CHAPTER 7. Aliens and Non-Residents in State Hospitals. During the past year, the first in which the commission has had charge of the matter, quite a number of non-resident and alien patients have been removed from the State hospitals to other States and countries. The commission regards this work as one of more than ordinary importance; and while the actual results in point of number of those removed are important, the greatest value of the work lies in the fact that the policy of promptly removing such persons tends to deter the authorities of other States and countries from attempting to shift the burden of caring for them from their own locality to the State of New York, and thus materially adding to our insane population. During the past year 23 patients have been removed, at a total cost of $1,950. The annual cost of maintaining these 23 patients, at the present per capita rate of $185 per annum, would of itself amount to $4,155. Their removal represents, therefore, an annual saving to the State of this sum, and, allowing the average duration of insane life to be 21 years, an ultimate saving in the cost of maintenance amounting to $87,255, which, added to the value of the space they would require, would bring the figures up to, in round numbers, $120,000, the average cost per bed, including repairs, being $1,500. In connection with this subject the commission would recommend that it be given power to remove non-residents found to be insane prior to their admission to State hospitals or other institutions, in order to avoid the additional expense of such admission, as well as the vitiation of the hospital statistics occasioned thereby, with reference to the apparent increase of insanity. CHAPTER 8. Women Nurses in Wards for Men. The question as to what extent, if any, it would be feasible or desirable to substitute women attendants or nurses for men in the care of men patients in the wards of a hospital for the insane has been the subject of careful consideration by the commission. The first step in this direction was substantially begun in 1893, when, in the belief that it would tend to improve the diningroom service, the following general recommendation was promulgated to the State hospitals : "Wherever the system of ward dining-rooms is maintained each dining-room for men should be supplied with a woman attendant." The results of this recommendation, which was quite generally carried out in the State hospitals, were most satisfactory, and, so far as the commission is aware, they tend in every respect to demonstrate the wisdom of the practice. The testimony of those in immediate charge of the patients is that the dining-room service is better performed by women, while at the same time their presence in the dining-rooms at meal times has apparently had a refining influence upon the deportment of the patients. Subsequently, in some of the hospitals, women were assigned to the care of the clothes rooms on men's wards, with satisfactory results. During the past year the practice has been still further extended in the St. Lawrence State Hospital, where one of the men's wards was placed wholly in the care of women nurses, except that a man was provided to attend to the bathing, heavy lifting, etc. This arrangement proved so satisfactory that the superintendent decided to extend it to the infirmary wards, in which infirm, helpless and untidy patients, mostly dements, were cared for. To these wards, consisting largely of dayroom and congregate SIXTH ANNUAL Report OF THE COMMISSION IN LUNACY. 61 Women Nurses in Wards for Men. dining-room and dormitory, and containing about 80 patients each, are assigned eight women nurses, with one man as porter and to supervise the bathing. The improvement in the condition of the patients as well as in the condition and order of the wards since this arrangement went into operation has been most marked, thus conclusively demonstrating the better adaptability and superiority of women in hospital nursing, and forcibly suggesting a more general substitution of women in the care of men patients. These results also prove that the objections which have been raised to the employment of women nurses on men's wards, on the ground that embarrassments were likely to arise from the presence of women there, are not well founded. On the contrary, the experience thus far had shows that no serious difficulties or embarrassments have been encountered by the nurses, and that their introduction into the wards has resulted in marked improvement in the conduct and speech of patients. Moreover, it may be said in reply to the objections which some have raised, that women would be unwilling to undertake this kind of service, that a majority of those who have tried it are willing to continue in preference to returning to service in the women's wards, especially in view of the better compensation which they very properly receive. The commission is informed that application for service in the new building for men at the St. Lawrence State Hospital, in which it is proposed to emp'oy women attendants, has exceeded the demand therefor. In connection with this subject it is suggested that if the nursing staff could be relieved of certain duties of a menial character which they now have to perform — such as scrubbing and cleaning the wards, toilet-rooms, etc. duties which might properly be done by "scrub women" or helpers employed exclusively for that purpose, the nurses would be able to give much more time to the immediate care of their patients than they can be expected to do under present methods. This would not necessarily imply an increase in the number of ward employés, for the reason that if they were relieved of the so-called "drudgery of labor" incident to the care of the wards, a lesser number of nurses would be required. Moreover, it would tend to elevate the status of this branch of the service generally, and through making it more Women Nurses in Wards for Men. greater permanency and also persons, socially, to enter upon doubtless materially raise the inviting would be conducive of tend to induce a higher grade of the work, and in this way would standard of care, so far as it relates to nursing. It would also appear to be desirable, in order to further inculcate the hospital idea in the treatment of the insane, and especially since the term "hospital" has been legally substituted for that of "asylum” in the titles of the State institutions for the insane, to discard the title of "attendant" altogether for the more appropriate one of nurse, as applied to the immediate caretakers of patients. CHAPTER 9. Reimbursing and Private Patients. From experience derived during the past year, the commission sees no reason at present for changing the rate to be charged for so-called reimbursing patients, namely, $3.75 per week or $195 per year. While this rate is slightly in excess of the actual cost during the past year, it would be inexpedient to change it, as the excess received in most cases is not large, and this is more than overbalanced by deficiencies of collection in others. The income received from reimbursing patients during the past year amounted to $43,714.52 and was collected at a total expense of $1,110. There can be little question, however, that one or more additional agents could be employed with advantage in collecting from relatives who are liable and friends who might be willing to assume the cost of support or a portion of the same, especially if the insane of New York and Kings counties are brought within the State care system. The commission would, therefore, recommend that it be authorized to employ such additional number of agents for this work as experience may indicate to be necessary. A carefully prepared classified list of public patients, arranged by counties and townships, is now being prepared by the commission, the number of such cases being over 7,000. It is the intention to have the facts as to liability carefully ascertained in such cases, and if the whole sum of cost of maintenance can not be secured, to collect such part of it as the relatives or friends can afford to pay, and in certain cases where nothing can be paid for board, to endeavor to induce the friends to supply the patient with clothing. Two very important results are expected to follow this work, namely: It will tend to prevent the admission into the State |