MINUTES OF QUARTERLY CONFERENCE DECEMBER 15, 1915 Minutes of the conference of State hospital superintendents and representatives with the State Hospital Commission, held at the Capitol in Albany, December 15, 1915. Present Commissioners MORGAN and MAY. Utica State Hospital, HAROLD L. PALMER, M. D., Medical Superintendent; SAMUEL W. HAMILTON, M. D., Senior Assistant Physician. Willard State Hospital, ROBERT M. ELLIOTT, M. D., Medical Superintendent; LOUIS T. WALDO, M. D., Senior Assistant Physician. Hudson River State Hospital, CHARLES W. PILGRIM, M. D., Medical Superintendent; MORTIMER W. RAYNOR, M. D., Senior Assistant Physician. Middletown State Homeopathic Hospital, Maurice C. AshlEY, M. D., Medical Superintendent. Buffalo State Hospital, ARthur W. HuRD, M. D., Medical Superintendent; GEORGE W. GoRRILL, M. D., First Assistant Physician. Binghamton State Hospital, CHARLES G. WAGNER, M. D., Medical Superintendent; Ross McCLure ChapmaN, M. D., Senior Assistant Physician. St. Lawrence State Hospital, PAUL G. TADDIKEN, M. D., First Assistant Physician. Rochester State Hospital, EUGENE H. HOWARD, M. D., Medical Superintendent; WILLARD H Veeder, M. D., Senior Assistant Physician. Gowanda State Homeopathic Hospital, CLARENCE A. POTTER, M. D., Medical Superintendent; CARL VON A. SCHNEIDER, M. D., First Assistant Physician. Mohansic State Hospital, ISHAM G. HARRIS, M. D., Medical Superintendent. Kings Park State Hospital, WM. AUSTIN MACY, M. D., Medical Superintendent; AARON J. Rosanoff, M. D., First Assistant Physician. Long Island State Hospital, ELBERT M. SOMERS, M. D., Medical Superintendent; ERVING HOLLEY, M. D., Senior Assistant Phy sician. Manhattan State Hospital, WILLIAM MABON, M. D., Medical Superintendent; George H. KIRBY, M. D., Director of Clinical Psychiatry. Central Islip State Hospital, G. W. MILLS, M. D., Senior Assistant Physician. Rev. EDWARD H. COLEY, Manager, Utica State Hospital. Miss BERTHA A. PECK, WILLIAM T. Morris, Fred J. MANRO, and Mrs. MARY S. GOODALE, Manager, St. Lawrence State Hospital. Mr. ALEXANDER MCKINNY, ALBERT E. KLEINERT and Very Rev. Mrs. JULIA KEMP WEST, and WHITMAN V. WHITE, M. D., Managers, Manhattan State Hospital. Rev. WILLIAM GARTH, Manager, Central Islip State Hospital. Dr. WALTER G. RYON, Medical Inspector. Mr. GEORGE A. HASTINGS, Executive Secretary, Committee on Mental Hygiene, State Charities Aid Association. The CHAIRMAN: order. The conference will please come to The first number on the programme to-day is a statistical comparison of operations and results in the several State hospitals for the year ending September 30, 1915, by Dr. H. M. Pollock, the Commission's statistician. (See page 168 of this issue.) The CHAIRMAN: The next on the programme is a paper on the standards of medical care in the State and licensed institutions by Dr. Walter G. Ryon, the medical inspector for the Commission. (See page 156 of this issue.) The CHAIRMAN: There will now be a discussion of the papers which you have heard to be conducted by Dr. Hoch. SUMMARY OF DR. HOCH'S REMARKS. Dr. Hoch said he was very much interested in the question of the discrepancies which Dr. Pollock had pointed out, and that it was important to find out what was the cause of them. They may be due: (1) To external unimportant factors, such as conditions of admission. (2) To mistakes in diagnosis (e. g., an arteriosclerotic dementia, or a dementia præcox diagnosed as general paralysis). (3) To an honest difference in diagnostic point of view (e. g., an involution melancholia diagnosed as manicdepressive, or a late dementia præcox as involution melancholia, an allied to manic-depressive insanity, as allied to dementia præcox). (4) To factors, an investigation of which might bring to light valuable information regarding questions of etiology or public health. The last point, of course, is the only one of any value, but in order to get that it is necessary to investigate first the other three. This should be done in order to make the statistics valuable. New York State has an unusually large number of cases available for statistical studies, cases which can be observed and diagnosed according to a uniform system. This represents probably a unique opportunity unequaled anywhere in the world at present. Therefore, every effort should be made to make these statistics comparable from year to year, and for the different hospitals among each other. Dr. Hoch stated that it had occurred to him to compare the results in the year 1914 and 1913 in each hospital, and the figures in the different hospitals for the year 1914 with each other, first not according to the specific diagnoses but according to a somewhat cruder classification, comparing a group in which all the organic mental disorders and one in which all the constitutional mental disorders were united, while the latter group was again sub-divided into that of the benign and non-benign constitutional disorders. This is useful (1) in order to arrange the mass of data; (2) because we might thus perhaps exclude