Special Reports of the New York and Kings County Asylums, 24. State the nature and extent of general and medical libraries in the asylums, including the number of volumes in each; also give a list of the medical books purchased during the fiscal year, and of the medical and general publications regularly taken by the asylums. NEW YORK CITY ASYLUMS. WARD'S ISLand. Female Department. There is a general library consisting of about 2,000 volumes; historical works, and works of fiction. There is a medical library consisting of about 20 volumes; works on psychology and general medicine. No medical books have been purchased during the fiscal year. Male Department. There is no regular medical library. The general library comprises about 1,560 numbers, including books and bound periodicals. No medical books nor general publications were bought or subscribed for by the asylum during the fiscal year, but a large number of general publications were given to the asylum during that period. HART'S ISLAND. No medical library, and no medical books purchased during the year. "Alienist and Neurologist" and "American Journal of Insanity" regularly taken. CENTRAL ISLIP. The general library contains about 500 volumes. There is no medical library in the asylum. No medical books were purchased during the fiscal year, and no general or medical publications were regularly taken by the asylum. KINGS COUNTY LUNATIC ASYLUMS. No medical libraries; a small general one of 125 volumes. No books have been purchased and no periodicals taken by the institutions. 25. State to what extent, if any, the medical officers of the asylums have contributed to the literature of psychological or other departments of medicine during the fiscal year. Special Reports of the New York and Kings County Asylums. NEW YORK CITY ASYLUMS The medical officers of the asylums have not contributed to the literature of psychological or other departments of medicine during the fiscal year. KINGS COUNTY LUNATIC ASYLUMS. Only by papers read before a local medical society. 26. To what extent, if any, are outside physicians, whether general practitioners or specialists, invited to consultations in the asylums? Would it be desirable, in your judgment, to have a board of consulting physicians? NEW YORK CITY ASYLUMS. There is a consulting board composed of 10 surgeons and physicians, who are called in consultation whenever required. "Outside physicians " frequently visit the asylums and consult as to patients therein, to whom they bear the relation of family physician. KINGS COUNTY LUNATIC ASYLUMS. When occasion has required appeals for consultation have been responded to by members of the visiting staff of the Kings County Hospital. In our opinion a consulting board is desirable and an early appointment of one is contemplated. 27. Describe the usual routine pursued on the admission of a patient, with reference to examinations, to determine the patient's mental and physical condition, case book entries, arrangements for special observation, etc.? NEW YORK CITY ASYLUMS. WARD'S ISLAND. Female Department. The medical officer on duty for the day personally receives the patient on admission, makes an examination and directs such treatment as may be immediately required, and, following this, examines her in the reception ward in reference to the following points : "Name, date and number of admission, where from, color, nativity, age, civil condition, height, weight, color of eyes and hair, religion, 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 accompanies the commitment and the information he has obtained in the case-book. The receiving officer and the senior physician in charge of the reception 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 in 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. |