18
Total	
73
332
Table No. 5.
Showing the religious denominations of those admitted during 1911.
Religious   Denominations.
Adventist  	
Anglican	
Baptist	
Buddhist	
Confucianist	
Congregationalist	
Episcopalian	
Greek Church.   	
Heathen	
Jews	
Lutheran	
Methodist	
Mohamedan	
Nonconformist	
Plymouth Brethren...
Presbyterian	
Protestant	
Roman Catholic	
Salvation Army	
Shintoist    ...
Wesleyan	
Unknown  	
None	
Total
259
Male.
Female.
Total.
1
1
3
2
5
3
2
5
4
4
3
1
3
I
5
4
9
2
2
2
2
4
2
6
13
3
16
14
8
22
1
1
1
1
1
1
23
10
33
78
27
105
78
10
88
2
2
3
3
o
1
3
12
1
13
5
1
6
332 D 28
Public Hospital for the Insane.
1912
Table No. 6.
Showing the degree of education of those admitted during 1911.
Degree of Education.
Male.
Female.
Total.
5
168
40
21
25
2
60
8
3
7
228
48
24
25
Tntnl
259
73
332
Table No.  7.
Showing the nationality of those admitted during 1911.
Nationality.
Australia	
Austria	
Azores Islands	
Channel Islands	
China	
Denmark	
England	
Finland    	
France 	
Germany	
Greece	
Hungary	
India	
Ireland	
Italy	
Japan 	
Mexico	
Montenegro	
Newfoundland	
New Zealand	
Norway	
Poland	
Roumania	
Russia	
Scotland	
South Africa	
Spain	
Sweden	
Switzerland	
United States	
Wales	
West Indies	
Canada—
Alberta    	
British Columbia....
Manitoba	
New Brunswick	
Nova Scotia	
Ontario  	
Prince Edward Island
Quebec	
Unknown	
Total...
Male.
Female.
1
1
7
1
]
2
7
48
19
2
2
1
2
1
1
1
2
1
18
3
11
7
i
3
1
1
8
1
2
1
8
27
7
1
2
7
3
2
18
8
3
3
1
k
6
4
5
2
4
1
24
10
3
13
3
2
259
73
Total.
2
8
1
2
7
67
4
1
3
1
1
3
21
11
7
i
4
1
9
2
1
8
34
3
io
2
26
3
4
14
4
7
5
34
3
16
2
332 2 Geo. 5
Public Hospital for the Insane.
D 29
Table No. 8.
Showing what districts contributed   patients  during  1911.
Place of Residence at Time of Committal.
Abbotsford .
Alberni ...
Albion ....
Male.     Female.
Ashcroft	
Bulkley Valley.
Burnaby
Campbell River
Cape Scott	
Central Park...
Chilliwack	
Colwood	
Coquitlam	
Courtenay	
Cowichan	
Cranbrook 	
East Delta	
Eburne	
Edmonds	
Extension	
Fernie	
Fort George .
Fort Steele . .
Francis Lake.
Galena Bay. .
Golden	
Greenwood
Harrison Mills .
Hazelton	
Hope	
Hosmer	
Kaledin	
Kamloops
Kaslo	
Keating ...
Kelowna ..
Keremeos  .
Ladner
Ladysmith.
Lumly
Lytto
Matsqui	
Merritt	
Michel	
Millside	
Mission City  .   ..
Nanaimo	
Nelson	
New Westminster.
Nicoman    .
Nine-mile Creek...
North Bend	
Northfield	
North Vancouver ,
Paxton Valley ..   .
Penticton	
Phoenix	
Port Essington	
Port Mann	
Port Moody	
Port Haney	
Princeton	
Prince Rupert	
Revelstoke	
Roberts Creek ....
1
1
2
1
2
1
1
2
8
31
1
1
1
1
5
Total.
1
1
1
2
1
1
1
1
1
4
1
1
2
1
3
1
3
1
2
2
1
1
1
1
1
3
1
3
1
1
1
4
1
1
1
1
2
1
1
1
o
1
3
1
1
3
10
34
1
1
1
1
5
1
2
3
1
1
4
1
1
5 D 30
Public Hospital for the Insane.
1912
Table No.   8—Concluded.
Place of Residence at Time of Committal.
Male.
Female.
Total.
1
1
1
4
1
1
1
1
28
9
1
1
Savona 	
1
2
6
1
1
1
1
1
1
1
1
1
Trail	
2
Trout Lake	
1
89
1
25
1
117
1
34
1
........
Yale	
2
7
1
7
Total	
259
73
332
Table No. 9.
Showing the occupation of those admitted during 1911.
Occupation.
Male.
Female.
Total.
1
1
1
1
2
1
2
1
1
1
1
1
7
1
2
1
2
1
1
1
1
1
7
1
1
13
4
2
1
1
9
1
45
1
Clerk	
14
Cook	
4
2
1
9
2
1
2
16
3
2
1
1
2
1
1
2
2
1
2
16
3
2
1
1
2
1
1
2
1
45 2 Geo. 5
Public Hospital for the Insane.
D 31
Table   No.  9—Concluded.
Occupation.
Male.
Female.
Total.
