RC REPORT OF THE SPECIAL COMMISSIONER ON THE ALIEN INSANE IN THE CIVIL HOSPITALS OF NEW YORK STATE REPORT ON THE Alien Insane in the Civil Hospitals OF NEW YORK STATE SUBMITTED TO HIS EXCELLENCY, HONORABLE MARTIN' H. GLYNN, GOVERNOR OF THE STATE OF NEW YORK, JANUARY 23, 1914 BY SPENCER L. DAWES, M.D. Special Commissioner on the Alien Insane LEWIS R. PARKER, CHARLES A. DOOLITTLE, JR. Counsel ALBANY J. B. LYON COMPANY. PRINTERS 1914 7 A REPORT ON THE ALIEN INSANE IN THE CIVIL HOSPITALS OF NEW YORK STATE To ILis Excellency, Honorable Mar (in 11. (jlynn, Governor of Ike ^lale of Xew York: The following study, made by direction of Hon. John A. Dix, former governor of the State of New York, deals with one im- portant part of the general problem of lessening the burden of in- sanity in our commonwealth, namely, the problem of the alien insane, and is based upon: 1. Public hearings at the State hospitals for the care of the insane. 2. Public hearings in the cities of Albany and New York, at which hearings were examined hospital superintendents, repre- sentatives of charitable organizations, private citizens, the chief examiner of the Bureau of Deportation and his assistants, the representatives of the various steamship companies which bring immigrants to this country, and representatives of foreign govern- ments. 3. Statistics of the nativity and citizenship of every patient in our State hospitals obtained from a special census taken September 30, 1912. 4. Investigation with reference to the following topics: I. Provision for and cost of maintenance of the insane in the State of New York. II. Increase of insane patients in the State hospitals com- pared with increase in general population. III. Nativity and citizenship of the insane in the State hos- pitals. IV. Nativity, parentage and citizenship of admissions to the State hospitals. Y. Nativity and parentage of the insane and of the population in New York State. VI. Nativity, parentage and insanity in New York State and the United States. 301866 4: ALIKN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE VII. Time of aliens in United States before admission to the State hospitals. Y 1 1 1 . Cost of caring for the alien insane. IX. Some of the causes of existing conditions. X. Eugenic effects. XI. Attitude of other states. XII. Suggestions received. This commission was appointed to examine into the questions relating to the alien insane in the civil hospitals of the State of New York, in order to ascertain existing conditions, the causes thereof and to suggest remedies therefor. While these problems of the alien insane are intimately con- nected with immigration it should be clearly borne in mind that the general subject of immigration is entirely without the province of this investigation. The great benefits which this country has derived from immi- gration, the relation of immigration to social, industrial, econo- mic and other problems and to phases of the public health other than the prevalence of mental diseases and kindred topics are not embraced within the scope of this inquiry. The results of the investigation of the above mentioned topics are as follows : I. PROVISION FOR AND COST OF MAINTENANCE OF THE INSANE IN THE STATE OF NEW YORK The State of New York maintains sixteen hospitals of which fourteen, .under the general management of the State Hospital Commission, are devoted exclusively to the care of the civil in- sane and two, under the control of the State Superintendent of Prisons, to the care of the criminal insane. The valuation of the lands and buildings of the civil hospitals as appraised by the State Comptroller (Mohansic excepted) dur- ing the years 1911-12 and the personal property of these institu- tions, as estimated by the several superintendents in their reports of September 30, 1912, together with the number of patients under treatment on September 30, 1912, arc shown in the follow- ing tables. REPORT OF SPECIAL COMMISSIOXKK Civil Hospitals STATE HOSPITAL Number of patients Value of real estate Value of personal property Utica 1,573 $1,663,300 $166, 000 Willard 2,381 2,166,900 220,000 Hudson River 3,087 3,253,425 418,855 Midclletown . . . 2,020 1,682,300 135,000 Buffalo 2,025 3,030,100 120,000 Binghamton 2,327 2,675,956 300,000 St Lawrence 1,988 2,910,000 159,710 Rochester 1,498 913,700 55,985 Gowanda 1,104 983,250 165,500- ]VIohansic 51 *169,155 33,937 Kings Park . ... 3,815 3,423,900 282,260 Long Island 747 698,500 85,000 Manhattan 4,570 4,446,150 340,660 Central Islip 4,438 3,077,905 204,002 Total 31,624 $31,094,541 $2,686,909 * As estimated by superintendent. During the period from 1900 to 1912 the expenditures for additions and betterments to the various civil hospitals and' for the maintenance of the insane were as follows : Expenditures of the Fourteen Civil Hospitals, 1900-1912 YEAR For maintenance For new buildings, additional land,, improvements, etc. 1900 . $3,766,615 49 $612,014 72 1901 3,558,407 84 819,389 81 1902 3,722,346 55 807,431 87 1903 4,104,689 23 631,945 17 1904 . . 4,402,380 32 670,651 19 1905 ... . . 4,593,477 63 838,500 50 1906 4,769,343 68 793,877 84 1907 4,948,809 72 917,994 32 1908 5,100,890 11 803,761 44 1909 5,509,764 13 992,753 62 1910 5,659,942 76 1,320,658 95 1911.. 5,718,618 43 1,114,366 87 1912 6,240,882 01 955,887 56 G ALIK.N LXSAXK ix CIVIL HOSPITALS OF XKNV Yoinc STATI-: 40.000 30.000 22.088 $4.378.630 20,000 10,000 Chart A INCREASE OF INSANE PATIENTS IN THE CIVIL STATE HOSPITALS COMPARED WITH INCREASE OF EXPENDITURES 1900-1912 / / / / s / "-- s _- ^"^"! r****^^ ^s' s s / '*&. ^ Patie nts in th iditures : Civil S >f the Ci ate Hos vil State titals Hpit . Expe 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 $8.000.000 $7.196.770 3 1.624 Patient* $6.000.000 $4.000.000 r= $2.000.000 JS Years T OF SPECIAL COMMISSIONKK 7 During the year ending September 30, 1912, alone, the cost to the State of ISTew York for actual maintenance of the patients in its fourteen civil hospitals was $6,240,882.01 ; for new buildings, additional lands, repairs, improvements, etc., $955,887.56, and for general administration, including inspection, deportation of aliens and scientific research, $163,766.86, making the huge total of $7,360,536.43. The enormous increase in annual expenditures shown in detail in the foregoing table was necessitated not alone by reason of the gradual rise in the cost of attendance and provisions in recent years, but also because the insane cared for in the State hospitals have increased. II. INCREASE OF INSANE PATIENTS IN THE STATE HOSPITALS COMPARED WITH INCREASE IN GEN- ERAL POPULATION The total population of the State of Xew York, as given by the Federal Census Bureau was: In 1890- 6,003,174 In 1900- 7,268,894 .......... Per cent of increase 21.1 In 1910- 9,113,614 .......... Per cent of increase 25.4 In 1912 *9,592,25S .......... Per cent of increase 5.3 Total (1890-1912). . .Per cent of increase 59.8 The insane in civil hospitals of Kew York State for the same period were: In 1890 14,952 In 1900 22,088 ...... Per cent of increase of insane 47.7 In 1910 30,445 ...... Per cent of increase of insane 37.8 In 1912 31,624. .... .Per cent of increase of insane 3.9 Total ....... Per cent of increase of insane 111.5 Chart B shows the foregoing graphically. The insane cared for in the civil hospitals have increased pro- portionately much more rapidly than has the general population of the State. This is readily apparent from the foregoing com- parisons. * Estimated. ^ ALIKN IN SANK IN CIVIL HOSPITALS OF NK\V YOUR it 7* ^D 1906 28 3 5 8 62 4 3 5 1907 . . . 