: '*m w Wi L« »* : (Jfatnell Unittersttg Sitbratg 3tt;aM, Nfm Inrh ...I.....E....IillcQX.. Cornell University Library RC 443.P77 Comparative statistics of state hospital 3 1924 012 457 283 COMPARATIVE STATISTICS OF STATE HOSPITALS FOR MENTAI^DISEASES 1920 BY HORATIO M, POLLOCK, Ph. D., STATISTICIAN, NEW YORK STATE HOBPITAI, COMMISSION EDITH M r FURBUSH, STATISTICIAN;,' f WE NATIONAL COMMITTEE FOR MENTAL H«e^!NE PUBLISHED BY BUREAU Q# STATISTICS THE NATIONAL COMMITTEE FOR MENTAL HYGIENE 370 SEVENTH AVENUE, NEW YORK CITY Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924012457283 COMPARATIVE STATISTICS OF STATE HOSPITALS FOR MENTAL DISEASES 1920 BY HORATIO M. POLLOCK, Ph. D., STATISTICIAN, NEW YORK STATS HOSPITAL COMMISSION EDITH M. FURBUSH, STATISTICIAN, THE NATIONAL COMMITTEE FOR MENTAL HYGIENE 1922 STATE HOSPITALS PRESS, UTICA COMPARATIVE STATISTICS OF STATE HOSPITALS FOR MENTAL DISEASES, 1920* HOEATIO M. POLLOCK, Ph. D., STATISTICIAN, NEW YORK STATE HOSPITAL COMMISSION EDITH M. FUEBUSH, STATISTICIAN, THE NATIONAL COMMITTEE FOR MENTAL HYGIENE "VT EARLY all of the state hospitals for mental diseases throughout the country are using the system of statis- tics and classification adopted by the American Psychiatric Association in 1917. The larger part of these hospitals are sending duplicate copies of their annual statistical tables to the National Committee for Mental Hygiene, which has actively cooperated with the American Psychiatric Associ- ation in introducing the system. The Bureau of Statistics of the National Committee has annually compiled the statistical reports received from the several hospitals, be- ginning with the year 1918, and has published the results in condensed form in. Mental Hygiene. These studies of state hospital data, together with the censuses of patients in institutions on January 1, 1917, 1918 and 1920, constitute the only available national statistics of mental disease since the Federal census study of 1910. This study is a continuation of the series begun in 1918 and comprises data compiled from the uniform tabular reports of 77 hospitals representing 26 states. The reports received from a few additional hospitals could not be in- cluded on account of various inconsistencies and inaccura- cies and the fact that some hospitals preparing biennial reports did not compile them by separate years. It is re- grettable that reports could not be secured from all the *The authors wish to express their appreciation of the generous cooperation of the superintendents of the state hospitals represented in this study, and to acknowledge their indebtedness to Miss Adah K. Attwood, Assistant Statis- tician of the National Committee for Mental Hygiene, who checked the reports from the hospitals and compiled many of the tables herein published. hospitals in a larger number of states so that comparative rates might be based upon the general population. It must be remembered, however, that the year 1920 was a trying period for most state hospitals. There was a serious short- age of physicians, nurses, attendants and clerks. Conse- quently many superintendents felt the necessity of curtail- ing their statistical reports. It is believed that when normal conditions are restored in the state hospitals a greater degree of cooperation in statistical reports will be secured. The data contained in this study, while not complete, are representative, and afford an adequate basis for the com- parison of the results of one hospital with those of others similarly situated. The following topics are included, each of which is the subject of a separate table : 1. Patients, physicians and employees. 2. Expenditures for maintenance. 3. Movement of patient population. 4. Psychoses of first admissions. 5. Nativity of first admissions. 6. Age of first admissions. 7. Degree of education of first admissions. 8. Environment of first admissions. 9. Economic condition of first admissions. 10. Use of alcohol by first admissions. 11. Marital condition of first admissions. 12. Discharges, classified with reference to psychoses and condition on discharge. 13. Eecovery and improvement rates. 14. Duration of hospital life of patients dying in the state hospitals. 