Labourer 	
82
1
19
1
5
3
1
2
1
9
1
82
Laundryman	
1
Logger            	
19
Longshoreman    	
1
5
3
Mill hand	
1
2
Milliner	
1
Miner    	
18
1
1
3
6
18
1
Moulder	
1
Musician    	
3
15
Nurse	
1
Painter.   	
3
1
1
1
1
4
2
3
1
1
1
1
4
2
2
1
3
1
1
1
1
1
2
2
1
3
1
1
1
2
3
1
1
2
1
2
1
2
1
1
4
3
Tailor	
3
1
2
2
1
2
1
2
1
1
6
259
73
332
Table No. 10.
Showing the age of those admitted during
1911.
Under 15 years	
From 15 to 20 years.
20 to 25 „ .
25 to 30 „ .
30 to 35 „ .
35 to 40 „ .
40 to 45 „ .
45 to 50 „ .
50 to 55 „ .
55 to 60 „ .
60 to 65 ,, .
65 to 70 „ .
70 to 75 /.
75 to 80 „ .
80 to 85 a .
Total.
Male.
Female.
3
1
5
3
26
6
44
6
49
12
37
12
36
11
20
8
8
2
8
4
6
3
9
1
3
1
5
1
2
259
73
Total.
32
50
61
49
'47
28
10
12
9
10
4
6
2
332 D 32
Public Hospital for the Insane.
1912
Table No.  11.
Showing the number of attacks in those admitted during 1911.
Number of Attacks.
First	
Second 	
Third	
Fourth	
Fifth	
Congenital	
Unknown	
Total
Male.
Female.
103
42
38
12
7
4
7
3
2
2
2
102
8
259
73
Total.
145
50
11
10
2
4
UO
332
Table No.  12.
Showing the alleged duration of attack prior to admission.
Duration of Attack.
Male.
Female.
Total.
37
51
30
20
13
11
11
S
4
75
13
19
6
7
4
6
3
3
5
6
50
70
36
27
17
17
„        2 to    5      ii        	
14
,t        5 to 10      //         	
11
//      10 to 15      ■!        	
9
81
Total	
259
73
332
Table No. 13.
Showing statistics of heredity in  those  admitted during 1911.
Heredity.
Grandparents	
Paternal branch	
Maternal branch	
Lateral branches	
History unascertained but presumed
Unknown. .       	
Total	
Male.
Female.
4
1
11
4
11
4
12
5
48
19
173
40
259
73
Total.
o
15
15
17
67
213
332 D 34
Public Hospital for the Insane.
1912
Table No.  17.
Showing the number allowed out on probation, and results during 1911.
Results.
Discharged recovered ..
n improved ..
/; unimproved
Returned to hospital. ..
Still out at close of year
Total.
Male.
Female.
33
14
22
9
7
4
13
12
11
8
86
47
Total.
47
31
11
25
19
133
Table No. 18.
Showing alleged duration of insanity prior to admission in those discharged during 1911.
Duration of Insanity.
Less than     1 week.
From
3
to
to
to    6
to 12
2
3
Over 3 years
Unknown....
1 month..
2 months
1 to
2 to
years.
Total.
Male.
Female.
26
10
31
9
13
3
12
3
6
3
7
2
5
3
4
13
1
25
5
142
39
Total.
36
40
16
15
9
9
8
4
14
30
181
Table No.  19.
Showing length of residence of those remaining under treatment in 1912, and those who
were discharged during the year 1911.
Length of residence.
Of those
under
Treatment
January  1st,
1912.
Of those
discharged
& recovered
in 1911.
Of those
discharged
improved
during  1911.
Of tliose
discharged
unimproved
during  1911.
Of those
discharged
not Insane
during  1911.
26
24
36
24
28
26
28
25
103
71
67
37
25
19
24
24
18
49
16
17
3
18
13
9
5
5
5
6
2
1
1
12
24
10
9
4
4
6
6
8
2
2
2
3
5
„     2 a    3     n       	
2
„         3   „      4          ,;
„     4 it    5     a
I
1
3
1
4
1
it     5 a    6     a
„     6 ii   9     „       	
„      q „  12      it
n      2 it    3       n
,i      3 n    4       „         	
1
I
„     5 „   6     a
2
1
1
,,     , i,   8     i,       	
„    8 n   9     //
it     9 // 10     a
,.   in „ 15     „
n    15 n 20       n
„   20 n   25     n
Total	
690
65
91
23
2 2 Geo. 5
Public Hospital for the Insane.
D 33
Table No.  14.
Showing the alleged exciting causes of attack of insanity.
Alleged Cause.
Male.
Female.
Total.
56
1
4
6
6
1
4
14
19
1
5
1
6
6
60
8
Child-birth	
6
6
3
1
1
1
1
38
48
1
4
1
1
1
52
67
1
1
1
1
1
2
19
11
2
1
1
1
1
2
24
11
2
1
1
16
3
51
22
3
57
Total	
259
73
332
Table No. 15.
Showing the state of bodily health on admission during 1911.
Bodily Condition.
In average bodily health
In reduced health	
In greatly reduced condition.
Total	
Male.
Female.
197
41
21
47
17
9
259
73
Form of Disorder.
Acute mania ,	
Dementia organic	
Dementia pnecox	
Epileptic insanity	
General paralysis	
Imbecility and idiocy	
Mania, depressive condition.