29 1 5 7 62 4 2 8 1908 27 8 5 5 64 2 2 5- 1909 29 3 5 8 62 8 2 1 1910 27 8 6 5 63 9 1 8- 1911. 27 8 6 64 6 1 6 1912. . . 28 6 5 63 6 1 CITIZENSHIP OF FIRST ADMISSIONS (See Table 11, page 106) Table 11 gives the citizenship of the first admissions to the- State hospitals for the years 1905-12. With respect to citizen- ship, five classes are' distinguished, as follows : " Citizens by birth/' which includes all native-born patients. " Citizens by parentage," which includes patients born in for- eign countries of parents who were American citizens at the time of the birth of the patient. " 'Citizens by naturalization," which includes all foreign-born patients who have been naturalized in any way since coming to this country. "Aliens," which includes all foreign-born patients who were not citizens by parentage and who have not been naturalized since coming to this country. " Unascertained," which includes those patients concerning whose citizenship nothing definite could be determined. Of the total first admissions, 23,267, or 53.5 per cent, were citizens by birth; 36, or .1 per cent, were citizens by parentage; 4,227, or 9.7 per cent, were citizens by naturalization ; 13,913, or 31.9 per cent, were aliens; and 2,072, or 4.8 per cent, were of un- ascertained citizenship. The percentages of the different classes admitted each year are shown by the following tabulation : REPOKT OF SPECIAL COMMISSIONER 23 Citizenship of First Admissions YEAR Per cent by birth Per cent by parentage Per cent by natur- alization Per cent aliens Per cent unascer- tained 1905 . 55.3 0.2 7.1 28.4 9 1906 54.3 0. 8.6 31.4 5 6 1907 53.8 0. 10.9 32.6 2.6 1908 51 8 10 4 33 9 3 8 1909 53.9 8 7 33 4 3 9 1910 53.7 0. 8.5 33 4 7 1911 1912 52.6 52.9 0. 0. 10.0 12.8 32.9 29.3 4.4 4 9 Here there is a slow decrease in the percentages of the native- born citizens with a rapid increase in the percentages of the naturalized citizens. The alien percentages show slow increases until 1912, when there is a sudden drop. This latter is probably explained by the fact that 370 of the aliens deported and non- residents removed from this State in 1912 never became patients in our State hospitals. CITIZENSHIP OF READMISSIONS (See Table 12, page 108) Table 12 shows the citizenship of readmissions to the State hospitals for the years 1905-12. Of the total readmissions, 5,561, or 64.3 per cent, were citizens by birth; 5, or .1 per cent, were citizens by parentage; 715, or 8.3 per cent, were citizens by naturalization; 1,995^ or 23.1 per cent, were aliens; and 367, or 4.2 per cent, were of unascertained citizenship. The percentage of aliens among the readmissions is considerably less than among the first admissions. This corresponds with the nativity of the two clases of admissions. A comparison of the percentages of re- admissions of the several years with respect to citizenship shows the following: 24 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YOKK STATE Citizenship of Readmissions YEAR Per cent by birth Per cent by parentage Per cent by natur- alization Per cent aliens Per cent unascer- tained 1905 64 7 1 22 2 6 7 1906... 64 3 2 8 7 22 5 4 3 1907 1908 66.7 65 6 8.0 9 8 21.3 20 7 4.0 3 9 1909 66 7 1 6 6 20 9 5 7 1910. 64 6 7 25 4 3 9 1911 62 6 1 8 8 25 5 3 1912 62.7 9.9 23 8 3 6 Here again is a slight decrease in the percentages of the native- born, with increases in those of the naturalized citizens and aliens. As 4,439 aliens were deported or repatriated from this State from 1905 to 1912 the increase in the alien percentage could hardly have been expected. CITIZENSHIP OF ALL ADMISSIONS (See Table 13, page 110) Table 13 gives the citizenship of all admissions for the years 1 05-12. Of the total admissions, 28,828, or 55.3 per cent, were citizens by birth; 41, or .1 per cent, were citizens by parent- age ; 4,942, or 9.4 per cent, were citizens by naturalization ; 15, 90S, or 30.5 per cent, were aliens; and 2,439, or 4.7 per cent, were of unascertained citizenship. Comparing the percentages shown of the different classes for each of the eight years, we have the following : Citizenship of All Admissions YEAR Per cent by birth Per cent by parentage Per cent by natur- alization Per cent aliens Per cent unascer- tained 1905. . 56.6 0.1 7.1 27.5 8.7 1906 . . 55 8 2 8 6 30 5 4 1907 55 5 10 6 31 2 8 1908 1909 53.7 56 0. o 10.3 8 4 32.1 31 4 3.8 4 1 1910 . . . 55 6 8 2 31 6 4 6 1911 1912 54.5 54 8 0. o 9.7 12 2 31.5 28 3 4.2 4 6 REPORT OF SPECIAL COM .MIS 25 Chart D NATIVITY, PARENTAGE AND CITIZENSHIP' OF ALL PATIENTS ADMITTED TO THE CIVIL STATE HOSPITALS 1905-1912 Years 'Includn un.K-rt,ncd ca 26 ALIEN IN SANK IN CIVIL HOSPITALS OF J^EW YORK STATE V. NATIVITY AND PARENTAGE OF THE INSANE AND OF THE POPULATION IN NEW YORK STATE NATIVITY OF INSANK COMPARED WITH NATIVITY OF GENERAL POPULATION A comparison of the percentages of native and foreign-born among the insane in the hospitals on September 30, 1912, and of the native and foreign-born admissions during the years 1905- 12, and for the year 1910, with the native and foreign-born in the general population of the State as given by the Federal census of 1910, shows that the percentage of foreign-born in the insane population is higher than in the general population. This differ- ence, however, is partially accounted for by the relatively large number of the foreign-born in the age groups in which insanity is most prevalent. The facts are set forth in the following tabula- tion : Nativity of Insane Compared with Nativity of General Population NATIVE-BORN FOREIGN-BORN Number Per cent Number Per cent Insane in hospitals, September 30, 1912, (Table 1) 17,896 56.6 13,728 43.4 First admissions, 1905-1912 (Table 2) . 23,267 53.5 20,121 46.2 Readmissions, 1905-1912 (Table 3) . . 5,561 64.3 3,075 35.6 All admissions, 1905-1912 (Table 4) . . 28,828 55.3 23,196 44.5 General population of the State, Census of 1910 6,365,603 69.8 2,748,011 30.2 First admissions, 1910 (Table 2) 3,151 53.7 2,701 46.0 Readmissions 1910 (Table 3) 822 64.0 462 35.9 All admissions 1910 (Table 4) 3,973 55.6 3.163 44.2 From the above table it appears that the foreign-born in 1910 constituted 30.2 per cent of the entire population of the State, while the foreign-born insane constituted 43.4 per cent of the patients in the State hospitals September 30, 1912; 46.2 per cent REPORT OF SPECIAL COMMISSIONER 27 of the first admissions ; 35.G per cent of the read missions ; and 44.5 per cent of all admissions from 1905 to 1912. If the percentages of the first 'admissions, of the readmissions mid of all admissions for 1910 are used as the basis for compari- son with the census figures instead of the corresponding per- centages covering the eight years from 1908 to 1912, the result shows hut little variation from that ahove stated, as the respective percentages are practically identical. The census taken by the federal government as of December 31, 1903, gives the number of foreign-bom patients in the Xew York civil hospitals for 1 the insane as 11,258 or 46.2 per cent of the total. This is 2.8 per cent higher than the percentage of September 30, 1912, as above stated. Two enumerations taken by ISew York State in February, 1909, and February, 1912, found the foreign-born in its civil insane .hospitals to number 12,253, or 42.9 per cent and 13,163, or 41.9 per cent on the respective dates. The percentage of the first .enumeration varies but .5 per cent and of the second 1.5 per cent from the 43.4 above given for September 30, 1912. OF THE PARENTAGE OF THE INSANE WITH THAT OF THE GENERAL WHITE POPULATION The first of the two following tabulations deals with the par- entage of all admissions to the Xew York State hospitals whose parentage was ascertained and the second only with the native- born admissions whose parentage was ascertained. Comparison with the white population is necessitated by rea- son of the inaccessibility, at this time, of census tabulations on the parentage statistics of the entire population. This, however makes but little difference as, according to the U. S. census of 1910 those other than whites numbered but 146,769 in Xew York State out of a total 'State population of 9,113,614. 