relief of the mentally sick. Recoveries of acute mental cases depend to a great extent upon the nature of the initial care. Such care, as described above, can be given in a psychopathic hospital; and the agitation for these institutions will continue until efforts in this direction are crowned with success.

VI. HOSPITAL DEVELOPMENT COMMISSION

The urgent necessity for relief of the overcrowded conditions existing in the state hospitals prior to 1914, and since aggravated by the war,1 became apparent to the legislature in 1917, when Chapter 238 was passed. This law created the Hospital Development Commission and authorized large expenditures for new buildings.2 The measure in brief provides for a survey of the state hospitals for the insane, the development and adoption of a plan to provide for the present surplus and the future increase in the patients, and directs the commission to recommend to the legislature each year the appropriation necessary to complete one-tenth of the entire hospital development plan. The measure also provides for the investigation of the problem of the care of the feeble-minded and the development of a plan for its solution.3

1 During the year 1916-1917 only 27 patients were deported, less than 7 per cent of the number deported under normal conditions. (29th A. R., S. H. C., p. 166.) During the year 1917-1918 the total number of aliens deported was 53, as compared with 825 in 1914. (30th A. R., S. H. C., p. 77.)

'Hospital Development Commission to consist of State Engineer, Chairman of State Hospital Commission, State Architect, Chairman Senate Finance Commission, Chairman Assembly Ways and Means Committee, two members to be appointed by Governor, one member of Legislature, who shall be a minority member of one of the financial committees of Legislature, to be named by Minority leaders of Senate and Assembly.

8 29th A. R., S. H. C., pp. 50-51.

3

Shortly after the organization of the commission,1 the State Charities Aid Association brought to the attention of the members of the new body the fact that the establishment of psychopathic hospitals is an important part of any complete program for the care and cure of the insane.2 In its report to the legislature of February 18, 1918, the Hospital Development Commission recommended the establishment of a psychiatric hospital on Manhattan Island, and gave its reasons for this action, outlining very briefly the nature and purposes of such an institution. After the submission of this report the Committee on Metropolitan District of the Comission continued its visits and studies of all the existing psychopathic hospitals in the United States. These continued investigations strengthened the committee's conviction that a psychopathic hospital was urgently needed on Manhattan Island as part of the state hospital system. The committee prepared a report detailing plans which, in its judgment, should be followed in organizing such an institution.

1

The purposes of the institution should be: 4

(A) Treatment-To reach persons suffering from mental disorders in their early and often curable stages, and lead them back to mental health without the sup

1 In the constitutional convention held in 1915 the proposal was made that a 20-year program be provided for the development of the state hospitals, in order to remove these institutions from the field of politics. (N. Y. Constitutional Convention, 1915, Revised Record, pp. 28832885.)

' Memorandum submitted to the Hospital Development Commission by the Committee on Mental Hygiene of the State Charities Aid Association, November 1917. This contained a concise and forceful statement of the problem and ways of meeting it, etc.

'N. Y. State Hospital Quarterly, August 1918; Mental Hygiene, Jan. 1919, p. 113.

posed stigma of legal commitment to an asylum for the insane. Entrance to be made easy. Many cases would thus be saved from prolonged stays in a state hospital.

(B) Research-To develop, through study and research, more and more methods, by which mental maladies may be prevented or recognized in their early stages, and by which they may be successfully treated.

(C) Teaching-To endeavor to spread abroad a better knowledge and understanding of mental disorders, with a view of securing effective cooperation in coping with them

(D) Service to State Hospitals-To serve as a place where each new plan of treatment that is seriously proposed shall be studied and tried out, with a view

to its introduction, if found worthy, into the other institutions of the system

Legislation seems to have assured the eventual establishment of a state psychopathic hospital in New York City, long advocated as an urgent need to round out the system of state care of the insane. The chief results that may be hoped for as a result of this legislation are as follows:

(A) Such hospitals will help check the present rapid increase in the number of insane by heading off the stream at its source.

(B) Such hospitals, by preventing and curing cases of mental disease in incipient and early stages, will prevent their becoming chronic insane patients, and will save the state the expense of continuous care of chronic cases for a long term of years in regular state hospitals.

(C) These hospitals, by receiving and caring for recent

and acute cases of insanity, will diminish the numbers annually committed to the other state hospitals, and so will relieve the overcrowding in these hospitals.

An expenditure of $700,000 was authorized by the legislature in 1920 for the construction of buildings and the development of the grounds of the new psychopathic hospital.1 Plans have already been drawn by the state architect for a state psychopathic hospital in New York City, for which it is hoped the city will be persuaded to provide a site. These plans have been considered by the Hospital Development Commission and are now being studied by the commission's medical committee and other medical experts. If they are approved by the commission, it is likely that an effort will be made to hasten the erection of this most important adjunct of the state hospital system.

In the foregoing pages the attempt has been made to present an outline of the most important phases of legislation affecting the insane in New York State, and to lay the background and prepare the field for a further consideration. of the problems involved in dealing with this group of the state's charges. The following chapters will consider a large number of cases of insanity as at present handled, and will indicate the social implications of the problem as a whole.

1 Laws of 1920, chap. 860.

CHAPTER II

INSANITY AS A COMMUNITY PROBLEM

I. CASES STUDIED

THE Cosmopolitan nature of the population of New York City makes it the most fertile field of study for the group of cases under consideration. Material for both social and clinical observation is found here in abundance, and it is because of these facts that this study is limited to a particular group of cases, namely, the Jewish patients admitted to the psychopathic or observation wards, male and female, of Bellevue Hospital during a twelve-month period. The writer has had unusual opportunities to observe and work with Jewish psychopathic cases for several years and it is his hope that out of such studies and observations as he and others in this field may be able to make and record, methods in the social care of the insane may be formulated and made the basis of further studies, as well as used as guides in the social care of the insane, irrespective of race or nationality.

II. INCIDENCE OF INSANITY AMONG JEWS

(a) In European Countries. For years it has been maintained by the psychiatrical world that the Jewish race contributed more cases of insanity than any other race.1 Of late years, however, some investigators in this field have

'Brill, A. A. and Karpas, M. J., "Insanity among Jews," Medical Record, Oct. 3, 1914, pp. 576-578.

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