Melancholia	
Not insane	
Paranoia	
Senile dementia.	
Terminal dementia	
Toxic insanity	
Total.
244
58
30
332
Table No.  16.
Showing the form of mental disorder in those admitted during 1911.
Total.
Male.
Female.
1
2
85
12
6
2
17
4
5
33
21
14
10
2
. 49
12
19
6
8
5
19
259
73
Total.
1
2
97
8
21
5
54
24
2
61
25
13
19
332   2 Geo. 5
Public Hospital for the Insane.
D 35
Table No. 20.
Records of death for the year 1911.
Register
No.
1566
1531
2716
2788
2523
2690
1806
2834
2004
2103
2865
2802
2264
2683
2900
2816
2905
2334
2321
2546
2792
2039
2613
2684
2762
383
2870
2634
2924
2151
2462
1942
2550
2725
2896
2620
2984
1302
2909
2033
3039
2908
163
2876
2932
2831
2637
2869
3052
3077
3002
2616
2805
2739
2668
2155
1984
2811
2605
3060
Initials.
T. W.
A. A.
M. McA.
H. G. C.
D. McK. A.
G. H.
R. R.
J. N. H.
C. S.
M. L. M.
A. G.
G. S.
W. B. K.
S. N.
F. J.
H. B.
A. J.
L. M. C.
K. McK.
E. A. L.
J. D. H. B.
B. G.
W. A.
A. B.
J. C.
E. M.
A. G. M.
C. L.
E. M.
D. B.
R. H.
G. S.
D. M.
A. I.
E. K.
J. C.
A. R.
N. C. N.
J. H. L.
D. B. S.
H. M.
D. M.
M. M.
M. A.
F. I. C.
W. R. C.
P. B
J. 0. H.
M. H.
A. A. M.
T. W. S.
J. M.
A. M. E.
J. C.
J. C.
J. R.
E. T.
J. S.
F. G.
J. C.
Sex.
M.
M.
M.
M.
M.
M.
M.
M.
M.
F.
M.
M.
M.
M.
M.
M.
M.
F.
M.
M.
M.
M.
M.
M.
M.
M.
F.
M.
F.
M.
M.
M.
F.
M.
M.
M.
M.
M.
M.
M.
M.
M.
F.
F.
F.
M.
M.
M.
F.
M.
M.
F.
M.
M.
F.
M.
F.
M.
M.
M.
Age.
38
40
61
40
73
36
67
65
81
47
45
50
50
50
45
60
32
33
77
47
33
58
57
46
20
70
21
30
36
47
56
57
67
29
65
55
30
37
48
55
44
27
75
64
51
30
76
60
36
42
78
63
59
71
74
53
24
44
40
75
Time in Hospital.
Years,
Months.
22
i'
3
29'
9
1
4
7
4
11
8
3
Days.
7
28
4
18
17
24
13
14
29
23
9
26
9
15
2
3
7
30
28
15
5
7
23
13
7
10
28
10
20
4
25
24
15
28
1
26
6
17
4
14
8
13
2
26
18
6
17
4
11
11
7
10
1
29
27
Certified Cause.
Pneumonia.
Epileptic exhaustion.
Pulmonary tuberculosis.
General paralysis
Senility.
General paralysis.
General paralysis.
Senility.
Senility.
Pneumonia.
Diphtheria.
Accidental.
General paralysis.
General debility.
Brain-tumour.
Interstitial nephritis.
Acute mania.
General debility.
Senilitj'.
Endocarditis.
Intestinal obstruction.
General debility.
General paralysis.
General paralysis.
Pulmonary tuberculosis.
Carcinoma of larynx.
Epileptic exhaustion.
General paralysis.
Meningitis.
General paralysis.
General paralysis.
General paralysis.
General debility.
General paralysis.
Senility.
General debility.
Tubercular peritonitis.
Syphilitic meningitis.
Maniacal exhaustion.
Endocarditis.
General paralysis.
Maniacal exhaustion.
Senility.
Interstitial nephritis.
General debility.
Pulmonary tuberculosis.
Pulmonary tuberculosis.
Senility.
General paralysis.
Chronic nephritis.
Senility.
General debility.
General paralysis.
Cerebral haemorrhage.
Cerebral haemorrhage.
General paralysis.
Pulmonary tuberculosis.
General paralysis.
General paralysis.
Senility. D 36
Public Hospital for the Insane.
1912
Table No. 21.
Work done by Patients during the year 1911.
Days.
1,024
677
4,759
744
8,414
3,159
392
1,719
301
3,211
1,031
85
164
952
1,622
285
848
29,764
Table No. 22.
Articles made by Female Patients.
Aprons	
Blouses	
Bedside rugs   ....
Bureau-covers
Chemises	
Cushions	
Doilies....   	
Drawers (pairs). ..
Dresses, gingham.
// night
Dusters	
Handkerchiefs ...
Mats, rag	
140
11
11
14
102
10
11
6
88
12
156
288
24
Napkins, table
Neckties	
Petticoats ....
Pillow-slips ...
Sheets	
Tablecloths
Towels, bath.
tt       roller .
n       tea ...
tray	
huckaback
Window-curtains (pairs).
12
254
12
716
718
50
510
307
126
102
40
58
Articles made for Nurses.
Aprons.