1. Comparison of the parentage of admissions (excluding those of unknown parentage) to the ~New York State hospitals, 1905- 1912 with that of the general white population of the State. 28 l:\sA.\E IN CIVIL HOSPITALS OF NEW YOEK STATE REPORT OF SPECIAL COMMISSIONER 29 Per cent native Per cent foreign or parentage parentage First admissions 1905-1912 (Table 6) 27 4 70 Readmissions, 1905-1912 (Table 8) 33 4 65 2 All admissions, 1905-1912 (Table 10) 28 4 69 2 General white population of the State, U. S. Census of 1910 . . . 35.4 62.9 2. Comparison of the parentage of the native-born admissions (excluding those of unknown parentage) with that of the native- born white population of the state. Per cent native- born of native parentage Per cent native- born of foreign or mixed parentage First admissions, 1905-1912 (Table 5).. . 52.7 47 3 Readmissions, 1905-1912 (Table 7) 52.7 47.3 All admissions, 1905-1912 (Table 9) 52.7 47.3 Native white population of the State, U. S. Census of 1910. .. 51.8 48.2 The first tabulation shows a considerably less percentage of those of native parentage and a considerably greater percentage of those of foreign or mixed parentage among the first admissions and all admissions to the New York State hospitals than there was among the white population of the State in 1910. This indicates that there is a relatively greater proportion of foreign parentage among those admitted to the hospitals than in the State at large; in other words that foreign parentage contri- utes more than its share to our hospital population. The reasons for the higher percentage, in the first tabulation, of those of native parentage among the readmissions are the same as those heretofore stated concerning the nativity of the readmis- sions. From the second tabulation, which deals only with the native- born, it is apparent that the native-born element in the New York 'State hospital population is practically indentical in parentage 30 ALIE.X INSANE ix CJVIL HOSPITALS OF XEW YORK STATE with that of the native white population of the State in 1910., the difference being .9 per cent. United States census statistics are not available from which comparisons of the foreign-born and aliens can be made. VI. NATIVITY, PARENTAGE AND INSANITY IN NEW YORK STATE AND THE UNITED STATES COMPARISON OF THE POPULATION OF XEW YORK STATE WITH THAT OF THE UNITED STATES WITH RESPECT TO NATIVITY,. PARENTAGE AND INSANITY As Xew York State contains the principal Atlantic seaport, a large proportion of the foreigners coming to this country enter the State, and of these relatively a large number remain in the State. During 1912, 28.5 per cent of all the immigrants who came to this country announced their intention of residing in this State. The following tabulation shows the foreign element in New York State to be relatively much larger than in the United States as a whole: Comparisons of the Population of the United States and of New York State. (From Federal Census of 1910) UNITED STATES NEW TORI STATE Number Number Per cent of United States Total population 91,972,266 9,113,614 9.90 Total white population Total foreign-born white population Total native-born white population of foreign parentage Total native-born white population of mixed parentage 81,731,957 13,345,545 12,916,311 5 981 526 8,966,845 2,729,272 2,241,837 765,411 10.97 20.40 17.35 12 80 Total white population of foreign birth or of foreign or mixed parentage Total native-born white population Total native-born white population of native parentage 32,243,382 68,386,412 49 488 575 5,736,520 6,237,573 3,230,325 17.80 9.12 6 52 Insane in institutions (January 1, 1910). . . . 187,454 31,265 16.70 REPORT OF SPECIAL COMMISSIONER 31 Chart F COMPARISON OF THE POPULATION OF THE UNITED STATES AND OF NEW YORK STATE (FROM FEDERAL CENSUS OF 1910) PER CENT IN NEW YORK STATE 5 10 15 20 25 30 White population ^ Foreign bom white population 1 i Native bom white population of foreign. parentage i i :::jmmmmm c. ^ Native bom white population of mixed parentage ar~i i 12.8 J ^ White population of foreign birth or of foreign or mixed parentage - _ ___ - _____ Native born white population I^LHBBL Native born white population of native parentage ^^IM '1 .! 1 . I..... . . ... 6.52. [ H__ Insane in institutions (January I, 1910) ^^^^^^^^^^^ i . _^^^^_^^^__ 16.7 | 1 1 - 32 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE Foreign-born white population Native-born white population of foreign or mixed parentage. . Total white population of foreign birth or of foreign or mixed parentage Total native-born white population of native parentage... . PER CENT OF TOTAL POPULATION United States 14.5 20.5 35.0 53.8 New York State 29.9 33.0 62.9 35.4 Foreign-born white population Native-born white population of foreign or mixed parentage. . Total white population of foreign birth or of foreign or mixed parentage Total native-born white population of native parentage .... PER CENT OF TOTAL WHITE POPULATION United States New York State 16.3 23.1 30.4 33.5 39.4 60.5 63.9 36.0 From the above tables it appears that while ISTew York has but 9.9 per cent of the total population of the United States it has 20.4 per cent of the total foreign-born white population, and 17.8 per cent of the total white population of foreign birth or of for- eign or mixed parentage. While it contains 10.97 per cent of the total white population it has but 6.52 per cent of the total native- born white population of native parentage. The insane in in- stitutions in New York State comprise 1C. 7 per cent of the total insane in institutions in the United States. Comparing the percentages of the foreign-born whites we find that while in the United States but 14.5 per cent of the total KEPOKT or SPECIAL COMMISSIONER 33 population and 16.3 per cent of the total white population are foreign-bo-m, in New York State the corresponding percentages of the foreign-born are 2\).