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N535
F 776 INCREASE of PATIENTS IN THE CIVIL
STATE HOSPITALS OF NEW YORK
BY
HORATIO M. Pollock, PH. D.
Director, Statistical Bureau, Department of Mental Hygiene
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REPRINTED FROM PSYCHIATRIC QUARTERLY
APRIL, 1928
STATE HOSPITALS PRESS
UTICA, NEW YORK
1928
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INCREASE OF PATIENTS IN THE CIVIL STATE HOSPITALS
OF NEW YORK
BY HORATIO M. POLLOCK, PH. D.,
DIRECTOR, STATISTICAL BUREAU, DEPARTMENT OF MENTAL HYGIENE
Four years ago this State undertook the enormous task of enlarg—
ing its hospital system to provide suitable accommodations for all
patients with mental disease in need of hospital care. Buildings
to accommodate 7,000 patients were needed to eliminate the over-
* crowding then existing and in addition it was estimated that it
would be necessary to provide buildings for a normal increase of
, about 1,000 patients a year. On February 1, 1924, which was
about the time the first installment of the $50,000,000 bond issue was
voted, the resident patient population of the civil State hospitals
... was 38,408 and the number of patients on parole 3,320; on Feb-
ruary 1, 1928, four years later, the resident patient population was
43,823 and the number of patients on parole 3,879. The increase
in resident patients during the four years was 5,415 and in paroles
559, the average annual increases being 1,354 and 140 respectively.
The increase in patients on books during the past fiscal year was
1,891 and during the seven months from July 1, 1927 to February 1,
1928, 1,392, a total increase of 3,283 in the 19 months. Naturally
this sudden doubling of the usual rate of increase gives rise to very
serious problems.
Before attempting to analyze the increase of the past fiscal year
I wish to refer to a bit of history that has a significant bearing on
the situation confronting us. On June 1, 1917, on the request of the
Hospital Development Commission I made an estimate of the prob-
able increase of patients in the civil State hospitals during the
period from 1917 to 1927. In making this estimate I assumed that
the rate of increase of patients in the several State hospital districts
during such period would be the same as that which had obtained
during the period from 1907 to 1917. On June 1, 1917, the patients
on the books of the civil State hospitals numbered 36,115. It was
computed that the increase during the 10-year period would be
12,500 and that the patients on June 1, 1927, would number 48,615.
The estimate fortunately was too large, the actual patient populº
2
tion of the hospitals on that date being 46,122. This was approxi-
mately 2,500 less than the estimate. The increase during the ten
years was 10,007, or approximately 1,000 a year, while the increase
during the preceding ten years was 9,013 or a trifle over 900 a year.
The percentage increase, however, during the period from 1917 to
1927 was 27.7 and during the preceding ten years 33.3.
Three outstanding causes operated during the years 1917-1920
to reduce the rate of increase. The first was the world war which
nearly stopped immigration and which by reducing the medical and
nursing personnel of the hospitals was indirectly a cause of the
high death rate in the hospitals during these three years. The sec-
ond cause was the influenza epidemic of 1918 and 1919, which with
associated pneumonia, was responsible for the death of a large
number of our patients as well as that of many persons who, had
they lived, would have become patients in the State hospitals. The
third cause was the restriction of the liquor traffic which began in
1918 and in a moré less effective way has since continued. None
of these events could have been foreseen and naturally they were
not taken into consideration in our statistical estimates of 1917.
We now come to the consideration of the results of the fiscal year
which ended June 30, 1927.
We have already stated that during such year the net
increase of patients on books of the civil State hospitals was
1,891. The largest previous increase in any year was 1,442 in 1921.
The average increase during the past ten years as we have seen was
about 1,000. This large deviation in 1927 from the average incre-
ment of patients has special signficance at this time, as our hospitals
are seriously crowded and the construction of new hospitals entails
a heavy burden on the State. I have therefore undertaken the task
of analyzing this remarkable increase with a hope of getting a
clearer view of the problem. I shall attempt to answer the follow-
ing questions:
1. How was the increase influenced by admissions, discharges,
deaths and paroles?
2. In what parts of the State did the increase occurº
3. In which forms of mental disease was the increase most
marked?
4. Are like increases in mental patients occurring in other
states?
