SIXTH ANNUAL REPORT of the COMMISSION IN LUNACY. 69 Recoveries in State Hospitals. recoveries on the aggregate insane population of the State, the insane inmates of both State hospitals and county asylums and poorhouses should be considered as a whole; and when so considered it is noteworthy that the average percentage of recoveries is maintained from year to year with comparative uniformity. A table is added to show the rates of recovery (based on the combined daily average population of the State hospitals and insane inmates of county-houses, not including the asylums of New York and Kings counties) from 1882 to 1894, both inclusive. It takes account not only of the insane in poorhouses, but also of the population of the Willard and Binghamton State hospitals during the time when they were restricted to the reception of "chronic" patients. This needs to be done in order to accurately judge of the curative results of the State hospital system as it was formerly conducted. From this table it will be noted that between 1882 and 1889 the insane population of the poorhouses largely increased, up to the beginning of 1890, after which it rapidly declined, and before the close of 1892 had practically disappeared, although a small number remained in 1893-4; but there were not enough to affect the general result. Of course, there were no real recoveries in the poorhouses, although a few cases that improved were claimed to have recovered. The important fact which the table reveals is, that the transfer of a large number of chronic cases from the poorhouses to State hospitals has not affected the recovery rate in the latter in any appreciable degree. Despite the temporary disturbance and confusion which resulted from the large addition to the hospital population of a class of inmates supposed to have reached the unrecoverable stage of their disease, it appears that the recovery rate, as applied to the whole State, has not been materially affected, thus demonstrating that, while in its humane aspect the removal of thousands of insane persons from poorhouses to the comforts and decencies of the State hospitals was a great step in advance, it yet did not unfavorably affect or materially lower the recovery rate in those institutions, and establishing the fact that there never was any really just ground for the separation and legal distinction of the insane in this respect. CHAPTER 13. Provision for Insane Convicts. The Matteawan State Hospital for Insane Criminals was planned with reference to a separation by buildings of those patients held on criminal orders, that is, persons charged with crime but who have been acquitted on trial or have escaped trial on the ground of insanity, from the convict insane, the latter class being composed of convicts who have become insane while undergoing sentence to penal servitude in prison. When the hospital at Matteawan was established it was not thought that there would be need of increased accommodations for the two classes for which it was designed, for many years to come, as the State care act, which has necessitated the transfer to Matteawan of all patients held on criminal orders in the other hospitals, was not then in existence. But the need of increased accommodations for the criminal insane having arisen, the question of how it can best be met must be determined. The establishment of the State Asylum for Insane Criminals at Auburn, in 1859, was the first instance in any State or country of a separate institution specially devoted to the care and treatment of insane criminals. At that time, and for many years thereafter, the number to be provided for was comparatively small and there was no serious objection to caring for the two classes in the same institution. In fact, at that time the number was not sufficient to warrant maintaining these two classes in separate institutions, while the establishment of the Asylum for Insane Convicts at Auburn and the transfer thereto from the other State hospitals of all insane convicts then confined therein and whose presence was very objectionable to the ordinary inmates, afforded a much-needed relief to these latter institutions. The original asylum for insane criminals was Provision for Insane Convicts. designed only for insane convicts and was accordingly located on grounds adjacent to the Auburn State Prison; subsequently, in 1869, the scope of the institution was widened by a statute which provided for the admission thereto of the class of patients referred to as being held on criminal orders and who were designated "insane criminals," in contradistinction to "insane convicts," and since that time the practice of caring for the two classes in the same institution has prevailed. Before the number of these two classes of patients became sufficiently large to justify providing for them in separate institutions, the objection to their association was more theoretical than practical, despite the difference in their legal status. But with the large increase in numbers since the Matteawan State Hospital was opened, the population having doubled in three years, while the transfers to it are steadily increasing, embarrassments in administration have arisen, owing to a mixed population which renders it extremely difficult to apply to all its members the same rules and regulations. The insane convict, as a rule, is constantly bent on effecting his escape from custody. This is especially true of those who have committed crimes against property. Not infrequently his native cunning and ingenuity are seemingly intensified by his mental disease; hence the exceeding difficulty in keeping this class in penal custody in an institution like the one at Matteawan, which is structurally a hospital rather than a prison. Then, too, the fact that convict patients do not wear the prison garb while in the hospital-it being impracticable to have them wear the striped uniform of the prison owing to the presence of the unconvicted patients -furnishes to them an additional incentive and opportunity to escape. Escapes and attempted escapes from the Matteawan State Hospital were frequent in the days of its early occupancy, and still occasionally occur despite the efforts of the attendants to prevent them. On the other hand, the class of inmates held on criminal orders and improperly designated "insane criminals," who, under the influence of mental disease, have committed acts of violence-homicide and the like which, had they been done by sane persons, would have been criminal, are usually not difficult to keep in custody, and do not require to be controlled by the rigid rules of discipline and Provision for Insane Convicts. restricted environment that is absolutely necessary in the case of the convict insane. In fact, were it not for their dangerous tendencies this class of patients might properly and safely be kept in an ordinary hospital for the insane. The capacity of the Matteawan State Hospital is 550, and its population has now reached almost that number, so that, without doubt, the number of inmates will exceed its capacity before the expiration of the present year. There would appear to be three methods of relief, namely: (1) By transferring those convict patients whose terms of sentence to penal servitude have expired, but who are still insane, to other State hospitals; (2) by increasing the accommodations at Matteawan by the erection of additional buildings; (3) the erection on the grounds of one of the State prisons of a building especially designed for the safe custody and care of insane convicts. Many of the convict patients whose terms have expired belong to the criminal class and have been devoted to a life of criminal conduct, so that even though their sentence may have expired and they are legally no longer convicts, their presence in the other State hospitals would be objectionable. In fact, it was mainly for this reason that the practice which formerly prevailed, of transferring them to these institutions on expiration of sentence, was discontinued. Respecting the enlargement of the Matteawan Hospital, it may be said that the present plant is not susceptible of enlargement to any great extent, though two additional ward buildings might be erected as proposed in the original plan, but such an extension would not meet the demand for increased accommodations for more than two years at the most, in view of the present rate of admissions. For these reasons the commision is of the opinion that the most desirable and satisfactory course would be to erect a suitable building on a plan that would be susceptible of extension from time to time on the grounds of one of the State prisons, and to remove thereto all convict patients who are still under sentence, as well as those who become insane while in penal institutions. Such a building would provide for the safe-keeping and proper care of all insane convicts, many of whom are habitual criminals, often of a dangerous character, and |