At our meeting in April, 1903, it was determined to change the closets on that part of the female wards where it was impossible to properly ventilate them, these being three in number—each of the three stories of the building. This change gives us five additional beds and largely repays the money expended in constructing the closets. For years we have been asking the Legislature for an appropriation to erect separate buildings as a means of dissociating our tubercular cases from other patients. So far as our females are concerned, we have solved this problem for the present at a cost of about $350 by connecting the northwestern end of Vance Hall to the, small brick building, the second story of which has been heretofore occupied as a sleeping apartment for a number of outside employees. The connection is made by means of an iron bridge, which serves also as a solarium for the class of patients who occupy this small building, which is fitted also with closet and bath-room and properly heated. It will accommodate five or six patients, and is a neat, well-ventilated little home for this class of patients. Our carriage and buggy house for years has been a mere makeshift, and it was deemed wise to reconstruct and enlarge so as to make it capable of accommodating all of our vehicles.

During the past year, by and with the consent of our Executive Committee, a tenement-house was erected and is situated on the public road opposite our Hospital building. You will also observe, doubtless with approving eyes, our reconstructed front steps and walk, a change which has long been needed, and adds much to the appearance of the State's property and also contributes to the comfort of all who visit the Hospital.

Two of our iron smoke-stacks became disabled during the storm of September, and the third one would doubtless in the near future become disabled by long use, and, realizing the necessity of a more permanent stack, by conferring with the Executive Committee it was determined to be a proper and wise thing to erect a brick stack sufficiently commodious for present and future needs. This improvement cost $1,128. All the common labor was furnished by the Hospital.

Our kitchen was built when there were less than an hundred patients in the Hospital, and it was a matter of necessity to enlarge the building, but upon examination the walls were ascertained to be but nine inches thick; so your Executive Committee, with the advice of the architect, deemed it best to remove the building and build de novo using the brick of the old building in reconstructing. You will observe that we have a building 97 feet long, 30 feet wide and three stories high, with stone steps and slate roof. We have also thoroughly equipped the kitchen with what additional furniture was necessary. The first floor of this building is used as a kitchen and also a bakery and a small intervening room for storing wood. The second story is for an associate dining-room, and a room cut off as a store-room for female patients. The third story has a large room which will serve as an assembly-room, and has also a room cut off to be used as a storeroom for males. I hope you will inspect this building very closely, believing you will find it very substantially built and well adapted for its several purposes.

The State made no special appropriation for any of these improvements, but they represent the economy and good business management of your administration, which should find an expression of appreciation from the tax-payers of the State.

This completes the short recital of improvements for the past two years with the exception of a thousand and one minor repairs in the engineer's department and by our carpenter.

At our last December meeting it was my pleasure to inform you that this Hospital had on hand funds sufficient to erect a cold-storage plant, and also machinery to manufacture ice quite sufficient for the use of this Hospital for years to come. According to law, this fund not being contributed by the State, was entirely subject to your commands, and you had a right to use it for whatever purpose your judgment deemed best for the institution. Having failed, after repeated efforts, to secure an appropriation from the Legislature for a cold storage and ice plant for this Hospital, and believing that future efforts would meet with like failure, and believing further that such a plant was a necessity for an institution like this, you will remember that I recommended and advised your honorable body to use this special fund for the purpose above indicated. This money was the accumulation of the savings of several years in the manufacture of brick and in trucking by our Hospital force, and did not represent the gross but net proceeds of brick-yard and farm, and the amount was $3,511.76. I will state, that the cold-storage plant and ice factory have been duly installed, and works to our satisfaction. We believe it to be first-class in every respect, and cost $3,500. Thus, you will observe that without a special appropriation, nor by savings of money appropriated by the Legislature for any purpose, you have a $3,500 cold storage and ice plant installed in the institution over which you are the Directors.

For a more detailed statement of the cost of the several improvements the past two years I respectfully refer you to the report of our Steward.

In consequence of advancing years and feeble health, our Matron for twenty years or more, Mrs. E. J. A. Smith, retired from the service of this institution, which she had so long and faithfully served.

Legislative enactments pertaining to the government of hospitals for the insane, at the session of 1899, made the retention of the office of Matron contingent upon the wishes of the Board of Directors, and in pursuance of this law, at our last December meeting it was ordered that the office of Matron be abolished for the time at least and the duties thereof be performed by a housekeeper and storekeeper jointly. Mrs. Victoria Bryan, our former seamstress, was made housekeeper, and she performs all the in-door duties of our former Matron, together with daily visits to the wards, male and female. Miss Mollie Kennedy, our former chief laundress, was appointed storekeeper, and she performs all the outside duties heretofore performed by the Matron, including daily visits to the dining-rooms of the patients.