\) per cent and 30.4 per cent. The percentages of native-born white population of foreign or mixed parentage in the total population and total white popula- tion of the United States are respectively 20.5 and 23.1, and in New York State are respectively 33 and 33.5. The corresponding percentages of the total white population of foreign birth or of foreign or mixed parentage in the United States are 35 and 39.4 and in New York State 62.9 and 63.9. In the United States at large the native-born white population of native parentage comprises 53.8 per cent of the total popula- tion and 60.5 per cent of the total white population, while in New York State the native-born whites of native parentage compose but 35.44 per cent of the total population of the State and 36 per cent O'f its total white population. The data of the Federal census of 1910 concerning the nativity of the foreign-born insane in institutions in the United States are not available, but taking the figures from the Federal census report of 1904 we note that in that year there were in all insti- tutions (civil, criminal and private) in New York State 11,858 foreign-born insane patients, while in the whole country there were only 47,078. It appears, therefore, that in 1904 New York State was caring for 25.2 per cent of the foreign-born insane of the whole country. Inasmuch as the foreign-born element in New York State has increased since 1904 relatively much more rapidly than the native-born element, it is probable that the proportion of the fo-reign-born insane patients of the whole country cared for by the State of New York has likewise in- creased. As it appears from Table 11, giving the citizenship of first admissions to the State hospitals for the insane, that 13,913, or 31.9 per cent of all the first admissions to the hospitals from 1905 to 1912 were aliens, it is evident that the State of New York receives more than its just share of the alien insane in this country. It is to be regretted that statistics of the citizenship of the in- 2 34 ALIEX INSANE IN CIVIL HOSPITALS OF A T EW YORK STATE sane in institutions throughout the whole country are not avail- able. However this may be remedied before many years as already statistics similar to those given herein are being prepared by several other States at the suggestion of this Commission. VII. TIME OF ALIENS IN UNITED STATES BEFORE ADMISSION TO THE STATE HOSPITALS (See Table 14, page 112) Table 14 shows the time in the United States before admission to the .Xew York civil hospitals of the first admissions from 1905 to 1912 who were aliens or of unascertained citizenship. Classified with respect to time, four groups are distinguished, as follows : Those admitted to the hospitals within three years after entry into the United States, those admitted more than three years but within five years after entry into the United States, those admitted more than five years after entry into the United States, and those whose time of entry into the United States could not be ascertained. Of the 15,985 patients who were either aliens or of unascer- tained citizenship, 2,831, or 17.7 per cent, were admitted to the New York State hospitals within three years after entry into the United States; 1,483, or 9.3 per cent, were admitted more than three years but, within five years after entry into the United States; 10,271, or 64.3 per cent, were admitted more than five years after entry into the United States. The time of entry into the United States of 1,4.00, or 8.7 per cent, of the first ad- missions, could not be ascertained. A tabulation of the percentages of each of the four groups, classified with respect to time in the United States before admis- sion, shows the following results: REPORT OF SPECIAL COMMISSIONER 35 Per Cent Distribution According to Time in United States Be- fore Admission to New York State Hospitals of Aliens and of Patients Whose Citizenship is Unascertained, 1905-1912. FIRST ADMISSIONS More than 3 Within 3 years but More than 5 years after within 5 years after Time YEARS entry into years after entry into un- the United entry into the United ascertained States the United States States 1905 14.7 6.8 67.3 11.2 1906 18.7 8.2 63.8 9.3 1907 ... 21.8 8.6 58. 7 10.9 1908 20.1 9.2 60.3 10.4 1909 18.1 9.6 64.2 8.1 1910 15.5 10.8 65.8 7.9 1911. 14.9 11.5 66.4 7.2 1912. 18.1 8.7 67.5 5.7 As five years must elapse after the coming of a foreigner to this country before he can become a naturalized citizen, it is evident that at least 2,352 of the male first admissions entered the State hospitals during the period under consideration before having had an opportunity to become citizens. Of the others included in Table 14 at least 5,317 males were in this country long enough to obtain citizenship papers but so far as could be ascertained, did not take advantage of their opportunity. Table 15 gives the time in the United States before readmissioii to the New York State hospitals of aliens and of patients whose citizenship is unascertained readmitted to the hospitals between 1905-12. It is probable that several of these readmissions had been in a hospital in a foreign country before coming to the United States, but the number of such cases could not be ascer- tained. Of the readmissions 115, or 5 per cent, of the patients were readmitted to the State hospitals within three years after entry into the United States; and 113, or 4.8 per cent, more than three but within five years after entry ; while 1,973, or 83.4 per cent, were readmitted more than five years after their entry into the United States. 36 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE The number of patients readmitted to the hospitals more than five years after their entry into this country has increased 68 per cent from 190,5 to 1912. Table 16 is a summary of Tables 14 and 15 and shows the time of admission to the 'State hospitals after entry into the United States of the whole number of aliens and of patients of unascer- tained citizenship admitted or readmitted during the years 1905- 12. Of these, 2,946, or 16.1 per cent, were admitted or re- admitted to the hospitals before having been in this country three years; 1,596, or 8.7 per cent, were admitted or readmitted more than three years but within five years after entry into the United States; 12,244, or 66.7 per cent, were admitted or readmitted more than five years after entry into the United States. The time in the United States before admission or readmission of 1,561, or 8.5 per cent, was unascertained. VIII. COST OF CARING FOR THE ALIEN INSANE From the financial standpoint there are three classes of patients in the civil hospitals of New York State viz : 1. Patients supported entirely by the State these are termed nonpaying patients. 2. Patients who repay to the State part or all of the bare cost of their maintenance up to $5 per week. 3. Patients who pay to the State more than $5 but not to exceed $10 per week. The last two classes of patients are herein called paying patients. On September 30, 1912, the aliens in the population of the ISTew York civil hospitals for the insane numbered 9,241, or 29.2 per cent of the total hospital population. This is probably some- what less than the average daily alien population for 1912, as dur- ing that year 961 aliens were deported or repatriated from the ISTew York civil hospitals by the Bureau of Deportation none of whom were in the State hospitals on September 30, 1912. More- over it is well know r n that of the 402 nonresident insane returned to other states in 1912 from the civil hospitals by the Bureau of Deportation many were aliens. In addition to this, Table 11 KEPOKT OF SPECIAL COMMISSIONER 37 shows that the alien patients constituted 31.9 per cent of all the first admissions to the civil hospitals from 1905 to 1912 inclusive and 29.3 per cent of the first admissions for 1912, which per- centages are exclusive of all patients whose citizenship was unas- certained. It seems reasonable, therefore, to assume that the average daily alien patient population in the civil hospitals for 1912 numbered at least 9,241. In April, 1913, a special census of the paying patients in the civil hospitals, taken by the State Hospital Commission, showed