previous years.
The interior of the hospital has been repapered and painted
where there was need. A tent cottage has been erected on the
33
grounds to relieve the crowding. The drivewa)" to the hos-
pital has been rendered safer and more convenient by widening
it and doing away with a sharp turn that was very objection-
able.
The Nezv Hospital.
The construction of the new Fordham Hospital is pro-
gressing ver)' satisfactorily. All the excavation has been com-
pleted and the water mains and drains are laid. The exteriors
of both the nurses' home and the ambluance station have been
nearly completed, the foundations of the main building are
finished and preparation is being made to lay the bases for the
columns.
Respectfully submitted.
J.\MEs K. Paulding,
Secretary.
34
REPORT OF ACTING SUPERINTENDENT.
To the Board of Trustees of Bellevue and Allied Hospitals:
Gentlemen — I have the honor to present the following
report of the hospitals in the Department for the year ending
December 31, 1904:
Number of Patients Treated.
There were remaining in Bellevue and Allied Hospitals
on December 31, 1903, 987 patients distributed as follows:
Bellevue, 816; Gouverneur, 93; Harlem, 45; Fordham, 32.
During the year there were admitted 36,430 patients and
327 infants were born during the year, making a total of
36,757. Of those admitted, Bellevue received 28,689 5 Gouver-
neur, 4,137; Harlem, 2,474; Fordham, 1,130. Of the infants
236 were born in Bellevue ; 6 in Gouverneur ; 76 in Harlem ;
and 9 in Fordham Hospital.
The total number of patients treated during the twelve
months was 37,744, and of this number Bellevue treated
29,741; Gouverneur, 4,236; Harlem, 2,596; and Fordham,
1,171. Of the total number treated 25,812 were males and
11,932 were females, a proportion of about 69 per cent, to 31
per cent.
Patients discharged and transferred numbered 33,249.
From Bellevue, 26,450; Gouverneur, 3,617; Harlem, 2,212;
Fordham, 970, respectiveh'.
Deaths and Death Rate.
The deaths were 3,489 in the four hospitals, viz. : Bellevue,
2,480; Gouverneur, 526; Harlem, 325; Fordham, 158.
The total death rate for Bellevue and Allied Hospitals was
9.24 per cent.
The deaths in Bellevue Hospital were 2,480, out of 29,741
palients treated, or 8.33 per cent. Of these 30 per cent, died
35
within 48 hours after admission, and 19 per cent, within 24
hours.
Of these 2,480 deaths there occurred within 48 hours after
admission, 745 or 2.50 per cent.; other deaths, 1,735 or 5.83
per cent. Total, 2,480 or 8.33 per cent.
There died within 24 hours after admission 469 or 1.57
per cent. ; other deaths, 2,01 1 or 6.76 per cent. Total, 2,480
or 8.33 per cent.
Admissions and Patients Held Over.
On December 31, 1904, there remained in the Department
1,006 patients, or 19 more than on December 31, 1903. On
the former date there were under treatment in Bellevue Hospi-
tal 811, or five less than the preceding year; in Gouverneur
Hospital 93, the same number; in Harlem Hospital 59, or 13
more; and in Fordham Hospital 43, or 11 more.
The greatest number of admissions was during the first
quarter of the year and the least during the third, as is usually
the case.
The average monthly admissions were 3,145: the average
monthly transfers and discharges were 2,771, and the average
monthly deaths were 291.
Ambulance Cases and Transfer Visits.
During the year there were 18,680 calls, being 2,060 more
than in 1903; 2,584 police cases, or 307 more, and 990
coroners' cases, or 1 1 1 more.
Casual Patients and Ont-Patii'nts.
The number of patients who received surgical dressings
but were not admitted to the hospitals or dispensaries of the
Department, was 10,235, or 164 less than the previous year.
The several Out Patient Departments registered over
209.309 visits during the year, an increase of 59,645 over 1903.
The actual number of visits of new patients, during 1904,
was 82,236. Of this nunilier 21,069 visits were made to Belle-
36
vue Out Patient Department, 29,043 to Gouverneur, 29,394
to Harlem, and 2,730 to Fordham.
Tlie Psyclinpathic Wards of Bellevue Hospital received
1,310 male patients and 1,301 female, a total of 2,611, being
an increase of 126 over 1903.
Other Department Census I'iy^iires.