By consent of the Executive Committee, each of these employees receive $17.50 per month. Miss Martha Newell who has long served as assistant seamstress, was made seamstress, at a salary of $15 per month, without board, and our former female supervisor was made her assistant.

While these changes required one additional employee, there is no additional expense to the Hospital, and the changes result in more efficient and satisfactory service.

During the past two years, and especially during the past year, have had a great many changes in our Hospital force, and your Superintendent has had some difficulty in securing desirable employees in their stead. The successful management of an hospital for the insane largely depends upon the efficiency of employees who are concerned in their care, and when several such resign in close succession the worry and embarrassment of the Superintendent may be imagined. Such has been the conditions here during the past year. The present demands for labor are so great and wages having advanced, there comes to this office but few applications for ward service, especially from females. In other years my file was kept full of applications, but now there is not one on file from a female. With a knowledge of wages that obtain in nearly all the hospitals of this country, I will state for your information that the wage schedule in this Hospital is the lowest in most respects of any in this country, and I respectfully ask, your careful consideration of this question.

As already intimated, we need a building for the of 140 female patients, which will cost, by a very conservative estimate, $35,000, besides about $3,000 for furniture. Between thirty and forty females are now accommodated in one of our male buildings, and about twenty are accommodated in a room over our boiler-house. There is on file in this office a large number of applications for admission, but who cannot be admitted for want of room. At least sixty of this number ought to be admitted at once. You will thus see from these statements how imperative and urgent are our needs for more room.

In view of the above facts, and of the further fact that the Legislature four years ago recognized the necessity of giving this Hospital $30,000 for the erection of a building for the accommodation of female patients, I respectfully submit it is scarcely conceivable that the amount now asked for will be withheld. The plans and drawings for this building have been prepared by our engineer and architect, Mr. W. J. Matthews, and are offered for your examination and, if needs be, correction. We need an eighty-horse-power boiler, which, in position and set for use, will cost about $1,200. I again renew my request for a building with proper equipments for tuberculous male patients, which will cost about $2,500. For many years we have needed a spur from the North Carolina Railroad, opposite this Hospital, to our boiler-house, a distance of half a mile. The ground has been surveyed by a competent civil engineer, and his estimate of cost, exclusive of common labor furnished by the Hospital, will be $3,000. We will need sixty thousand dollars for maintenance and repairs of the Hospital for the year 1905; and if our new building for females is to be erected and prepared for occupancy the present fiscal year, we will need $65,000 for maintenance and repairs for the year 1906.

I again respectfully submit for your consideration the statement that these estimates are very conservative, and that our requests are most reasonable.

I again take pleasure in acknowledging the loyalty and intelligent helpfulness of my assistant physicians and all others who have assisted in the care and management of our humble and unfortunate population, and to commend to you the faithfulness and punctuality of our Executive Committee.

  Males. Females. Total. Epilepsy 3 1 4 Paresis 5   5 Tuberculosis 12 22 34 Bright's Disease 2   2 Exhaustion from chronic mania 11 13 24 Exhaustion from acute mania 1 5 6 No diagnosis   2 2 Enterocolytis 1 2 3 Dysentery   10 10 Died suddenly—no cause known 2 1 3 Pyemia 1 2 3 Apoplexy   3 3 Organic heart disease   7 7 Paralysis   1 1 Inanition   3 3 Syphilis of the brain   1 1 Pulmonary hemorrhage 1   1 Heart failure   1 1 Senility 1 1 2 Intersusception of bowel with perforation   1 1 Obstructed bowel 1   1 Abscess of lung with heart complication   1 1 Proctites   1 1 Cardiac asthma with complications   1 1           41 79 120

  Males. Females. Total. Less than one month 40 43 83 From one to three months 19 25 44 From three to six months 12 27 39 From six to twelve months 9 19 28 From one to two years 9 12 21 From two to three years 6 12 18 From three to four years 3 5 8 From four to five years 1 5 6 From five to ten years 6 5 11 More than ten years 3 2 5 Not known 5 5 10           113 160 270

  Males. Females. Total. Single 58 62 120 Married 48 78 126 Widowed 4 18 22 Not stated 3 2 5           113 160 273

  Males. Females. Total. From one to thirty days 2 9 11 From one to three months 4 10 14 From three to six months 8 5 13 From six to nine months 1 7 8 From nine to twelve months 1 5 6 From one to two years 9 8 17 From two to three years 1 7 8 From three to four years 2 3 5 From four to five years   5 5 From five to ten years 9 11 20 From ten to twenty years 4 7 11 From twenty to twenty-five years   2 2           41 79 120