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PAPERS ON SPECIAL

SUBJECTS.

The Need of Psychopathic Wards in General

Hospitals.

A. R. DIEFENDORF, M.D., Middletown.

I desire first to show how little is being done to actually check the alarming increase of insanity in the State of Connecticut; and second, to point out how the physicians of the State can take an active part in the campaign against this great scourge of civilization.

On all sides we learn of the astounding increase of insanity. Your president will call your attention to figures, which show that from 1890 to 1906, the increase of accumulated insane in Connecticut has risen from 1 in 555, to 1 in 323 of our population; i. e., in the year 1906, there is 1 insane to every 323 of our population. What has and is being done to meet this alarming condition? The State of Connecticut has expended $1,252,573.00 to build, equip, and enlarge from time to time one of the largest insane hospitals in the United States, and at the last two sessions of the legislature, there was voted $600,000 to build and equip another large State institution. This money, carefully expended, has created a fine and complete equipment, which is almost the equal of the best of State institutions, and fully the equal of many private institutions. But what is being accomplished with this equipment? From 500 to 600 patients are being yearly committed by the various courts to these two institutions. Of these from 15 to 20% are being discharged recovered, and as recovered or benefited, 25 to 32%. In explanation of these unsatisfactory results an argument can be offered, which I regard of the greatest importance. It is an accepted fact among pyschiatrists, that only a small percentage of cases recover after the disease has been in existence over twelve months. Bearing this in mind, observe that during the year 1902-1903, 67% of all the patients admitted to the Connecticut Hospital for the Insane had been suffering from

their disease over twelve months. In the year 1903-1904, 61% had been insane over twelve months before admission. From the establishment of the hospital in 1867 to 1904, 57% of the patients had been subjects of disease twelve months and over before they were committed to the State institution for treatment. In order to show that the same condition exists elsewhere than in Connecticut, I quote from the last report of the Manhattan Hospital, West, where 42% of the admissions had been insane over one year before admission; again, in the report of the Pennsylvania Hospital at Dixmont, we find that 56% had been insane over one year. State hospital reports gathered from all parts of the country will show an identical state of affairs. In none of the State hospital reports is any account taken of the number of cases which are readmissions of patients formerly discharged not recovered. Eliminating this factor in our own cases, I find that there still remains the very large percentage of 41% of the admissions in 1904 in which the disease had been in existence over twelve months before commitment.

While I do not wish to burden you with statistics, for the benefit of those who might ask if some of these patients had not been cared for elsewhere than at home, I can say that during the year 1904-1905, only 2% of the patients had received treatment in other insane or general hospitals or sanitoria.

The diseases presenting the largest number of cases of a duration of more than twelve months are epileptic insanity, 80%; senile dementia, 67%; organic dementia, 63%; paranoia, 50%; dementia paralytica, 48%; dementia præcox, 35%; melancholia, 21%; alcoholic delusional insanity, 16%; and manic-depressive insanity only 7%.

In view of the fact that only a small percentage of cases recover after a duration of twelve months and that 41% of our cases have been insane at least that long, it is easy to explain why our percentage of recoveries cannot get above 15 or 20%. Viewed in this light, it at once becomes apparent that our State insane hospitals, the institutions designed to treat the middle and lower classes of society, are little more than asylums for the care of those who are irrecoverably insane. Therefore, I contend that

our equipment, however complete it may be, does not and cannot improve our percentage of recoveries and cannot cope with the increase of the insane until we are enabled to treat a larger number of the early and recoverable cases. Twenty millions cannot, applied in this way, stop the ever increasing percentage of the accumulated insane.

There are two prominent obstacles to the attainment of the object for which our hospitals are established; one is a prejudice abroad in the public mind, and the other is the prohibitive nature of our State laws as regards the commitment of the insane.

In the minds of very many persons, including even many professional men, indeed even medical men, our institutions are places to be avoided except as a last resort. It is safe to say that most of these skeptical persons are wholly ignorant of the character of an up-to-date insane hospital. Their minds are still filled with prejudices arising from horrible tales of long ago about the dark cells, the numerous implements of restraint, and the outrageous abuse by nurses. They have never seen the interior of a modern insane hospital and have no conception of the great change that has been wrought in hospital treatment by the use of the prolonged warm bath, the bed treatment, the training school for nurses, and the absence of mechanical restraint. Besides this there is the stigma that attaches to a family if one of its members has to be sent to an institution, which deters a parent or relative from taking such a step, even though they know that the treatment afforded there I would be beneficial.

For those enlightened individuals who are wholly free from prejudice, the present method of probate commitment, based upon the absurd principle that only persons legally adjudged insane can be confined in a public insane hospital, is a stumbling block. It prevents a patient being committed until he has become dangerous or his conduct has become intolerable at home. The practical working of the law is prohibitive to the treatment of that very large number of cases that develop gradually and insidiously. These cases do not show dangerous tendencies or exhibit intolerable conduct until after the disease has been in existence many months.

Thus the institutions are deprived of an opportunity to do their

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