Appendix-lowa's Duty to the Insane.

focalized upon the next general assembly that no delay be permitted in meeting the demands of the hour in this direction.

The hospitals at Independence and Mt. Pleasant are now practically completed, except as it may be desirable to have attached infirmary wards for the sick and feeble, or to be used in case of contagious diseases. Sufficient appropriations should be made by the next general assembly to complete the hospital at Clarinda, thereby accomodating at least 400 more, and it seems almost criminal that there should be further delay in establishing a hospital in northwestern Iowa, and pushing it to completion as rapidly as the work can be economically carried forward. No reason seems obvious why this provision should not be promptly made. The howl of the demagogue for personal political aggrandizement of party purposes, as has sometimes been the case in the past by narrowminded and no-hearted men of all parties, should meet with the rebuke deserved, and the broad philanthropy and intelligent progress of this State should rally to the demands of the hour.

A section of land should be secured, and the opportunity afforded for all of its patients capable, to be employed in its early history in cultivating the soil or in aiding in the construction of the buildings, and in grading the grounds, as accommodation may be made for them from time to time. There is nothing more detrimental to the interests of any class than idleness, and we owe it to the large class of insane, not suffering acute brain disease, to take advanced steps in making arrangements for diversified industries, in connection with all of our hospitals. In a small way we have always done more or less in this direction, but by proper and well organized effort, and the facilities in the way of shops and tools, a great deal more may be accomplished, which will not only be useful in our domestic economy, but in relieving to a great extent the restlessness resulting from the monotony of non-employment. The advanced steps taken by other States, in making proper provision for all their insane, should act as a stimulus to Iowa. New York is not only making the necessary provision, but has, by its legislature, enacted a law prohibiting the placing of the insane in county almshouses. Vermont has practically done the same thing, and even Minnesota, on the north of us, younger and less wealthy, with its three hospitals, is providing for every insane person in the State. The comparatively new State of Nebraska has three institutions for the care

Appendix Iowa's Duty to the Insane.

of the insane, and Dakota two. Missouri has practically four and Illinois five, and is moving toward the construction of an additional one. California, on the Pacific, is providing for all of its insane. Thus we are surrounded by States making provision for all, or a much larger per cent than Iowa is doing, and with one hand stretched out to the Atlantic, and the other to the Pacific, the great heart of the Nation is rapidly enfolding within its comfortable retreats these unfortunate of God's children. No more patriotic or economic question at present occupies the attention of our people, right here in Iowa, and he who accomplishes most in pushing forward to an early consummation the needed accommodation and care of the insane of the State, will call forth the warmest encomiums of a grateful commonwealth.

While the homes for these people are being provided, a constant, persistent effort must be made to increase the efficiency of the working force of each hospital. It is frequently the case that we are compelled to employ as nurses and attendants young men and women from the country or town with no experience whatever. They may learn aptly and become valued employés; many, however, will not, and the weeding out process must continually go on. The training school in many institutions is doing much to educate proper attendants; but I feel that in connection with the medical department of the State University, there should be constructed a hospital and training school for nurses and attendants, who could have the advantages of lectures on anatomy, physiology and pharmacy, and practicable demonstration of the care of the sick at the bedside; and at the same time have the advantage of lectures, by the chair on mental diseases, adapted to persons seeking to enter the profession of nurses or attendants. By such a course of instruction we can have such material to draw from for attendants in our hospitals as will warrant the best possible efficiency, and guarantee that skilled and conscientious care which the superintendent of every hospital is constantly seeking for in each case placed in his charge.

The chapel exercises, the varied programs for amusements, the athletic exercises, the industrial departments, together with such wise medicament as will aid nature in the restoration of both mental and physical health, covers in general our course of treatment.

Appendix-Disposal of Sewage.

All individuals thus saved to themselves, their families and the community, not only escape the torture of chronic insanity with it; delusions confirmed for life, sometimes of a most distressing character, and most likely a lifetime expense to the county or State, but they become producers of wealth, useful citizens, and supporters of the family. Are not these two sides of the question sufficient to arouse the students of political economy on the one hand, and the philanthropists on the other? To you, gentlemen of this society, in your several committees, the people look for guidance in these matters, and for the formation of public opinion you are largely responsible. Is it too much to expect that your influence will be felt in the right direction? Whether by the side of the death-bed of the mother's darling, or when in the throes of agony, a republic was in danger, you have not been found wanting. I believe your sympathy and substantial support extends to, and will in all the future aid in maintaining by your voices and efforts, the sacred duty we owe to those for whom "the light of reason has gone out." and who thus beclouded can not appeal in their own behalf.