3
5. What increases in mental patients may be expected in this
State in the next 10 years? -
In answering the first question I invite your attention to Table 1.
The first admissions of 1927 numbered 7,928, the largest number
of any year for which we have record. The increase in first admis-
sions over those of the previous year was 633. There was, however,
a decrease of 69 in readmissions making a total net increase in
admissions of 564. The discharges in 1927, excluding transfers,
were 4,282, a decrease of 244 as compared with those of the preced-
ing year. There was a total of 3,806 deaths of patients in 1927, a
decrease of 301 compared with those of the preceding year. The
death rate was 70 per 1,000 under treatment. This was lower than
that of any preceding year since 1912. The patients on parole dur-
ing the year increased by 405. Excluding paroles, we find the
TABLE 1. COMPARISON OF ADMISSIONS DISCHARGES, DEATHS AND HOSPITAL POPULATION,
CIVIL STATE HospitaLs, 1927 AND 1926
Change in
1927 1926 1927
First admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,928 7,295 + 633
Readmissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,059 2,128 — 69
All admissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,987 9,423 + 564
Discharges, excluding transfers . . . . . . . . . . . . . . 4,282 4,526 — 244
Deaths . . . . . . . . . . . . . . . . . . . . . . . . . e o e º e e s e e º e 3,806 4,107 — 301
Paroles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,487 3,082 + 405
Resident patients . . . . . . . . . . . . . . . . . . . . . . . . . . . 42,823 41,337 + 1,486
Patients on books . . . . . © e º e o e º & e g º e º 'º e e º e º 'º e 46,310 44,419 + 1,891
Average daily population, excluding paroles. . . . 42,121 40,866 + 1,255
Male patients on books . . . . . . . . . . . . . . . . . . . . . . 22,096 21,002 + 1,094
Female patients on books. . . . . . . . . . . . . . . . . . . . 24,214 23,417 + 797
Male first admissions . . . . . . . . . . . . . . . . . . . . . . . 4,364 3,966 + 398
Female first admissions . . . . . . . . . . . . . . . . . . . . . 3,564 3,329 –– 235
Male readmissions . . . . . . . . . . . . . . . . . . . . . . . . . . 954 1,014 — 60
Female readmissions . . . . . . . . . . . . . . . . . . . . . . . . 1,105 1,114 -*s 9
Patients on books per 100,000 of population.... 433.1 419.8 + 13.3
Urban first admissions . . . . . . . . . . . . . . . . . . . . . . 6,997 6,364 + 633
Rural first admissions . . . . . . . . . . . . . . . . . . . . . . . 898 913 — 15
(33 unascertained in 1927)
Native first admissions . . . . . . . . . . . . . . . . . . . . . . 4,443 4,163 + 280
Foreign-born first admissions . . . . . . . . . . . . . . . . 3,460 3,116 + 344
(25 unascertained in 1927)
increase in resident patients to be 1,486 and the increase in average
daily population, 1,255. The increase in male patients on books was
1,094 and of female patients on the books 797. The increase in male
4
first admissions was 398 and in female first admissions 235. In
1926, the increases were as follows: Patients in institutions, males
558, females 260; first admissions, males 102 and females a decrease
of 242. In the last two years among patients in hospitals the
increase in males has been 595 more than in females. This dispro-
portionate increase of the males is a matter of significance as female
patients have always outnumbered males in the State hospitals.
Table 1 shows an increase in 1927 of 280 native first admissions
and 344 foreign-born first admissions. This large increase in
foreign-born cases is very remarkable in view of the fact that the
Bureau of Special Examination removed 436 alien insane patients
from the State during the fiscal year. There were also removed 807
non-resident insane, making total removals of 1,243 persons who
otherwise would have swelled the population of our State hospitals.
