DEAR SIR:—We herewith submit the report of Dr. James McKee, Superintendent of the institution which you have placed in our charge, and beg to call your attention to what we regard as urgent needs of this institution:

1. An annual appropriation for 1905 $ 75,000.00 For 1906 75,000.00 2. For Engineering Department, which includes three boilers, etc 17,500.00 3. Carpenter's house and equipments and dormitories for employees and laundry 8,500.00 4. For the purchase of land and erecting buildings for the increased accommodation of outside insane 90,000.00 5. Painting houses and repairs 3,500.00 6. For fencing 1,000.00 7. For reflooring portions of the house 1,800.00 8. Water rent for 1905 1,500.00 Water rent for 1906 1,500.00 9. Annual payment for lights for 1905 1,500.00 Annual payment for lights for 1906 1,500.00 10. For outstanding indebtedness 1,835.45   $280,135.45

While every best endeavor was made to avoid a deficit in accordance with law, we have been compelled to make a deficit on account of the condemning of the electric wiring in the house. To protect the property and patients against fire, connection was made with the Raleigh Gas and Electric Company at a cost of $1,000.

The undersigned committee, appointed by your respective bodies, beg leave to report the following:

We believe a certain and well-defined policy should be adopted by the State either to provide adequately for its insane citizens or decline to do so in unqualified terms. If the latter policy is followed, the authorities of the different counties, knowing they cannot depend on the State, will provide for their insane the best they can, and the insane will have some care that is now denied to many. Under the present plan the counties wait for the State to build and the State does not and thus the insane are left uncared for.

There is no need to discuss the humane or economical side of the question, for we assume that all are agreed that the public should undertake to provide amply for all the insane, especially those whose friends and relatives are unable to care for them.

It is well known that North Carolina has not erected enough buildings to house all its white insane, but it is not certain how many are in their homes, in jails and alms-houses or roaming the country at large.

The United States Census for 1900 does not enumerate the insane except those in State and Private Hospitals, and the census of 1890 was so notoriously and glaringly inaccurate in the enumeration of the insane that not the slightest credence is given it. The numerations of previous years are out of date and may be as worthless as that of 1890, but a study of the census of 1880 is interesting; the white population was 867,242, the insane 1,591, one insane person to every 545 of inhabitants; the negro insane was one to every 1,215. (Negroes under the foregoing should have room for 520; the whites room for 2,181. The negroes have room for 500; the whites room for 1,400. There are 20 negro insane on the outside to 700 white). We, therefore, must rely on the carefully prepared statistics of other countries and States. In more thickly populated countries there are slightly more than three insane persons to every 1,000 of population. Probably insanity is not so prevalent amongst our citizens, but we believe that two to 1,000 of white people in North Carolina are insane. The large number of applications on file in the offices of the two hospitals for white insane and the many letters of inquiries would seem to prove this number to be correct, but to be well within limits we will base our calculations on one insane person to 600 of white inhabitants.

North Carolina by the census of 1900 had 1,263,603 white inhabitants; 779,049 in the Western Hospital District and 484,554 in the Eastern. On the basis of one insane person to 600 inhabitants we had in the State in 1900, 2,106 insane; 1,298 in the Western District and 808 in the Eastern. The Western District increased in population during the decade 1890-1900, 148,269, or 14,827 per annum. The Eastern District 66,143, or 6,614 per annum. At the same ratio the population in the Western District for the past five years has increased 74,133, the insane 123; in the Eastern the increase of population for five years has been 33,070, the insane 55. If these estimates are correct there are in the Western District 1,421 insane persons, in the Eastern 863, or a total of 2,284 in the State. The Morganton Hospital has in round numbers beds for 1,000 patients, the one in Raleigh beds for 400. These estimates show the need for an increase of 421 beds at Morganton and 463 Raleigh, and also that in the Western District there is one patient cared for to every 853 inhabitants, and in the Eastern one to every 1,294. It appears from the foregoing that the Eastern District needs room for more. To equalize the two districts there should be at Morganton 129 patients from the East. The yearly increase of the white insane in North Carolina is about 36.

In accordance with the agreement of the two boards, 70 women were received from the East. On 22d of October there were 77 patients in the Hospital at Morganton from the East and 16 in the Raleigh Hospital from the West. It is plain that sending patients so far is expensive, and, everything else being equal, the Raleigh Hospital needs enlargement more than the one at Morganton.

It is our opinion that in consideration of the large number of insane outside the walls of the Hospitals, who are in need, and the difficulty and expense of providing for so many at once, that dotards, paralytics, idiots, imbeciles and epileptics for the present be excluded or accommodations prepared for them in other places.

