MINUTES OF QUARTERLY CONFERENCE DECEMBER 12, 1916 Minutes of the conference of State hospital managers and superintendents with the State Hospital Commission, held at the Manhattan State Hospital, December 12, 1916. Present Commissioners PILGRIM, HIGGINS and MORGAN. Secretary EVERETT S. ELWOOD, State Hospital Commission. Statistician H. M. POLLOCK, Ph. D., State Hospital Commission. Utica State Hospital, GEO. B. CAMPBELL, M.D., First Assistant Physician; Steward, CHARLES A. Mosher. Willard State Hospital, ROBERT M. ELLIOTT, M. D., Medical Superintendent; Miss BERTHA A. PECK, CHARLES R. PHILLIPS, M. D., JOHN M. QUIRK, M. D., members of the Board of Managers. Hudson River State Hospital, FREDERICK W. Parsons, M. D., Acting Superintendent. Middletown State Homeopathic Hospital, MAURICE C. ASHLEY, M. D., Medical Superintendent. Buffalo State Hospital, ARTHUR W. HURD, M. D., Medical Superintendent; PHILip G. Schaefer, GEO. M. ZIMMERMAN, members the Board of Managers. Binghamton State Hospital, Charles G. WAGNER, M. D., Medical Superintendent; Mrs. ANNIE DEVEREUX MILLS, WILLIAM H. HECOX, members of the Board of Managers. St. Lawrence State Hospital, R. H. HUTCHINGS, M. D., Medical Superintendent; JAMES M. Wells, James F. KELLY, Members of the Board of Managers. Rochester State Hospital, EUGENE H. HOWARD, M. D., Medical Superintendent. Gowanda State Homeopathic Hospital, CLARENCE A. POTTER, M. D., Medical Superintendent. Kings Park State Hospital, WM. C. GARVIN, M. D., First Assistant Physician; Mrs. ALLIE A. Rogers, Albert E. KLEINERT, members of the Board of Managers; CHARLES S. PITCHER, Steward. Brooklyn State Hospital, ISHAM G. HARRIS, M. D., Medical Superintendent. Manhattan State Hospital, WILLIAM MABON, M. D., Medical Superintendent; CHARLES V. Fornes, Gustav SCHOLER, Mrs. JULIA KEMP WEST, members of the Board of Managers; Drs. EVARTS, Central Islip State Hospital, GEORGE A. SMITH, Medical Superintendent; M. B. HEYMAN, M. D., Assistant Medical Superintendent. JOHN T. MACCURDY, M. D., Assistant in Psychiatry, Psychiatric JOSEPH W. MOORE, M. D., First Assistant Physician, Matteawan C. FLOYD HAVILAND, M. D., Superintendent, Middletown (Conn.) State Hospital. SYLVESTER R. LEAHY, M. D., Assistant Physician, Kings County Psychopathic Pavilion. WILLIAM L. RUSSELL, M. D., Superintendent, Bloomingdale Asylum, White Plains, N. Y. The conference was called to order at 10.40 A. M. by the Chairman, Dr. Charles W. Pilgrim, who said: Ladies and Gentlemen of the Conference: We shall have only one session to-day, and I have been requested by Dr. Mabon to say that luncheon will be served at 1.30. We will therefore try to get through with our business so as to be on hand at that time. First in order will be a paper by Dr. Poate of the Manhattan State Hospital staff on "The Management of Disturbed Patients in State Hospitals." (Dr. Poate's paper appears on page 143 of this issue.) At the close of Dr. Poate's paper Chairman Pilgrim said: "Dr. Poate's very interesting and instructive paper is now open for discussion. In my opinion this subject is one of considerable importance and well worth discussion by the members present. I hope that some one will start the discussion by describing conditions as they exist in his in stitution. I certainly hope that the subject will not go by default. Dr. HARRIS: Mr. Chairman, Ladies and Gentlemen of Poate has read a very I may say that I am subject, as, I believe, the Conference-To my mind Dr. interesting and instructive paper. very considerably interested in this are all the hospital men present. It would seem that the institution in Brooklyn stands rather high on the restraint list as exhibited here to-day by Dr. Poate. I want to say on behalf of Brooklyn that a great majority of patients admitted there are of the exhaustive and senile classes. The fact attention. is that last month over 50 per cent of all patients admitted were brought in on stretchers; that is, they were senile, organic or arteriosclerotic cases. These are the most troublesome classes to care for in the hospitals; they need more It is in this class that you find more bruises, more fractures, more assaults from their fellow-patients. I believe this to be one reason for the apparently high rate of so-called restraint in Brooklyn. Since assuming charge of the institution I have looked very carefully into this subject. This record presented by Dr. Poate is for the fiscal year ending June 30. I did not go there until August. The form of restraint used in Brooklyn is the protection sheet; it is used when it is absolutely essential for the welfare of the patient. Another form is the camisole or jacket which leaves the patient with full freedom, as a rule, of his arms. This is put on to keep the patient from pulling off surgical dressings of various kinds; it is used as a really therapeutic measure and is not mechanical