Westcott, Dr. Adeline M., reappointed medical interne at Central Islip State Hospital, October 20, 1916; resigned November 8, 1916. Williams, Dr. Rodney R., assistant physician in Binghamton State Hospital, promoted to senior assistant physician, August 1, 1916. Wood, Dr. Alfred Trenchard, assistant physician in Central Islip State Hospital, appointed assistant physician in Kings Park State Hospital March 15, 1917. Zeiss, Dr. Robert F., appointed special attendant at Manhattan State Hospital November 8, 1916, and promoted to medical interne December 1, 1916; resigned June 28, 1917. EMPLOYEES At the close of the fiscal year there were 6,204 employees on the payrolls of the civil State hospitals; 3,799 of these were nurses and attendants. The ratio of all employees to patients was 1 to 5.86, and of nurses and attendants to patients, 1 to 9.57. The daily average number of employees in the hospitals during the year was 6,079, and the ratio to the average number of patients was 1 to 5.6. Further details concerning employees are given in statistical tables on page 374. Owing to the high wages offered in commercial industries and the increased demand for labor, it has been exceedingly difficult for the hospitals to fill vacancies as they have occurred. In order to enable the hospitals to meet outside competition more effectually, the Legislature of 1917 passed an act providing for an increase of two dollars per month in the maximum pay of employees of the hospitals. This act was approved by the Governor, and will become effective January 1, 1918. RETIREMENT FUND The Retirement Fund for State Hospital Employees has been in operation since March 22, 1912. According to the report of the fund for the fiscal year as given by the State Comptroller on page 148, the reserve now amounts to $220,769.97; the revenue for the year was $108,176.57; and the expense, $85,953.41; the surplus added to the reserve during the year was $22,223.16. Since the establishment of the fund, 265 employees have retired; the annuity of 26 of these has been cancelled by death or otherwise, leaving 239 annuitants on June 30, 1917. The average annuity is $370.81 and the average service of retiring employees, 26.2 years. The increase in annuitants was 33. These figures seem to indicate that the financial success of the fund is now assured. The fund is also successful from a social and administrative point of view. EMERGENCY ADMISSIONS Subdivisions 1 and 2 of section 82 of the Insanity Law provide for the admission of emergency cases to the State hospitals and private licensed institutions. Under subdivision 1 an insane person may be received in the hospital upon a certificate of lunacy executed by two medical examiners in lunacy after an examination as provided by law without a court order of commitment. The patient thus received may be retained by the hospital for a period not to exceed ten days. A court order of commitment may be obtained prior to the expiration of such time, or the patient must be discharged from the hospital. Under subdivision 2 the superintendent of any State hospital for the insane may, when requested by a health officer, receive and care for, during a period not exceeding ten days, any person who needs immediate treatment because of mental derangement other than delirium tremens or drunkenness. These provisions of the law have proven of great benefit to patients requiring immediate treatment. During the fiscal year of 1916 the civil State hospitals received a total of 496 emergency cases, which were distributed among the civil State hospitals as follows: The voluntary admissions of the year comprised 255 patients, of which 141 were males and 114 females; the voluntary readmissions numbered 197, of which 99 were males and 98 females. The total number of voluntary cases, 452, exceeds that of any previous year in the history of the hospital system. In 83 cases the condition of the voluntary patients was such as to necessitate commitment. The increase in voluntary first admissions is evidence of the growing confidence of the public in the State hospitals; and the increase in voluntary readmissions indicates the satisfaction derived by the patients from their former treatment. PREVENTION OF INSANITY It is significant that, while the rate of physical disease and mortality has been steadily declining, the rate of insanity has apparently been mounting upward. It is said that the number of hospital beds occupied by the insane now exceeds the total number of hospital beds for general physical disease of all kinds in the State. The total yearly economic loss to the State on account of insanity is now more than $35,000,000. These facts, together with the knowledge that nearly one-half of all the cases of insanity are preventable, call for a most vigorous prophylactic campaign. The steps indicated by present conditions are: 1. The prevention of the excessive use of alcoholic liquors.Judging from the decreasing number of alcoholic admissions to the State hospitals, there has been marked improvement in the drinking habits of the people of the State during the past four years; that there is room for further improvement is shown by the fact that there was a total of 684 patients with alcoholic psy choses admitted to the civil State hospitals during the fiscal year. These consituted 7.8 per cent of all admissions. The nation-wide sentiment against the liquor traffic which every day seems to be growing stronger, will probably compel the entire elimination of the traffic within the next ten years. 2. The checking of syphilis.-Although the disastrous effects of syphilis, both physical and mental, have been known for many years, it was practically ignored by health departments, until in 1916 the State Health Department included syphilis in its list of communicable diseases and established certain rules relative to its control. The action thus taken is highly commendable, and will undoubtedly be followed by more strenuous measures. There is no good reason why syphilis should not be attacked with all the weapons known to the health authorities. If a fraction of the attention now being given to the prevention of smallpox were devoted to the elimination of syphilis, this plague. would soon disappear. With the passing of syphilis, the cause of 15 per cent of the mental diseases of the first admissions to our State hospitals will have been removed. As syphilitics that are promptly treated and cured do not develop mental disease, health authorities should take every means within their power to compel the proper treatment of all cases of syphilis coming to their attention. Such treatment would also prevent the spread of the disease. 3. The teaching of mental hygiene.-The discovery that mental health is subject to control in large measure gives encouragement to those who hope for the ultimate prevention of most forms of mental disease. The science of mental hygiene is rapidly being perfected and simplified so that it may be taught with physical hygiene in the public schools. Efforts should also be made to inculcate correct habits of thought, especially in children with psychopathic tendencies or unfavorable heredity. General action along these lines should prevent many cases of dementia praecox and manic-depressive insanity. 4. The elimination of extreme poverty.—The privation, mental anguish and physical disease caused by extreme poverty is a prolific cause of mental disease. Poverty, on the other hand, is caused by disease, inefficiency, drunkenness, accident and lack of employment. The problem is a most difficult one, but something may be done by an adequate system of supervision of poor families with authority to take action to prevent pauperization as well as to relieve distress. Too often, under the present system of poor relief, help is deferred until the family becomes a complete wreck. 5. The extension of social work in behalf of the mentally afflicted. In this field much is already being done by the State hospitals through their system of clinics and social service, but only a small portion of the many who need help are being reached. Every city and large village in the State should be provided with mental clinics which would treat incipient cases of nervous and mental disease. That these clinics meet a great need is shown by the attendance at those already established. MENTAL CLINICS In accordance with the provisions of subdivision 11-a of section 45 of the Insanity Law, each of the 13 civil State hospitals has established one or more mental clinics for the treatment of incipient cases of mental and nervous disease. A summary of the monthly statistical reports of attendance at these clinics shows that a total of 6,105 visitors appeared at the clinics held during the year. Of these 2,952 were made by paroled patients, 529 by discharged patients, and 2,624 by persons who had had no connection with the hospital; 2,343 persons came for advice or treatment; 814 for advice concerning friends and relatives; and 2,948 to report only. Of the 6,105 visitors, 2,889 were males and 3,216 females; the number of first visits was 2,928, and of return visits 3,177. The Commission feels that the development of the mental clinics calls for the employment of a supervising expert to visit the various clinics and assist the physicians in making them effective and to stimulate interest in the communities for whose benefit the clinics are held. He would also establish new clinics, assist social workers, and carry on general preventive work for the Commission. The Commission recommends that an assistant medical inspector be employed to take charge of this work. The schedule of clinics, effective on June 30, 1917, and statistical tables showing the attendance at the clinics held by the several hospitals are submitted herewith: |