DISPOSAL OF SEWAGE.

EDITOR OF BULLETIN (1):-I have lately been reading a number of articles in various sanitary works and journals on sewers and sewage. The authors of these pose as sanitary engineers (?).

Their whole system is this: Given: A river or harbor: what grade must be established to run the sewage of a city into the water and so pollute it as much as possible for ten or twenty miles around?

Here is a city extending back from the waters of river or harbor for seven, eight or more miles; what grade is needful to dump the filth of the suburbs down on that part of the city, bordering on the water side?

(1) From the MONTHLY BULLETIN of the State Board of Health for March, 1891.

Appendix-Disposal of Sewage.

How many holes shall there be in the sewer, to permit the smell and gases to fill the atmosphere, and permeate the residences of the solidly built parts of the city?

That, in a nutshell, is what nine-tenths of these works and articles amount to.

And to do that class of work does not require a man of national reputation. An engineer capable of running a level and deciding on a gradient is fully competent to build such a filth conveyor.

The idea is all wrong that the filth of five miles, or a greater distance, should be run through the entire city, exposing the inhabitants of that part of the city nearest the terminus of the sewer to the contamination of the sewage of some one living half a dozen miles away.

Suppose the sewers all lead to the river or harbor, and the part of the city nearest the initial points of the sewers is attacked with typhoid fever. Would it be right, or is it right, to run all the excreta from the thinly settled part of the city so affected, down through the thickly built and inhabited portion, and float the typhoid germs out along the entire water front?

It seems to me as if each portion of the city has enough to do to keep itself in sanitary condition, without having to guard against the evils that another portion pours down on it.

Until an engineer arises capable of devising ways and means to district a city and have each district secure its own sanitation, without danger from another district, the present race of so-called sanitary engineers would do well to take in their signs, and call themselves just simply what they are, surveyors and civil engineers. JAMES L. LORING, C. E.

To the Honorable State Board of Health of Iowa: (2)

Having been requested to furnish a paper on SEWERAGE, the following remarks are suggested as the result of an endeavor to read as much as time would permit, the results of the experience of others.

In a former paper published in the BULLETIN of this Board your engineer suggested that the day must come when district sewerage must take the place of the sewerage of large areas, and he is glad

(2) Presented to the State Board of Health by James L. Loring, C. E. of the State Board, and ordered printed.

Appendix-Disposal of Sewage.

to notice that such influential journals as the Sanitary News, of Chicago, have in several later numbers advanced the same views. How best to accomplish this end is as yet a question, but discussion has commenced, and from a multitude of counsellors perhaps the wisdom of methods may be evolved.

Doubtless many ways will be devised, but science eventually triumphs, and even as this powerful agency has harnessed the lightning for man's daily use, so the same untiring research will arrange for his sanitary well being.

The sewerage system of nearly all the cities and towns of the United States is in its swaddling cloths.

Given: A city or town set upon a hill at the foot of which runs a stream of water; establish a gradient and thereon build a brickringed tunnel, or lay an iron pipe, thus forming a channel through which to discharge as rapidly as possible, water, which will run down hill if left to itself, and which shall be the carrying agent for the hourly accumulating filth of ten square miles of humanity. Is that sanitary engineering? It seems as if the veriest tyro at the eye-piece of an engineer's level could establish the grade, and a fairly skillful brick-layer build the tunnel.

But that is not all. Into the stream pours all the sewage, under the delusion that the water will purify everything it touches. Will it kill germs and bacteria? Have not the scientists who make these matters a study, demonstrated that the chill or cold does not destroy, but that only a certain heightened temperature can obliterate those organisms which propagate disease?

Let the case be taken of a city situated as is Des Moines, already grown to sixty thousand population, the greater part of whose waste goes into the rivers that bound two of its borders. One hundred and sixty miles from the Mississippi river this sewage is added to all that may flow down all along the current from far up in Minnesota, increased by all that the numerous towns and slaughterhouses below may choose to add, growing greater in volume every day. Will such a state of affairs be permitted to exist continuously? It is not to be believed; there must come a stopping place. This last year, and for four or five years past, but little rain has fallen. The river, that used so frequently to exceed its banks, has fallen so low that grass has grown, and cattle have browsed, in the