The Alcoholic Wards sheltered 8,360 patients; 6,075 males
and 2,285 females. Of the males, 218 died or 3.59 per cent.,
and of the females 42 died, or 1.84 per cent. The total mor-
tality in the Alcoholic Wards was 3. 11 per cent.
riie average daily population of Bellevue and Allied Hospi-
tals was 1,811, and of these 1,042 were patients. The daily
average in Bellevue was 1,427, of whom 851 were patients;
in Gouverneur 195, with 99 patients; in Harlem 109, with 52
patients ; and in Fordham 80, with 40 patients.
Annual Department Disbursements.
The total expenditure for 1904 was $613,362.59, at set
forth in Table VHL, General Statistics. To this amount
should be added the sum of $9,648.39, which represents the
reduction of our inventory of $16,306.01 on January i, 1904,
to $6,657.62 on January i, 1905, making a grand total of
actual expenses of $623,010.98. Of this amount $45,996.83
were paid for Departmental Salaries, Portable Buildings,
Rents, taxes, etc., leaving a net distribution of $567,365.76.
Of this amount $474,817.06 were expended for maintenance,
and $92,548.70 for alterations, improvements, new ambu-
lances, horses, and departmental and other expenses of an ex-
traordinary nature.
Distribution of Expenditures.
The Distribution for 1904 was as follows: Provisions,
$157,593.16, an average of $13,132.75 a month; Clothing and
Bedding, $36,248.36, ah average of $3,020.69 a month ;
Salaries, $179,183.31, an average of $14,931.94 a month;
37
Drugs and Liquors, $43,715.92, an average of $3,642.99 a
month ; Surgical Instruments, $5,000.93, an average of $416.74
a month ; Fuel, $30,655, an average of $2,554.58 a month ; Mis-
cellaneous Expenses, including improvements, additions, alter-
ations, clothing for insane, new ambulances and horses, etc.,
$114,969.08, an average of $9,580.76 a month.
The total average distribution was $47,280.48 a month.
Per Capita Cost of Patients.
The daily per capita cost for each patient was $1.25 against
$1.28 for 1903. This saving of three cents per day represents
$12,441.16 for the year.
There has been a reduction in the per capita cost in three
of the hospitals in the Department, during the year 1904.
Bellevue per capita cost for 1904 was $1.18, the same as
1903; Gouverneur, $1.43, against $1.67; Harlem, $1.55,
against $1.78; Fordham $1.82, against $1.86 for 1903.
The daily per capita cost of the whole average population,
viz., 1,811, was y2 cents.
The expenses and per capita cost of each hospital, separ-
ately, are set forth in Table IX., General Statistics.
Overcrowding on the Increase.
That phase of the Department's routine work most pro-
minent in the minds of the public for the early part of the
year, has been the overta.\-ing of Bellevue's accommodations,
where three-fourths of the patients are treated. Necessarily
this embarrassing condition of affairs must become worse, in-
stead of better, until a new hospital affords the needed relief.
For the first time in the history of this institution, the
census on March 14 reached the 1,000 mark, or 75 more than
the quota of beds.
In the late spring and summer there was an appreciable in-
crease in the number of vacancies, but the last three months of
the year have shown the census again rising to high figures.
The four portable buildings, to be presently noticed, will doubt-
less provide a temporary relief.
38
III Gouverneur tlie congestion in the patients' wards has
been still further aggravated by the necessity of moving the
trachoma ward from the building in which it was formerly in-
stalled to the first floor of the hospital proper. This change
was effected to make room for building operations on the new
wing. Much the same story of insufifiency of space applies to
the Harlem and Fordham Ho-Spital's.
Notable Additions to Bellevue's Plant.
The most important betterment of Bellevue as a curative
institution within the past twelve months, has been the step
already taken by your Honorable Board for the installation of
four movable pavilions, providing accommodations for 112
convalescent patients. The letting of the contract during last
month to the Ducker Portable Construction Company insures
the requisite dispatch in the erection of these new wards, and
further provides the Department with four useful structures,
which can be taken apart and set up wherever required.
Fathological Laboratory and Prison Ward.
Among the other additions to Bellevue's equipment is the
conversion of the large room over the Carpenters' Shop into a
pathological laboratory, supplied with all necessary furniture,
fixtures and fittings.
The Men's Prison Ward has been painted and enlarged to
make room for ten new beds.
In the month of May a partly open, wooden pavilion was
erected at the riverside for male tuberculesis patients, and in
June another one was put up nearby for the use of children,
thus providing for the overflow from the Marquand Pavilion.