15. Deaths and death rates. Owing to the incompleteness of some of the reports, the number of hospitals represented varies somewhat in the several tables. The number is indicated in the heading of each table. Patients, Physicians, and Employees (See Table 1, page 23) Table 1 shows a wide divergence in the ratio of patients to physicians and employees in the several states. In very few hospitals is the pre-war standard of 1 physician to 150 patients maintained; in some states the ratio is lower than 1 to 300. The average ratio in the whole group com- bined is 1 to 218.9. This is a marked gain over the average ratio shown in the study of 1918,* namely, 1 to 242.7. Had the vacancies on the medical staffs in 1920 been filled, the average ratio would probably have been better than 1 to 200. The general average ratio of ward employees to patients in 1920 was 1 to 13.0, as compared with 1 to 12.5 in 1918; of all employees to patients in 1920, 1 to 6.7 and in 1918, 1 to 6.9. These figures indicate an unsatisfactory standard of care in many hospitals, which it is hoped will prove to be merely a transient condition. Expenditures foe Maintenance (See Table 2, page 27) The amounts required for the maintenance of patients in state hospitals in 1920 were appalling. The average per state hospital was nearly a half million dollars, while the expenditures of Manhattan State Hospital, the largest of the group, were $1,783,048.88. The general average per capita expenditure for maintenance in 1920 was $315.28, as compared with $261.79 for the same group of hospitals in 1918. It will be remembered that the index of the cost of living, which rose rapidly during the war, reached its high- est point in 1920. Comparing the figures of 1918 with those of 1920, it will be observed that there was an increase in nearly every hospital in the latter year, although in some hospitals the increase is much more marked than in others. The per capita cost of maintenance in the hospitals of * Comparative Statistics of State Hospitals for Mental Diseases, 1918. By H. M. Pollock and Edith M. Furbush. Mental Hygiene, vol. IV, pp. 137-191, January, 1920. Massachusetts and New York was much higher than in those of Ohio and Pennsylvania. The per capita cost in the northern and eastern states in general was also higher than in the southern and western states. Movement of Patients (See Table 3, page 29) The distinction between "first admissions " and "readmis- sions, ' ' which until recently has caused so much confusion in hospital statistics, is now being uniformly made, and there is no longer any serious difficulty with respect to returned escapes and paroles. The latter are not counted as admissions unless they have been previously discharged from the books. Likewise the data relative to discharges are freed from the duplications which previously occurred in some hos- pitals when paroles and escapes were counted as discharges while still being carried on the hospital books. Under the present system, parole is considered as an incident in treatment, and the paroled patient is continued on the books until the expiration of the parole period. The increase in patients during the year in most of the hospitals listed in the table was very small, and in some a decrease occurred. The total net increase was less than two per cent. Psychoses of First Admissions (See Table 4, page 33) The 21,742 first admissions classified in Table 4 consti- tute the largest group of diagnoses of mental disorders that has been brought together under the uniform system. Al- though marked variations are seen in the relative distribu- tion of the various psychoses in the several hospitals, the results as a whole are very similar to those obtained in our study* of mental diseases for the year 1919. * Mental Diseases in Twelve States, 1919. By H. M. Pollock and Edith M. Purbush. Mental Hygiene, vol. V, pp. 353-389, April, 1921. 7 Distribution of Principal Psychoses, 1919 and 1920 1919 1920 Psychoses Number Per cent Number Per cent Senile 1,742 11.4 2,550 12.1 With cerebral arteriosclerosis.. 844 5.5 1,350 6.4 General paralysis 1,514 9.9 2,219 10.6 Alcoholic 703 4.6 476 2.3 Manic-depressive 2,269 14.8 3,366 16.0 Involution melancholia 453 3.0 683 3.3 Dementia precox 4,280 28.0 5,676 27.0 Paranoia or paranoid con- ditions . 266 1.7 594 2.8 Epileptic psychoses 464 3.0 560 2.7 Psychoneuroses and neuroses. . 272 1.8 435 2.1 "With psychopathic personality 210 1.4 492 2.3 With mental deficiency 508 3.3 680 3.2 All other psychoses 1,769 11 . 6 1,931 9 . 2 Total 15,294 100.0 21,012 100.0 The most remarkable change since 1919 has been the reduction of alcoholic psychoses, the percentage having dropped from 4.6 to 2.3. This is apparently due to more rigid restrictions of the liquor traffic. It will be noted that a few hospitals report no alcoholic cases. The gradual reduction of alcoholic cases from about 10 per cent in 1910 to about 2 per cent in 1920 is a noteworthy accomplishment. Data presented in other studies* also indicate that alcohol has been largely eliminated as an etiological factor in psy- choses other than the alcoholic group. The percentage of general paralysis cases among the first admissions included in this study is a trifle larger than that found in the group studied in 1919, but the variation is not sufficient to indicate a rising trend. The prevalence of de- mentia prsecox and of manic-depressive psychoses among the first admissions varies greatly in the different states. This is probably due in part to differences in standards of diagnosis and in part to actual differences in forms of mental disease occurring in various parts of the country. * Decline of Alcohol and Drugs as Causes of Mental Disease. By H. M. Pollock. Mental Hygiene, vol. V, pp. 123-129, January, 1,921. 