RECENT STATISTICS OF THE INSANE IN THE NEW YORK STATE HOSPITALS* BY HORATIO M. POLLOCK, PH. D., During the past sixteen months, three special censuses of the insane in the State hospitals have been taken. The first of these was a general census taken by the State Census Bureau in June, 1915; the second, a special study of patients over 50 years of age, made by the superintendents and other medical officers on January 1, 1916; and the third, a census of patients according to psychoses taken by the medical staffs on July 1, 1916. The State Census Bureau in making the enumeration of the patients, used the same schedules as were used in enumerating ordinary citizens. Unfortunately, the Census Bureau made no separate tabulation of the insane, and the report of the Bureau gives no data concerning the number of insane in the State. In order to answer definitely certain questions that were being raised concerning the ages of the patients in the civil State hospitals, we borrowed from the Census Bureau the original schedules prepared by the enumerators at the State hospitals. From these schedules we prepared tables showing the distribution of the patients according to age groups in each of the hospitals, and also ascertained the average age of the insane in each hospital. It was found that 1.1 per cent of the patients under treatment were under 20 years of age; 3.7 per cent between 20 and 25 years; 6.8 per cent between 25 and 30 years; 9.2 per cent between 30 and 35 years; 11.2 per cent between 35 and 40 years; 12.4 per cent between 40 and 45 years; 12.7 per cent between 45 and 50 years; 11.5 per cent between 50 and 55 years; 10.1 per cent between 55 and 60 years; 7.9 per cent between 60 and 65 years; 5.8 per cent between 65 and 70 years; 3.8 per cent between 70 and 75 years; 2.3 per cent between 75 and 80 years; and 1.7 per cent over 80 years. Fifty-seven and nine-tenths per cent of the patients * Paper read at the Quarterly Conference held at Central Islip State Hospital, October 18, 1916. were between 35 and 60 years of age. The total number of female patients exceeded that of the males by 2,468. The females above the age of 50 exceeded the males above that age by 2,051. The percentages above 50 years of age were 45.7 and 40.0 respectively. The average age in years of the patients in the civil State hospitals were as follows: Utica, 49.25; Willard, 52.83; Hudson River, 47.96; Middletown, 50.66; Buffalo, 48.11; Binghamton, 51.52; St. Lawrence, 50.12; Rochester, 48.48; Gowanda, 49.43; Kings Park, 43.90; Brooklyn, 47.17; Manhattan, 43.65, and Central Islip, 44.62. General average, 47.29. The patients in the up-State hospitals averaged about 5 years older than the patients in the metropolitan hospitals. The purpose of the special inquiry made on January 1, 1916, relative to the mental and physical condition of patients in the civil State hospitals, who were over 50 years of age was to ascertain facts on which to base a plan for the care of this class of patients. The census reported by the superintendents of the several hospitals showed that the patients over 50 years of age on that date numbered 14,464, or 41.8 per cent of the total patients. The males numbered 6,165, and the females 8,299. Of the total 14,464 patients over 50 years of age, 3,176, or 22 per cent, were feeble or bedridden; 1,811 others, or 12.5 per cent, were violent, suicidal or homicidal; 369 others, or 2.6 per cent, were epileptic; 3,283 others, or 22.7 per cent, were reported as infirm or needing special hospital care for physical or mental ills. The able-bodied patients over 50 years of age numbered 5,777 or 39.9 per cent. Of these, 4,209 were workers, and 1,568 non-workers. The patients over 50 years of age that were reported as needing custodial care only, numbered. 4,646, or 32.1 per cent, and 4,179 of these were considered transferable cases. The reports concerning the mental and physical condition of the patients over 50 years of age varied greatly in the several hospitals. The percentage of cases reported as feeble or bedridden in all the hospitals was 22. The percentages reported by the several hospitals were: Utica, 22.3; Willard, 20.5; Hudson River, 22.8; Middletown, 26.5; Buffalo, 30.1; Binghamton, 15.9; St. Lawrence, 41.3; Rochester, 20.0; Gowanda, 18.1; Kings Park, 14.4; Brooklyn, 16.7; Manhattan, 22.6; Central Islip, 16.3. The lowest percentage, 14.4, was reported from Kings Park, and the highest, 41.3, was reported from St. Lawrence. It is evident that the terms "feeble" and "bedridden" did not mean the same thing to all of the reporting physicians. The percentage of cases above 50 years of age, not included in the feeble or bedridden class, that were violent, suicidal, or homicidal, or who made attempts to escape, was 12.5. The lowest percentage in this class was 3, reported from Brooklyn, and the highest percentage, 20.7, reported from Willard. The percentage of patients over 50 years of age that were able-bodied, was 39.9. The percentages in this class reported by the several hospitals were: Utica, 53.7; Willard, 13.9; Hudson River, 43.5; Middletown, 31.1; Buffalo, 29.7; Binghamton, 27.0; St. Lawrence, 27.6; Rochester, 41.5; Gowanda, 58.6; Kings Park, 42.9; Brooklyn, 64.4; Manhattan, 61.1; Central