229 Purchasing Committee for State Hospitals....... News of the State Hospitals for the Quarter ending Decem Changes in the Personnel of the Medical Service....... 240 246 Summary of Operations of Bureau of Deportation... Movement of Patients in the State Hospitals for Three Months General Statement of the State Hospitals. ... 247 248 THE STATE'S EFFORTS TO MEET THE MENTALLY SICK HALF-WAY.* BY CHARLES W. PILGRIM, M. D., In order to give you an idea of what the State is doing for its insane, it will be necessary for me to devote a few minutes to statistics: There were 35,731 insane persons in the civil State hospitals on the 1st of October, 1916, and 6,390 persons were employed by the State in caring for these patients on the same date. During the year ending September 30, 1915, 7,934 persons were admitted to the hospitals of the State and during the same period 3,495 or more than 44 per cent were discharged as recovered, or sufficiently improved to live under home conditions. The net annual increase of patients for the five years from 1910 to 1915 averaged 853, but at the present time the increase is at the rate of 100 per month or about 40 per cent greater than the average for the five years mentioned. A large part of this increase is due to the fact that it has been impossible to deport the alien insane since the commencement of the European war. The importance of this question will be understood when I tell you that for the five years from 1910 to 1915 inclusive, 4,258 alien insane, or an average of 851 per year, were deported. In 1912 alone, 1,171 were returned to European countries. Therefore, you will see that when this great relief is almost entirely stopped the net annual increase must reach alarming proportions. This naturally calls up the question which is asked frequently of the alienist, that is: "Is insanity increasing out of proportion to the increase in the population of the State and country?" Statistics show that the insane in institutions in the State * Address given December 1, 1916, at opening of Peekskill clinic. have increased from 255.2 per 100,000 population in 1889, to 378.4 per 100,000 in 1915. The increase of patients in the civil State hospitals from 1890 to 1900 was 47.7 per cent; while the increase in the general population of the State during the same period was 21.2 per cent. The increase of the insane in the civil State hospitals from 1900 to 1910 was 37.8 per cent; while the increase of the general population during the same decade was 25.4 per cent. The increase in the number of patients in the civil State hospitals of the State from 1910 to 1915 was 12.7 per cent, and the increase in general population during these years was 6.3 per cent. If we consider the bare figures alone it would appear that the insane are increasing much faster than the general population. Many factors, however, must be taken into consideration in coming to a conclusion upon this question. It is, of course, clear that the insane in institutions are increasing faster than the general population of the State and country, but this can be accounted for by the fact that much of this apparent increase is due to accumulation, as under the present conditions of institutional care and treatment, patients live much longer than they used to, and also on account of the fact that due to the better knowledge of the care and treatment given in hospitals for the insane many are now sent to them who would have been kept at home in former years. Both these causes, of course, add to the hospital census. The better knowledge of insanity and the present day refinements in diagnosis cause many to be classed as insane, who, a decade ago, would have been considered merely eccentric, for there can be no doubt that the relationship of insanity to the general population changes with the corresponding stages of progress in our social organization. Therefore, in summing up the answer to this question, I would say that while it is clear that the insane in institutions are increasing faster than the general population, the data available does not show positively that insanity is increasing throughout the country at a disproportionate rate. The land and buildings and the personal property devoted to the care of the insane on October 1, 1915, were valued at about $38,000,000.00, and in order to provide for the net annual increase at least one million and a half should be appropriated for new buildings and their equipment each year. It is in this respect only that the State has fallen behind, for appropriations during the past few years have been so meagre that the hospitals are now all overcrowded. In fact there are over 6,000 more patients in the hospitals of the State than their certified capacity calls for. In other words the overcrowding is now about 22 per cent. Corridors intended for day use, and sitting rooms as well, have been converted into dormitories so that in many cases the original design of the institution has been completely changed. Some comprehensive plan, either a bond issue, or the commitment of the State to a regular yearly appropriation of a sum more than sufficient to care for the net annual increase must soon be adopted to overcome existing conditions, and when the plan is formulated, I hope it may meet with the approval of all who are interested in the welfare of the insane. The cost of caring for the insane in the State for the year ending October 1, 1915, was a little more than $7,600,000.00, and this year, owing to the increased cost of all supplies, the total will be considerably greater. These figures will give you some idea of the stupendous task which the State has undertaken in assuming the care of its insane. All who have visited our State institutions and have made themselves familiar with the care and treatment of the insane must admit that the work is well done. The patients are kindly treated, notwithstanding occasional stories to the contrary; they are carefully and intelligently cared for and nursed, and they are scientifically treated from a medical standpoint. All that it is possible to do is done for them when once they enter the hospitals as patients, which they may now do without commitment or legal formali ties of any kind, and after they leave the hospital they are watched over and guided and directed by our social workers, who endeavor in every way to keep them from disturbing influences; but for some time it has been felt by those familiar with the subject that more might be done towards the prevention of insanity and that the State should reach out and "meet the mentally sick half-way," and it is with this object in view that clinics and dispensaries, such as you are about to open here, have been started in many cities of the State. It is not unusual to look upon insanity as a disease of mysterious origin which requires mysterious treatment, but I want to impress upon your minds the fact that mental disorders are no more mysterious than are disorders of the lungs, the heart or the kidneys, and that brain diseases are just as amenable to treatment as are serious diseases of any other organs. The old ideas of the mysterious origin and still more mysterious treatment of mental disorders have no place in our enlightened days. It has been estimated that nearly 40 per cent of all cases of insanity are due to preventable causes. These causes are heredity, diseases resulting from immoral habits, the excessive use of alcohol, and the abuse of drugs resulting in the drug habit. About 23 per cent of the men and 5 per cent of the women admitted to our State hospitals suffer from general paresis and other nervous diseases, which are always preceded by a disease due to immorality; about 15 per cent of the men and 5 per cent of the women suffer from the excessive use of alcohol; and nearly 1 per cent suffer from drug addiction, such as opium and its derivatives, cocaine, etc. What a wonderful field these figures present for preventive work, and that preventive work has already accomplished something is proven by the figures which show the marked decrease in the number of first admissions diagnosed as alcoholic insanity. In 1911 the percentage of alcoholic cases was 10.2; in 1912, 9.9: in 1913, 9.4, in 1914, 7-4; and in 1915, only 5.6. The cases in which alcohol was reported as an etiological |