Quoting from the report of the Committee on Insane of the National Conference, Dr. Owen Copp, chairman, says:

There should be a certain policy for the care of the annual increase of the insane. We should have in mind the maximum limit of our hospitals, and when that has been reached a new one should be established. The maximum, so the best authorities say, should not exceed 1,500, and others say that the number should be less to attain the best results.

The hospital districts should not be immovable, but should be changed from time to time to meet the needs of our rapidly growing population—a growth which is necessarily not uniform in all sections at the same period. The real question is the care of the insane of the whole State in the most economical manner consistent with the best medical results.

The State Hospital Commission having thoroughly taken up the needs of the hospitals as to adequate room and equipment, we will simply call attention to the general need of increased maintenance funds to meet the increased number now in charge and those to be admitted upon completion of the buildings in course of construction.

This department, which occupies the western wing of the State's Prison, has outgrown its capacity. Thirteen are now in charge who must occupy prison cells at night. It was but a makeshift to meet urgent need of separating this class from the more tractable insane—a forward step for North Carolina—but the attention of the Legislature is respectfully called to the necessity of soon providing other quarters for this class. The wards are comfortable, but there are no facilities or space for outdoor life or occupation, those active factors in the proper treatment of the insane. The statistics show eight curse out of seventy-five patients during the year, with all the attendant drawbacks. We would recommend that this department and its needs be included in the general appropriation for the adequate provision for our insane, and that the Hospital Commission be requested to take up the question.

Reports have been received during the year from all jails except three and all County Homes except two, in regard to the mental defectives. The reports not coming promptly gives less value to these statistics, as some of the insane in the jails have doubtless since been transferred to the hospitals and a few from the County Homes. However, it shows about the average number passing through the prisons, those in such condition as to necessitate confinement at the Homes (and who should most emphatically not be there) and a large number who are harmlessly insane or feeble in mind and perhaps can with security be left where they are at present, though there is more or less danger, and our policy should be State care for all the insane.

There are ninety-seven epileptics reported in the County Homes. A number of those classed as insane in the jails are insane epileptics. The time will come—perhaps is here—when we should provide for the “care and treatment of epileptics”—not the epileptic who has lost all his opportunity in life for want of this care, and is already a dement and incurable, but for the class who are living in the community handicapped on every side and daily losing ground. The young especially—and this disease begins in early life—should be received and cared for in such a village. There are curse, though it is a disease which is not so well diagnosed and in the study of which many men are spending their lives, still the attacks are arrested and further brain deterioration reduced to the minimum. But to the State it will mean not alone the possible cures, but the cutting off of a large number of this class eventually by segregating such as should not return to the community.

Such a village should be entirely separated from the hospitals for the insane. In preparing for these classes we must look to future needs. It should be removed from any large city, though accessible to transportation facilities. It should have room to grow and should be developed under its own corps of officers, like such villages as Craig Colony, New York, Epileptic Village of New Jersey and many others.

The insane epileptic, the unfortunate for whom there is no hope of real improvement, would not properly come under this care; he can be cared for in a colony at the Hospital for the Insane. To so care for him will be a great relief to the institutions which have had to provide for some of this class to the detriment of other patients; so, also, many who are in the County Homes; but this is only custodial. It should be only for the classes who are not susceptible of much improvement, and the State village should give community life to epileptics, but so guarded as to protect them from injury—to alleviate, to teach, to cure, to make happier during their lives, and in so doing to protect the State.

There are twenty institutions caring for about 1,700 children. Most of these are in flourishing condition, and the children are properly fed, clothed and educated. The majority are under the control and subject to the inspection of their respective boards of trustees, and they in turn represent churches or fraternal orders, but several are under the sole management of an individual.

Every institution caring for helpless humanity, whether from defect or from unbalanced mind or from tender years, should be under the supervision of capable boards of trustees or other organizations, and in addition the State should have the right of inspection and visitation. It is a mistake to permit the existence of an institution caring for helpless children to depend upon the life of one person. No such institution should be chartered or allowed to open its doors for the reception of irresponsible waifs, homeless children, except it has satisfied the Board of Public Charities that conditions are fit, and when it has received a certificate from this board granting permission to receive children. Such is the law in New York and elsewhere.

We are of the opinion that the Legislature should not make appropriations to private institutions, except, perhaps, for some special reasons which might arise, and in no case unless the State has representation on the boards of management and unless the institution is subject to visitation and inspection of the State boards.

The financial and physical condition of the Prison are excellent. The death rate during the year was low, being 2⅓ per cent. upon the whole number in charge. Only two deaths from tuberculosis demonstrating the wisdom of outdoor life and the isolation of such prisoners as have contracted the disease.

According to the present law, the terms of all the directors end simultaneously every four years. The entire Prison régime, from superintendent to guards, is subject to arbitrary change. We therefore recommend that the directors of the State's Prison be appointed in like manner and for similar terms as the directors of the charitable and educational institutions, namely, by appointment of the Governor, by and with the consent and advice of the Senate.