Suitable detached service kitchens were placed contiguous to
these.
Dietary Improvements.
A room on the first floor of the main building, back of the
linen room, has been fitted up as a diet kitchen and cooking
school for women nurses.
39
Steam tables have been placed in the orderlies' dining,
room, and new ranges, sinks, drains and water supply in the
commissary mess.
In the main kitchen the ranges, ovens and kettles have
been repaired, and a new range has been placed in the doctors'
kitchen.
Out Patient Department or College Building.
New partitions have been put up on the lower floor to
make a room for cutting bandages, and an extension erected
on the east end of the building. Closets were placed in the
demonstration and lecture rooms, and foothpaths laid down
about the building. Record rooms were fitted up for the recep-
tion of the medical and surgical records of Bellevue Hospital.
Metal Ceilings and Repairs.
On account of old and defective plastering it has been
found necessary to install metal ceilings in various parts of
the institution.
The age of the main building makes constant repairs neces-
sary to plumbing, fire-escapes, ceilings, floors, roofs, leaders,
etc. \Miile a great many repairs have been made, some of
which were done by contract and others by employees of the
institution, these are the most important.
Extensive repairs have also been made in connection with
the refrigerating plant in the morgue, such as new lines of
ammonia pipes, repairs to ammonia engine, etc.
Appointments and Promotions.
Miss Harriette Gorton, formerly Dietitian to the Ward's
Island Institutions and, at one time, to the King's Park Insane
Asylum, was appointed to fill a like position in Bellevue and
Allied Hospitals. She established her headquarters in the new
diet kitchen at Bellevue, and immediately made her presence
felt.
The position of Resident Physician in the P.sychopathic
W'ards having been vacated by its previous incumbent. Dr.
40
Menas S. Gregory, at the same time Assistant Resident
Physician therein, was promoted to tiie iiigher position on
October 7. For the preceding month, liowever, Dr. Gregory
had been in sole charge of those two trying wards, and his
conduct of their perplexing affairs gave unqualified satisfac-
tion to all concerned. After October 3 he was temporarily as-
sisted by Dr. C. H. Holmes, until colleagues supplied by the
Municipal Civil Service Commission could be installed.
Walter P. Stowe, Apothecary, was promoted on November
4 to the position of Chief Apothecary, to fill the vacancy due
to the death of his predecessor. He has conducted the affairs
of this bureau in such manner as to give no cause for criticism
up to this time, and bid's fair to continue to render faithful
service.
Resignations.
Dr. Flavius Packer, Resident Physician in the Psycho-
pathic Wards, and Dr. Sidney D. Wilgus, his assistant, re-
signed their respective positions in the course of the year. Dr.
Packer's resignation was framed to take effect September 30,
but, inasmuch as his annual month's vacation began September
I, his actual responsibility for the affairs of these Wards
ceased on that date. Dr. Wilgus retired August 2.
Duty Done Courageously.
Hospital workers of all classes, whose vocation brings them
into immediate contact with the sick, many of them afflicted
with contagious diseases, necessarily display endurance and
quiet heroism seemingly so commonplace that, in the minds
of the general public, they never receive due credit therefor.
Ambulance duty, however, frequently calls upon those as-
signed to it. to lead the strenuous life under conditions seamed
with surprises.
Last spring Dr. H. B. Blackwell in answering a hurry call
to the scene of the Darlington Apartment House disaster, dis-
covered that the maimed and injured needing his attention
were lying in the basement of the shattered building and
directly underneath its shaky walls, liable to fall at any mo-
41
ment. With admirable professional composure he busied him-
self about his work of relief, and extricated his charges from
their dangerous position with all possible speed. The com-
mendation he received from your Honorable Board for his
" fearless and energetic service " has produced an excellent
effect upon the morale of the House Staff, and the public em-
ployees related thereto.
Early in the summer Dr. H. Pearson, answering another
hurry call, was knocked from his seat by a street car and
driven headforemost against a pillar of the elevated structure.
He was picked up insensible, and it was several weeks before
he recovered from his injuries. He devotedly offered to re-
sume the same kind of service if required.
A few weeks later Dr. Harold C. Bailey was knocked off
his seat and temporarily stunned by collision with another
street car. As soon as he recovered his senses he bra\-ely con-
tinued on his way to his waiting patient, and brought him to
Bellevue with the least possible delay.