Caps ..
82
54
Cuffs (pairs
Dresses ...
Aprons
Caps ...
Repairs for Nurses.
Dresses ..
220
11
Mending done j1 or Female Patients.
Aprons	
Blankets	
Blouses 	
Chemises	
Drawers (pairs) ..
Dresses, gingham
«        serge ...
//        night ...
Hose (pairs)	
Pillow-slips	
.    291
.    228
.    199
145
447
.    354
.    228
.   329
.2,849
211
Sheets	
Skirts	
Spreads, bed..
Tablecloths.. .
Ticks, bed....
// pillow .
Towels, bath .
it roller.
Vests, under .
Petticoats
52
28
167
211
355
166
237
97
13
200
112
457
184 2 Geo. 5 Public Hospital for the Insane. D 37
Mending done for Male Patients.
Aprons         15        Shirts, under   2,059
Blankets     354        Socks (pairs) 5,694
Coats         345        Spreads, bed     276
Drawers 1,814        Tablecloths •  .    263
Jumpers     153        Ticks, bed       136
Overalls    258 „      pillow       37
Pants (pairs)     622        Towels, bath     265
Pillow-slips    330 „ roller     145
Sheets        357       Vests     183
Shirts, duck 2,076
Report of Tailoring Department.
Stock :—
260 pairs pants $   635 00
343 coats     1,894 40
313 vests	
18 suits	
44 mattresses	
12 aprons 	
11 canvas blankets	
1 camisole  	
64 shirts	
66 undershirts	
27 pairs drawers	
59    tt      overalls	
12 cooks' caps	
Repairs	
Miscellaneous work	
Total stock work $3,785 16
Uniforms :—
51 suits      1,106 80
1 vest   3 50
48 pairs pants         321 60
Total uniform work    $1,431 90
Total uniforms      $1,43190
,,     stock      3,785 16
713 60
216 70
78 06
3 30
55 00
5 00
51 20
39 60
14 85
45 35
3 00
17 60
12 50
579
90
186 75
51
75
9
00
8
80
Grand total    $5,217 06
Work done by Shoemaker.
New work :—
New shoes, men's, 36 pairs    $278 00
«    slippers, men's,        45    »         93 50
ii    slippers, women's,   10   «        20 00
Repairs :—
Men's shoes, 451    n 	
n      slippers, 211    a 	
Women's shoes, 69    n 	
tt slippers, 1    n 	
Miscellaneous work	
Total    $1,220 70
Preserves put up.
Blackberries   20 quarts.
Crab-apples   35 n
Currants, black   65 »
ii        red        68 n
Gooseberries   54 «
Peaches  28 »
Pears  44 n
Plums 122 „
Raspberries   40 n
Rhubarb   74 „
Strawberries   86 // D 38 Public Hospital for the Insane. 1912
Pickles.
Tomato 255 quarts.
Cucumber        25      «
Jelly.
Apple   12 quarts.
Black currant  45      «
Red currant   30     «   2 Geo. 5 Public Hospital for the Insane. D 39
APPENDIX.
It is a pleasure to know that our institution is steadily forging ahead in that slow but
steady march to a scientific basis in the study and interpretation of the causes, clinical manifestations, pathology, prophylaxis, and cure of those unfortunate members of the community
whose mental affliction necessitates their committal to us.
In order to most fully study, interpret, and treat any condition of mental disease, it is of
the first importance that accurate, detailed, and truthful statements of the facts relating to
influences of heredity, environment, and previous mental life be given on the admission of each
patient. Unfortunately, it does not seem to be generally understood that insanity is a disease
for which much can be done in the way of prevention, and which intelligent handling early in
its advent does much to ameliorate and cure. Too often we have to depend upon the unreliable
statements of relatives and friends, who do not comprehend the importance of an accurate
history, in its bearing upon the ultimate outcome of the case, or else have the disconnected,
unintelligent statements of the patient himself, as to the family history, his early life, mental
constitution, education, training, peculiarities, or idiosyncrasies.
The legal commitment of a patient to the Hospital requires four forms to be filled
out—i.e., the Magistrate's Order for Committal (Form A), two Medical Certificates (Form B)
and a Statement by Relatives or Friends (Form C).
For the purpose of illustrating our methods, we will take a hypothetical case, give him
the name of John Thomas, and handle it as we would a patient.
On admission, the four forms mentioned above must accompany him to the Hospital. A
facsimile of these forms is given below.
First in order is Form A, being the Magistrate's order for the patient's commitment:—
HOSPITALS FOR INSANE ACT, 1897.
Form A.    (Section 7 (a).
Order for the admission op a Patient or of a Lunatic
wandering at large.
(1.) Judge  or   Registrar
or Deputy Registrar of
stFendiar Magistrate     *> the undersigned, William Holland, being a (1) Stipendiary Magistrate,
orPoiiceMagistrate,or and not being a near relative of (2) John Thomas, and having personally
theSpCrov"ceeofPBrifc°h examined him, and read the certificates of (3) Henry Cole and (4) Ernest
Columbia. Harvey,   both   duly   qualified   Medical   Practitioners,   and  being   satisfied
(2.) Name in full. that (5) John Thomas (*is in such circumstances as to require relief for his
(3.) Name in full. care an(j  maintenance,  and  that  the said (6) John Thomas) is a lunatic
(t.) Name in full. an(j a proper person to be taken charge of and detained under care and
(5.) Name in full. treatment, do hereby authorize you to receive the said (7) John Thomas
(6.) Name in full. ,.      .   .    , tt        • t   l
as a patient into your Hospital.
