REPORT OF THE MEDICAL INSPECTOR

To the State Hospital Commission:

I herewith respectfully submit my report as medical inspector from July 1, 1916, to May 1, 1917, on which date I assumed the duties of superintendent of the Hudson River State Hospital.

During the above period 126 visits have been made to the 40 institutions which are subject to the visitation and inspection of your Commission and your representatives. Forty-nine visits were made to the State hospitals, and 77 to licensed private institutions. Three visits have been made to each State hospital and to each licensed private institution with the following exceptions: Four visits were made to the Utica, Hudson River, and Manhattan State Hospitals, and four visits to the River Crest Sanitarium.

Detailed reports embracing the medical and nursing services, complaints of patients, recommendations concerning new cases admitted, and the general efficiency of the institutions visited have been filed both at these institutions and in the office of your Commission.

Five thousand three hundred and twenty-five patients admitted to the State hospitals, and 569 admitted to licensed private institutions, a total of 5,894, were examined and the suitability of their detention passed upon, each patient being allowed an interview as provided in the statute.

In addition to the foregoing, two visits were made to two unlicensed institutions.

I am indebted to Dr. John L. Van De Mark, medical examiner of the Bureau of Deportation, for assistance in making the above visitations. Dr. Van De Mark made four visits to State hospitals and 13 to licensed private houses.

A large portion of my time was devoted to investigating accidents and casualties, the complaints of patients, the most important of which are considered in detail in this report.

During the year I attended the Quarterly Conference of your Commission with the managers and superintendents, and I was also present at meetings of the Albany and Rensselaer County Medical Societies, the State Conference of Charities and Correc

tions, the Clinical Society of the Samaritan Hospital of Troy, and the annual meeting of the American Medico-Psychological Association.

STATE HOSPITALS-ADMISSIONS AND DISCHARGES-CIVIL

HOSPITALS

In the period covered by this report, there have been admitted, exclusive of transfers, 7,071 patients to the 13 civil State hospitals for the insane. Of this number 360 were voluntary patients. Of these 150, or 42 per cent, were readmissions. This high percentage of voluntary readmissions illustrates the success of the voluntary admission law, and the increasing tendency on the part of patients to voluntarily return to the hospital and receive early in their psychosis treatment which proved of so much benefit to them on former admissions.

One hundred and seven of these voluntary patients were seen. Of this number but 6 proved to be unsuitable cases for voluntary admission, and therefore their formal commitment was recommended. In addition to those whose formal certification was suggested, there were 100 others committed, making a total of 106 voluntary cases formally certified during the period, or a percentage of 29.4 of the total number admitted during the first ten months of the fiscal year.

Among the new patients seen, there were 21 imbeciles, 1 idiot, 19 alcoholics, 6 dotards and 11 others suffering from various physical or nervous disorders, a total of 58, who, in my judgment, proved to be unsuitable cases for admission to a State hospital, and their discharge was therefore recommended.

One thousand and nine, or 18.3 per cent of the new patients seen, proved to be aliens or nonresidents. Of these 150 were deportable aliens, 815 were nondeportable aliens and 44 were nonresidents. In each instance the Bureau of Deportation was informed and every effort made to deport and repatriate the aliens and to return the nonresidents to their respective States. Because of the continued existence of the war the facilities and opportunities for the deportation and repatriation of aliens have been very much restricted, so that the work of the Bureau in this respect has been very much hampered. In the ten months reported

upon, there have been discharged from the civil State hospitals 3,073 patients. Of these 2,849 were committed patients and 224 were voluntary.

Of the number discharged, 1,332 were discharged as recovered, 663 as much improved, and 720 as improved, making a total of 2,715 patients who were returned to their homes to again be able to resume their daily occupation. This is 38.4 per cent of the total number admitted during the ten months' period.

Such results are gratifying and speak well for the efficient care and treatment afforded patients in our State hospitals.

HOSPITALS FOR THE CRIMINAL INSANE

During the ten months' period, there were 158 patients admitted, exclusive of transfers, to the Matteawan and Dannemora State Hospitals for the criminal insane. Of this number 146 were seen during my visits to these institutions, and the suitability of their detention determined.