8 Readmissions As the psychoses of readmissions have less significance, they are not set forth in detail for the several hospitals, but the data are condensed into the following table showing the number and per cent distribution of the different psy- choses. Psychoses of Readmissions to 70 State Hospitals for Mental Diseases, for the Fiscal Tear 1920 Number Per cent Psychoses Males Females Total Males Females Total Traumatic 5 •• 5 °- 2 •■• 0- 1 Senile 56 84 140 2.1 3.3 2.7 With cerebral arteriosclerosis ... 63 36 99 2.3 1.4 1.9 General paralysis 159 44 203 5.9 1.7 3.8 With cerebral syphilis 11 13 24 0.4 0.5 0.5 With Huntington's chorea r 1 1 With brain tumor 2 1 3 0.1 ... 0.1 With other brain or nervous dis- eases 9 9 18 0.3 0.4 0.3 Alcoholic 102 17 119 3.8 0.7 2.3 Due to drugs and other exogenous toxins 12 11 23 0.4 0.4 0.4 With pellagra 1 12 13 ... 0.5 0.2 With other somatic diseases 14 27 41 0.5 1.1 0.8 Manic-depressive 789 1,047 1,836 29.1 40.9 34.8 Involution melancholia 40 70 110 1.5 2.7 2.1 Dementia precox 964 758 1,722 35.5 29.6 32.6 Paranoia or paranoid conditions.. 64 75 139 2.4 2.9 2.6 Epileptic psychoses 56 62 118 2.1 2.4 2.2 Psychoneuroses and neuroses .... 37 55 92 1.4 2.1 1.7 With psychopathic personality .. . 92 65 157 3.4 2.5 3.0 With mental deficiency 85 79 164 3.1 3.1 3.1 Undiagnosed psychoses 61 52 113 2.2 2.0 2.1 Without psychosis 94 42 136 3.5 1.6 2.6 Total 2,716 2,560 5,276 100.0 100.0 100.0 It will be noted that more than two-thirds of the read- missions are classed in the two groups, manic-depressive psychoses and dementia prsecox. Nativity and Citizenship (See Table 5/page 41) Table 5 shows marked variations in the different sections of the country with respect to the admission of foreign-born and alien patients. The eastern states receive a very much larger proportion of immigrants than the western states. The per cent distribution of the whole group with respect to nativity is shown in the accompanying tabulation. Nativity of First Admissions to 71 State Hospitals for Mental Diseases, for the Fiscal Year 1920 Country of birth Number Per cent United States 14,006 67.0 Total foreign born 6,902 33.0 Austria 597 2.9 Belgium 24 0.1 Bohemia 37 0.2 Canada 562 2.7 Czecho-Slovakia 47 0.2 Denmark 71 0.3 England 390 1.9 Finland 72 0.3 France 83 0.4 Germany- 773 3.7 Greece 89 0.4 Holland 33 0.2 Hungary 277 1.3 Ireland 869 4.2 Italy 847 4.1 Mexico 163 0.8 Norway 88 0.4 Poland 321 1.5 Portugal 28 0.1 Roumania 53 0.3 Russia 733 3.5 Scotland 105 0.5 Spain 37 0.2 Sweden 198 0.9 Switzerland 50 0.2 Turkey 58 0.3 West Indies 83 0.4 Other countries 214 1.0 Total 20,908 100.0 10 The above figures indicate the types of immigrant patients being received in the hospitals, but in the absence- of data with respect to the general population do not throw any light on the question of the relative prevalence of mental diseases among the immigrants coming from the different countries. The data received from the hospitals reporting the citi- zenship of first admissions when combined give the follow- ing totals : Citizenship of First Admissions to 68 State Hospitals for Mental Diseases, for the Fiscal Year 1920 Citizenship Males Citizens by birth. 7,552 Citizens by naturalization. . 1,309 Aliens 2,034 Citizenship unascertained. . 503 Total Females Number Per cent 6,210 13,762 67.1 1,120 2,429 11.8 1,340 3,374 16.5 438 941 4.6 Total 11,398 9,108 20,506 100.0 The fact that one-sixth of the first admissions to these- state hospitals are aliens calls for remedial legislation.. It cannot be expected that the states will continue indefi- nitely to make provision for so large a number of citizens of other countries when the state hospitals are now filled to- overflowing and the burden of the care of the citizen insane is becoming so heavy. Age Distribution (See Table 6, page 53) Table 6 shows very clearly that age and sex are highly important factors in the various psychoses. It is seen that, the distribution by age groups varies greatly in the differ- ent forms of mental disease and that the distribution of the totals throws very little light on the relative frequence of any particular psychosis at different periods of life. The accompanying series of frequency charts illustrates these differences and indicates in a striking way the distribution of the various disorders in the several age groups. PER CENT DISTRIBUTION BY AGE GROUPS OF FIRST