MINUTES OF QUARTERLY CONFERENCE MARCH 15, 1916 Minutes of the conference of State hospital superintendents and representatives with the State Hospital Commission, held at the Capitol in Albany, March 15, 1916. Present Commissioners MORGAN, MAY and HIGGINS. Utica State Hospital, HAROld L. Palmer, M. D., Medical Superintendent; C. A. MOSHER, Steward. Willard State Hospital, ROBERT M. ELLIOTT, M. D., Medical Superintendent; FRANK L. WARNE, Steward. Hudson River State Hospital, CHARLES W. PILGRIM, M. D., Medical Superintendent; GEORGE R. FINTON, Steward. Middletown State Homeopathic Hospital, MAURICE C. ASHLEY, M. D., Medical Superintendent; HENRY J. LEONARD, Steward. Buffalo State Hospital, ARthur W. HurD, M. D., Medical Superintendent. Binghamton State Hospital, CHARLES G. WAGNER, M. D., Medical Superintendent; EDWARD S. GRANEY, Steward. St. Lawrence State Hospital, RICHARD H. HUTCHINGS, M. D., Medical Superintendent; RAYMOnd L. Cooley, M. D., Medical Interne; LEWIS WEBB, Steward. Rochester State Hospital, EUGENE H. HOWARD, M. D., Medical Superintendent; CALVIN L. WEST, Steward. Gowanda State Homeopathic Hospital, CLARENCE A. POTTER, M. D., Medical Superintendent. Mohansic State Hospital, ISHAM G. HARRIS, M. D., Medical Superintendent. Kings Park State Hospital, WM. AUSTIN MACY, M. D., Medical Superintendent; CHARLES S. PITCHER, Steward. Long Island State Hospital, ELBERT M. SOMERS, M. D., Medical Superintendent; JAMES A. COTTER, Steward. Manhattan State Hospital, WILLIAM MABON, M. D., Medical Superintendent; GEORGE P. WATSON, Steward. Central Islip State Hospital, M. B. HEYMAN, M. D., Assistant Superintendent. Mattewan State Hospital, R. F. C. KIEB, M. D., Medical Superin tendent. Bloomingdale Hospital, WILLIAM L. RUSSELL, M. D., Medical Super intendent. Miss BERTHA A. PECK, Mr. WILLIAM T. MORRIS, Managers, Willard State Hospital. Mr. ALLEN W. CORWIN, Manager, Middletown State Homeopathic Hospital. Mr. PHILIP G. Schaefer, President Board of Managers, Buffalo State Hospital. Mrs. ANNIE Devereux MilLS, Manager, Binghamton State Hospital. Mr. PETER W, NEEFUS, Manager, Gowanda State Homeopathic Hospital. WILLIAM D. Granger, M. D., Manager, Mohansic State Hospital. Very Rev. JOHN C. YORK, Secretary Board of Managers; Mr. ALBERT E. KLEINERT and Mr. MATTHEW J. TOBIN, Managers, Kings Park State Hospital. Mrs. JULIA KEMP WEST, Secretary Board of Managers, and Mr. CHARLES V. FORNES, Manager, Manhattan State Hospital. Dr. WALTER G. RYON, Medical Inspector. JOHN L. VAN DE MARK, M. D., Deputy Medical Examiner, Bureau of Deportation. Mr. CHARLES B. Dix, Inspector of Buildings and Engineering. Commissioner MORGAN, (in the Chair) The CHAIRMAN: The conference will please come to order. The first number on to-day's program is a comparative study of the cost of maintenance of the inmates in other State hospitals by Mr. McGarr. (See page 186 of this issue.) It is usual to have a discussion on papers. Is there any one here who would like to ask questions? If so, Mr. McGarr would be pleased to answer them. Or, if anyone has any views on the subject we should be glad to hear them. If there is no discussion, we will proceed to an informal discussion on the maintenance cost in the different State hospitals. (There followed a prolonged detailed discussion of maintenance costs in the several hospitals.) Commissioner MAY: (in the Chair) The report of the committee on Rules and Regulations will now be received. Dr. SOMERS: The Committee on Rules and Regulations met to-day to consider communications which had been referred to the committee from the Employees' Association, sent to the Commission and turned over to the committee, relative to the washing of uniforms of ward employees, and the committee adopted the following resolution: RESOLVED, That wherever ward employees, who live outside the hospital, are directed to wear washable uniforms, that the hospital shall launder them without expense to the ward employee." Commissioner May: Was it the intention of the committee to limit that to those who are required to wear them? I understood Dr. Mabon to say where such uniforms were required by the hospitals they were to be laundered by the State without expense to employees. Dr. SOMERS: I think that is the case where it is recommended by the superintendent of the hospital. Dr. HUTCHINGS: Does that change existing regulations regarding employees living off the grounds and receiving commutation? Dr. SOMERS: No; except with regard to washable uniforms. The change is made to meet the views of employees who live outside the hospitals and who work with filthy patients and are required to wear washable uniforms. Commissioner MAY: That brings out the point; if the employees are required to wear such uniforms they should be laundered in the institutions, but it should be limited to uniforms which are required to be worn. Dr. HUTCHINGS: I move the adoption of the resolution as read. The motion was duly seconded and adopted by the conference. Dr. HUTCHINGS: The Committee on Statistics has done some work since the last conference. The sub-committee, consisting