Employment is the best remedy for insanity and farming is the best and most remunerative form of labor. It is estimated there should be an acre of land to every patient under treatment. The Hospital at Raleigh has felt greatly the need for land and this need cannot but grow greater as time goes on. We respectfully urge that this matter cannot be too strongly insisted on to the Legislature by your respective boards. Sufficiency of land is the one great means of reducing the cost of maintenance; it is not only a curative measure, but an economical one.

It is absolutely necessary to make more room for the insane at Raleigh. The cost for their maintenance will be materially decreased by the purchase of more land and a cheaper water supply. They now pay two thousand dollars per annum for water and for the rent of land, which represents the interest on a capital of forty thousand dollars at five per cent.

We again ask that attention be drawn to the large amount of tuberculosis in our midst, which we are helpless to combat with our insufficient accommodation for the tuberculous patients.

There is a great demand on the resources of the State for every purpose and these resources are limited. We for this reason recommend that at present you ask for accommodation for the insane on a basis of one bed in the Hospital for every 750 of population. This would require about one hundred and fifty more beds at Morganton and three hundred and fifty at Raleigh. This makes no allowance for the yearly increase, and will not, in our judgment, supply the demand, but by excluding the classes we think under the circumstances should be excluded, it may care for the curable, violent and troublesome cases. The beds at Morganton should be limited to men, because of the excess of accommodation for women, 600 to 400 men; the beds at Raleigh to be divided equally between the sexes.

The colonization of patients at Morganton has proved so efficient we recommend this be tried at Raleigh and increased at Morganton. If this be done more land will also be needed at Morganton. For obvious reasons it is better to have land joining the present holdings, but this is not essential; land more than three or four miles away can be utilized.

We respectfully call your attention to an effort that may be made to change the State's Prison into a hospital for the insane. We believe this would be harmful to the State's best interests, and we know it is not and cannot be made suitable for the innocent insane. The laws governing hospitals and the general subject of insanity could be amended in some particulars with advantage.

If the Legislature of 1905 should determine to provide to any large extent for the insane it would be the part of wisdom to appoint a competent commission to examine this great question in all its aspects before large amounts of money be spent. The best thought of this and all other countries should be studied and the wisest course adopted. There is a disposition to break away from the old plan of large, expensive structures to smaller, simpler, cheaper, and we believe, more efficient ones.

We feel we have a great State, and we are proud of it. We cannot but earnestly hope that this subject of caring for its insane so long neglected may be systematically taken up and treated in a business-like way. If, after discussion, the General Assembly believes the State cannot afford to erect any more buildings, then it should so declare. If, on the other hand, it thinks our people can further and adequately provide for them, then this should be dealt with in a plain, business-like way.

I have the honor to submit, by custom and law, the biennial report of the State Hospital at Raleigh for the two years ending November 30, 1904. To this report will be found annexed the Steward's, and the accompanying tables of receipts and expenditures, the reports of the Engineer, Carpenter, Gardener, Stock and Dairyman and Matron, all of which will inform you of the operations of the respective departments for this biennial period. At the beginning of this biennial period, December 1, 1902, there were in this Hospital, patients—164 males; 233 females; total, 399. The number of male patients admitted during this period was 180; females 148; total, 328. The total number under treatment during the bienneum, 725; number of deaths, 32 males; 25 females; total 57. Number discharged as restored, 113 males; 63 females; total, 173. The per cent. of restorations based on admissions was, males, 67; females, 42; average per cent. of restorations, 54; remaining in the Hospital December 1, 1904, 178 males; 202 females; total, 480. Seventy-two were declined for the following reasons: for want of room, being blind, forfeiting beds, being paralytics, epileptics, imbeciles and idiots. The number of deaths has been 57; of them 4 were over 70 years, 5 over 60, 11 over 50 years, 17 over 40 years, 14 over 30, 5 over 20 years, and 1 under 20 years. Only one patient died of an acute disease, that was pneumonia. Tuberculosis comes in as usual as the cause of the greatest number of deaths. And just here it is well enough to suggest the necessity of providing isolation, disinfection and treatment for these cases. Cheaply constructed houses, or, what is better, tents, should be provided for them that their time might be spent in the open air, and during sleeping hours get as much oxygen in their lungs as possible. When these cottages or tents shall have become so infected as to be unfit for use they can be burned, and the loss will be small. A rgeat many cases of recurrent mania have been discharged that will return.

While the mortality is greater than in the preceding two years, yet we should and do feel grateful that no unusual sickness or acute disease has prevailed on Dix Hill among the inhabitants.

We have had no accidents, but have been unfortunate in losing 168 head of hogs by cholera. The infection was probably brought in by a hog purchased, yet the hog pasture has been in constant use for forty-five years, and cholera has invaded it before. The herd is being replaced by purchases, which have been an unexpected draught upon the maintenance appropriation.