60 THE CARE AND TREATMENT OF THE INSANE. 



sanity. In chronic cases it i=? true that medicines have 

 bat little direct effect and, like other chronic diseases, we 

 must devote our energies to treatment on general instead 

 o£ on special lines. There is no danger, however, that 

 the asylum physician will fall into routine methods un- 

 less he desires to do so, for the ordinary ailments which 

 so frequently occur in the insane give ample opportunity 

 for general practice and keep him in touch with all 

 branches of medicine. In acute cases of insanity, medi- 

 cines and nursing play a most important part, and the 

 treatment and attention given to such cases often decide 

 whether the result is to be speedy recovery or death, or 

 what is still worse, hopeless dementia. 



My paper has already assumed unexpeced proportions 

 but I have not touched upon the most important thing 

 of all, that is the result of treatment in modern hospitals 

 for the insane. In the Hudson River State Hospital 

 there have been admitted since its opening in 1871, 7,003 

 insane persons. Of that number 5,496 have been dis- 

 charged from our records while 1,507 still remain in the 

 institution. Of the 5,496 discharged, 1,474 were entirely 

 recovered, 804 improved enough to live at home, 1,906 

 did not improve under treatment, and 1,316 died. If we 

 therefore take the record of this State Hospital for the 

 quarter century of its existence, we find that about 

 twenty-one per cent, of all those admitted recovered ; 

 eleven aiid one-half per cent.' improved sufficiently to 

 live at home ; nineteen per cent, died ; twenty-seven per 

 cent, did not improve, and twenty-one and one- half per 

 cent, still remain under treatment. In other words, and 

 with sufficient accuracy for practical purposes, of every 

 six patients sent to hospitals for the insane, three will 

 not recover and will have to remain in the hospital for 

 the rest of their lives, with possibly brief intervals of 

 home care during periods of remission ; two will either 

 entirely recover or get well enough to live without hos- 



