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Puerperal Fever-Its Prevention.

having a greater power of resistance to destructive agents, and having the potentiality of indefinite millions of parasites. It is probable that some preparation is necessary to put the germs in a state for action, and these changes occur most readily under circumstances most unfavorable to health.

The proportion of infected persons in any community depends, first, on the number of germs present in food, air or water; secondly, on the susceptibility of those who receive the germs. Susceptibility may be an original fault of the organism: it may consist in an abnormal state of the small intestine, especially the lower ilium, whence it becomes an adaptable home—a nidus for the parasite; or it may consist in the preliminary influence of filth, the emanations from ordure, inhalation of sewer gas, etc. That organic matter from human bodies can have an influence is probable, because the parasites are found to have close relations with such materials, especially when decomposing.

Certain climatic and terrestrial causes also, influence to some extent, the activity of the Typhoid germ, but do not prevent its development under any circumstances of heat, cold, or character of soil. It is true, nevertheless, that the Typhoid parasite has its preferences, but these are only partial in operation, and do not act in such force as to prevent its lodgment and multiplication whereever civilization creates the conditions shown herein to be influential.

PUERPERAL FEVER.

ITS PREVENTION.

During the year 1888, a large number of cases of Puerperal Fever were reported, and in some localities there were plain indications of gross carelessness. In nearly every case the result was fatal. Few diseases excite in a community greater alarm and fearful forebodings than this, and yet it is an unnecessary, and easily preventable

Our Insane.

disease. This disease can be traced, more directly than all others, to septic poisoning, and probably no disease is so exclusively disseminated by the physician and midwife as this. It is a disease that does not come within the purview of quarantine law. Hence, it depends upon the medical attendant, by the practice and enforcement of personal cleanliness, and by the free use of antiseptics and disinfection, not only to themselves, but to their patients, that this disease can be prevented, or stamped out, whenever it makes its appearance. A repetition of cases in a community, would be sufficient warrant for investigation by a local board, to ascertain the cause and prevent further spreading thereof.

OUR INSANE.

There is nothing that more forcibly and eloquently illustrates the principles of Christianity, and so practically demonstrates faith in the brotherhood of man, as the humane and well-directed efforts that are made to take care of those who are so unfortunate as to become temporarily or permanently mentally deranged.

A late visit by direction of the Governor, to the hospitals at Independence, Mt. Pleasant and Clarinda, revealed the pleasant fact that Iowa has reason to be proud of her care for this unfortunate class.

At all these institutions, a more liberal appropriation would greatly aid the superintendents in their well-directed and efficient efforts to care for those under their charge.

It is perhaps not the province of the State Board of Health to criticise or commend, or to recommend or suggest any improvements, and yet, insomuch as the law creating the State Board of Health gives it a "general supervision" of the lives and health of the people of the State, it is pertinent here to indicate a few changes that it is believed would be greatly to the advantage of the inmates.

Our Insane.

At Independence, the wards are greatly over-crowded--especially on the female side. Everything is scrupulously clean; the classification of the patients is good, and with additional room for the female patients, much better results could be accomplished. Quite a number of women were found there on the fourth and fifth floors -attic wards. No man or woman should be kept above the third floor. There should be constructed there in the near future, additional cottages, similar to those now in use by the men, capable of accommodating at least one hundred each.

All the hospitals should have elevators. With proper guards to prevent accident many who are doomed to remain in their rooms, could be given two or three times weekly, if not daily, "outings," and such exercise as would prove an important factor in their treatment.

Each hospital should have a small, detached infirmary, or hospital, for the treatment and proper isolation of patients affected with contagious, or infectious, diseases. Should Measles, or Smallpox, or cases of venereal diseases occur, there should be better facilities for their proper treatment, without danger of infecting others. Such a building should be entirely separated from the main building, and should be so constructed that either, or both sexes, could be successfully quarantined in their respective quarters. At both Independence and Clarinda, especially the latter, additional groves should be grown, and better facilities provided for protection from the sun during the outdoor sports and exercise of the patients. The superintendents fully appreciate this, and are planning for relief. But the groves can only be brought to them by the slow process of growth.