2. In what parts of the State did the increase occur? Data to
answer this question are given in Tables 2 and 3. Your attention is
first directed to Table 2. Comparing first admissions in 1927 and
1926 in urban and rural communities of the State as a whole, we
find an increase in 1927 of 633 in the former and a decrease of 15 in
the latter. The environment of 33 cases was unascertained. The
rate of first admissions per 100,000 of population was 72.5 in urban
districts and 49.8 in rural districts. In this table a comparison is
TABLE 2. FIRST ADMISSIONS TO CIVIL STATE HOSPITALS FROM URBAN AND RURAL
DISTRICTS IN NEW YORK STATE, 1917-1927

Number Rate per 100,000
population
Year
Urban Rural Urban Rural
1917 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,007 795 73.9 43.2
1918 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,906 876 71.3 48.0
1919 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,898 852 69.9 47.0
1920 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,715 823 69.5 45.8
1921 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,137 791 70.2 44.5
1922 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,177 803 69.4 45.6
1923 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,117 768 67.5 44.1
1924 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,136 78.1 66.5 45.3
1925 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,543 882 69.6 50.2
1926 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,364 913 66.7 51.3
1927 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,997 898 72.5 49.8
5
given of first admissions from urban and rural districts from 1917
to 1927. In both environmental divisions the trend during this
period in rates of first admissions per 100,000 of population has not
undergone much change, but when absolute numbers are considered,
it will be seen that the first admissions from cities have rapidly
increased, those for 1927 being 1,282 more than those for 1920. The
change in first admissions from rural districts has been compara-
tively slight, the difference between those of 1920 and those of 1927
being only 75.
TABLE 3. DISTRIBUTION BY COUNTY OF RESIDENCE OF INCREASE OF PATIENTS IN CIVIL
STATE HospitaLs, YEAR ENDED JUNE 30, 1927

Increase of Increase of
County patients on first
books admissions
Metropolitan district:
Bronx . . . . . . . . . . . . . . . . . . . . . . . . . . . & e º e e º e º e © e º e o e 309 87
Rings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 91
Nassau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 — 3
New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . & © tº dº tº 537 340
Queens . . . . . . . . . . . . . . . . . . . . . . . . . . © e º e º e º ºr e e © e º e º e 103 — 7
Richmond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 8
Suffolk . . . . . . . . . . • * > 0 & 6 & e º & º 'º - G - e º ºs e º e º 'º e º 'º e º e º Gº 16 11
Total . . . . . . . . . . . . . . . . . . . . . . . . . . * & C & © e º e o e º º 1,419 527
Up-State counties:
Albany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 — 19
Broome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 11
Cattaraugus . . . . . . . . . . . . . . . . © 0 6 @ & © 2 e º 'º e º e º e º e º e e 19 — 2
Cortland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . © e º 'º e º 'º e 19 22
Dutchess . . . . . . . . . . . . . . . . e º O © - © e º & © e º e º 'o e s e e e © tº e 5 20
Erie . . . . . . . . . . • e º e a 9 • * * * * * * * * * * * * * * * * * * * * * * º e º 'º 19 — 21
Herkimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3
Montgomery . . . . . . . . . . . . . . . . . . & © 6 tº gº e º e o e o 'º e º e º e e 17 15 .
Niagara . . . . . . . . . . . . . . . . . . . . . . © e º 'º 3 tº ºr º e º e º 6 © tº e º º 35 31
Oneida . . . . . . . . . . . . . . . * * * e s e º e o & e © 6 e º & e º e º e º e º O e 11 35
Onondaga . . . . . . . . . . . . . . . . . . . . e e > * > * > * > e • e º e o e º e 45 24
Rockland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 22
Westchester . . . . . . . . . . . . . . . . . . © e º e o e º e º e º e º e º e º e 40 — 8
42 other counties . . . . . . . & & © e º a tº e © e e o e e • * ~ e º 'º e º e º e 159 — 27
Total . . . . . . . . . . . . . . . . . . tº e º 'º e º º e º e o e e © º e o e > * 472 106
Grand total . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,891 633
6
Referring now to Table 3, it will be noted that in the seven
counties comprising the districts of the metropolitan hospitals
there was in 1927 an increase of 1,419 patients on books and of 527
in first admissions. In the other 55 counties of the State the
increases were only 472 and 106 respectively. The up-state counties
having the largest increases are specified in the table. The counties
listed include some but not all of the more populous counties of the
State. The rural counties of Cortland, Montgomery and Rockland
have increases in marked contrast to those of other rural sections.
It is surprising also that Niagara and Onondaga should have larger
increases than Erie and Monroe Counties. Notwithstanding the
marked additions to patient population in the State as a whole and
in urban centers, we find that in 31 counties there was a decrease
in first admissions, the total reduction for this group being 199.