restraint in the sense that freedom is controlled. There are a few cases in which the long sleeve extends, but it is almost entirely the feeble senile cases that are in restraint as a therapeutic measure and for the safety of the patient. We use hydrotherapy in a certain number of cases and I think a daily average would be four since I have been connected with the hospital; it is not often that we have more than four. We have two baths for male, and two for female cases. The question of administering sedatives is always one of personal equation, at least to a certain extent. I think we use a relatively small amount of drugs in Brooklyn, certainly small compared to the amount I have seen used in some of the other hospitals. We don't use hyoscin; I don't think we are recorded as using any of that drug during the year. We give paraldehyde, a 25 per cent solution, and we have given some veronal, trional, and other sedatives in the way of bromides. This question of restraint is always one foremost in the minds of those having the care of the insane. I might mention another thing which should be taken into consideration when the statistics concerning the Brooklyn State Hospital are being discussed; that is, that on the women's side where we have some restraint, we have 60 per cent of overcrowding. Also we are short in our nursing force-a condition I presume that exists in other hospitals. It will be seen, therefore, that it resolves itself into a question of proper accommodation of patients, of a sufficient and efficient nursing force (as stated by Dr. Poate in his paper) and until those things are brought up to their proper proportions we shall be obliged, certainly, to use restraint more or less; certainly more than we want to use. Dr. HOWARD: Doctor, you have a great many visitors there too, have you not? Dr. HARRIS: Yes; and we note the same disturbance of patients after such visitation. Dr. MABON: Mr. Chairman-It seems to me the whole question resolves itself into a therapeutic measure. Formerly restraint was used very largely and was left to a great extent in the hands of attendants and nurses. Of course that should not be; it should be placed directly in the hands of physicians and should be applied whenever in the judgment of physicians of experience it is indicated as a therapeutic measure. The use of the safety-sheet is a humane measure, and I endorse Dr. Poate in his commendation of it. We have to-day a number of patients in restraint, and I have spoken to Dr. Garvin about the matter,-he was formerly here— and I asked him how he got along without it at Kings Park, and he replied that he did not get the same kind of patients at Kings Park that we are receiving at Manhattan. The safety-sheet is certainly more humane and is, in my judgment, far better to use than some forms of packs. Chairman PILGRIM: This is a subject of very great interest to me. In 1882-which is a long time ago I went as an assistant to an institution known as the State Asylum for Insane Criminals at Auburn, where only a few years before it had been the custom for the superintendent of the institution to make his rounds of the wards with a revolver in his pocket, and where mechanical restraint was used to a great extent. On the 8th of March, 1882, Dr. Carlos F. MacDonald, the superintendent of the institution, decided to abolish restraint and at the same time to withdraw from the patients the privilege of the use of tobacco which they had enjoyed for a long time. Now it might very well be assumed that those two things coming together would lead to no end of trouble. As a matter of fact the new rules did cause some trouble, but after a time things quieted down and went on in their usual course, and I believe that restraint was never again used in the institutiou; at least I know it was never used there while Dr. MacDonald remained superintendent. I went from there to Utica where mechanical restraint was in favor; in fact the superintendent, Dr. Gray, advocated the use of restraint and considered the Utica crib bed, which was known all over the world, as a very humane means of restraining disturbed patients; in fact it is said to have been invented by a French priest and was considered by a great many, as I have said, a very humane method of restraining patients. But you may all imagine how it must have felt to be locked in one of those cribs, night and day. It was impossible for a patient to rise, although they were large enough to permit some freedom of movement within the crib. But it was impossible to get out or to move about in any but a quite restricted way. Of those beds there were on an average from 30 to 40 in constant use. Shortly after succeeding to the superintendency of the institution Dr. Blumer gave orders that they were to be abolished. From that time restraint became a thing to be dreaded and avoided, and I never could |