(7.) Name in full. r J r
(8.) To be dated within     Dated the (8) twelfth day of January, one thousand nine hundred and
one  month   prior   to eleven
admission' (Signed)        Wm. Holland,
Stipendiary Magistrate,
Vancouver, B.C.
To the Medical Superintendent of the Public Hospital
for Insane at New Westminster, B.C.
•Words in parentheses to be struck out in the case of private patients. (1.) Name in full.
(2.) Patient's
I) 40 Public Hospital for the Insane. 1912
Then come the two B Forms, in which the medical practitioners state their reasons for
adjudging him insane. It may be here mentioned that too much information cannot be given
in these two forms, as the nature of the statements contained therein can be of great assistance
to us.    For our present purpose we will illustrate only one of these forms :—
HOSPITALS FOR INSANE ACT, 1897.
Form B. Section 7 (b).
Medical Certificate.
I, the undersigned, (1) Henry Cole do hereby declare and certify that—
1. I am a duly qualified Medical Practitioner, of the Province of British
Columbia, and in the actual practice of the Medical Profession.
2. I am not a partner, nor an assistant, nor a near relative of the Medical
Practitioner who signs the other certificate, nor a near relative of the patient
in this case.
3. I have with care and diligence personally observed and examined
within  seven  days prior  to  the   date  of  this Certificate,  namely,  on the
'tarC" '  twentieth day of January, 1911, (2) John Thomas, and as a result of such
(3.) Patient's name. examination find that the said (3) John Thomas is insane and a proper
person for care and treatment in some Hospital or Institution for the Insane,
as an insane person under the provisions of the Statute.
4. I have formed the above opinion upon the subjoined facts, viz. :—
(a.) Facts indicating insanity personally observed by me as follows :—
patient said. The patient said (4) that for some time past he had noticed his fellow-
workmen acting in a rather suspicious manner towards him; this he
recognized by suspicious glances cast towards him, and also noticing that
they were grouped at times, and evidently in secret conversation concerning
him. This gradually increased until they commenced to bother him at his
own home, where they would come at night-time, and threaten him by
talking through windows, etc.
patient did. The   patient   did (5) act as   if   suspicious   of myself  and others in the
room; this he indicated by furtive glances from one to the other, when any
remarks were passed; he threatened that he would get even with his
persecutors, and when told that his imagination must be getting the better
of him, he became very angry and made an attempt to leave the room.
appearance.   Pa '     S     The patient's appearance was (6) that of a mechanic, rather careless in
his dress and personal appearance; hair rather long and shaggy and face
unshaven.
(7.) Here state patient's     The patient's manner was (7)  rather  restless,  with furtive glance,  and
iimnnsr. *■ *   *
when crossed shows a tendency to be irritable,
(s.) state name of infor-     /j\ Other facts indicating insanity communicated to me by others:—(8)
•   mant or informants and       v    ' .- 1*1111-111 • i i
degree of relationship, His wife states that of late her husband has been acting rather strangely.
stances0co°nnectedwith -A-b0u* one rnonth ago he became more morose than formerly ; this gradually
the patient. became worse, until finally he began to grow suspicious, and, upon questioning
him, he made the statement that people were all against him ; he even went
as far as to state that he suspected his wife of tampering with his food.
5. The answers to the questions contained in this statement are true, to
the best of my knowledge, information, and belief.
(Signed)        Henry Cole,  M.D.
1216 Grand Street, Vancouver, B.C.
Witnesses:
1. Charles Conway.
(9.) To be dated within 2'   GrEOBGE   ROBERTS.
admission.    pn°r    °     Dated the (9) 20th day of January, one thousand nine hundred and eleven.   2 Geo. 5 Public Hospital for the Insane. D 41
Next in order is the Form C, or statement by the patient's relatives or friends, in which
they should give every item of information possible that may have any bearing whatever on the
case.    The medical attendant could be of great value in giving his assistance towards this end
HOSPITAL FOR THE INSANE ACT, 1897.
Form C.    (Section 7 (c) and Section 20.)
Statement to be forwarded to the Medical Superintendent when Application
is made for the Reception of a Patient.
N.B.—If any of the particulars in this Statement be not known, the fact to be so stated.
1. Name of patient (in full): John Thomas.
2. Where born : Montreal Quebec.    Son of John Henry and Mary Ellen Thomas.
3. Present residence :  68 Olive Street, Vancouver, B.C.
4. Sex and age last birthday: Male, 26 years.    Date of birthday (if known), 16th February,
1885.
5. State as to marriage : Married.
6. Number and age of children : Two, 3 years and six months, respectively.
7. Occupation of patient : Printer.
8. Natural disposition : Amiable, loving husband and father.
9. Habits in health—as to temperance,   industry,   general   conduct,   etc :   Temperate   and
industrious until recently, when he began to use alcohol to greater excess.
10. Education : Common school.
11. Religion: Roman Catholic.
12. Whether first attack : No.    If not, state number and duration of previous attacks : One
previous attack in 1904, lasting twelve months.