From the data presented, it is evident that the problem of increase
of patients is mainly an urban one and is most acute in the metro-
politan district.
3. In what forms of mental disease was the increase in 1927
most marked? Answer to this question is found in Table 4. Taking
up first the patients on books it is seen that increases occurred in
17 clinical groups and decreases in 5. The increases were most
marked in the arteriosclerotic, paretic, alcoholic, manic-depressive
and dementia praecox groups. The paranoic group is the only one
that had a marked decrease. -
The trend in the arteriosclerotic group has been upward from
1912 to the present time. During the same period the senile group
has remained at practically the same level. The influence of the
annual gains in the arteriosclerotic group on the growth of hospital
population is seen by the fact that there were 812 more arterio-
sclerotic first admissions to the civil State hospitals in 1927 than in
1912. The only other group that has had as large an absolute
increase in first admissions in the same period is dementia praecox.
The trend in the rate of first admissions with general paralysis
has been slightly downward since 1918. Nevertheless these cases
are coming into the State hospitals faster than they are going out.
The introduction of new methods of treatment has resulted in
reducing the death rate in this group, in prolonging the hospital
life of the patients, and in restoring of many of them to the
community.
{
In this connection it seems unfortunate that more determined
measures are not taken to eradicate syphilis. The 800 paretics that
enter our hospitals represent only a fraction of the large
number of syphilitics that are needlessly sacrificed each year.
TABLE 4. INCREASE IN PATIENTS CLASSIFIED BY PSYCHOSEs, CIVIL STATE HospitaLs,
YEAR, ENDED JUNE 30, 1927
Increase in patients Increase in first
on books admissions
Psychoses § # "… 3. # "G
: # | # : #. š
Traumatic . . . . . . . . . . . . . . . . . . . . 16 7 23 3 4 7
Senile . . . . . . . . . . . . . . . … 33 38 71 — 2 19 17
With cerebral arteriosclerosis. . . . 164 102 266 82 30 112
General paralysis . . . . . . . . . . . . . . 93 28 121 — 6 17 11
With cerebral syphilis . . . . . . . . . . 7 19 26 — 3 1. — 2
With Huntington’s chorea. . . . . . . — 1 — 5 — 6 e tº — 6 — 6
With brain tumor . . . . . . . . . . . . . g 1 6 7 1 5 6
With other brain or nervous dis... 29 8 37 10 2 12
Alcoholic . . . . . . . . . . . . . . . . . . . . . . 115 11 126 107 25 132
Due to drugs & other exog. toxins 8 2 10 8 15
With pellagra . . . . . . . . . . . . . . . . . l ---
With other somatic diseases. . . . . . — 4 e — 4 — 8 2 — 6
Manic-depressive . . . . . . . . . . . . . . . 106 223 329 4 71 75
Involution melancholia. . . . . . . . . . 22 18 40 3 14 17
Dementia præcox . . . . . . e s e e e o e e 458 447 905 152 51 203
Paranoia or paranoic conditions... — 11 –107 –118 — 1 — 7 — S
Epileptic psychoses . . . . . . . . . . . . 36 — 13 23 34 — 5 29
Psychoneuroses and neuroses . . . . 9 12 21 — 2 9 7
With psychopathic personality. . . 3 19 22 12 11 23
With mental deficiency . . . . . . . . . — 7 — 1 — 8 — 4 — 5 — 9
Undiagnosed psychoses . . . . . . . . . 5 — 11 — 6 — 1 – 7 — 8
Without psychosis. . . . . . . . . . . . . . 7 — 1 6 8 — 2 6
Total . . . . . . . . . . . . * tº a c e o e º e 1,089 802 1,891 398 235 633

The trend in the alcoholic group of first admissions rose again in
1927. There was a marked reduction of cases in this group from
1917 to 1920 but since 1920 the group has been gradually increasing
and is once more a factor of large importance. As would be
expected, the alcoholic cases are admitted principally from the large
8
cities. Of the 554 alcoholic admissions of 1927, 166 came to the
Manhattan State Hospital, 96 to the Central Islip State Hospital, 63
to the Brooklyn State Hospital and 32 to the Kings Park State Hos-
pital. Buffalo State Hospital received 38 cases and Utica State
Hospital 31 cases. The other 8 State hospitals together received
128 cases.
