Εικόνες σελίδας
PDF
Ηλεκτρ. έκδοση

3. Medical Service. It was inevitable that during the war period the State hospitals, despite the best efforts, should have been unable to maintain the highest standards of medical work. Special attention is now being given to the matter of building up the medical service in all the State hospitals. A committee representing the State Hospital Commission is cooperating with the superintendents in surveying the situation and making recommendations. Tangible progress in one direction has been made during the year by the purchase of X-ray apparatus for several of the hospitals.

4. Occupational Therapy.- What will probably prove to be the most significant development of the year was the grant by the Legislature of a special appropriation of $13,700 for developing occupational therapy in the State hospitals. The appropriation is small enough in itself, but it represents in principle a new departure. For many years this association in cooperation with your Commission has endeavored to gain from the Legislature special recognition of this work. That recognition is now obtained, and it is hoped that it will establish a precedent for continuing and larger appropriations each year.

The association is pleased to note that this initial appropriation has been at least large enough to permit the appointment of a director of occupational therapy for the State hospital system in the person of Mrs. Eleanor Clark Slagle. It hopes that it may be possible to give sufficient demonstration during the year of what can be accomplished by adequate development of this work to assure a much more substantial appropriation during the coming year. The association is particularly in sympathy with the plans of your Commission to extend the occupational work to idle, chronic, and disturbed patients.

5. Out-patient Work.- During the year the average number of patients on parole increased from 2,841 to 3,128. The following table gives the average number of patients on parole from the State hospitals for the past five years:

[blocks in formation]

An important new mental clinic was opened during the year at Troy by the IIudson River State Hospital. This affords a needed addition to the health resources of a large center of population which has heretofore been without such prevention and aftercare facilities. A total of 40 State hospital clinics are now in regular operation. Judged by attendance figures the clinic work has only held its own during the year, the total number of visits being but one more than last year. The association has furnished regular newspaper publicity for about half of the clinics, and the kindness of the press in publishing these notices has been a large factor in getting the general public to use the clinics.

6. Decrease in New Admissions.- Last year this report had occasion to call attention to a rather startling increase in the population of the civil State hospitals, which proved to be the largest annual increment on record. An analysis of this unusual increment made by the statistician of your Commission indicated that it was due in large measure to the difficult economic conditions of that year, making it necessary for many patients formerly cared for at home to be committed to public institutions. As compared with this record annual increase of 1,445 it is encouraging to note that the increase in population during the past year was 1,155. This may in turn be a reflection of improving economic conditions.

7. Deportation of Alien Insane.-During the past fiscal year 172 insane aliens were deported by the United States Immigration. Service, as compared with 329 in the year previous. The total number of alien insane deported, including those repatriated at the expense of the State and at the expense of friends, was 367; 353 nonresident insane were returned to other States, making a total of 720 deported and removed, including both aliens and nonresidents.

IMPORTANT NEEDS

1. Continued Construction.- Although some decrease in the number of new admissions as compared with the preceding year has been noted, it must nevertheless be kept in mind that the 1922 increase in population is second only to that of 1921 and that the census of the 13 civil State hospitals has now passed the 40,000 mark. The association would most strongly urge, therefore, appropriations on a scale much larger than in previous years for the relief of the present serious overcrowding, which is the greatest since 1917, the first year of the war.

All the best efforts of your Commission and the superintendents and staffs of the hospitals to raise the standards of curative work, and all the plans for rehabilitation through the application of occupational therapy to practically all types of patients will be handicapped if it is not possible to make real progress toward reaching that long-sought-for goal of having the certified number of beds equal the number of patients. The State hospital population is annually increasing at so rapid a rate that very substantial appropriations need to be made every year over a considerable period of years if the State is to keep pace in its building program

with the annual increase in population and at the same time make up the present deficiency of beds. If the State hospitals are to continue as curative institutions the overcrowding must be relieved.

To say that on June 30 last the State hospitals were overcrowded by 7,229 patients or 23.7 per cent fails to convey any real impression of what overcrowding means. Mere figures can be so easily read and lightly passed over. To appreciate the seriousness of overcrowding one must visit the State hospitals and see the way in which the patients are herded together with no chance for privacy or a feeling of space and freedom. One needs only to visit, for example, a typical metropolitan State hospital and observe the wards, especially those of the chronic and chronicdisturbed patients; beds everywhere, greedily absorbing every bit of available space-long uninterrupted rows of them in close formation; beds packed in so tightly in some instances that not even a finger's breadth separates them, so that the patient has to get in and out over the foot-board; two beds as a regular thing in rooms designed for only one patient; many beds jammed into corridors; others so much encroaching upon day rooms that the patients have no suitable place in which to pass the long waking hours.

All this is very far from hospital standards. It is a condition. that even under the stringency of war conditions was not permitted in our army cantonments. Such overcrowding is not only contrary to all principles of physical hygiene but has a most deleterious effect upon the mental attitude of patients whose mental illnesses the State is endeavoring to cure.

In addition to new beds for patients, one other matter that should have special attention is that of providing suitable and attractive quarters for physicians, nurses, and attendants, so that the right type of employee may be attracted to the State hospital service and may remain over period of years.