that 109 were known to be aliens and 103 were of unascertained citizenship. As the total number of paying patients increased 189 or 7.2 per cent from September 30, 1912 to September 30, 1913, it is not prejudicial to the alien to assume that on Septem- ber 30, 1912, there were only 212 paying patients in our hospitals who were aliens or of unascertained citizenship. The following is a summary and comparison of the paying and nonpaying patients in the civil hospitals on September 30, 1912, classified according to citizenship: Paying and Nonpaying Patients Classified According to Citizenship TOTAL PAYING PATIENTS NONPATING PATIENTS Number Per cent Number Per cent Number Per cent Patient population, Citizens (native bo Aliens Citizens Per cents September 30, 1912 rn and naturalized) based on total of eac 31,624 100.0 22,383 100.0 9,241 , 100.0 ased on total patient 22,383 1 70.8 9,241 | 29.2 sed on subtotal in ea h group 2,613 2,401 212 populatio 2,401 212 ch diiisioi 8.26 10.73 2.30 n 7.59 0.67 1 29,011 19,982 9,029 19,982 9,029 91.74 89.27 97.70 63.21 28.53 Per cents b Aliens Per cents ba Citizens 22 383 70 8 2 401 91 89 19 982 68 88 Aliens 9,241 29.2 212 8 11 9,029 31.12 Subtotal 31 624 100 2 613 100 00 29 Oil 100 00 From the first portion of the foregoing tabulation it appears that on September 30, 1912, of the total patient population in the civil hospitals of New York State (numbering 31,624) 2,613, or 8.26 38 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YOKK STATE per cent, were paying patients and 29,011, or 91.74 per cent were nonpaying patients; that of the total citizen patient popula- tion (numbering 22,383) 2,401, or 10.73 per cent, were paying patients and 19,982, or 89.27 per cent, were nonpaying patients, while of the total alien patient population (numbering 9,241) 212, or 2.3 per cent, were paying patients and 9,029, or 97.7 per cent, were nonpaying patients. From the second portion of the above tabulation it is apparent that the citizen paying patients composed 7.59 per cent of the total patient population while the citizen nonpaying patients were 63.21 per cent thereof; that the alien paying patients comprised .67 per OKT OK Sl'KCJAL COMMISSIONER (\-> " 4. The State Hospital Commission to furnish certificate stating the exact condition of the alien, and giving full particulars as far as known of the case. " 5. The State Hospital Commission to furnish transport- ing line with the name and address of the nearest relatives abroad who will care for the passenger after arrival. " 6. The State Hospital Commission to purchase tickets for such passengers only through the head offices of the lines in New York. " 7. That as far as possible insane aliens will be returned to the country from whence they came on the lines which brought them." The foregoing arrangement is entirely informal, is not legally binding, and no definite duration being stated, may be terminated at any time and without notice by the steamship companies. It seems superfluous to point out that the right of the State of New York to repatriate aliens by the steamship companies which originally brought the aliens to this country should be derived from the law and not rest upon an unstable understanding. Under section 21 of the Immigration Act steamship companies are guilty of a misdemeanor and subject to a fine of not less than $300, the vessel being denied clearance until the fine is paid, " for failure or refusal * * * to take on board, guard safely and return to the country whence he came any alien ordered to be deported." Steamship companies should be under the same legal penalties " for failure or refusal to take on board, guard safely and return " those whom the State desires to repatriate as those whom the United States orders deported. The Immigration Act should be amended to this effect and the State of New York should enact a law to accomplish the same purpose. EXAMINATION OF IMMIGRANTS BY THE STEAMSHIP COMPANIES The testimony of representatives of various steamship com- panies entering the Port of New York developed a further reason for the heavv burden of foreign-born insane that the State of <34 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE .Xew York is obliged to bear, which is much more than that of any other State in this country. \ 7 arious methods of medical examination of immigrants are employed by the different steamship companies. On the borders of Germany certain steamship lines jointly maintain the so-called " Control Stations " at which all immigrants from Russia must be examined before they are permitted to pass through Germany. At these stations the doctor of the steamship companies examines the immigrants to ascertain if they come within the requirements of the Federal Immigration Act. On the way to Hamburg the Russians are submitted to a cursory examination at a suburb of Berlin by another physician of the steamship lines, are looked over by other doctors of the companies in the immigrant halls at Ham- burg, more particularly with reference to contagious diseases and hernia, and finally file before a government doctor and a ship's doctor as they embark upon the transfer boat. Of the remaining immigrants from Northern Europe some are subjected only to the examination of passing in line before ex- amining physicians as they embark, while others in addition to this undergo an examination like that had in the immigrant halls at Hamburg. In Great Britain there is but one examination made of British immigrants, which is conducted upon the wharf of the steamship company or upon the lighter which carries the immigrants to the ship. In Italy the examination is made at the various ports by an official of the Italian Government, assisted by the ship's surgeon and in some instances (through the courtesy of the Italian Govern- ment) by an officer of the United States Public Health Service. The chief purpose however of the presence of the latter at the examination is the detection of trachoma a contagious disease of the eyes. The value of these examinations in detecting mental defects or psychoses may be readily seen when we are told, for example, that the British immigrants are examined during the time required for the barge to go from the landing-place to the ship, which KEPOKT OF SPECIAL COMMISSIONER 05 means that from 200 to 600 are examined in about half an hour, or from 7 to 20 per minute, and that at the Italian ports the lowest rate of examination is 200 per hour, and the highest rate 400 per hour, or about 3 to 6 per minute. We are further told that these immigrants are under observation during their journey from the port of embarkation to Ellis Island, but that no special examination is made as to their mental condition. No testimony was produced before this Commission which showed anything approaching an adequate examination by the steamship companies for the detection of mental diseases. Such examinations as were had appeared to be merely incidental to the examination to detect the physical diseases which exclude immi- grants under the Federal Immigration Act, Section 9 of the Immigration Act imposes a fine of $100 upon a transportation company (other than railway lines entering the United States from foreign contiguous territory) bringing into this country " any alien, subject to any of the following disabili- ties: idiots, imbeciles, epileptics or persons afflicted with tuber- culosis or with a loathsome or dangerous contagious disease " if it