Mt. Pleasant was particularly fortunate in the acquisition lately, of a fine grove, and additional grounds where picnics are held daily by the inmates, under the supervision of their attendants-the patients from the various wards attending.

Without instituting any invidious comparisons, it may not be amiss to say that a visit to the three institutions in succession will demonstrate the fact that liberal appropriations, and time, are

Our Insane.

requisite to secure these facilities and advantages, that experience has taught are necessary to the best results.

The management in all our hospitals is excellent, but Clarinda is sadly in need of help, that will doubtless be specified in detail, in the report of the superintendent. The other wing, with the contemplated additions to both wings, should be constructed within the next biennial period, so as to relieve the over-crowded condition of the other hospitals, as well as to afford a better classification of those already under treatment.

A chapel and amusement hall combined, is needed at both Mt. Pleasant and Clarinda. The one at Mt. Pleasant is wholly inadequate, being too small, and improperly arranged. The one at Clarinda exists only in the hopeful anticipation of the superintend

ent.

The trustees of all the institutions should reside within the territory assigned to each hospital. The reasons for this are so obvious as to need no argument.

The General Assembly should, in the near future, make provision for the location of another hospital somewhere in the northwest. The site should be selected, groves planted, the grounds graded, if necessary, so that when the building is ready for occupancy, there should be such advantages in the way of small fruit, groves, walks, drives, and drainage, as only can be secured by time as well as money.

It is pertinent here to supplement, and emphasize what the superintendents may say in regard to the great importance of early treatment in cases of insanity. It has been satisfactorily demonstrated that insanity is a disease of the brain, and not merely a perverted imagination, or demoniacal possession. These institutions are not designed to be asylums so much as hospitals for the proper treatment of such cases. Careful observation shows that of those sent to these hospitals within a fortnight after the attack comes on, especially in cases of acute mania, fully seventy-five per cent are permanently cured. On the other hand, where the case has lasted for one year or more, subsequent to the outbreak of the

Our Insane.

disease, scarcely ten per cent are permanently cured, though many are greatly benefited.

Attention is especially requested to the following article by Dr. Gershom H. Hill, superintendent of the hospital at Independence, on "The Prevention of Insanity," read before the Iowa State Medical Society, and unanimously commended by that body to the State Board of Health for publication:

Since this paper is practical rather than theoretical in its character, and since much of the subject-matter is familiar, platitudes may be pardonable. Paradoxical as it may seem, there are no citizens in our commonwealth more zealous in their endeavors to prevent epidemics and diseases of every kind than those whose living and prosperity depend upon the amount of sickness prevailing among the people.

The State Board of Health was created to promote the sanitary condition of the people of Iowa. By so doing, happiness is increased, and life lengthened. The total loss of life in this country, from causes well known to be preventable, is certainly over one hundred thousand annually. If we were to consider theoretical possibilities, rather than actual probabilities, these figures might be doubled.

An equal amount of sickness, which does not speedily terminate in death, constantly prevails in the United States from causes which we have good reason to think are preventable.

In former times, insanity was not considered a physical disease, but due to the mysterious influence of the moon, or an infliction by an offended deity. Mental alienation could only be prevented by appeasing the wrath of an unseen agent. Almost the only kind of treatment given for this "shameful disorder" was starvation, or some form of corporal punishment.

In these, the closing years of the nineteenth century, we find a radical change. Now it is understood that the mind can only act through the instrumentality of the brain; hence, if there are alterations in the perceptive or reasoning faculties, if the sensibilities and the will are abnormal, so that the individual is evidently not himself, it must be inferred that the nervous centers are diseased.

The citizens of Iowa are deeply interested in the subject of insanity or such generous provisions would not be made for those disabled by mental derangement. Furthermore, it is realized by observation that this, the worst of maladies, may visit individuals or families who are least expecting it. In 1870, one person in one thousand six hundred and nine of the whole population in Iowa was insane; in 1880, the proportion was one insane to six hundred and thirty-nine sane persons; if we include the feeble-minded with the insane in the census of 1880, there was one unsound mind for every three hundred thirty-four sound ones. In 1890, when the next general census is taken, the percentage of the insane will be still greater.

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