Two imbeciles in which no evidences of a psychosis could be elicited were recommended to be returned to prison, as not being suitable cases for detention in a hospital for the care and treatment of the insane.

Seventeen of the new admissions seen proved to be aliens. Of these three were deportable. In addition to these one patient was found to be a nonresident.

In each case, the Bureau of Deportation was notified but was powerless to act because the patients in question were either court cases or were serving sentences, and therefore could not be removed from the hospital, until either a dismissal of the indictment or a pardon could be obtained. It is therefore again urged that every effort be made upon the part of these hospitals to persuade district attorneys and other officials directly concerned, to co-operate with the Bureau of Deportation so that more of the alien and nonresident criminal insane may be removed from State

care.

RESTRAINT AND SECLUSION

During the period reported upon, there were in the civil State hospitals a total of 818 patients in restraint and 59 in seclusion, while in the hospitals for the criminal insane the daily average

was 13 in restraint and 33 in seclusion. Of this number 183 in restraint and 101 in seclusion were seen during my visits to these institutions.

Whenever practicable, advice was given to remedy these conditions. I am still firmly of the opinion that in many instances the use of restraint and seclusion can in a large measure be avoided, especially in the civil State hospitals, and hydrotherapeutic treatment substituted, such as the hot or cold pack, or the use of the continuous warm bath, thereby not only attaining the results sought by the use of restraint, but a general improvement in the mental and physical condition of the patient.

The frequent and habitual use of restraint or seclusion in our State hospitals raises the question as to whether there exists on the part of the ward physician a lack of thoughtful administration, of tact and careful nursing, and of knowledge of the individual characteristics of his patients, which, if carefully studied, may suggest other means of controlling their activities by various amusements or diversional occupation.

COMPLAINTS OF PATIENTS

During my visits to the State hospitals, in addition to the new patients seen, 145 patients requested and were granted special interviews. Of these 143 complained of illegal detention. Each of these cases, upon being investigated, proved to be legally committed, and at the time of interview had not sufficiently recovered to warrant their discharge.

Two patients, one at the Utica State Hospital, and one at the Hudson River State Hospital, complained of abuse upon the part of employees. A very careful investigation in each case showed the charge preferred to be without foundation. Thirty-four patients interviewed during my visits to the hospitals for the criminal insane, requested either to be returned to court, or to prison, or to be transferred to civil State hospitals. In none of these cases could the request be granted for the reason that either they had not recovered from their psychosis or their sentence had not expired.

In addition to the above, 143 patients who had written to the Governor, your Commission, and to the medical inspector, were

seen and interviewed and their requests or complaints made a subject of inquiry. In each instance the complaints made were founded upon a delusional basis, and those requesting their discharge were found to be not sufficiently recovered to leave the institution.

ACCIDENTS AND CASUALTIES

One hundred and ninety accidents of importance occurring in the State hospitals were reported to your Commission during the period covered by this report. Of these 145 were fractures. These were mainly caused by accidental falls and by assaults upon the part of other patients. Five patients suffered from dislocations, all of which were incurred by falls. Six patients suffered from minor accidents sustained during their various occupations, such as slight cuts or burns.

It is noteworthy that in but two instances did accidents occur during struggles between patients and employees. Both of these accidents were most carefully investigated and in one in which the accident was due to undue roughness on the part of an employee it was recommended that such employee be dismissed from the service.

Fourteen sudden deaths occurred during the period. In each instance a careful investigation by the coroner showed death to be due to natural causes.

Twenty attempts at suicide occurred among the patients in the State hospitals during the year, of which 12 were successful. In each of the fatal cases the coroner was called and an inquest held. An inquiry was conducted by me not only in the fatal cases but into the circumstances surrounding each suicidal attempt.

Two slight fires occurred during the period at the Manhattan State Hospital, one in the basement of the Verplanck Building and the other in the passenger house of the Ward's Island dock. These were both quickly extinguished and but slight damage was sustained.

Special credit should be accorded the Misses Gleason, Osborne, Clayton, Tuite, and Lindsley, employees of the Manhattan State Hospital, who risked their lives in rescuing two patients who had