hydrotherapeutic work. Such methods should be extended to other institutions. During the year in these institutions, 38 patients were placed in restraint and 3 in seclusion. Restraint measures were adopted at eight and seclusion used at but two of the houses, the remainder using no such methods of treatment. While the forms of restraint were those prescribed by the State Hospital Commission, it is my opinion that such measures of treatment should be abolished entirely in the licensed institutions. A closer relationship should exist between the State hospitals and the licensed institutions. The physicians of the latter should feel free to visit the Psychiatric Institute and the State hospitals and attend the inter-hospital meetings held from time to time at the several State hospitals, and thus familiarize themselves with modern psychiatric methods and with the work that is being done. In this way the standard of care in these institutions could be improved, and the medical work put upon a higher scientific plane than now exists. All are interested in the same special work; all hope for the best results, and therefore all should work together for the best standards. A STATISTICAL COMPARISON OF OPERATIONS AND RESULTS IN THE SEVERAL STATE HOSPITALS IN 1915 BY HORATIO M. POLLOCK, Ph. D., Our fourteen civil State hospitals under the leadership of our Commission form one department — one great unified system for the care and treatment of the insane in the State. We are all deeply interested in the success of every branch of the work, and through these conferences and through our labors to promote a common cause, we have become fellow-workers instead of rivals. We discuss proposed changes and modifications of our hospital system on a common level, and each willingly shapes his own work to accord with the prevailing opinion. In view of this unity of interest and purpose, the differences in the classification and results of the treatment of the insane in our several State hospitals as shown by statistical reports published from year to year have given rise to much comment, and we are led to inquire more particularly concerning the nature and cause of these differences. The unit of our system is the State hospital, and the unit with which we deal is the individual patient. The State hospitals in their organization and plan of work are quite similar, but each hospital has a plant and equipment unlike the others, and each has its own traditions and its own peculiarities of management. All of the superintendents have been long in the service, and through experience and study each has evolved a system of management adapted to the needs of his institution. Likewise the other responsible officers of each institution through long service have developed a working system of procedure within their own domain. The officers of each institution naturally have their peculiar interests and are sometimes led to emphasize one phase of their work more than another. They also have Hospital their own conceptions of the various mental diseases which come to them for diagnosis. The units with which we deal, the individual patients, are not a homogeneous class. They are of all races and of all sorts and conditions, and afflicted with diverse diseases. Moreover, patients from the various sections of the State vary widely in their mental and economic status. In some sections we have a rapidly increasing population; in other sections, a stationary or diminishing population. These and many other factors naturally cause differences in results in the several State hospitals. Some of these differences are entirely beyond our control, while others can be changed by a shifting of emphasis or point of view. We have placed in your hands a series of tables giving comparative results in the several State hospitals, most of the figures given relating to the last fiscal year. We shall now take up these tables in order and refer briefly to some of the striking points of difference found therein. TABLE No. 1. ADMISSIONS TO THE STATE HOSPITALS DURING THE YEAR ENDING SEPTEMBER 30, 1915 Number Per cent of total patients Per cent Table 1 shows a relatively large number of admissions to the metropolitan hospitals. The four metropolitan hospitals had on September 30, 1915, a total of 15,092 patients, or 43.9 per cent of the whole number in the hospitals; the first admissions to these hospitals numbered 3,684, or 59.4 per cent of the total first admissions, and the readmissions thereto numbered 970, or 56.1 per cent of the total readmissions. The first admissions to the metropolitan hospitals amounted to 24.4 per cent of the hospital population; while those to the up-State hospitals constituted but 13.1 per cent. The readmissions to the metropolitan hospitals formed 6.4 per cent of the total patients, while in the up-State hospitals they formed but 3.9 per cent. In Long Island State Hospital the number of first admissions was 45.1 per cent of the total patients, and the number of readmissions 7.8 per cent. These percentages are higher than those of any other State hospital. Compared to the census population of September 30, 1915, Long Island had relatively 5.7 times as many first admissions as had Binghamton. Willard and Middletown also had comparatively low percentages of first admissions. A high rate of admissions compared with patient population is clearly an indication that the hospital is inadequate for the district it serves. Is it not also true that a hospital having a high rate of admissions should have a higher ratio of physicians to patients than one having a low rate of admissions? Comparing the percentages of first admissions and readmissions as based on total admissions, we find that Middletown and Binghamton have the highest percentages of readmissions, while Long Island and Central Islip have the lowest. Table 2 compares the voluntary admissions to the several State hospitals. Hudson River had the highest number of voluntary cases, but in ratio of voluntary admissions to population and to total admissions, St. Lawrence heads the list. The voluntary cases admitted to Kings Park and Central Islip are low compared with the others. |