ADMISSIONS WITH CERTAIN PSYCHOSES PER CENT 70 SENILE GENERAL PARALYSIS 60 50 40 30 20 to 70 60 w CM CM O) O) MANIC-DEPRESSIVE PER CENT 1 70 94 IO DEMENTIA PRAECOX V o 60 50 40 60 50 40 30 10 AGE IN YEARS AT TIME OF ADMISSION 12 Degree of Education (See Table 7, page 57) Of the 20,238 patients in Table 7 whose degree of educa- tion was ascertained, 2,054, or 10.1 per cent, were reported as illiterate ; 4,565, or 22.6 per cent, as merely able to read and write; 11,257, or 55.6 per cent, as having a common school education; 1,852, or 9.2 per cent, as having attended high school; and 510, or 2.5 per cent, as having attended college. The degree of education of 1,122 cases was not ascertained. A noteworthy fact brought out in the table is the high percentage of patients with drug psychoses who had the advantage of a high-school or collegiate education. An explanation is found in part in the relatively large number of trained nurses and physicians who acquire the drug habit. Other groups in which the admissions have educational training above the average are the traumatic, with brain tumor, manic-depressive, involution melancholia, and psy- choneuroses and neuroses groups. The highest proportion of illiterates is, of course, found in the mental deficiency group, while high percentages are also seen in the senile, pellagra and epileptic groups. Environment (See Table 8, page 58) Of the 21,817 first admissions included in Table 8, 15,577, or 71.4 per cent, were from urban environment, 5,913, or 27.1 per cent, were from rural, while the environment of 327, or 1.5 per cent, was unascertained. The terms urban and rural are used as in the classification of the Federal Census Bureau, "urban" applying to places having a pop- ulation of 2,500 or more and "rural" to all others. The dementia-prsecox group furnishes 28.4 per cent of the first admissions from an urban environment, manic-depressive 15.1 per cent, general paralysis 12.6 per cent, and senile psychoses 10.7 per cent. In the rural group, the dementia- prsecox cases constitute 25.3 per cent of the first admissions, followed by the manic-depressive with 18.6 per cent, and 13 the senile with 15.6 per cent, with general paralysis con- tributing only 5.2 per cent. The number and percentage of each psychosis among the first admissions for the years 1919 and 1920 are shown in the following table, the 1919 data including 32 state hospitals and the 1920, 72 such hospitals. Distribution by Psychoses of First Admissions from Urban and Rural Environments, 1919 and 1920 Urban Rural 1919 1920 1U19 1920 Per Per Per Per Psychoses Number cent Number cent Number cent Number cent Senile 873 10.6 1,611 10.7 468 14.9 887 15.6 With cerebral arteriosclerosis 403 4.9 1,001 6.6 118 3.8 363 6.4 General paralysis 1,041 12.6 1,902 12.6 178 5.7 297 5.2 Alcoholic 333 4.0 400 2.7 56 1.8 77 1.4 Manic-depressive 1,271 15^ 2,272 15.1 598 19.0 1,059 18.6 Involution melancholia 253 371 417 2.8 109 3.5 205 3.6 Dementia precox 2,341 28.4 4,276 28.4 826 26.3 1,444 25.3 Paranoia or paranoid conditions 131 1.6 347 2.3 49 1.6 148 2.6 Epileptic psychoses .. . 231 2.8 359 2.4 144 4.6 209 3.7 Psychoneuroses and neuroses 128 1.6 292 1.9 45 1.4 138 2.4 With psychopathic personality 136 1.7 383 2.5 44 1.4 97 1.7 With mental deficiency 224 2.7 415 2.8 139 4.4 260 4.6 All other psychoses . . 871 10.6 1,404 9.3 366 11.7 514 9.0 Total 8,236 100 . 15,079 100 . 3,140 100.0 5,698 100 . The following psychoses showed increases in percentages for urban admissions from 1919 to 1920, worthy of mention : psychoses with cerebral arteriosclerosis, paranoia, psycho- neuroses and neuroses, and psychoses with psychopathic personality. In the following groups among the admissions from urban environment, there was a decrease in the per- centage of first admissions: alcoholic psychoses, manic- depressive, involution melancholia and epileptic psychoses. Among the first admissions from rural communities, the following showed an increase in percentage of first admis- sions : senile, with cerebral arteriosclerosis, paranoia, psy- 14 choneuroses and neuroses, psychoses with psychopathic personality, and with mental deficiency, while a decrease is noted in the following : general paralysis, alcoholic psy- choses, manic-depressive, dementia praecox and epileptic psychoses. The most important changes were in the alco- holic and arteriosclerotic groups. Economic Condition (See Table 9, page 59) The headings in Table 9 are used as in the Statistical Manual and are defined as follows: "Dependent," lacking in the necessities of life or receiving aid from public funds or persons outside the immediate family; "marginal," liv- ing on daily earnings, but accumulating little or nothing, being on the margin between self-support and dependency ; "comfortable" having