The burning of the river steamboat " General Slocum "
with its attendant horrors, tasked to the utmost the services
of Bellevue's officials, as well as those of the Department of
Public Charities. The subscriber gladly attests the faithful
services Bellevue's workers rendered, in properly disposing of
the bodies of the victims on the Charity Dock at the foot of
East 26th street.
Miscellaneous.
On October i, Mr. Martin O'Connor, for many years su-
pervising Apothecary of the Department, was taken ill with
appendicitis, and died three days thereafter. He was exceed-
ingly popular and many of his fellow employees have expressed
themselves as greatly pleased that your Honorable Board in-
corporated its appreciation of him in its minutes.
The schedule of visiting hours adopted last year, whereby
patients' friends were allowed to see them every day, is work-
ing well and continues to give general satisfaction.
M. J. RiCKARD,
Acting Superintendent.
42
REPORT OF RESIDENT PHYSICIAN.
Psychopathic Wards, Bellevue Hospital
To the Board of Trustees, Bellevue and Allied Hospitals:
Gentlemen — I have the honor to submit herewith the
Annual Report of the Psychopathic Wards of Bellevue Hos-
pital for the year ending December 31, 1904.
Movement of Population.
The total number of patients admitted to these wards dur-
ing the year was 2,611 ; of whom 1,310 were men, and 1,301
women. Of these, 2,241, 1,064 i^i^n and 1,177 women, or
85 per cent, of the admissions — were found to be insane.
The following disposition was made of the patients : 1,854
cases, 868 men and 986 women were committed to State Hos-
pitals for the Insane; 93 patients, 48 men and 45 women,
were committed to various private sanitaria ; 403 were dis-
charged to the custody of friends : 48 died ; 58 were trans-
ferred to the Department of Public Charities; two were de-
ported and 162 were transferred to medical wards of the hos-
pital.
On December 31, 1904, there were 21 patients in these
wards, while there were 28 on the corresponding date of the
previous year.
These figures may, perhaps, be more readily appreciated
when statistically tabulated as follows :
43
Remaining in Tsychopathic Wards December 31,
1903
Admitted during 1904
Total.
Committed to State hospitals
Committed to private sanitaria
Transferred to Bellevue general wards
Transferred to Department of Public Charities
Discharged to the custody of friends and relatives. . .
Deported
Died
Total.
Remaining in Psychopathic Wards on December
3I> 1904
«5
1.310
33
226
31
1. 310
IS
1.325
13
1,301
986
45
60
25
>75
•7
1,314
6
1,314
28
2,6n
1,314 2,639
1,854
93
162
58
401
2
48
2,639
2,639
Medical A dministration.
The Medical Staff of the Psychopathic Wards underwent
a number of changes during the year. Dr. Flavius Packer,
the Resident Physician, submitted his resignation on August i,
1904, to' assume charge of a private hospital for the insane.
Dr. M. S. Gregory, who was First Assistant Resident
Physician, was promoted by your Honorable Board to fill the
position, pursuant to Civil Service Regulations. Shortly after,
Dr. Sidney D. W'ilgus. the .Second Assistant Resident Phy-
sician, also resigned to accept the position of Chairman of the
State Board of Alienists. The almost simultaneous resignation
of these two capable and experienced officers threw the entire
work upon the present Resident Physician who, owing to
Civil Service complications, was unable to secure permanent
44
assistants for several niontlis. In this connection, tlie Resident
Pliysician feels it incumljcnt updn himself to express his grati-
tude to his many friends who came to his assistance during this
time; and especially to Dr. William Steinach and Dr. Charles
H. Holmes, who served as Acting Assistant Resident Pliysi-
cian until the vacancies were filled by permanent appointees
from the Civil Service List.
The medical work has Ijecn continued along the lines
pursued in the previous year, and an effort has been made to
introduce the newer methods in the care and study of the
insane in the light of recent advances in psychiatry.
As in the previous year, an attempt has been made to
diagnosticate the cases as far as possible, and the appended
table gives the number of the various types of psychoses
treated.
The Consulting Alienists have made frequent visits to the
wards, and have continued to aid us by- many valuable sugges-
tions.
Nursing Service.
