Social Aspects of the Treatment of the Insane

act of the legislature of this year. The attempt was made in the same year to put New York County under the State Care Act but the bill to convert the New York City Asylums into the Manhattan State Hospitals failed to become a law. The authorities of New York City at this time began to question the constitutionality of the State Care Act, insofar as under its provisions New York County had to pay not only for the care and maintenance of its own insane, but also had to contribute its share of the state tax. It should be noted that the tax had been paid for a period of nearly sixty years. However, the difficulty was solved and state care for all New York State consummated by the enactment of a law in 1896 covering New York County.3

The effect of the enactment and practical application of the State Care Act in New York was not only felt throughout the United States but influenced legislation along similar lines in countries in America and in Europe. The energy of those connected with the management of the state hospitals was fully occupied, during the first decade of state care (1890-1900), with the completion of the general frame-work of the system, with bringing the great metropolitan hospitals into it, and with establishing, at least in statutory form, the outlines of a coordinated and organized state system. This accomplished, the next decade was de

1 Laws of 1895, chap. 628, entitled An Act for the transfer of the grounds, buildings and equipment of the Kings County Lunatic asylums, with their inmates to the state, and for the establishment in lieu thereof of the Long Island State Hospital.

'New York City Dept. of Public Charities and Corr., Annual Report, 1894, p. 58.

*Laws of 1896, chap. 2, entitled An Act for the conversion of New York City asylums for the insane into a state hospital, and to establish the Manhattan State Hospital.

4 Hurd, op. cit., vol. i, p. 324.

State Com. in Lunacy, Annual Report, 1895, p. 7.

voted to developing the smooth and efficient operation of all of the state hospitals under conditions established by the new system. Due to the large number of insane cared for in state hospitals, it has been necessary to develop a system of smooth, efficient, and economical administration. It is the practical application of the State Care Act, as well as in the act itself, that many other states and countries have been interested.1

The benefits and achievements resulting from the enactment of the State Care Act in 1890 are not only numerous, but, as noted below, most important for the proper care and treatment of the insane:

Adoption, on July 1, 1890, of a new and improved form of medical certificate in lunacy, designed to facilitate the commitment of insane persons to institutions, and at the same time to provide the liberty of the individual with better safeguards against wrongful intent than had heretofore existed.2

Registration in the office of the commission of all qualified medical examiners in lunacy in the state, thus enabling the commission on receipt of a lunacy certificate to determine if the examiners signing the same are legally qualified to perform these services.3

Complete registration in the office of the commission of all persons held in custody as insane, whether in public or private institutions.*

Adoption of a uniform system of statistical returns for all hospitals and asylums, public and private.5

1 Folks, Homer, The State Hospitals at the Parting of the Ways, address at Buffalo, N. Y., Sept. 6, 1912, p. 4.

'State Com. in Lunacy, Annual Report, 1890, p. 125.

Provision for the transfer of patients from one institution to another, on the order of the commission, whenever for any sufficient reasons this may be deemed desirable.1 Regulation providing for the admission of private patients to state hospitals from any part of the state without restriction as to district, at a maximum rate not to exceed $10.00 per week. The rights of the other patients are protected by the provision that there shall be no distinction between public and private patients in regard to the scale of care and accommodations furnished them.2

Provision for the paroling of patients who are not regarded as homicidal, suicidal, or otherwise dangerous for a period of six months, during any portion of which they may be returned to the hospital without a new process of commitment. This permits patients whose condition warrants it to go home on trial before final discharge."

Change in the legal title of the state institutions from asylum to hospital.*

Division of state into districts dependent upon number of cases and accommodations.5

1 Recommendation for regulation relating to transfer of patients made by Com. in Lunacy in Annual Report of 1889. State Care Act of 1890 made such provision. See State Com. in Lunacy, Annual Report, 1893, pp. 75-76.

'State Com. in Lunacy, Annual Report, 1890, p. 30. State Care Act only contemplated the public or indigent insane. All pay patients were absolutely excluded from its consideration. This necessitated the issuance of the regulation. See State Com. in Lunacy, Annual Report, 1890, p. 82.

State Com. in Lunacy, Annual Report, 1890, p. 163. Recommendation first made that a law be enacted permitting patients to be disdischarged on parole.

Laws of 1917, chap. 335, extended parole period to not exceeding

one year.

* State Com. in Lunacy, Annual Report, 1890, pp. 15-16.

'Ibid., p. 25.

Provision requiring relatives who are legally liable to do so to pay at the rate of $10.00 per week or less.1

Abolition of spoils system in appointing medical officers through adoption of plan of civil service examinations.2 Maintenance of a training school for nurses made obligatory by amendment to law in 1895.3

Creation of a psychiatric institute at Ward's Island, with special courses of instruction for benefit of medical officers. at the various hospitals.*

Appointment of a medical inspector to visit and inspect the state hospitals and other institutions for the insane, and to examine all patients admitted, subject to the direction of the commission. All the state and private institutions are under the general supervision of the commission."

Abolition of mechanical restraint and substitution of prolonged baths and occasional seclusion for brief periods in treatment of violent and disturbed patients."

Segregation and special treatment of tuberculous insane." Establishment of a system of after-care of the insane in collaboration with the State Charities Aid Association." At the present time this work is carried on practically independently of the association by the State Hospital Commission.

Establishment of a bureau of deportation, to return to other states and countries deportable cases."

1 Laws of 1896, chap. 545, sec. 69; Laws of 1910, chap. 389, sec. 85.

• State Com. in Lunacy, Annual Report, 1890, pp. 93-94,

3 Ibid., 1896, pp. 124-125.

* State Com. in Lunacy, Annual Report, 1895, p. 104; Annual Report, 1896, pp. 75-79.

• Ibid.

• State Com. in Lunacy, Annual Report, 1901, p. 35.

" Ibid.

8 State Hospital Com. Annual Report, 1916, p. 121.

9 Laws of 1912, chap. 121, sec. 19.

Change in the name of the State Lunacy Commission to the State Hospital Commission.1

Promotion of the work of the State Charities Aid Association in opening clinics for nervous and mental diseases in the large centers, in cooperation with the medical staffs of the nearest hospitals.2 Though the original impetus to after-care and preventive work in this state came from the State Charities Aid Association, it never established any clinics of its own, except in the sense that the association urged their establishment and took some part in the physical arrangement thereof, as well as in the provision of social service workers. In the establishment and operation of the out-patient departments of the various state hospitals, the rôle of the association has been merely that of an interested, cooperating outsider.

V. RECEPTION OR PSYCHOPATHIC HOSPITALS

Between the years 1880 and 1890, medical men began to realize that in order to increase the ratio of recoveries among insane persons, radical changes would have to be made in the methods of treatment, especially insofar as acute cases were concerned. Dr. Frederick Peterson, subsequently Commissioner of Lunacy in New York, especially urged the desirability of the erection of psychopathic hospitals arranged for the treatment of acute mental cases." In 1888 the Commissioner in Lunacy reviewed the work of the pavilion for the insane in Bellevue Hospital, New York City, and found that one-fourth of the persons admitted at that time were discharged as not insane, as they were, for the most part, persons addicted to the excessive use of intoxicating liquors or drugs. This pavilion, however, now

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