The trend in the rate of the manic-depressive group increased
from 1909 to 1919 but since 1919 it has slightly declined although
the rate in 1922 was the largest of which we have record. There
is a steady accumulation of patients with this psychosis in our State
hospitals notwithstanding the fact that the rate of first admissions
is not increasing. -
The same is true of the dementia praecox group. There was an
increase in this group of 905 patients on the books during the last
fiscal year. The total dementia praecox patients on the books of the
hospitals on June 30, 1927, was 27,107, or 58.5 per cent of the entire
State hospital population. Owing to the large number of new cases
and the chronic nature of this disorder it constitutes our largest
institution problem.
The reduction of 118 in the paranoic group during the past year
is surprising in view of the large increases in the other groups.
The increase in the traumatic group although not large is an
indication of more serious additions in the future as our automobile
traffic continues to increase.
As we have previously mentioned there was an increase of 405
in patients on parole during the last fiscal year. Such increase was
well distributed in the various clinical groups; there being a gain
of 79 in the arteriosclerotic group, 52 in the general paralysis group,
54 in the alcoholic group, 116 in the manic-depressive group and
118 in the dementia praecox group. The only large groups in which
the paroles declined were the somatic disease group, the paranoic
group and the group of psychoses with mental deficiency.
4. Are like increases in mental patients occurring in other
states? Last November, Commissioner Parsons wrote to super-
visory boards in other states asking whether the increase of patients
with mental disease had been unusually large during the preceding
year. Replies were received from several populous states none
of which reported an abnormal increase of patients during 1927.
9
Illinois had a large increase of patients in 1924 and 1925 but a
comparatively small increase in 1927. Massachusetts reported
about the average increase during the past year. The Ohio Depart-
ment of Public Welfare stated that the increase in patients in that
State during the past ten years had been only 1,511. The State of
Washington sent us data for the biennial period of 1925-1926 which
showed an increase of only 62 admissions during the two years.
In the QUARTERLY for October, 1927, I summarized the results of
the census of patients in State hospitals for mental disease taken
by the Federal Census Bureau as of January 1, 1927. Complete
returns were shown for 30 states. An increase in resident patients
occurred between 1923 and 1927 in all of these states except Oregon
and an increase in the rate of patients per 100,000 of population was
found in all of the states except Ohio, Michigan, Oregon and Cali-
fornia. The rate of resident patients in State hospitals per 100,000
of population in the 30 states taken together increased from 218.5 in
1923 to 226.9 in 1927. The increase from 1910 to 1923 in both
public and private hospitals for mental disease in the country as a
whole had been from 204.2 to 245 per 100,000 of population. Appar-
ently the relative rate of increase of patients has not been acceler-
ated in recent years.
5. What increases in mental patients may be eacpected in this
State during the neart ten years? It is evident that the immediate
outlook is rather gloomy. The net increase of 399 patients in Janu-
ary, 1928, was greater than that of any other month in recent years.
Personally, I do not think this rapid rate of increase will continue.
But I do think we can reasonably look forward to an increase of
approximately 12,000 patients during the next ten years. This
estimate is based on the rate of increase of the last decade.
Preventive measures, no doubt, are gaining ground; but I think
few people realize how difficult a matter the prevention of mental
disease really is. It involves a long period of research and educa-
tion in a field in which there is now a deplorable lack of under-
standing and agreement among scientists. It involves changes in
family life, changes in social habits and customs, changes in educa-
tional systems, and changes in industrial and commercial life. Our
present methods of living were established in a pre-mental-hygiene
age. No thought of mental hygiene entered into their making. Per-
10
haps some mental hygiene may be grafted on these established
customs and habits. This is now being tried in a half-hearted way.
But gradually, I believe, as the new science of mental hygiene
develops, there will come into being new systems of human rela-
tionships, new habits, new customs, new standards and ideals that
together will produce a race much healthier mentally than we are
today. This will take much time as well as much thought and much
patience.
In the meantime it behooves us to expedite our building program
and thus be equipped to receive the many thousand mental patients
that will need care before the mental hygiene millenium arrives.