appears to the satisfaction of the 'Secretary of Labor that the alien was so diseased or disabled at the time of foreign embarkation and that the existence of such disease or disability might have been detected by means of a competent medical examination at such time. The mental defectives and the insane excluded from admission into the United States under section 2 of the Immigration Act, as heretofore stated, include "All idiots, imbeciles, feeble-minded persons, epileptics, insane persons, and persons who have been in- sane within five years previous ; persons who have had two or more attacks of insanity at any time previously; " *; persons likely to become a public charge ; * * ; persons not compre- hended within any of the foregoing excluded classes who are found to be and are certified by the examining surgeon as being mentally or physically defective, such mental or physical defect being of a nature which may affect the ability of such alien to earn a living." Though the insane and feeble-minded are forbidden entry into this country by section 2 of the Immigration Act there is no 3 66 ALIEN INSANE IN CIVIL HOSPITALS OF XEW YORK STATE penalty imposed by section 9 thereof for bringing them here, the importation of " idiots, imbeciles and epileptics " alone in the aforementioned excluded classes, being a Unable offense. This condition should be remedied and section 9 of the Immi- gration Act should be broadened so as to include, in the same manner as in the proposed amendment to section 2, not only the insane and the mental defectives, but also persons with chronic alcoholism and persons with constitutional psychopathic in- feriority, while the amount of the fine should be substantially in- creased. With their agencies all over Europe the steamship companies have both facilities and opportunity for making careful investiga- tion and examination of intending immigrants in order to prevent the classes above enumerated from coming to us and, in view of the profits derived by these companies from immigrant traffic, it is but reasonable that they should be required to do this, to the best of their ability. To see what may be accomplished along similar lines we need only consider what has been done in the past toward eliminating from among immigrants some of the contagious diseases. INADEQUACY OF MEANS FOR DETECTING INSANITY OF IMMI- GRANTS AT THE PORTS OF DEBARKATION As to the examinations heretofore had at Ellis Island, it is sufhV cient to quote from an address of the Hon. William Williams, late United States Commissioner of Immigration, before the Mental Hygiene Conference at New York City, November 14, 1912, in which he says: " I shall refer only to the detection of the mental diseases with which immigrants may be afflicted, and shall show how inadequate are the ways and means which Congress has pro- vided therefor. I am one of those who believe that the Legis- lature does only half its duty when it enacts a good law. The other half is to furnish adequate machinery and ways and means for its execution, without which the law accomplishes only a part of its purpose, and is there to perplex executive officials whose sworn duty and desire it is to execute it. REPORT OF SPECIAL COMMISSIONER 07 " Immigration to this county is at a very heavy rate. In round numbers it has during each of the past ten years averaged 900,000 annually, and the great bulk of it has been through Ellis Island. Only last month there arrived at New York over 80,000 aliens, an average of nearly 2,600 a day. Nor are the arrivals evenly distributed over the days of the month, on the contrary there arrive sometimes for several days in succession 4,000 or 5,000 a day. A great many of these people come from the poorer classes of the poorer coun- tries of Europe. Their general physical condition is often far from good and their ignorance beyond belief. Not only are many illiterate, but many do not know the days of the week, the months of the year, their ages, or any country in Europe outside of their own. These people speak many strange tongues and dialects, and interpreters familiar with approximately forty are necessary to enable the government authorities to converse with them. A number of those who are undesirable additions to our population are nevertheless admissible under the low requirements of existing law. Ob- viously the task of picking out from amongst this heterogen- eous mass those suffering from any mental disability is a gigantic one. It would be impossible of complete perform- ance even if the medical staff was in size what it should be. But Ellis Island has to transact its heavy business with the instrumentalities and facilities which Congress provides. It has in all 650 officials. Of these about 130 belong to the Public Health Service, which number includes all medical officers, (doctors), hospital attendants, and nurses. The medi- cal officers number only 21, far too few, for they have to per- form a multitude of duties in relation both to the inspection of the masses of immigrants who arrive and the care of those detained at Ellis Island hospitals for sickness, such sick num- bering at times several hundred. " The process of medical inspection is roughly this : Each immigrant passes before two medical officers who rapidly look him over with a trained eye and set aside for special examination all who bear any indications of physical or CS ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE mental defects. Those so set aside are, for the purposes of mental examination, subjected to well systematized test ques- tions, which the medical officers have evolved from their own special experience, and they apply also such recent modern and scientific methods as those worked out by Biiiet-Simon, Fernald, Goddard, and others. All such special cases, of which last year there were about 5,000, are gone into very thoroughly and are often detained eight days, or longer, for mental observation. But not enough cases are thus set aside, because the medical officers are compelled to work too quickly and lack the requisite number of interpreters to enable them to converse with each immigrant as he goes by. Furthermore, the space at Ellis Island available for the observation of immigrants suspected to be suffering from mental defects is too small." Mr. Williams further stated that he had frequently called attention to these matters, asking for an additional force of medical officers, for better accommodations for the examination of the incoming immigrants, and for various other necessary facilities, and that Congress had, to a limited extent only, taken note of these matters. Since this address was delivered in November, 1912, reports from Ellis Island show that the examinations there made for the detection of mental disease have been much more effective than formerly but that the number of medical officers, and the facilities and funds are still very inadequate. NEW ENVIRONMENT OF THE IMMIGRANT It has been suggested, and with reason, that one of the causes of insanity among our alien population is changed environment. Immigrants are plunged into a hurried struggle for existence, quite different in many instances from the slower and more even life to which they have been accustomed ; a vast rural population suddenly enters city life; they are in a strange country, whoso language, food and customs differ from their own ; they are called upon to make unusual exertions and to undergo much privation, REPORT