13. Age at first attack :  20.    Insanity how first   manifested : By gradual   departure  from
normal amiable disposition.
14. Where previous under treatment and when: Torquay Asylum,  Quebec; admitted 2nd
June, 1904, and discharged 3rd May, 1905.
15. What relatives similarly affected : Paternal uncle.
16. Supposed cause, remote : Hereditary.
17. Supposed cause, recent: Alcohol.
18. Duration of present attack : One month.
19. State as to sleep : Up late; more or less disturbed.
20. Appetite for food : Variable of late.
21. State of bodily health : Fair.
22. Whether subject to epilepsy : No.
23. Any faltering of speech, or loss of power, and when :  No.
24. Present habits and propensities : Has threatened his supposed persecutors.
25. What delusions : Imagines that every one is against him, plotting for his downfall.
26. Whether suicidal (attempted or threatened), and how : No.
27. Whether dangerous to others, how : Might be.
28. Whether patient has been charged with any criminal offence or convicted ; if so, state
particulars : No.
29. Pecuniary circumstances (or to whom chargeable): Able to supply clothing but not main
tenance.
30. Post-office address of nearest friend, and degree of relationship (if any^l, or other circum
stances of connection with the patient: Mrs. Janet Thomas, 68 Olive Street Vancouver,
B.C., patient's wife.
31. Other particulars: Patient owns his own home, valued at $2,000 ; wife and children depend
upon this alone.
I certify to the best of my knowledge that the above particulars are correctly stated ; and
I herebj request you to receive the above-named John Thomas, whom I last saw at Vancouver,
B.C., on the 20th day of January, 1911, as a person of unsound mind, as a patient in the
Public Hospital for Insane at New Westminster, B.C.
(Name)        Janet Thomas
(Address)        68 Olive Street, Vancouver, B.C. D 42 Public Hospital for the Insane. 1912
Degree of relationship (if any) or other circumstances of connection with patient: Wife.
Dated* this twentieth day of January, one thousand nine hundred and eleven.
*To be dated within one month prior to admission.
The above four forms must accompany the patient when presented at the Hospital for
legal admission, and the more information contained in these forms, the more assistance they
are to us in the treatment, and probably ultimate outcome, of the case.
Following admission, as complete a record as it is possible to obtain is made as to any
departure from the normal, mental or physical, of the direct ancestors and near blood-relations
of the patient. A careful scrutiny is made of his past life, mental and physical, noting
particularly his apparent normal status, and grave or slight obliquity or variation of mind or
character. Then a minute review is made of the course and progress of the condition which
brings him to us.
First we inquire into his family history, then the personal history, after which comes a
psychical examination, followed by a physical examination; all this according to the scheme
to be outlined below :—
Family History.—Name of father and mother; where patient was born, and when ;
cause of death of the various members of the family ; heredity or other predisposing factors, as
accentric characteristics, syphilis, suicides, criminals, alcoholics, tuberculosis, etc., in parents,
grandparents, uncles, aunts, and also children of the patient, and children of the brothers and
sisters of patient; consanguinity of parents and social and intellectual status of family.
Personal History.—Environment under which patient had been living, and condition
under which mental development had taken place ; what infectious diseases or trauma occurred
during infancy; early physical development; notes of the severity, duration, and sequel® of
so-called children's diseases; age school education began and what education patient received,
what progress made; development of puberty, menstruation, and masturbation; was the mental
and physical development precocious, delayed, or in any way abnormal, and particularly at this
time eccentricities of character; further development of patient, both mentally and physically,
and the occurrence of any attack of an infectious disease, as typhoid fever, pneumonia, malaria,
meningitis, etc., as well as any constitutional disease, as hysteria, hypochondriasis, epilepsy,
etc.; personal idiosyncrasies; evidence of a neuropathic constitution ; the emotional life of the
patient and general view of life, characterized by excessive optimism or pessimism, and also
apparent lack of ability to adapt himself to his surroundings; as patient became older, the
cropping-up of personal eccentricities and exaggerated egotism, and an abnormal tenacity of
personal views on social, political, or religious questions; was the temperament indicative of a
phlegmatic, apathetic, excessively ambitious, or jealous nature; nature of the social relationships ; in women, anomalies of the mental functions associated with the menses, pregnancy,
and climacterium ; capabilities as regards vocation; later mental interests, religious interests,
and, later, development of character; marriage, conjugal relations; other sexual intercourse;
syphilitic infection, puerperium, gynaecological ailments; mental and physical overtaxation,
emotional exeitements, abuses of alcohol and tobacco; nutritive consitions; caloric injuries
and injuries to head.
Physical Examination.—Facial expression; manner of speech; actions, spontaneous
movements. Conduct, associations with relatives, capability of conducting business; sleep,
commanded movements, grasping of objects, writing, etc.; character or dress, eccentricities
and mannerisms; presence of negativism; refuse food ; katatonic attitude, etc. Hallucinations,
illusions, affecting the senses of hearing, sight, taste, touch, etc. Delusions, persecutory,
grandiose, spiritual, and whether fixed or not. Attitude, manner, was patient suspicious,
excited, or depressed while being questioned 1 Attention, could he concentrate himself or was
his attention easily diverted 1 Retention, for remote, recent, and immediate past. Orientation,
for time, place and person. Memory, account of past life, present illness, test numbers, etc.
