with little extension of building operations during the past. few years and with an ever increasing population and a proportionate increase in the number of cases of insanity committed to the already overcrowded state hospitals, the problem has become more aggravated each year.1

II. OVERCROWDING

The following table indicates the overcrowding of the state hospitals as conditions existed on June 30, 1918.2

TABLE 18. OVERCROWDING IN THE STATE HOSPITALS

1

1 Page, Charles Whitney, The Care of the Insane and Hospital Management, 1912; presents a discussion of the method to be followed in choosing a superintendent, his qualifications, duties, his official relation to officers and employees, etc.

'S. H. C., 30th A. R., p. 235. Also Hastings, George A., “Some Essentials of a State Program for Mental Hygiene," State Char. Aid Assn. Publication, no. 146, pp. 11-14.

1

crowded conditions before plans thus far developed by the Hospital Development Commission are carried out.' Among the more important recommendations of the commission are: A new state hospital at Creedmoor; enlarging the hospitals in and near New York City; securing a site for a new hospital in the metropolitan district in place of the abandoned Mohansic institution; the establishment of a psychopathic hospital in New York City; completion of a state hospital at Marcy near Utica; a more orderly method of making appropriations; better planning of institutions, and more preventive and research work.2

III. EXTENSION OF OBSERVATION PERIOD

3

Still another factor in the overcrowding of the state hospitals has been the shortness of the detention period in the observation wards of the municipal institutions. Patients brought to the psychopathic wards of Bellevue and other hospitals are not kept there for a sufficient length of time to permit those suffering from slight attacks to recover prior to their commitment to a state hospital. The reasons for this are two-fold; in the first place, the officers of the observation or psychopathic wards, particularly of the largest among them, Bellevue, to which came the cases considered in this work, have for a number of years been facing the same difficulty as the state hospitals, to wit, lack of sufficient accommodations. Were it possible to detain a number of the so-called hopeful cases for ten days or more until they had recovered from the attack which caused them to be

1 Survey, Jan. 26, 1918, p. 467, "Crowding in the Insane Hospitals." 'S. H. C., 30th A. R., pp. 235-236.

3Mason, Frank H., “Modern Hospital for the Insane,” Daily Consular Reports, Dept. of Commerce and Labor, no. 2264, May 22, 1905; gives an illustrated description of the reception hospital erected by the city of Munich, Germany, for the temporary care and treatment of incipient. cases. Dr. Emil Kraepelin was appointed director of this hospital.

brought to the psychopathic ward, in the majority of such cases commitment to a state hospital might have been avoided. It is quite apparent that such a plan would in practice amount to a working out of the psychopathic hospital idea within the limited confines of wards in municipal hospitals. Any means employed to decrease the crowded conditions of our state hospitals and at the same time aid in the early recovery of a number of patients would be welcomed by all interested in the proper care and treatment of the insane. The second reason for the short duration of the observation period lies in that provision of the Insanity Law which reads as follows: "In no case shall any insane person be confined in any other place than a state hospital or duly licensed institution for the insane, for a period longer than ten days." This of course makes it impossible for any municipal hospital maintaining a psychopathic service to detain an insane or alleged insane person longer than the period of time prescribed in the law, though an extension of this period, if limited to cases indicated, would undoubtedly result in much benefit.

Table 19 indicates that 47, or about 6 per cent of the patients were transferred to state hospitals within 24 hours after their arrival in Bellevue Hospital. It should be pointed out, however, that most of these were cases that were out on parole from one of the state hospitals and had been brought to the psychopathic wards of Bellevue Hospital for transfer to the institution from which they had been paroled. Among the others were a number whose parole period had expired and who had suffered a recurrent attack, necessitating their re-commitment to the state hospital, usually to the one in which they had been previously confined. There were 172 who were transferred within two days, 192 in three days, 129 in four days, giving a total

1Chap. 27 of the Consolidated Laws, "The Insanity Law," sec, 87.

TABLE 19. NUMBER OF DAYS SPENT IN PSYCHOPATHIC WARDS OF BELLEVUE HOSPITAL PRIOR TO COMMITMENT TO STATE HOSPITAL

of 540 or 68.3 per cent transferred within four days from the time of admission; 83 were detained five days, making the percentage 78.8 per cent of the total kept in the psychopathic wards less than one-half the maximum time allowed by law. Most of the 15 who were kept in the psychopathic wards over ten days were remanded to the hospital by some court for observation and examination, and the ensuing complications resulted in their detention one or more days beyond the ten-day period; the few remaining cases could not be transferred to a state hospital within ten days because of their mental or physical condition, or both.

Dr. Henry Maudsley was among the first to propose the erection of an observation hospital for the treatment of incipient mental cases in London. The purposes of this hospital were to be largely those assigned to psychopathic hospitals at the present time. In smaller communities, how

Female.

Male and

ever, where institutions of large size are unnecessary, psychopathic wards in the local general hospitals would often be the means of preventing insanity and accomplishing the early recovery of incipient cases, provided, of course, that the law was changed to allow a longer detention period than is at present prescribed.

Among the states making specific mention in their laws of the length of time patients may be kept in observation or psychopathic wards, California provides that the board of supervisors of each city or county must maintain a room or rooms suitable for the detention, care and treatment of alleged insane persons, for a period of not more than twenty days.1 The District of Columbia permits the detention of such persons in the government hospital for the insane or in any other hospital for a period not exceeding thirty days.2 Michigan allows for the detention in any hospital, home or retreat for not more than thirty days, except by special order of the court. In the State of Pennsylvania, persons. suffering from mental disorders may be committed for not more than thirty days to the psychopathic wards of hospitals for observation and treatment in the same manner as persons are committed to hospitals for the insane; but persons admitted to these wards who are found insane must be regularly committed and removed to a hospital for the insane within thirty days. Some of the more important advantages of such an extended period over the ten days allowed by law in New York State, may be summed up as follows: 5

3:

4

1Political Code of California, 1905, as amended by Laws of 1909, chap. 65, sec. 2167.

4

2 Revised Statutes of the United States, Act of 1904, 33 Stat. 316.

3 Laws of 1909, pp. 16, 185.

* Laws of 1911, chap. 855, sec. 2.

5 Briggs, L. Vernon, "What can be done for the Prevention of Insanity by the Treatment of Incipient Cases in General Hospitals,” Amer. Jo. of Ins., April, 1911, p. 660.