accumu^ted resources sufficient to maintain self and family for at least four months. Comparing the results shown in Table 9 with those ob- tained in the study of 1919," we find marked differences in the relative proportion of patients who were ' ' dependent, ' ' "marginal," and "comfortable" on admission. The fol- lowing summary presents numbers and percentages based upon the totals ascertained for the two years, including 40 hospitals for 1919, and 69 hospitals for 1920. Distribution by Economic Condition of First Admissions, 1919 and 1920 1919 1920 Economic condition Number Per cent Number Per cent Dependent 1,857 13.9 3,979 20.4 Marginal 9,178 68.5 10,897 56.0 Comfortable 2,358 17.6 4,597 23.6 Total 13,393 100.0 19,473 100.0 The differences in the percentages for the two years are larger than would be expected, but conditions have been * Social Facts Relative to Patients with Mental Diseases. By Edith M. Eurbush. Mental Hygiene, vol. V, pp. 587-611, July, 1921. 15 mnusual and it is known that marked changes in the eco- nomic condition of a considerable proportion of the popula- tion took place in 1919 and 1920. Use of Alcohol (See Table 10, page 60) As previously mentioned, the proportion of patients ad- mitted with a record of intemperate use of alcohol is lessening year by year. The data shown by this table indicate a decline since 1919. These results do not bear out the statements frequently found in the daily press that the consumption of strong liquor is increasing. The pro- portion of first admissions in the principal psychoses for the years 1919 and 1920 with a record of intemperate use of alcohol is shown in the accompanying table. The 1919 data include 38 state hospitals with 12,179 first admissions ; .and the 1920, 69 such hospitals with 18,687 first admissions. Intemperate Users of Alcohol among First Admissions in Principal Psychoses, 1919 and 1920 1919 1920 Psychoses Number Per cent* Number Per cent* Senile 130 10.4 210 '9.7 With cerebral arteriosclerosis.. 105 14.2 178 14.1 Oeneral paralysis 316 25.1 563 28.4 Alcoholic 667 100.0 468 100.0 Manic-depressive 114 6.8 240 8.1 Involution melancholia 21 5.0 33 5.4 Dementia prsecox 331 9.6 552 10.6 Paranoia or paranoid con- ditions 26 12.0 50 11.4 Epileptic psychoses 38 10.5 46 9.4 Psychoneuroses and neuroses. . 10 4.3 20 5.0 With psychopathic personality 27 15.3 81 17.5 With mental deficiency 43 11.1 71 12.5 All other psychoses 175 12.8 228 13.5 Total 2,003 16.4 2,740 14.7 * Based upon total ascertained and excluding admissions without psychosis. 16 Marital Condition (See Table 11, page 61) Table 11 has much significance in indicating the social make-up of the first admissions in the various psychoses. An analysis of results in the several groups shows marked differences between males and females in regard to mar- riage prior to the onset of the psychosis. A comparison of ,the distribution with respect to marital state in the principal psychoses is shown in the accompanying table (page 17). The very high percentage of single patients in the de- mentia-prsecox group confirms previous observations that sexual maladaptation is a prominent factor in this disorder. Results of Treatment (See Tables 12 and 13, pages 63 and 64) Table 12 includes the discharges of 69 state hospitals and classifies them by psychoses and condition on discharge, while Table 13 gives the number of patients discharged as recovered and improved in the separate hospitals and the rate based on all admissions for each sex. Of the 13,540 discharges classified in Table 12, 4,781, or 35.3 per cent, were discharged as recovered; 6,034, or 44.6 per cent, as improved ; 2,022, or 14.9 per cent, as unimproved, and 703, or 5.2 per cent, as without psychosis. More than half of the recoveries were in the manic-depressive group. The next largest group of recoveries was the alcoholic. Three hundred and fifty-seven dementia-prsecox patients were discharged as recovered and 2,448 as improved. These figures would indicate that this type of mental disease is not so hopeless as was once thought. Referring to Table 13, we find wide variation in the per- centages of cases discharged as recovered and improved from the several hospitals. This fact is accounted for in part by differences in administrative policies in the various states, and in part by actual differences in results of treat- ment. 17 «0 CO © ?> ■■■A <3 a. © SO HA © s o 9i © «0 SWMMOOHOJtOSOHiSOO o B o a I HHMNHCqHCONCOIMOH eq §3 HSnHamoammoio^ en a t* iH t- r-l W r-f rH iH r-H i-H rH CO rH 3 £ 11 OOOlOinOl^Ht^QOSb-COCirH 00 H % PS HHOJHHHHCOHOWHN rH 1 IO^»OSWCHOWHM"-S COOJHHO©?OOllNiSO>lO'* o a »«O0Ji>'*'*C0(D<0«MH ■* O s ■^ CO rH rH iH r-i IH s OSQOrHCOOaiHCCOSlfSOSOS'^PO' N 1* 0-*(MTt)Mffi«0©CQIMHNr- O S 03 -e* (M W .CC •* a PS coioco^iracocoTtitMWeOi-Hic T* g QO^^aTHWOWOl^lMOO^ CM 8 coooioa CO fc»s0GOt>eoc DQ ss H EQ O 4 o 03 'o GO O _« PI o o t3 s 5 £ ■> -H ■K.S oS 8? 