Special Reports of the New York and Kings County Asylums. occupation, property, education, morals, habits, occupation of father, heredity, time in United States, time in city, marks, deformities or injuries, previous attacks and duration of each, relation to other diseases, premonitory symptoms, duration of present attack, cause of same, if in any hospital before, convulsions, general health, appetite, sleep, tongue and digestive functions, speech, sight, hearing, if suicidal, homicidal, assaulting or destructive, sensibility, movement, temperature, circulation, pulse, respiratory organs, if filthy, physical condition, whether good, fair or poor, mental condition and synopsis of phenomena of case, nature of symptoms, whether of mental exaltation, depression or enfeeblement, nature and degree of alteration or perversion of sensation, general or special perception, conception, reason, memory and will, the feelings, emotions and instincts as manifeste 1 by conduct, father's name and nativity, mother's name and nativity, cause of father's death, cause of mother's death, last residence, and address of friends." This officer then enters the commitment of the patient and history that accompan es the commitment and the information he has obtained in the case-book. The receiving officer and the senior physician in charge of the recep tion ward visit the patient during the same day, make any necessary examination, prescribe medicine, or give treatment if required, and direct any care or special watchfulness requisite. On the following morning the medical officer in charge of the reception ward makes a physical examination of the heart and lungs, and such special examination - ophthalmic, aural, uterine, etc., as may be indicated by the information obtained from the patient, or the history or reports of the night and day attendants of the ward. He also makes an examination as to the patient's mental condition, nature of symptoms, delusions, hallucinations and conduct, and writes a synopsis of the same and the progress of the case, to be entered, with prescriptions and treatment, in the case-book. Male Department. On admission, each patient is examined by three physicians, one of whom is the assistant medical superintendent; one a senior; and the third (who may be a senior or a junior assistant), who is on duty as officer of the day. After a careful examination, both mental and physical, by the three physicians, the certificates on which the patient is admitted are copied Special Reports of the New York and Kings County Asylums. into the case-book, and an additional record is made of the notes that may accompany his history, and such matters as may be found important in the examination. A separate record is made of any marks of injuries observed upon the patient. The general particulars noted in the history comprise information under the following headings: Received from; color; age; hair; eyes; occupation; social relations; nativity; religion; habits; degree of education; time of residence in the country and city; hereditary influences; duration of disease before admission; causes; relation to other diseases or derangement; premonitory symptoms and the length of time supposed to exist before the disease. Diagnosis: Whether suicidal; whether dangerous to others; whether subject to epilepsy; duration of existing attacks; number of previous attacks; age at first attack; bodily condition; speech; sight; hearing; sensibility; movement; temperature; circulation; pulse; respiratory organs; tongue and digestive functions; weight on admission. After the above information is noted, the patient is assigned to one of the reception wards (according to the form of the patient's insanity) by the assistant superintendent, and there kept under continuous observation till such time as he may be transferred to one of the other wards, this latter transfer governed by the classification and by the changes in the patient's mental and physical condition. Patients are ordinarily admitted to the other asylums only by transfer from Ward's Island. Abstracts of their history accompany each patient, together with their medical certificates, and these are copied into the case-books as soon as practicable after their admission and their subsequent history continued therefrom. KINGS COUNTY LUNATIC ASYLUMS. On admission, the physician in charge makes an examination as to the mental and physical condition of the patient. Entries are immediately made in the case-books and various records. Reception wards are provided for special observation of new cases. 28. Are autopsies regularly made in the asylums, and, if so, by whom, and to what extent? Special Reports of the New York and Kings County Asylums. NEW YORK CITY ASYLUMS. Autopsies are held in all cases of special interest where the consent of the patient's friends can be obtained, and in all cases where the cause of death is obscure. In the latter cases, when consent for an autopsy is refused, permission is sought from the board of coroners, the case being referred to that board. A board of pathologists, consisting of three members, and composed of gentlemen skilled ia the investigation of morbid conditions, supplements the study of the grosser lesions, made at the asylums, by special examinations of more minute character. KINGS COUNTY LUNATIC ASYLUMS. Autopsies are not regularly made in the asylums, only as we are able to obtain the consent of friends. 29. To what extent are ophthalmoscopic examinations made on patients when admitted to the asylum? NEW YORK CITY ASYLUMS. Ophthalmoscopic examinations are made from time to time as the cases coming under observation are thought to require such examinations. These examinations are not made in every case on admission. KINGS COUNTY LUNATIC ASYLUMS. Only as occasion requires. 30. To what extent, if any, are examinations of the blood and urine of the patient made; also state the practice in regard to uterine examinations? NEW YORK CITY ASYLUMS. WARD'S ISLAND. Female Department. Examinations of urine are made of patients in whom the symptoms point to diseased conditions of the kidneys; during an acute infectious disease, or during an acute exacerbation of a chronic disease and of patients who are found to be pregnant. Special Reports of the New York and Kings County Asylums. Examinations of blood are infrequently made. Uterine examinations are made when there are menstrual perversities, when there are evidences of inflammatory conditions of the uterus, such as the presence of leucorrhoeal discharge, and when patients evidence symptoms such as pains, etc., pointing to irregularities of the uterine function and when pregnancy is suspected. If one is known to be pregnant, she is examined to determine the condition and size of pelvic viscera. The examinations are, when possible, made in a special examining room reserved for gynaecological work, and strict aseptic precautions. are always used. This room is attached to the hospital ward, and the patients to be examined are brought there from their respective wards. Male Department. Examinations of the urine are made in all cases where necessary for the purpose of diagnosis. The blood is seldom examined. We have no female patients. HART'S ISLAND. Examinations are made of blood and urine, when necessary, to establish diagnosis. Uterine examinations are made, when necessary, by the female physician connected with the asylum. CENTRAL ISLIP. Examinations of urine of patients are made when renal or vesical disease is suspected. Uterine examinations are only made when indications point to their necessity. KINGS COUNTY LUNATIC ASYLUMS. Such as are made in cases which require it. 31. Are the nurses and attendants in the asylums instructed in the use of the wet pack, massage, etc., and, if so, by whom, and to what extent? NEW YORK CITY ASYLUMS. Instruction of this kind is given to the attendants by their physicians as cases develop that may require such treatment. No. Special Reports of the New York and Kings County Asylums. 32. Do the asylums employ the services of a dentist for the benefit of the patients? Would it, in your opinion, be practicable and desirable to make provision for such services in the case of public patients? No. Yes. NEW YORK CITY ASYLUMS. KINGS COUNTY LUNATIC ASYLUMS. No dentist employed by the asylums; it would be desirable. 33. State in detail the special facilities, structural or otherwise, if any, together with methods used, for the special treatment of recoverable cases. NEW YORK CITY ASYLUMS. WARD'S ISLAND. Female Department. Special facilities are, amusements, schools, calisthenics, systematic employment and outdoor games. The methods used: Patients are selected by the physicians and assigned to the various classes, over which presides an attendant who has been selected for the purpose of instructing them. Male Department. The asylum possesses no particular structural facilities different and apart from those usually found in modern institutions of this kind. Other facilities for the special treatment of recoverable cases consist in the comparatively large number of physicians on our medical staff, insuring a greater amount of individual attention for the patients; the system of constantly having a medical officer on duty, day and night, so that any case can always get immediate attention, if required, and in procuring a larger number of visits among the patients and closer supervision throughout the whole 24 hours, by the physicians. |