mistakes in diagnoses or differences due to different diagnostic points of view. Tables were presented which showed these comparisons according to the grouping discussed. It was shown, among other points, that the figures of the organic group did not differ so much among the different hospitals as might have been expected, and that certain differences were readily explained by differences in the conditions of admission to the hospitals. However, certain striking facts stood out, such as the unusually high percentage of admissions of general paralysis to Gowanda, both in 1914 and 1913, which could hardly be accounted for by the conditions of admissions; again, the fact that Binghamton had an unusually small number of cases of manic-depressive insanity and dementia præcox at the expense of psychoneuroses and constitutional inferiority; and that an unusually large number of cases had been diagnosed as non-benign psychoses in Kings Park, which was due almost exclusively to the frequency with which the diagnosis of allied to dementia præcox is made. It was pointed out that both of these results, in which these two hospitals stood out among the others, were probably of somewhat the same origin-both depended on a diagnostic point of view which might be defended, but in regard to which a general agreement should be reached. It was suggested that at the end of each year each hospital try to study its results with a view of seeing what changes were taking place from year to year, and in what way the results differed from other hospitals in order to see whether these differences are due to the material or to mistakes or special points of view not shared by the rest of the hospitals. The CHAIRMAN: After this very interesting analysis of the statistics by Dr. Hoch, I am sure the superintendents and the members of the staffs who are here will be glad to explain and discuss the questions raised. Dr. HOWARD: Dr. Hoch seems to have covered that portion of the discussion so thoroughly that it would hardly be proper for us to try to elaborate it. Dr. Ryon came back to me and said he was sorry he had to rub it into Rochester so hard about the autopsies. I told him I would go as mild as possible on the other side of the question but the fact is that when hospitals are close to the heart of the community that they serve and cultivate a relation of friendly interest by relatives in patients during their hospital life and are courteous and considerate in making a request for autopsy at the time of death, and in fact bear the true relation of a State hospital to an intelligent and refined community such as we have in western New York, you will find the autopsy rate at Rochester is about right. You set a lot of young doctors at work to rival each other in how many autopsies they can hold in the course of a year, give them a free hand, and the wishes of the relatives have very little to do with it. Sometimes when the patient comes to the hospital and the family is in trouble, overwhelmed with great grief over such a sickness, and at the outset consents to autopsy in case of death this is put down on the record and then when death occurs the autopsy is done without further inquiry— that is the procedure, as I understand the case, practised by some of the doctors in the hospitals. The intention of the law is that when the patient dies, the relatives are to be consulted as to whether there will be an autopsy. Supposing you have a large proportion of patients visited often during the last sickness, and the relatives have the undertaker there promptly to give proper family burial, the autopsy proportion reduces itself to about the rate at Rochester. There is such a thing as carrying on this study to such a degree that the hospital does not serve the community as best it could. Dr. ELLIOTT: The Rochester State Hospital is not the only one that has had certain things rubbed into it. Dr. Hoch has given a very good analysis of these statistical data and has simplified to a considerable extent the discussion of them. He laid great stress on the fact that the proportion or percentage of organic cases received at Willard is very high. He coupled Willard with Long Island in regard to that feature. This I think can be explained satisfactorily. I have known for a long time that the proportion of this class of patients is high at Willard, and several years ago I made some investigations to find out the reason for it. A large proportion of the so-called organic cases. include patients who are advanced in years, particularly senile cases. Now, as is well known, the district from which patients come to Willard is extremely rural in character; it embraces nine counties which have an aggregate population of something like 400,000-about the same as the city of Buffalo. An interesting thing, too, is the fact that at least three of these counties have been steadily decreasing in population for several years. According to the reports of the United States Census Bureau the relative pro MAY-1916-D |