Insight, realization of mental unbalance or seriousness of present condition. Mental grasp,
with regard to the seriousness of his condition and environment. Propensity with regard to
suicide, homicide, or being agressive. 2 Geo. 5 Public Hospital for the Insane. D 43
Physical Examination.—General appearance; muscular development; weight; complexion;
colour of hair and eyes ; skin-eruptions ; decubitus ; scars. Eyes, strabismus, retinitis, arcus
senilis, conjunctivitis, abnormalities of the lids, pupils small or large, equal or unequal, round,
oval, or distorted ; reaction to light and accommodation. Nose, malformation, etc. Ears,
malformation, discharges, etc. Mouth, teeth, gums, palate, tongue, etc. Thorax, lungs,
respiration, condition of apices, etc. Heart, murmurs, etc. Liver, area of dulness. Abdomen
and viscera. Bladder, retention or incontinence of urine. Constipation or diarrhoea. Pelvic
organs and genitalia, cicatrices, malformations, etc. Vessels and pulse, condition of arterial
walls, volume, etc. Glandular enlargements. Spinal column, pain or tenderness, malformations, etc. Disturbances of reflex and tendon phenomena. Sensory disturbances. Stigmata
of degeneracy.
We will now proceed to take a history of our case, following along the lines laid down
above, and taking into consideration the commitment papers :—
Registrar No. 2063.    Name, John Thomas.    Admitted, 20th January, 1911.
Family History.—Son of John H. and Mary E. Thomas. Born in Montreal on the 16th
February, 1885. Father was a printer, died aged 65; cause, kidney-trouble. Mother living
and healthy, aged 63; present residence, 168 Chevaux Street, Montreal. Had four brothers,
three of whom are still living and healthy, aged 38, 32, and 24 yeais respectively; the eldest
brother is married, living in Quebec, and has two children, both healthy ; the next brother
also married, living in Quebec, and has four children, all healthy, except one who is subject
to "fits." The younger brother is single and working as farm-hand in Manitoba. Had three
sisters, two of whom are still living and healthy, aged 36 and 34 respectively; the elder sister
is married, living in Alberta, and has three children, all healthy; the other sister also married
and living in Prince Edward Island, has three children living and healthy, while one died
aged about two years; cause, diphtheria. One sister died aged 18 years ; cause, typhoid fever.
Paternal uncle was in Burton Asylum for some years prior to his death ten years ago. Denies
any further history of insanity on either side of family.
Personal History.—Born and raised in the City of Montreal, his father being a printer
and having a business of his own. Commenced school at age of six years, attending common
school until age of fourteen years, when he left, then being fairly proficient in his studies. On
leaving school became apprenticed to the printing trade, serving four years with his father,
and after coming out of his time, continued working at his trade with his father for the next
year, while on the 2nd June, 1904, he was committed to Torquay Asylum, Quebec, of which
institution he was an inmate until May 3rd, 1905, when he was discharged as recovered. On
leaving the hospital, returned home and went back to work for a period of eight months, at
the end of which time he went to Moose Jaw, where he remained for three months, but could
not obtain employment. In consequence of this failure to obtain a position, he returned home
and went to work at his trade for six months, then married, and having obtained a position
in Vancouver, B.C., came to the coast, bringing his wife with him. Worked steadily for the
Coast Printing Company until August, 1906 ; during this time purchasing his own home and
behaving in an exemplary manner. In August, 1906, he fell sick with pneumonia, for which
he was under treatment in the Vancouver General Hospital for seven weeks, but made a good
recovery, and returned to his work, at which he continued steadily until about a month ago,
when he began to neglect his work and also commenced to drink. For a week prior to his
admission to this hospital he has not been working at all, and has gone home drunk on two
occasions, the last of which was on the 17th instant. Wife living at 68 Olive Street,
Vancouver, B.C., and has one boy aged three years and one girl aged six months, both healthy.
Patient admits the excessive use of alcohol for the last six or eight weeks, but claims that he
was temperate prior to that time.    Denies specific infection.
Present Illness.—Patient states that, since about the beginning of December last, he has
been followed by men who have tried to poison him, in order that they may get hold of his
property; these men have also been circulating malicious rumours that he had a " bad disease,"
this to discredit him and do him out of his job; imagines that the masons were at the back
of this persecution. Also that his wife was in league with these people. After taking food
on several occasions, both at home and in restaurants, imagined that he had been poisoned,
as he states that his eyes would stand out and his tongue become hot and dry. D 44 Public Hospital for the Insane. 1912
Mental Status.—Attitude, suspicious, with furtive glance. Manner, restless and inclined
to be irritable. Attention, easily attained, but tends to wander to his persecutory delusions.
Retention, good when attention can be held. Orientation, for time, place, and person, good.
Memory, shows no gross deterioration. Insight, lacking, claims that he is not insane. Mental
grasp, poor for the seriousness of his condition, but good on environment. Emotional trend,
restless and irritable. Delusional trend, of a persecutory character. Hallucinatory trend,
auditory and gustatory.