It is gratifying to be able to report that another year has
passed without a single accident or serious injury to patients
in these wards. This fact is all the more striking, when one
considers the class of patients admitted. A very large number
of them are brought to us in a condition of excitement or pro-
found depression, exhibiting marked homicidal or suicidal
tendencies. Often, relatives are unwilling to send the patient
from home until some act of violence has been committed, or
he has become a source of danger to himself or to those around
him. This deplorable tendency to keep the patient at home
until one of these attacks, unfortunately makes our task more
difficult, as well as most trying for the nurses. Nearly 30
per cent, of our admissions during the year were of this char-
acter. Prior to admission, 15 patients had actually- attempted
homicide; 124 had made threats of this nature, while 175 had
made unsuccessful attempts at self-destruction, and 244 had
threatened to commit suicide. Fully 100 patients had been
charged with assaults against nther individuals.
45
These figxires bear splendid testimony to the vigilance,
faithful care and kindliness of our nurses. An improvement to
be noted in this connection is the addition of a permanent
graduate nurse to assist the head nurse of the female ward,
and to take charge of the same in the latter's absence. This
has added much to the safety of the ward, as it is scarcely
prudent to intrust this work wholly to pupil nurses from the
training school, who are ob\ionsly inexperienced in handling
and caring for insane patients.
Patients Received With Injuries.
It might be well here to call attention to the physical con-
dition of a .large number of patients on their admission to the
Psychopathic Wards. Alan)- have bruises, contusions, abra-
sions, fractures, and even more serious injuries, either self-
inflicted or acquired while excited or violent, as a result of ill-
usage or unskilful handling prior to admission. A large pro-
portion are found wandering aimlessly about the City,
naturally receiving injuries of various kinds, and are brought
to the hospital by the police. Others, as has already been
pointed out, are kept at Imme by their friends until they
become absolutely unmanageable, and have received bruises in
their struggles with inexperienced attendants. For instance,
during the year 518 patients had extensive contusions on ad-
mission, and 447 exhibited injuries of various kinds, nearly
43 per cent, of the total admissions. This matter is worth
mentioning inasmuch as not infrequently the hospital is blamed
for these injuries, whereas they are due to conditions that ex-
isted prior to the patient's admission.
N on-resident and Alien Insane.
Non-resident patients from adjoining counties and towns
are still being admitted to the Psychopathic Wards, as was
intimated in the report for the previous year. During the year
just past over one hundred patients who resided outside of
the City of New York were admitted to the Psychopathic
Wards, maintained, and committed tri the State Hospitals at
46
the expense of the City, despite the protest of the State auth-
orities. Many of these patients are brought to the hospital by
the poHce and must be received. However, many are brought
by their relatives from neighboring counties and States, and
cannot be denied admission as their condition is such that it
would be unsafe to send them away. This state of affairs can
only be remedied by the co-operation of the Dei)artment of
Public Charities, which has .sole jurisdiction in returning non-
resident dependents to the communities to which they properly
belong.
The number of alien insane coming under the provisions of
the statute providing for the deportation of alien insane, ad-
mitted during the year, was 231. 'j'he following table shows
in detail the length of residence in the I'nitcd States ])rior to
admission :
TIME IN UNITED STATES PREVIOUS TO ADMISSION.
Less than six months . . . .
Less than one year
From one to two years. . .
From two to three years.
Totals
MEN.
WOMEN.
TOTAL.
25
39
64
20
24
44
33
33
66
30
27
57
108
123
231
Increased Admissions.
It may be of interest to note that the admissions ti_) these
wards have steadily increased during the past three years. In
1903 the admissions were 143 in excess of those in 1902. while
during the year just closed there were 126 more than during
the previous }'ear. In other words, the admissions were
greater by 269 patients than in 1902. This gradual increase
in the number of admissions in successive years at first sight
might seem to mean an increased prevalance of insanity, as
some hold. However, there seems to be no adcduate reason
47
for this view. While the increase may, no doubt, in part be
explained by the natural growth of population, a great deal is
due to the fact that many more are brought here because of the
increased confidence with which the public and the medical pro-
fession regard the institution.
Before concluding I take the opportunity of expressing my
gratitude to my colleagues who so ably assisted me; to the
nurses for their patient, faithful and conscientious service; to
the Acting Superintendent for his ready co-operation, and
above all to your Honorable Board for the kindly interest,
useful suggestions and hearty support in this most arduous de-
partment.
Respectfully submitted,
M. S. Gregory,
Resident Physician.
48
REPORT OF SUPERINTENDENT, TRAINING
SCHOOLS FOR NURSES.
To the Board of Tnistecs. BcUevne and Allied Hospitals:
Gentlemen- — I have the honor to submit to you the fol-
lowing report for the year 1904 of the two Training Schools
for Nurses attached to Bellevue Hospital, together with list of