2. Psychopathic Hospitals. It is high time that the State of New York should meet an important need of the State hospital system which it has recognized ever since 1904 but has never met, that is, a system of State psychopathic hospitals. The need of such an institution in New York City is particularly urgent, but efforts which have been made in this direction for the past twenty years have not yet borne fruit. In a memorandum recently submitted to the Public Health Committee of the New York Academy of Medicine, Dr. Thomas W. Salmon called attention to the fact that "with the single exception of Philadelphia, New York is less adequately provided with facilities for the treatment of acute mental disorders than any other American city of the first rank in population." In 1904 the Legislature passed a bill establishing a State psychopathic hospital in New York City provided the city furnished a suitable site. A site offered by the city was not regarded as suitable and no further action was taken, although the law was not repealed. In 1920 the Legislature

passed a bill amending this act, but again providing that New York City should furnish the site. This bill was vetoed by Mayor Hylan. It is apparent that no progress will be made so long as the State waits upon the city. If the State after these eighteen years is finally to realize its project it would seem that it should provide outright for the purchase of a site and for the construction of a suitable hospital.

Why psychopathic hospitals are needed to complete the New York State hospital system has frequently been pointed out in these reports. No State program for caring for mental diseases can be modern without psychopathic hospital facilities, and such. facilities should eventually not be confined to New York City but should be established in every important population center in the State. A beginning should be made at once in New York City. 3. Medical and Nursing Service. In the last analysis after all other considerations have been taken into account, the standards of hospital work depend upon the quality and adequacy of the medical and nursing service. This is as true of State hospitals for the insane as of general hospitals. Close students and observers of the State hospitals over a period of years frankly find that medical standards have deteriorated in the last decade. This is a situation which has come about despite the valiant efforts of your Commission, the superintendents and many members of the hospital staffs. In the several years past conditions arising from the war have been found largely responsible for this retrogression. There is no longer, however, any good reason why medical standards should not be as high or higher than ten years ago. It is now a straightforward question of adequate appropriations for personal service and for suitable living quarters that are necessary among other things to obtain the type of trained service needed. Concretely as a first step toward re-establishing the position of the State hospitals as curative institutions, the appropriating authorities should without delay restore the former fixed ratio of one physician to every 150 patients and one attendant to every eight patients. Even this allowance is small enough for the grade of attention which the patients should receive.

4. Occupational Therapy.-As has been mentioned above, a sizeable appropriation is needed during the coming year if occupational therapy is to be so developed as to reach the patients who most sorely need such treatment, namely, the chronic and disturbed groups.

5. Medical Equipment. The highest medical standards in the State hospitals cannot be maintained by personnel alone. There are many facilities in the way of laboratory and medical equipment which are sorely needed. Some progress in this direction has been noted during the past year. A considerable appropriation for this purpose will be necessary to meet existing deficiencies. 6. Prevention.— The Association would renew its recommendation of last year that an additional psychiatrist be allowed on the staff of the State Hospital Commission to give his time to the

oversight and development of out-patient clinics. As a means of permitting the several hospitals to undertake more clinic work than at present it is important that physicians be allowed for this work in a ratio of one physician to every 150 patients. The fact that only one new clinic was opened during the past year and that the attendance remained stationary is an indication that with their present staffs the State hospitals cannot greatly extend the clinic work beyond its present scope and at the same time do justice to the patients in the hospital. If prevention is to be made effective in reducing the number of new admissions to the State. hospitals it must reach a much larger proportion of the State's population than is possible through the present centers. For the preventive work it would also be desirable to have an additional social worker allowed each State hospital to give full time to cases coming from the community. An allowance for traveling expenses, which would permit regular periodic conferences of the clinic physicians and social workers, would also be an important aid in developing this work.

REPORT OF THE BUREAU OF STATISTICS
Submitted by Horatio M. Pollock, Statistician and Editor

To the State Hospital Commission:

Your statistician and editor respectfully submits herewith the report of the Bureau of Statistics for the fiscal year ended June 30, 1922.

EDITORIAL WORK

The Bureau has continued to conduct the editorial work of the department including the preparation of the annual report of the Commission, the Handbook, Directory and special bulletins, and the editing of the annual reports of the State hospitals and the State Hospital Quarterly.

The Quarterly continues to grow in size and interest. With the resumption of more normal conditions in the State hospitals, renewed interest has been taken by the hospital staffs in scientific studies and, consequently, there has been an abundance of material for the Quarterly produced by our own physicians. While the magazine publishes a few articles by authors outside the system, the preference is naturally given to articles showing results of investigations in our own department.

EXHIBITS

The Bureau conducted two noteworthy exhibits during the year. One of these was shown at the Second International Congress of Eugenics, which was held in the Museum of Natural History, New York City, during the months of September and October, 1921. In the preparation of this exhibit the statistician was assisted by Dr. A. J. Rosanoff of Kings Park State Hospital. The exhibit of the Commission and the State hospitals at the State Fair, September 8 to 13, was devoted principally to the demonstration of the work of the hospitals in occupational therapy. The exhibit

« ΠροηγούμενηΣυνέχεια »