RE-EDUCATION OF INSANE

While no school for the re-education of dementia praecox cases is maintained, much special attention has been given to this class of patients. The great amount of labor required in building construction, extension of lines, grading, clearing land, and other out of door work about a new and incomplete institution makes imperative the re-education and training of as many deteriorated patients as possible for such work. It has therefore resulted that a considerable number of patients showing marked mental deterioration, who, when the effort to employ them was first made, were so inattentive, confused and indifferent as to make practical results seem out of the question, have by persistent effort been so improved as to co-operate with others, carry out instructions, and to a limited extent show some initiative, thus demonstrating the value of practical employment as a re-educational measure, and at the same time accomplishing something worth while for the institution.

AMUSEMENT AND RECREATION OF PATIENTS

The usual recreations and entertainments have been provided for the patients during the year. These consist of books, periodicals and various games for the wards, baseball, handball, and other out-of-door sports for the airing court, with an occasional excursion into the nearby woods and blueberry tracts, or to the circus or county fair, for a limited number to whom such privileges can be extended. Motion pictures, phonographs and the hospital orchestra furnish frequent entertainment in the assembly hall, and the orchestra furnishes music during dinner on Thanksgiving Day, Christmas and other holidays. In addition an occasional entertainment is given by professionals, but the opportunity for securing professional entertainers is limited.

NOTEWORTHY OCCURRENCES

There have been no escapes nor suicides. Four accidental injuries occurred during the year, none of them of a serious nature. One patient fell and fractured his wrist, another his clavicle, and one patient suffered a fracture of three ribs, the result of falling

across a bed. Another patient, who had for years been employed about the woodworking machinery, caught his hand while assisting the carpenters. As is so often the case with such accidents everywhere, he was unable to give a very clear account of it. The index and little fingers of the right hand were so badly mangled that amputation was necessary.

NEEDS FOR THE COMING YEAR

The hospital is most in need of more room, as the overcrowding is about 43 per cent.

CHANGES IN THE PERSONNEL OF THE MEDICAL STAFF

October 1, 1913, John R. Ross, M. D., appointed first assistant physician.

April 1, 1914, Roger Dexter, M. D., promoted from assistant to senior assistant physician.

October 1, 1913, Harold R. Robert, M. D., appointed medical interne.

March 4, 1914, Lloyd T. McNulty, M. D., appointed medical interne.

January 15, 1914, Frank E. Spencer, M. D., assistant physician, resigned to accept a similar position at Matteawan.

OTHER ITEMS OF INTEREST

A new wing is being constructed and will be ready for occupancy within a year. It will accommodate approximately 100 additional patients.

TWENTY-SECOND ANNUAL REPORT OF THE STATE CHARITIES AID ASSOCIATION TO THE STATE

HOSPITAL COMMISSION

To the State Hospital Commission:

In accordance with Chapter 635 of the Laws of 1893, and amendatory acts, the State Charities Aid Association herewith respectfully submits to your Honorable Commission its twentysecond annual report. The report contains, as usual, much matter which is not new to those to whom it is addressed, but which it seems to us desirable to include for the benefit of the large number of persons to whom it is sent, most of whom are not so well informed.

The Association's legally appointed visitors to the State hospitals now number 36. They have continued to do efficient work during the past year and have presented interesting annual reports, brief summaries of which are included herewith.

The Committee on Mental Hygiene has continued its work for the prevention of insanity in New York State, a report of which is given on page 454.

APPROPRIATIONS

The direct appropriations for the yearly maintenance of the fourteen State hospitals for the civil insane for the year beginning October 1, 1914, were reduced by the extraordinary session of the Legislature last May more than $200,000 below the minimum which the State Hospital Commission and the State hospital superintendents had estimated as necessary for the proper management of the hospitals and the maintenance of high standards. of care and treatment. A further blow to the service was the retention in the State treasury of one-half of the money received from reimbursing patients, all of which had hitherto been reappropriated to the State Hospital Commission. Instead of reappropriating the entire amount, $550,000, for distribution among the hospitals according to their needs, only $275,000 was so returned. In accordance with precedent the State Hospital Commission had already apportioned the entire $550,000, to the different institutions and the hospital superintendents had made up their

budgets for the year accordingly. This unexpected and unwarranted cut in the amount allowed the State hospitals for the remainder of the fiscal year ending September 30, 1914, resulted in the discharge of many attendants, some medical officers, and in placing other employees at a lower grade of work, at lower pay, and in withholding the commutation allowance from many others. The position of attendant is not an attractive one, and it is with great difficulty that a sufficient number of well-qualified employees are secured. The uncertainty occasioned by this failure to make financial provision for keeping full forces of attendants will make the task of securing employees very difficult. This reduction in the medical staff means that the patients will receive just so much less medical care and attention, thereby reducing to that extent the probability of cure. Consequently the attempt to save the State some money by not appropriating the full $550,000 of so-called board money will increase the burden of the State, lower the standards of care and treatment, and result in a larger number of individuals remaining in the institution uncured.

The failure to make adequate appropriations this year will result in delaying the development of the out-patient departments and mental dispensaries, as well as checking the after-care and parole work, all of which have been frequently urged as the most effective measures in the prevention of insanity. This means that instead of attempting to solve the great problem of insanity in New York State by promoting those preventive measures which already have been demonstrated to be effective and well warranted, the Legislature has adopted the short-sighted policy of cutting down expenditures so extensively that standards of care must be lowered and preventive measures must be laid aside for another year. It also means that New York State will soon be obliged to surrender its title of affording the best care and treatment for its insane of any State in the Union.

LEGISLATION

Two bills of great importance, drafted by the Committee on Mental Hygiene with the approval of the State Hospital Commission, were introduced at our request, passed and were signed

by the Governor. One of the bills authorizes the reception by the State hospitals of patients alleged to be insane for a ten-day period of observation and treatment while their formal commitment papers are being executed. Such patients are to be received by the superintendents of the hospitals upon the request of the health officer of the district where the patient lives. This provision will be of great value in the rural communities located conveniently near the State hospitals. It is often very difficult in these localities to provide suitable care for a disturbed patient while the medical examination and legal commitment are being made. The emergency commitment law enables the hospitals to receive disturbed patients as soon as the medical examination is completed without waiting for the action of the court, but the tenday observation law enables them to receive any case on the written request of a health officer. This will result in many mild cases being received in the hospital for observation and treatment which will either clear up during the ten days or improve sufficiently to sign a voluntary admission request, thus obviating the necessity of legal commitment.

The second bill places upon the State Hospital Commission the duty of seeing that the insanity law is enforced. The Commission is instructed to inspect all places caring for the insane temporarily or permanently, with the exception of Pavilion F of the Albany General Hospital, and to make recommendations for the improvement or alteration of these institutions. If such recommendations are not carried out by the authorities in charge of these institutions, the Commission is authorized to appeal to the Supreme Court for an order directing the authorities to make the changes recommended, after an opportunity has been given them to be heard in their own behalf. The law also authorizes the Commission to employ an addition medical inspector to carry out these provisions.

The Governor's veto was secured for two very objectionable bills which passed the Legislature the last day of the special session under an emergency message from the Governor. One of these bills provided for the sale of the site and present preliminary buildings of the Mohansic State Hospital. The other provided for the purchase of a new site for a new hospital at a cost not