OF SPECIAL COMMISSIONER 69 frequently in order that they may send for their families as soon as possible, and often, having but weak resisting powers, they succumb to an hereditary taint or to a fundamental defect in personality and their insanity develops. It is doubtless true that the new environment of the immigrant is in part responsible for some of the insanity among aliens, nut to what extent it is impossible at this time to determine. It is very significant, however, that many, if not the majority of authorities believe that an unfavorable environment, as a cause of insanity, is usually associated with an inherited weakness or a fundamental defect in makeup ; that the mental breakdown occurs in such instances when the stress of existence bears down, upon an individual already thus predisposed, As bearing upon the subject of environment some of the statis- tics published in the New York State Hospital Commission's " Statistics of the Insane for the year ending September 30, 1912 " are of interest. It appears therefrom (pages 26 and 27) that 65.1 per cent of all the first admissions to the civil state hospi- tals for that year were residents of first class cities, New York City alone furnishing 58.3 per cent, of which 1,673 were males and 1,672 females. In the villages and rural districts the male first admissions numbered 577 and the females 480, while in the rural districts alone the male first admissions numbered 205 and the female 122. Of the first admissions for 1912 the number of insane per 100,- 000 of population was as follows : Number per 100,000 of population Whole State 59.9 First class cities 64 . 5 Second class cities 54.1 Third class cities (20,000 to 50,000) 55.6 Third class cities (10,000 to 20,000) 63.5 Third class cities ( 8,000 to 10,000) 49 . 9 Villages and rural districts 45 . 3 The greater frequency of insanity in the cities as compared with the country is apparent from the foregoing. 70 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE Other interesting data in " Statistics of the Insane" show that senile insanity is relatively less frequent in the larger cities than in the villages and rural districts, but that dementia paralytica and alcoholic insanity are much more prevalent in the former. To improve the environment of the immigrant in this country is highly desirable, but that alone will not solve this portion of the problem of the alien insane, if we are to continue to receive nu- merous individuals with an inherited weakness or a fundamental defect in makeup. Both improvement in environment and ex- clusion of these individuals are essential. From the standpoint of humanity alone, and aside from all thought of the State, the com- munity and the future generations, we should not permit such persons to be subjected to the possibilities of mental disaster present in a new and strenuous environment. PREVALENT PSYCHOSES What we term " insanity " includes many different mental dis- eases or " psychoses." In a study directed to the consideration of insanity as a disease it would be desirable to consider these psy- choses at length. According to the testimony of the various hospital superinten- dents and the statistics of the New York State Hospital 'Com- mission the most prevalent psychosis in the civil hospitals of Xew York is what is now generally known as dementia praecox ; the second in order of prevalence is general paresis (dementia paralytica) with manic-depressive insanity, senile dementia and alcoholic insanity following. The first of these is an incurable psychosis of long duration having in some instances, periods of lucidity ; the second is uni- formly fatal, while alcoholic insanity may present an apparent cure yet the individual afflicted with it usually succumbs to his dispsomania with the result that the return of his psychosis is only a matter of time. From the testimony of the hospital superintendents but little difference exists in the prevalence of dementia praecox in native- born and foreign-born, but general paresis and alcoholic insanity are relatively more frequent among the forei the alien insane in public institutions at the present time and of those who may hereafter be admitted thereto. When this is donJ, saiBtnaj saiu W BUFFALO Wox ea^rad^ 881BJV MIDDLETOWN r*>j B31BIU9J B3[VPI 1 g w I^OJ, saiBaia^ eaiK WILLARD mox Ba^raaj sapjAi 3 I'^j, eajBtaaj 881B W 1 I*QX 83IBU13J RJ18 W C^ CS O CO <*< COU200,-ceS isiss < CO O OO t i O COOO t^ en o pt^-co ooo CO CD 05 CO COCO C ;1 Hill REPORT OF SPECIAL COMMISSIONER 87 g 1 o T co <*<' oo co' 00 M> T-4 O CO O * CO (N I-H O-O (N rH rH i-l (t^r^co oco * co us * 10 * fsj os^t^oo "3 ^ cocoo O g"-- s ' CO 10 IM 1C" TH 1C OTJ g|^3 Sl&S Mil KEPORT OF SPECIAL COMMISSION KU 89 T3 O 1 I O I 3 'I o A I 3 CO I 3 1 I COIMfOCO O O CO ^s I & 2 fS 03 1 1 O j ^ (N _( H H i O) Females ! 2 3 H 3 H 1 3 s I -* /) 1 1 1 ^ 3 H 2 I | u O fl 3 * i 2 1 i 1 \ 1 2 o | H D H 1 1 -4 D ^ 1 J 4 3 i ^ ^ o D 1 H g ^T^COrH COIN i-< OJOiO 111! lill ... goo ... O 05 O o 111! 111! >:3 ALILN INSANE IN CIVIL ![OSIMTALS OF .Xi-:w YOUK SXATK a o -2 & I 2 3 3 w < 00 IN Tf O "0 CO (N > CO O O >C * O O>C^ l^^ 00 ceo occ^S^ ' N.' ( 1C- SiO< iO ' issr CO OOI> OCCOi-H co oco r- S CO O GO Ci W O O I s * CO g s:-:- g i-- z E OCOCIN 8' C rf O 1C-* c cot^o CS) OOCXJiC .SflES |l|i ill! OF SPECIAL COMMISSIONER 3 'o H > 5 | 2 o> 5 1 ^ D 5 2 3 o H Q * D H I 1 .0 3 ! 1 3 H ^J 4 00 43 -( rf 05 a rH aj 3 >> fe 'J H > 3 2 5 1 2 D H i CO O 00 O C^ O'f^M S^o SS^ co~COOOCO *" 1 CO PH OOOOIN o to co oio-OCO .... OCOCOO OiO^ .. O iH O"O 1 e : si d . -s g 94 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE "o 1 Females M 8 hH 2 i s M 1 1 H .1 i 1 1 1 i J 3 i *a 1 1 1 i I 55 i o 3 1 M i o .2 H ca j g CO to H 1 1 i ^rentag HH 1 in w O W g 1 a CO -i M 00 00 (N M raoD>ooOf-4ooc) *' o o o iO c ^ M* ci c oo -H o IN IN 1C 00 >O OS rH Tj< -OCCOOO ic oo IN ic o o Tj o o ^< t> ic oo IN ic o o Tj CO 1C O >C t^- C --H -* t^''H )OOCCOOOO .T-H rjl O cgo.cc^goeg. C^-i IN T-I 1 C<100 COCO .- ; 3 ( n co o-oo C4 o IH 10 o JH QO oo INOOINCOOS^ -(N-HI-H- O3.kO * i-H C^l rH J^HTJH O O 1C b- Tj< O C "C CN -* CO CO *"" -H i-l N^'I-*'-^' d d ^00"505rHiCOO^OOC f|Ir. : 5^^? sPillPii.L lull lull it |occo|oooo;|^ REPORT OF SPECIAL COMMISSIONER 95 CO- rH -COt^rH 5 \~tr COCO TtO5rH(N .' d o' co o' (N N o'd o Females rH t^rH CO O O O rt* O-J CO O5 rH 1C ti CO CO 1C (N CN =? ICICCOCO rH 1C - -ON- O Tfl Ttl 1 Tf CO tN. CD TP CO OOrH 1C fT- COCO * 5 2 O5rH(NrH 1C CO O O CD O do I 10 CD co co t- rH ICCOrH CO rH rH rH CO >C 00 1C O rHVOt^O CO CO CO 1C O rH 10 CO CO CO 1C O t- 00 C5 # p> CO OOrH 1C CQ ^ 05rHO5COCO oo O -^O(N C Et ic c^ i t^. . JO (N iM coco o'd 1 .. lc .. (NC i CO rH rH 1C rH OCO 1C 1C 22 O OCOo' d do' : : :J> : : : :L : 1 I E i i I q 4 5 2 d f\ L) Native-born patients Of native parentage . . Of mixed parentage. . Of foreign parentage . Of unknown parentage Foreign-born patients. . . . Of native parentage. . Of mixed parentage . . Of foreign parentage . Of unknown parentage Nativity unascertained. . . Parentage unascertained . . Native-born patients Of native parentage . . Of mixed parentage . . Of foreign parentage . Of unascertained pare age Foreign-born patients. . . . Of native parentage . . Of mixed parentage . . Of foreign parentage . Of unascertained pare age Nativity unascertained. . . Parentage unascertained. . 