'S'3 J3 cS 2 * t epressive . on melanch a prsecox . a or parano c psychoses euroses and yehopathic ental deflci 1 XL 1 i _ a § J < i 1 E j 4- E a I P 1 I p- I ■i- p i > - » p. is >* i c < ■5 E- 18 In considering rates of recovery and improvement based on all admissions, it must be borne in mind that any marked increase or decrease of admissions during a given year in any hospital will inversely affect such rates. It is well understood that a large part of the discharges of one year come from the admissions of the preceding year. When the admission rate of the hospital is uniform year by year, it is fair to compute recovery rates on all admissions, but if the admissions from year to year change to a considerable extent, the basis becomes less satisfactory. The following table shows a comparison of the recovery and improvement rates in the various psychoses for the years 1919 and 1920. The rates are based upon the total number of patients admitted, excluding transfers and those admissions without psychosis. The better results in 1920 are noteworthy. Recovery and Improvement Rates in Principal Psychoses Based on Total Admissions, 1919 and 1920 Psychoses Total 1919 1920 Senile 7.3 8.4 With cerebral arteriosclerosis 12.2 12.9 General paralysis 8.9 13.0 Alcoholic 85.1 127.1 Manic-depressive 63.3 75.4 Involution melancholia 34 . 6 43 . 3 Dementia prsecox 30 . 9 39 . 1 Paranoia or paranoid con- ditions 44.7 39.8 Epileptic psychoses 28 . 9 29 . 6 Psychoneuroses and neuroses 65.0 69.4 With psychopathic personality 71.7 63.0 With mental deficiency 52 . 2 41 . 8 All other psychoses 33.6 44.4 Per cent dis- charged as recovered Per cent dis- charged as improved 1919 1920 1919 1920 0.3 0.5 7.0 7.9 2.1 1.5 10.1 11.4 0.4 8.9 12.6 50.2 80.7 34.9 46.4 42.8 51.4 20.5 24.0 16.4 20.3 18.2 23.0 2.0 4.9 28.9 34.2 4.3 8.3 40.4 31.5 5.7 7.5 23.2 22.1 25.8 30.9 39.2 28.5 40.7 36.6 31.0 26.4 26.0 20.0 26.2 21.8 17.3 26.3 16.3 18.1 Total 36.6. 42.5 15.1 18.8 21.5 23.7 19 Deaths (See Tables 14 and 15, pages 68 and 72) The 11,420 patients who died in 71 state hospitals are classified in Table 14 according to psychosis and length of hospital residence. Of these deaths, 1,648, or 14.4 per cent, were in the hospital less than one month ; 1,626, or 14.2 per cent, had a hospital residence of from one to three months ; 1,221, or 10.7 per cent, from 4 to 7 months ; 761, or 6.7 per cent, from 8 to 12 months; 1,966, or 17.2 per cent, from 1 to 2 years ; 977, or 8.6 per cent, from 3 to 4 years, and 545, or 4.8 per cent, from 5 to 6 years. Nine hundred seventy- nine, or 8.6 per cent of the patients who died, had been in the hospital for 20 years or over. The duration of hospital life varies greatly in the different psychoses, being longest in the dementia-prsecox and paranoid groups, and shortest in the drug and somatic groups. On account of the acute illness of many patients on ad- mission, the death rate during the first year of hospital life is much higher than in the immediately succeeding years. The per cent distribution of the hospital-life period in the several groups, excluding those without psychosis, is shown in the tabulation on pages 20 and 21. (See also the accompanying chart, page 22.) Table 15 presents the number of deaths in each hospital for the fiscal year 1920 and the death rates per 1,000 patients under treatment for the years 1910, 1918, and 1920. The general death rate for 1920 in the hospitals studied was 77.8 per 1,000 patients under treatment. The rate among the males was 84.5 and among the females 70.6. In 1910 the death rate for the same group of hospitals was 73.3, and in 1918 it was 85.5. In 1919 the general rate in the state hospitals of 12 states was 93.4. This abnormally high rate was due principally to the influenza epidemic which occurred in many of the hospitals during the fiscal year that ended in 1919. The death rates in the several hospitals vary greatly. Hospitals that are located in large cities and receive a large 20 *8 P4 o OOM^«OriO»M^O!00 StOt-tOQOOOOOU3>OHCqlO iH rH iH rH i-l CO©I>OHW(OMHCO t>(O^COOCinNt- rH CO ^ rH rH rH CM oo-THoa^coiQcqooicoiM^o^ rH rH (M tH rH r-t rH H W Cq H H OOOTtfCSSTflTHOSOirHCi^COCO OIOQOMt-Wl>HOi HCOO ^HW H M, rH ■5 as CO OcOMNHrtWCOHONOH O (MC00S000iTjHTji(D04iHM ■«# CO O CO rHTflCOt-rHCOeMCOrHO»OrHeO OSOOt-cOCq^cOeOCJrHrHlOCq CO b- rH H3 rH CO «D OOOOOOOOOOOOO 53 H*i CO o &3 © s CO § CO o CO ft. "tfb-b-OCOCOOsasb-COCO^lO cq O OS (M CO CO CM rH ^ cq CO I NHH rH o (=1 aots it ! 