Islip, 47.0. The highest percentage, 64.4, was ported from Brooklyn, and the lowest 13.9, was reported from Willard. The average percentage of patients over 50 years of age reported as needing custodial care only, was 32.1. The percentage reported from Utica was 53.7; Willard, 5.4; Hudson River, 23.0; Middletown, 20.5; Buffalo, 27.3; Binghamton, 16.9; St. Lawrence, 30.0; Rochester, 41.5; Gowanda, 58.6; Kings Park, 25.3; Brooklyn, 36.4; Manhattan, 64.3; Central Islip, 37.4. The highest percentage, 64.3, was reported from Manhattan; and the lowest percentage, 5.4, was reported from Willard. It is hardly believable that the patients in the several hospitals differ as much as these figures would indicate. There are undoubtedly wide differences to be found in the patients of the several hospitals, but the difference in attitude and interpretation on the part of the physicians who made the enumerations in the several hospitals was evidently wider. The census taken of the patient population according to psychoses, on July 1, 1916, was the first of its kind ever taken in the State hospitals. The reports indicate that this census was carefully taken and we believe that it will furnish a satisfactory basis for the computation of recovery rates and death rates according to psychoses. Table 1, of the accompanying statistical tables, shows the per cent distribution of the principal psychoses in the several State hospitals. The most striking fact shown by the table is the high percentage of dementia præcox cases in the patient population. The dementia præcox and allied to dementia præcox groups, together constitute 57.31 per cent of the total patients in the State hospitals. The manic depressive and allied to manic depressive groups constitute 9.84 per cent, only about one-sixth as many as the dementia præcox groups. The alcoholic group is next largest, with a percentage of 4.68; and paranoic conditions next with a percentage of 4.66. The highest percentage of dementia præcox cases were reported in Gowanda and Middletown; and the lowest in Utica and Binghamton. In the allied to dementia præcox group, the highest percentage is in Kings Park; and the lowest in Utica. In the manic-depressive group the highest percentages are found in Central Islip and Willard; the lowest in St. Lawrence and Middletown. In the allied to manic-depressive group, Kings Park has the highest percentage; and Hudson River the lowest. In the alcoholic group, Brooklyn has the highest percentage, and Gowanda the lowest. Utica reports a percentage of 12.4 in the paranoic group, which is nearly three times the average percentage of 4.66. The small percentages of paretic and arteriosclerotic cases are probably due to the short hospital life of these cases. The statistics for the nine months period ending June 30, 1916, are far from complete, but we have compiled a few comparative tables showing operations and results in the several State hospitals. These tables will be furnished to each of the State hospitals so that each hospital may compare its work with that of the others. Table 2 shows the first admissions and readmissions to each of the hospitals during the period, together with the percentages of total patients and of total admissions. The high admission rate of the Brooklyn State Hospital, compared with the size of the hospital, is noteworthy. Of the up State hospitals, Utica has relatively the most active reception service. Table 3 shows the paroles in the State hospitals on June 30, 1916, and Table 4 the average number on parole during the nine months ending June 30, 1916. The total number of patients on parole at the end of the year was 1,340, an increase of 187 over the number on parole on October 1, 1915. The percentage on parole increased from 3.4 to 3.8. The daily average on parole during the nine months period was 1,346, an increase of 166 over the average for the year ending September 30, 1915. The hospitals having the highest average percentage of patients on parole during the period were Central Islip, Utica and Kings Park. Tables 5, 6, 7 and 8 deal with discharges from the several hospitals. The percentages given in the tables are not comparable with the percentages computed for one year periods in our annual tables, but they are useful in comparing the discharges from the several State hospitals during the period covered. On the basis of all admissions, which we consider most satisfactory, we find that two of the hospitals have a recovery rate of over 34 per cent, while six of the hospitals have a rate of less than 20 per cent. The percentages of patients discharged as much improved vary even more widely than of those discharged as recovered. Based on all admissions, the percentage of patients discharged as much improved, from Willard and Gowanda was 4.6; while from Hudson River the percentage was 17.5, and from Binghamton, 14.7. The variations in the percentages of cases discharged as improved as shown by Table 7, were considerably less than in the preceding table. The lowest percentage of cases discharged as improved, was 5.4, at Brooklyn; and the highest, 15.7, at Rochester. The percentages of total patients discharged benefited by treatment, shown in Table 8, are more in agreement than those of the |