Physical Examination.—Male, white, hair brown, eyes grey, tongue slightly coated, moist
and non-tremulous; palate arched; teeth regular and in good preservation ; no other facial or
cranial stigmata of degeneration ; pharynx somewhat congested. Heart and vessels normal.
Slight friction rub at base of lower lobe, right lung. Abdominal viscera apparently normal.
Pupils equal, react to light and accommodation. Deep and superficial reflexes normal. No
Rhonberg.    Scar over right eye and on left knee result of fall some years ago.
In addition to the above history and examination of the patient, the following form is
used, on which notes are made from time to time, with regard to any apparent change in his
mental or physical health. Should the patient be discharged, this fact is also recorded on this
form, together with the form of insanity exhibited during his residence, and whether
discharged, recovered, improved, or unimproved.
WARD NOTES.
Reg. No. 2063
Name. Date of Admission.
John Thomas. 20th January, 1911.
On admission, the patient is sent to the "Admission Ward," where he is placed under
strict observation (this period varying according to the case), and the following charts are kept,
on which is recorded his weight, amount of sleep he obtains each night, pulse, respirations,
and temperature, medicines and food he receives, stools, urine, and any other remarks on his
behaviour during meal-time or on the ward. at
m  2 Geo. 5                         Public Hospital for the Insane.                                D 45
■   -
PROVINCE OF BRITISH  COLUMBIA.
Reg.   2063
sleep and weight chart.    Name,     John Thomas                            Date £0.1.  11
DAY
£0
21
tt
Hi
21
25
26
E?
28
23
30
3!
1
2
3
4-
S
6
7
S
9
IO
It
12
WEIGHT
SLEEP
POUNDS
HOURS
160
12
11
10
9
8
^k
t»-
-•-
^s*±~
?
y
f
'V
V
6
r
•"
5
/
4
3
2
1
DAY
13
14
15
16
1?
18
19
WEIGHT
Sleep
POUNDS
HOURS
164
12
11
10
9
8
.*-
?
6
5
4
3
2
1
. D 46
Public Hospital for the Insane.
1912
CLINICAL   CHART.
Province or
British Columbia.
Page   216
Case Book No. 2063
Name : John Thomas ; Ward : D ; Nurse : Harper.
Date.
Hour.
P.
R.
T.
Medicine.
Food.
S.
1
i
i
u.
2
1
1
3
2
2
1
Remarks.
1911
Jan.
20
21
2 p.m.
8 a.m.
5 p.m.
8 a.m.
73
70
72
70
18
18
18
18
98.4
98
98.2
97.6
A. B. & S.
Pill.	
Refused food
Refused food
Tube fed....
Breakfast...
Dinner and
supper. .
Breakfast...
Food    refused   evidently   as   result   of
delusions.
Patient took only small quantity of coffee.
Patient has been complaining bitterly of
his forced feeding.
Patient showed no disposition to refuse
breakfast.
22
23
Ate both dinner and supper ; has  been
quiet on ward, respectful  to  other
patients,   but   rather  suspicious   of
attendants.
12
Quiet.
Quiet.
Quiet.
Quiet.
Quiet.
24
12
In addition to the above, examinations of the blood and urine are made at the laboratory,
on admission, and also at any time during residence in Hospital, when such examination is
specially indicated ; also examinations of sputa or other excretions are made and recorded,
the following chart being used for the purpose :—
Register No. 2063.
LABORATORY RECORD.
Urinalysis.
Name John Thomas.
03
a
h=
Lab. No.
Date.
0
4^
a
CD
«J
o
a
60
it
O
o
S
3
Eh
cS
aj
GQ
cS
92
o
a
Ph
a-
CD
Ph
-a
CD
CO
60
m
ag
Q
13
W
616
21/1/11
6/6/11
A
A
1024
1018
Ac
Ac
720
Blood Analysis.
Lab. No.
Date.
H.
R.B.C.
W.B.C.
Remarks.
540
636
830
21/1/11
17/2/11
4/7/11
90
90
90
4,880,000
5.060,000
5,208,000
13,200
8,420
8,600
Reds normal in size. 2 Geo. 5
Public Hospital for the Insane.
D 47
Bacteriological Record.
Lab. No.
Date.
Specimen.
Result.
120
126
133
137
7/9/11
9/9/11
16/10/11
18/10/11
Sputum.
Sputum.
Vomitus.
Gastric juice.
Negative for T.B.
Negative for pneumococci.
Microscopically negative.
Chemically negative.
Should the patient die, an autopsy report is attached to the file, together with the
microscopical findings from sections of the nervous system and organs, thus making a complete
case record.
This method was adopted in October, 1908, and ere long every case in our care will have
recorded a complete, minute case history. True, many of the cases will never prove of
practical value, yet all must be considered, so that the now and then valuable ease will not
escape observation and study.
In some of our cases, however, the clinical histories are incomplete. This is due to the
faulty commitment papers, which at times depend merely on the word of the patient, as well
as the difficulties which arise in examining patients who are demented, restless, talkative, and
sometimes violent. Those who are familiar with the surroundings, which make such examinations difficult and at times impossible, as well as the faulty records in the early history of the
institution, can fully appreciate the difficultly which at times arises in the scientific and
systematic study of these cases.
VICTORIA, B.C.:
Printed by William H.  Cullin, Printer to the King's Most Excellent Majesty.
1912.  CO
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