Reports have been received from all jails except Halifax and Randolph and the new county of Lee, whose jail is in course of construction. A close scrutiny of the tabulated reports of the commissioners and the visitors' reports show these facts:

1. Bathing facilities range from none at all to hot and cold shower baths. As a rule, new prisoners are admitted without bath or change of clothing, and thus introduce vermin. If a bath were compulsory upon admission and the jail could own a few suits of clothing to be worn while the old clothes were being washed, the difficult problem of keeping the buildings in condition would be nearer a solution.

2. The old bucket system for the disposition of excreta is in use in sixteen counties. This should be replaced with sewerage and sanitary arrangements.

3. The daily cleansing of the cells or rooms required by law should be strictly enforced.

4. Two-thirds of the counties give three daily meals of wholesome prison fare and most of them furnish coffee once a day.

5. Twenty-nine counties report no religious services; others are ministered to by the local preachers, the King's Daughters and the Woman's Christian Temperance Union. This is a great lack, but is explained in part by the fact that a number of our jails are unoccupied for months at a time.

The reports of the county commissioners and those of the visitors are included in the annual report. Duplin, Madison, Montgomery, Haywood and Onslow have erected new buildings, those of Onslow and Haywood occupying new farm sites. Tyrrell's has been repaired and improved.

These institutions are required by law to make semiannual reports to the Board of Charities. The licenses of Broadoaks Sanatorium, Dr. Carroll's and Telfair Institute have been renewed. During the year Dr. B. B. Williams has been licensed to open Williams' Sanatorium at Greensboro and Dr. J. J. McKanna, of Reidsville, has obtained license. The Perfected Liquor Cure Institution at Greensboro has been discontinued. Telfair Institute has been removed from Asheville to commodious new quarters in Greensboro. The institutions in Greensboro were inspected before license was granted.

These private sanatoria, subject by law to the inspection and regulation of the Board of Public Charities, should be visited at least twice annually, and attention is called to the fact that no funds are appropriated for this purpose.

Questions and letters were mailed to seventy-five private orphanages, hospitals and other benevolent institutions. Many of them have reported, and show a great and growing work in the field of private charity. They embrace orphanages, hospitals for the sick and injured, homes for the aged, rescue homes, associated charities and other organizations for the alleviation of suffering and the uplift of humanity. Reports are included in the general report.

The Board is in the unfortunate position of having no direct appropriation, and therefore cannot inspect the institutions except at the time of meetings or as opportunity arises to the individual members. Regular semiannual inspections should be made in a systematic way, and can be done with a slight increase of funds and some liberty in expenditure. Three meetings have been held—one at Winston-Salem and two at Raleigh. Inspections have been made of the Hospital at Raleigh, the Dangerous Insane Department, the Penitentiary, the Soldiers' Home, the School for the Blind, the Department for the Colored Blind and Deaf, the Hospital at Goldsboro, the Williams Sanatorium and Telfair Institute at Greensboro, the County Home of Forsyth and the jail of Wayne. In addition have been visited the Odd Fellows' Orphanage and Odd Fellows' Home for the Aged and the City Hospital at Goldsboro and the Rescue Home at Greensboro.

The Board has lost by death two members—Commissioner W. F. Craig, of Marion, and Commissioner E. L. Haughton, of Pollocksville. Governor Glenn appointed Mr. Joseph G. Brown, of Raleigh, and Mr. Henry C. Dockery, of Rockingham, to fill out the unexpired terms.

In addition to the collecting of data by sending out blanks and inquiries at stated intervals, the heavy correspondence with the county boards of visitors (voluntary workers), the various reports made to Chairman and Board, and the individual cases of insane, orphans or wayward boys whose friends constantly consult the Secretary of the Board, there is all the other clerical work of the office and a constant call from all parts of the United States for information respecting our laws regarding institutions and sociological questions. This exchange of information from other States is a source of much help in arriving at proper and modern standards of care. Such inquiries are promptly answered. Fuller reports of the work can be found in the quarterly reports made to the Board.

The Library has acquired by gift a number of valuable books during the past year.

Special attention has been given to the subject of tuberculosis in county institutions. The blanks sent out to the commissioners and other officials included the law for the separation of the prisoners from other inmates, and the rules for their care, compiled by Dr. Lewis, of the Board of Health.

This noted body met at Richmond, Va., May 6th to 13th. The Secretary attended as a delegate, duly appointed by Governor R. B. Glenn. Section meetings were held in the mornings, great public sessions in the evenings and institutions were visited in the afternoon. The Penitentiary, the Industrial School for Boys at Laurel and the Hospital for the Colored Insane at Petersburg were visited. The Secretary was honored by being invited, with several other members of the conference, to receive with Governor and Mrs. Swanson at the mansion at a reception tendered the conference. Leave of absence was granted by the Board, the Secretary defraying her own expenses.

Many new members have been added to our list of visitors, and others who will be sadly missed have been called to their reward. The earnest co-operation of these boards in the counties, working without compensation, has resulted in vastly improved conditions and a higher standard of care. We desire to publicly thank them for this efficient service.

Acknowledgments are due Dr. R. H. Lewis for interest and assistance, to the Governor and the State officials for aid and sympathy. The State owes the Chairman, Commissioner W. A. Blair, a debt of gratitude for his whole-souled interest and prompt attention to the details of the work, and to all the members for their interest in the work, which they receive no monetary consideration. With my personal thanks to the Board,