of Dr. Hoch, Dr. Ryon and Dr. Pollock visited several hospitals with the idea of ascertaining the causes of certain discrepancies of diagnoses of cases submitted, and both Dr. Ryon and Dr. Pollock have a report to make on the work of that sub-committee, Dr. Ryon speaking of the medical aspects and Dr. Pollock on the statistical. They are both ready to report briefly. Dr. RYON: It is not the intention of the committee at this time to give a very complete report of what has been done but a brief outline of the purposes of the visit. You will remember that at the last conference papers were presented by Dr. Pollock and myself regarding the discrepan cies in statistics relative to the diagnoses of first admissions and readmissions for the year, and it was noticed in several of the hospitals that these discrepancies were quite large. It is the purpose of the visit of the committee first to go over the statistical data in this regard for each hospital and try to find out the cause of the discrepancies, if any exist. So far, we have visited Binghamton, Willard and Rochester, spending a week in each hospital and it is the intention later, as soon as Dr. Hoch's work enables him to do so, to visit the other hospitals. At Binghamton it was found that the percentage of dementia præcox had been rather large and that manicdepressive insanity was low and also there was an increase in the psychoneuroses. It is found this was due to a difference of view on the part of the staff. As you know there is a committee of the American Medico-Psychological Association which is working toward establishing national statistics and Dr. Pollock informs me that the tentative form which they have made out so far, very closely resembles our present form in New York State, and for this reason we wish to come to some agreement throughout the whole service as to certain statistical points so that our statistics shall be uniform and so that, perhaps, we will be able to have the committee adopt our forms for national use. Dr. Hoch has made a study of the Wassermann reactions which have been sent to the Institute from the various hospitals and he has found in some instances that in some of the hospitals about 25 per cent of first admissions have been studied as regards Wassermann reactions, both in blood and spinal fluid; while in others, less than 1 per cent have been so studied and sent to the Institute. Of course, some of the hospitals, such as Buffalo, do all their own reactions. It was urged by Dr. Hoch that as it was so often necessary to exclude syphilis as an etiological factor, that very close attention should be paid to this study, and he feels it ought to be done on at least 20 per cent of the first admissions. It is not justifiable simply to do the Wassermann on the blood alone without examination of the spinal fluid with regard to the central nervous system. The blood shows the patient has syphilis but unless we do the Wassermann on the spinal fluid, we do not know whether the patient has had syphilis of the central nervous system or not. This should be done on cases of suspected general paresis and cases in which any organic mental defect or reaction exists. Also, cases in which there is a slight involvement of the nervous system, a slight affection of the pupils, a difference in any other reflexes should be studied as regards this reaction. It has also been noted that in some cases, even on a basis of syphilis, other psychoses are present, sometimes demen-· tia præcox, paranoic conditions, etc., especially in connection with any defect of the nervous system. These cases should be examined for Wassermann, both blood and spinal fluid. And also, cases where the history points to iritis, abortions, etc., studies should be made. It is noticed also that there is some carelessness on the part of the medical staff regarding the taking of histories. Some seem to be satisfied to take as the history of the case, the one brought to the hospital, without any attempt to add to it when visits are made by the relatives. It often becomes very important in the history of the case to learn the history of the make-up, etc. In fact, one case of stupor in a hospital which we visited had no history whatever of make-up and it was therefore difficult for the doctor to determine whether such case was benign or malignant, although opportunities had existed by reason of visits of relatives to the patient since admission. At the Institute it is the custom of Dr. Hoch, after a case has been studied, to put down on a card for this case, questions he wishes to ask the relatives who come to see the patient so that, the assistant, when the visitor arrives, can go to the card and find out what information is desired; that could be followed out in any hospital. Dr. Hoch also has gone over carefully the guide for the diagnosis of cases and has taken up with the staff any difficulties they have had regarding classification, and has made a note in each hospital of things that have come up and left a copy of the notes with the institutions. Many interesting questions |