males and females show that it would be impossible as well as impracticable to establish industries within the hospital walls and grounds akin to those in which the patients were engaged prior to commitment. It is quite apparent from a perusal of these lists that there are many trades and occupations which are not listed here, simply because among the patients considered certain industrial and commercial activities are not as common as among other people. Thus, among the males, there is to be found but a small number of patients who were employed in the building and mechanical lines, whereas there is a comparatively large number represented among the clerks, salesmen, tailors, clothing operators, and kindred or allied trades. The same difference is also found among the females. There were only eight domestics, though a considerable number of the single young women were foreign born, and a large number in the needle trades. The 185 patients indicated as being engaged in housework represent married women caring for their own households, not leaving their homes to become domestics or servants in the homes of others. The intent and purpose of the discussion of the trades and occupations of the patients will become more apparent in the last chapter of this work, for there thought will be given to ways and means of providing gainful occupation for discharged and paroled patients, as well as for those who may under unfavorable circumstances and conditions become so ill mentally as to make their commitment to a state hospital advisable. As pointed out above, the aim has also been to indicate the inadequacy of present accommodations and provisions in the state hospitals for the therapeutic treatment of patients through a sufficiently varied and interesting scheme of light occupations. VII. READMISSIONS TO STATE HOSPITALS One very important way properly to gauge the efficacy of the care and treatment accorded patients in state hospitals is to consider the proportion of patients that find it necessary to return to the hospitals from which they have been discharged or paroled, or taken home by relatives. There are necessarily a number of factors that enter into such a consideration, among them being the over-crowding in the hospitals, the ratio of officers, nurses, and attendants to the number of patients, diagnoses of the patients permitted to leave the hospital, and ease with which patients may be returned to the institutions. Of the 8,700 total admissions to the state hospitals for the year 1918, 6,797 or 78.1 per cent were first admissions; 1,903, or 21.9 per cent were readmissions.1 There was a marked difference between the readmission rates among the several hospitals; the Brooklyn State Hospital had a readmission percentage of only 16.7, largely because of the disproportionate number of senile cases quartered there, whereas there was a percentage of 28.4 of readmissions in the Middletown State Hospital." The readmission rates for the two hospitals which figure largely in this study, namely Manhattan and Central Islip State Hospitals, were 18.9 per cent for the former, and 21.4 per cent for the latter. Table 22 indicates the readmissions to the state hospitals of the Jewish patients, who were admitted to these institutions from Bellevue Hospital during the year beginning September 1, 1917 and ending August 31, 1918: 1S. H. C., 30th A. R., p. 278. • Ibid., p. 343. There were 512 first admissions and 278 readmissions. to the three state hospitals to which the patients were committed, showing a readmission rate of 35.2 per cent for the Jewish cases sent to these institutions from Bellevue Hospital. This percentage is considerably higher than the rate for the entire state hospital system, and also higher than the rate of readmissioins to the Manhattan and Central Islip State Hospitals. In view of these facts, it might be advisable to consider in brief the elements that possibly contributed to this greater percentage of readmissions among the group studied in this work. Several reasons have already been assigned for the return of patients to hospitals after they have once been discharged either as recovered or in an improved condition. There are, however, more specific and definite factors that can be held responsible for the high rate of readmissions that have been shown to be prevalent among the Jewish patients admitted to the state hospitals. It has been contended by some students of the subject that the cause of the larger pro Female. portion of readmissions among Jewish patients could be assigned almost entirely to the disproportionate number of certain of the psychoses appearing among these patients, particularly dementia praecox in all its variations, and also the several forms of manic depressive insanity.1 2 (a) High Readmission Rates Among Jewish Patients. In order to find what is probably the cardinal reason for the high readmission rates among the Jewish patients, it will again be necessary to revert to the figures for the state hospitals so as to have a basis upon which to make an accurate comparison. For the state as a whole, the per cent distribution among readmissions for the year 1918 was as follows: for dementia praecox the rate for the entire state was 31.2 per cent, with rates of 37.3 per cent for Manhattan State Hospital, and 35.0 per cent for Central Islip State Hospital; for manic depressive readmissions the rate was 36.5 per cent for the state as a whole, 36.6 per cent for Manhattan State Hospital and 33.1 per cent for Central Islip State Hospital. From the percentages presented in Table 23 it is seen that the Jewish patients contributed, in fact, a smaller percentage of readmissions of cases of dementia praecox than either the state as a whole or Manhattan and Central Islip State Hospitals, while they seemingly were responsible for a higher readmission rate among the cases of manic depressive insanity than that which prevailed throughout the state, or in Manhattan and Central Islip State Hospitals. In reference to the latter group, the rate of readmissions to the Manhattan State Hospital for the preceding year, namely 1917, was likewise 41.8 per cent, identical with the rate of Jewish readmissions for the year 1918. Table 23 indicates the percentages in summarized form: 1 S. H. C., 30th A. R., p. 376, for discussion of readmissions to all state hospitals. 'Ibid., p. 294. |