8 3° » g OStOr-tCOasCCOTfl NNH^^lMHHcq rH CO rH Tfl tH lO (M 00 C rH l> CM i-l CO O i-l a a Hoo©rt'tDioi>i>cqco?DH CO HOMHHCO rH rH 00 1 NOOOO^co(DCacOW«OtOH 00 t» Tti t» co cm itj Cl rH rH Tfl IO lO WHOCOWOJIMWSHOOt-.QO I C3S(MC31»OCOcOCOaiCOCMeOOi^i NdCO W t-Cd© "* CM(M Oh ■e.s as -£ is 3 S d • J3 „ fossil •B „_ »S d d » -H id u 3 « 3 "S ,2 « S S O ^ .SS„ Eh 22 PER CENT DISTRIBUTION OF HOSPITAL LIFE PERIODS OF PATIENTS DYING IN STATE HOSPITALS -1920 PER CENT 10 10 30 40 50 3 TO 4 YEARS BB 8.6 5 TO 6 YEARS H 4■<& w •ki a d> k. o >sS "*~, »>. Oi CO *s 1-^ C3 !» CO e CO 5si rSg o CO CO rS£ © ■*» »-^ a. ■w § W co CO co "w ■«> W s -K> QQ "\ ^ s£ co e -K& CI s •** CO b CO I e Oh co e a o.s lis Wli | o.|8 o £ 43 e! m •33 b ^ « « FN X a o CO in co o co o 00 O CM CO CO CD 00 t- 00 US'* O^ O O CO CM O0 CO CM CO »0 CO CM T-I rH f-t ONHt> CO "^ 05 ■* W CO OO rH i-t iH rH CM rH 00 o ■a o EH to OH©.© i-l W W b- C© 00 CD CO G5 W CO t- OS 00 oo co irj t* t- co b- O OS O rH -* CO O CM HC3QOCO rH rH ■^ CD O CO CO 00 rH rH rH rH rH CD 1 rH rH rH rH rH CO O CO o CO OO 00 OS Cq OO CO rH O rH O CO b- CO -* O os co oo oo oo o; > c6 Q §,3 rl H Pl|lgll|||^|g g o w fc aj £ o o ih S M -"" 02 CO CO B co to "B i". CO w -» CO 9> CO W «i o <^ CO ««, •-i~. O CO -S CO ■K* CO S-. 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S ft "V o o cS © g 55 +. Pi '3 b P3 o g Si r^-a-c; ■» c 1 ^ is § B ^ is « i i 31 g * 4 g i o -^ 73 m 111 OO0 a 2 & pi : a 2.2 fc !ZJ o 26 co CO CO to e co CO IS e — s 5- co *> I O 5- •s ^> to Oi to e to Co >*-& e 05 « tC °> " •II § to 2 s .§ S CO rsi to *l § to ■** e e t3+* mber of each se an mdan H oc cc co co cm 00 ^ ac t^ b- O OS to « C ^* ot tow in T-f T-l r-l ?H iH T-H rH r-i ri tH I- r-i rH r-l r-i S -g-gs oc HOWtD^Nr- IO O C c tc GO r-l r-l ■ Num oi patie to et empk c- b- tD CO CO CO IO ON b- OC t^ IC O t-' r-l O rH c b- co as oi m co cc CXI cc oc CN c CO CC O o3 u: co as co 10 m as m CO CO c a- cc too CO Eh HHHCq^) r-i r4 rl 1- 1- TH r-l r-l CO w M P* O S s CC CO CO rH CO CO CM C CXI r^i CC t- c 10 ec. 5 i CM b- O b- rH CO CO r] lO OC ■* a tc O rH tH # « in « in c 00 t> »o OJ GO CO CO -^ (M CO 1- CO w X c t- in 00 rH N rH r-l rH 2 tt B - w £*, c sis tc o^ieoawwc CO ^fl * S 5 oa 0,4 cc OS CO O rH CO (N 1- OS b- w: T— oc en oc CO T- HHCONWHr rH (N T- cr I- CM r-i CM fc ft** A •O'o CC CO b- CO 00 rH Tfl r- b- Th ir: t£ Tt to-* W son rH >> ^ p. BO j* OC WHt-OWHr b* ifi T- t- T( sot- CXI 00 nnoHAOr in cc IC I- CN toco rH o> "s "3 ■tf rH rH OS t- CO W r- CO c l> a- t» >■- ic- CO •42 p s * ' r(H rH CM rH 1- 7— r-l rH fcgft bo Q, C cr HNCONOMa cr tc CN r-l ^ ^-^ ■< £ 'o' S **•*< 'i t a 5 CD O H w 03 i ■*- a G §1 S T3 ■Vi O W ~- ' 1^ a c -*- c < i ■s c 1 i CO 1 3 3 03 2 ^ g H m B H H flt a.' i S-S ™ « a cc S E ra a I 8 1 -- H- I it 1 "8 E DC rS O 8 S |is ga rtr* H- gotz CO h> -OP CM H 35 fcH H > r> £ 27 Table 2. Expenditures for maintenance in 72 state hospitals for mental diseases, for the fiscal year 1920, with per capita expenditures in 1918 State hospital Average daily population 1920 Expenditures fob maintenance 1920 Amount Per capita Per capita 1918 Arizona State Hospital (Phoenix) California Mendocino (Talmage) Colorado State Hospital (Pueblo) Connecticut State Hospital (Middletown) . Indiana Central (Indianapolis) Eastern (Richmond) Northern (Logansport) Southeastern (Madison) Iowa Cherokee Clarinda Independence Mount Pleasant Maine Augusta Bangor Maryland Spring Grove (Catonsville) . . . Massachusetts Bostonf Danvers (Hathorne) Gardner Grafton (Worcester) Medfield (Harding) Northampton Taunton Westborough Worcester Michigan Ionia Pontiac Nebraska Hastings Lincoln New Hampshire State Hospital (Concord) New Jersey Morris Plains Trenton New York Binghamton Brooklyn Buffalo Central Islip ■ ■ ■ 519 1,158 1,968 2,599 1,395 884 967 1,190 1,123 1,129 1,102 1,130 1,120 688 775 1,814 1,873 811 1,478 1,615 1,008 1,313 1,282 1,914 522 1,497 1,142 862 1,304 2,668 1,873 2,700 1,090 2,163 5,330 I 136,179.54 322,513.22 439,155.08 853,863.39 545,145.94 249,916.22 289,239.66 301,698.86 336,161.24 358,845.71 315,877.35 366,102.39 384,172.09 317,937.48 206,680.18 854,689.01 588,640.97 315,203.67 537,132.09 593,486.49 350,514.01 471,537.43 556,826.37 677,295.88 184,732.00 605,088.84 336,876.76 289,131.40 458,390.71 901,948.18 619,725.44 885,995.52 396,447.30 667,268.47 1,586,714.96 $262.39 278.51 223.15 328.54 390.79 282.71 299.11 253.53 299.34 317.84 286.64 323.98 343.01 462.12 266.68 471.16 314.28 388.66 363.42 367.48 347.73 359.13 434.34 353.86 353.89 404.20 294.99 335.42 351.53 338.06 330.87 328.15 363.71 308.49 297.70 $211.56 214.47 292.59 298.74 234.96 252.22 216.86 201.59 206.18 210.86 207.34 295.17 310.00 261.27 480.98 370.41 323.71 338.24 313.88 312.39 338.47 401.11 318.60 272.80 285.77 $227.90 219.48 305.04 295.25 279.13 260.71 323.56 266.44 249.95 * Data not available, t IncludeB Psychopathic Department. X Estimated. 28 Table 2. Expenditures for maintenance in 72 state hospitals for mental diseases, for the fiscal year 1920, with per capita expenditures in 1918 — (Concluded) State hospital New York (Concluded) Dannemora Gowanda Homeopathic (Collins) Hudson River (Poughkoepsie) . . Kings Park Manhattan (Ward's Island). Matteawan (Beacon) Middletown Homeopathic . . . Rochester St. Lawrence (Ogdensburg) . Utica Willard North Carolina State Hospital (Morganton) . Ohio Athens Cleveland Columbus Dayton Lima Longview (Cincinnati) Massillon Toledo Oregon Eastern (Pendleton) Pennsylvania Harrisburg Homeopathic (Allentown) . . . Asylum (Wernersville) State Hospital (Danville) . . . State Hospital (Norristown) Criminal (Waymart) Western (Torrance) Rhode Island State Hospital (Howard) . . . Sodth Carolina State Hospital (Columbia) . South Dakota Yankton Tennessee Eastern (Bearden) Vermont State Hospital (Waterbury) . Virginia Central (Petersburg) Eastern (Williamsburg) Southwestern (Marion) Washington Western (Fort Steilacoom) . Average daily population 1920 Expenditures for maintenance 1920 Amount Per capita Per capita 1918 525 1,250 3,423 4,384 5,427 903 2,091 1,556 2,215 1,662 2,427 1,3.13 1,282 1,814 1,882 1,210 850 1,486 1,808 1,855 492 1,162 1,111 913 1,705 2,874 447 76 1,376 2,180 1,112 740 722 1,725 897 715 1,362 $226,569.58 413,616.64 1,204,486.67 1,381,992.39 1,783,048.88 351,575.45 610,786.61 565,638.81 712,652.98 565,446.76 787,372.53 370,526.53 378,725.76 400,648.44 472,366.87 317,433.79 237,844.32 350,515.75 409,610.10 494,808.74 121,806.86 336,983.99 364,372.62 302,982.39 563,949.81 779,844.48 211,071.20 26,885.40 462,936.79 703,140.86 362,024.83 139,820.27 205,751.12 430,201.32 187,736.09 149,587.52 302,961.44 Tota l 110,978 $34,988,858.4 4 $315.28 t Estimated. § Not open in 1918. $431.56 330.89 351.88 315.24 328.55 389.34 292 . 10 363.52 321.74 340.22 324.42 282.20 295.42 220.86 250.99 262.34 279.82 235.88 226.55 266.74 247.57 290.00 327.97 331.85 330.76 271.34 472.20 353.76 336.44 322.54 325.56 188.95 284.97 249.39 209.29 209.21 222.44 $335.79 249.93 280.94 249.08 268.62 302.67 243.90 269.59 256.25 261.99 273.20 231.50 195.06 194.72 198.27 204.81 242.94 184.17 175.64 226.73 $215.02 269.02 266.44 208.51 266.18 298.41 383.23 257.77 237.95 242.50 200.91 276.10 176.90 191.28 186.35 $171.81 $261.79 29 CO Ci e £? .2 — to to Z **> 8 ■** •Ml Co e <» o b- o c Cl 00 io o »Q Ol [OOq U(J i-T CM oa rH" rH'rH' i-Ti-Ti-Tt-T r-T cf en CO b- b« « O <0-tf COOOO OS ooic: m oq-* Ci ■* CO o- tJiCOCMO CO CO b- 00 r-l b- o COCO li?oj, tH oq CO ->* WHWN CO cq CO rH co cs CM ■* in t> w c- ©HOH ■^ oa 00 00 CO 10 05 CO o 00 b- o cc OtOQO rH rH O rH CM O- t- OS Th OitH^O • b- CO T»( ira oc ■* W CO b- •>* CO r- 00 CO 00 t- r-t b- b- i-t OS 1-i poiojduii sy T- b- CO i-l CC (M Tjl l> CM oq o os co ■* CC i-l rH C» CM b- CO t- tH CO rH (M co oi co m m ■* in CD P919A099J By 00 CO b- t> tH 00 rH tH qo o oq b- b- C b- CO t~ j^SiC 3uijnp CO IH b- tc O Tfl c» Oi O oo co cq •* a b- ■*os )U9UT)B9.I} b- in CO^ r- b^O^Cv^-^ CD^CO^b-^ in c Ol japtm pj|oj. r-T csT (T T-TrH'rH'i-r i-Ti-T i-Tr-T i-Ti- cm" TH IO CO 00 rH W cn co 00 l-H© »H !H w OC co co cr* io in f-tcq th Ttt cc O) co b- P9AI999J IBJOX tt< en o va r ^ <-v 0^ O &< "3 CO 1 or? •♦a e 'W «4 13 -Ki ;g fcs locqtocoooccoocob- cotter tM e3i CM to t- oon^it- JVOA 1 JO C1WOOt)(CD01I>WO& OH^ CM OS <* pu9 IB s^ooq ao i-T r^t-Ti-T rH^r-TcN) cM t~ rH IH * -^i CO IC b- "<* rH CXI l-T (Mt-ftOlCMCOHHCOC 00 t* oc t- ■«* rH 00 oc to OS CO W ©coco^aico^r-ioscc iH rH c OSCf ea O C ^W«^ p9Ure?j:90S'BUTl JO -*CM rH CM ^ rH CO CO »fi t> te "* CJ rH cr. rH THtM CM r-i w 5 peAOJCluiiuii sy CO IQtJ r-i ^ SO ce« OS CO OS rH ^coHcocqt- cm 00 ^1 CM CC CD CM CC t> CM OS CO paAOjduij sy CM HHr- rH rH rH CO HQOCO ■ O CM ■ CM O CC O CO CC CM r- eft O CN OS 00 O • rH b- • W* in W c£ CM1 ■* t-CO CO CO t* iO pajdAOoej sy rH CC r^ CM OOCDCMb-COH^rHCOCOC: 00 01 cc m tI QO ■* t- OS ca O r-i .UMA SUTJTip W M t> CO Ol ^ CO 1>(N C CO b- r- CM QC O t- C O Tf< IO OS )n9iD!)Qdj:) H^coosast-cob-ososoc 10 00 a -^ r- t- eaoc rH O 00 O J9pUTl {B^OJ, CM iH r-f rH rH rH CO (M 1- r-Tr- ?-t CO 00 CO CM CM b- ^rHt-oasooosaocoa- CM W b- IO IT CO wc kC CM CO O rHCMOOOOOOCNllOOWCv (OOr CO OC CO V. rH W W W poAiaoaj iwjoj, «OH H-* -*H CO O" b- H; rH eg CO CO t- CO OS ■<* cq^ i-T ■^NHowcqTHcowcy rH ^ OO CO W HHMIOOJ CM Her i-h e*" rH r-i*ti r-i rH s CO SJ9JSTIBJJ, T? rH fc-t-OOHHH>HHiO-«*asa' toow; t- C 00 O IT. t^ OS OS Tj* COM HCOOJ b- OS r- th c: co 0- CO rH C\ 00 CO CO U3 % suoi8snnpii9a rH r- rH CO CCt>OOtOOCvlCJQO(Mr b- CO r- t» in tH ID rH r-i COb-TflrHCOCOCOCM , <*b- ^iicc ■^ CO CO CM CC \o 0; rH OC CM ■* CC CM b- CO rH »«!£ rH ^HQOOOHlMtfl^t- «O^H!C O CT O b- O" J QOWC0 01«0(MI>IOWCC IO rH rj CM1 CC b- O CO TjH !.« sjjooq nQ rH HHH HHr- tM r- rH rH CM CN} CM rH CM W CD T3 . ^— . . i O n ■$ tu> :,§ : •tod -on . • «5 '.* • a O 5. 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