96 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE I lO O O\ .a :* *- w 5 S W ^ .1 6 w g o IM 800 10 CO I * O d Tf! O 00 O OOJINCCCO OCOOOOO (Nt^fNrWt^ '',/'' Tj 1 a a ^ 1 I 2 S g M O O ^ t A I O 8iO !OO W Ot>COCO i-H - -. oOO CO OCOCOIN O> CJt>- C^IOO O ..... t>.iOCOt -l Ot~iOO i-l 2 N * . i-l CO O(N CO I>O CO OOOCiCO O CO I s - *O C^ ^H .... 00*00000 i-l OOOiO O5O CO pj OOOrHOJ (^ COOIN 11 * 1 O OOOiOCO 1-1 SSSS 2 : :^s OCOOO l> COINO'O t>iCCOt>- i-t ..... iOi-l CO Ot>COiO ^ 00 O5 .... COCOrHt> OlOlOCO CO rH- 2^ 05-.0 CO OOOCOOO OOOQ Joooo 98 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE 1 si*s a pr - s?-;-2 co' d N* d CO CO o'd | Tj-OiOiO^t CO . w'~ l s i s 5 COt-CO^CO CO -lOCO -H^H CO CO CO OHO IO -00 1>- NN M w 3 CV) r-l ,-( ,H -r-l CO CO 1 1 sr c :- :- """"" S|8 o'd I ; ; ; ; ; I TABLE E c P P 5 1 4 H 1 4 f" d &$ &&& : MSsrt W)t*rtfl -aa 1 C8*3O1 03*Oj-|Ja> a)fl ^g^gs -si^gs .23 9 2 9 % PI a;^.a fi 'pill !! . ! |1 S'^S^'U^ t'j3x^ g 3 11111 Ilijl *| ^Sooo loooo fl 1 1 11 Native-born patients Of native parentage Of mixed parentage Of foreign parentage Of unascertained parentag Foreign-born patients Of native parentage Of mixed parentage Of foreign parentage Of unascertained parentag Nativity unascertained Parentage unascertained REPORT OF SPECIAL COMMISSIONEE Ot^- rH OS s . T^ CO s | O Oi Tt* 00 O *O CO Tj< O CO -COO t-i ;dt>i do H H 1 - O OS ooi^-t^co o rH O O do 05 s ON CM ^ TJH h s COCO10 CD (N -rHrH a *O CO CO C-1 O5 (N i-H iH rHIOOOOS OS t>- -CO rH CO CO O ,_,' ; d d d tS PH \Z COCO IN CO CO H> S m 1 -j l> OOSCO 1O M CDt>CD ^H rH g COCO IN CM IO >O IN co -OIN o CO CO o'd J O5O'OOO ^ iOt>-C^ i iT-H IO1> OOCO ^ a .-. co (N IN 2 1 : c, do 1 IOO5IN (N * * t^CO (N CO T(< IN OO -00 O (N -(N a i-H IN IO i-H IN 1-H COCO IN CO CO COCOOSiO OS rtn'odl*' '' H I (NCOCOOSrt* r-KNrHOO 00 t- rH (N 00 N ^ (N 3 O CO rH i-H C^ rH SrHlOCC O Oi O O 00 O CO (N CO CO | * 05CDCT0^ O-H 05 TfCOOSOS O (N rf o3 CN T t T 1 i-H i-H t i Oi O CO I-H 00 O 00 S- I>CO IN -IN .- : --i : -J, . ' ' a ' . M M ' ' : :g : pi c < 1 s < 3 J H H H ! * a> M-2 ! aj uj-2 -"d WiM^c! .^5oa -aS .c3o3-*J(lJ mjo3*3O> fj ll g'43 X 0;^) ^'^ X V^ g ^ ^il ^r^ ^a 3orn patients. . . . native parentage mixed parentage . foreign parentage unascertained pa ge -born patients. . . native parentage mixed parentage, foreign parentage unascertained pa ge f unascertained. . ge unascertained _>oooo .jsoooo ;|| ^3 "^ C3 3 03 d <*, <_ o* t_ * .aoooo '> fl H fc fe r?fe 100 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE In a a V) 2 o o 00 w OOOt^i-iO ,0 CO CO 00- h-m w oo T-H Tt* CO 'o6o6r-i( 0 Oi OCOIOOCO D CO CO OJ !S W S3 (Nb-COOOO (N T-lOOOO OCOOrHCO 5 rH O iCD^ g % CO T-tOi-H i T}< O5CO O< CDOOCOOi GOCM" io" oo B OcOWOO-^ O O00l-' IN oco o PH rH fL, >TfCO OS' )CO t>' .lip lllll I fl'a^ Soooo I sill & % v $ !' loooo REPORT OF SPECIAL COMMISSIONER 101 o g ctf pq I I ,D O 3 f 5 P I J -2 H 3 o o PH 00 0> 00 O I-H >O rti 00 O ro-tiQ Ot^OOOs CD '^' d OOCDCOCO CO CO r-llOOS COIN CO IQ IN I-H OS O3 00 o co 10 S^t>-<* o (N CO OCOCOOO CO O (N 00 OO O OCO OO5COO O (N 00 t> "-I CO iO OO n w*5 M 04 lai s loooo oooo 102 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE ^ (MCOOtNb- OSWOiOOO 0000 tN b rH CO l> Tf< COCO Tf< O *O CO 1C TH O5 TH 10 oo r-i m co w cot^ooo!N COOOTHI-H oo t^ Tf lO ^ 5--KO CO D COi-H Ti 2 OiOi O Oi-N-*CO J> ICOCOCOCO COOirHOCO THTh COCOt^t^CO l/5rH(NCOCO (N (N U>CiCO rH rH IO 00 "5 O5 rH TH O O CO O OO ;rHCOCOrHO5TH OO t- O CO TH b- rHrHO O OO ........ - - lOlNrHTHTjH IOICOOO OS5OrH(N rttrH 00 O l> rH 1C O5 rH (N (N ** COCO TH 00 "^ CM O O rH b rH rH 0000 ..... ..... ' * COOJICT^TH D THrH COO5COrH C^IOOlNO OO '" il - a 9P5 ftft ftafe ao,te giili i ni giili I 0000 .SfOOOO * >0000 .SfOOOO OF SPECIAL COMMISSIONER 103 H CD OS 00 lO *< 55 CO'CM" TH OSCMiO^OO COCO t>- CM CM CM iH rH CM CN CO CO F| 10 ' d *' d CM CM do Tt^ CM CO rH GO COCNCNTK'O COCO rHTtO CM rH . .31 do' I OSrHOOQO TH^COTHO 0.0 >O t00 OSrH CO tH CM tCO CNCM "o H sr:- CM CM co" co" <* t^- "OOSrH OCM rH .OOOrtjO 00 8 ot-cot-co 03-HOO^cO CNCN 00 t t>->OOS rH -CMt^CM rHrH 2 1 1 |SS8 s s COCO u^ OO CD -OiOO OO Males 00 CM CO * OCM t^ lOCOOOO * CO CO T-t 1-1 "5OO COOS rH 10 rH CM 00-* rt* O O CO O coco o'd 1 CO OS CM CO CO t>00 * >OOO CO CO CO 00 CM * CM IO t^CO O rH lO CM CM CM -CO.OHH *' ' O CO O Tfi Tfl o'o' o 2 02 1 CO GO 00 rH OS CO 00 OS rH CO CO OOrHl> rs - CO OS 00 00 rH CO >0 10 O rH ^O CM CM CM rH CM CO CO co d d o' d o'd 1 fcSSiSb co O ^r "^r HH 00 rH CO CD GO O O ^SSdS CO COOOCM CM O rH O COCO o'o' ~ " W g^S^co 22 O ocooosco 00 CO OS CO CM CM 1 |D t- OS CO CO I 2 * Co"rH TH" O4 CO OCMO OO 0} I 1 CM OS 00 O "* t~ GO rHCO ^ : ^1 Iwf s 'i d o'd j Is ^5 CM t> 00 00 03>OI>rHri< O3O rH t^. TH^COO^ OSOS COHHr-lt^-* 1>O O O 1-1 "5CO CN S dSd o'o' 13 CO t^ O ^t* *O COCOOCNrH 030S t^t-^cMTK OrHrHOOO COCO o H ^3 00 CO CM COi-( rH co" co" SSJ^S- COOO^5O 00 I Females iOCOl>00 O COOOrHIO l> CM CM 00 lO IO lO HH OCO COrH-^COOO (NrHrHOrH do 1 lll OSCOWtfCO rtt-* lO Tt< i-H rH Sg 10 '^' OSCNrHiHlO co d d co" d o'd *ci f ~s -i Native-born patients Of native parentage . . . Of mixed parentage . . . Of foreign parentage . . Of unknown parentage Foreign-born patients Of native parentage . . . Of mixed parentage . . . Of foreign parentage . . Of unknown parentage Nativity unascertained .... Parentage unascertaine Native-born patients Of native parentage. . . Of mixed parentage . . . Of foreign parentage . . Of unknown parentage Foreign-born patients Of native parentage . . . Of mixed parentage. . . Of foreign parentage . . Of unknown parentage Nativity unascertained .... Parentage unascertaine 104 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE in & 18 s s CO i/j t_| I ^ I o M s a "* O oo r^ "T OCOOOIXN l> t> rH( O CcOOS [jq * - O O n 8 H GJ H J 1 1 S 1 i i 2 i i i 1 i 1 1 00 1 1 j TO 10 O O iO CO O> 88 ' %% <=">*- 05 IN 01 '> 10 M '> 10 (N O-*iOCO 00 CO OOOOCO iO G5 O CO CO ^-IO5-*O rH Sofeo S t^'-'INCO (NCOOOtN l^- O C5 ^ co" rHCO (N OOrHOSCOCO g o C3 rH 1C H g 00 CO 1C Tj % |NOrH03CO o g 5 00 "OOO3 o g *-4 (M rH * 2 3 3 1C g ! rssi rH (N (M t^-COCO rH 1C O CO 00 OS o g o> tH (N D M 1 OH T^Ttil^OOcO 03 ^ COINiCCOt^ o 1O ^ .'.... i CQ W rH CO (N g S ^ COI>CO(N 1C p^ !CrHI>O300 a 1 J N rHt>.rH CO 1-1 >>>>> a >>>>> a 999 1 | 99 1 1 N N N 3 N H N N N N EH -^ -M .** Q; .r-< .^H .r-( -P-l C> CM U5 CO IN CO -CO^HO CO CO O5 rH COrHOO5T}< ) - S 2 :: sJ:l 000^0 iai H 108 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE i w e^ ' 8 N >^5 GO O i O 1C lO t^ 10 5CO I (N O * t> ) OO5t- S :'? O i CO CM CD ^ CO (N COlO COOC3J I O co o o CO CO --ICO i-H (N S ^o^^' 00 II 11.1 1 S 2 2 S ' sasis : :i i si ^ RKI-OKT OK SI-KCIAL ( 1 o.\i . \IISSIO\KI; 3 OS -t< CO 'O IN o o 00 ; rH CO 8 H 3 l> IN O5 en l o> | ;es f 05 -COrHCM l> O5 OI>CM 1C -rHO Tf CO COrHOO'OO H 3\ CO CM 8 s OJCN^rH^ o oocoi^oseo o | O5 1 CD "* O (N 8 3 2 | CD -O51OOO Tt< -lOTOOOCO 2 rH .(.NO /> s CO rH S :^* ir5 1 XI FEJ 3, o -32 O5 O5 CD >O O /j o 3 tf 50 g co :'CM W 8 4, a w X) i-> 1 3 S ^rHrH^rH p^ rH b- (M CO S ^. 00 ^ g COOCDO.O o I D S 05 rH CO CO 00 "* >n (M ic 05 os o 5 i M ^^JCM *" IN O h- * * 8 8 w to 1-OOrHCO gj * -COCOI> o S CO ; * rH -iQCDCO t> rH I i OS 1 CD i^S 70 CO 1 s S (N .05NO CO 00 IOOOO5 s 1 CO >0 ^ COCO 0> ^ i o ' * r ; ; ; 1 -J S '. '. i"s M p 1 :|| j| 3 '5 afl g 1 II i i H >>>>>> ; a ^J ^i ^> >> ] CX 3 Ipgi H iiigg o 000^0 Hill 110 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE 3 OOlOCNGOrH Tfl lOrHCOOOO CO lO rH CO ^ o 8 O CO rH CO H CO CO CO" rH 10 00 (N CO <* t- IOOOO O >O lO CO 10 d s 1 Gi CO ^f I s -* CO rfr* (N O !> Oi C3 CO (N O> t^OO rH Tj< o 8 -2 & 3 OOrHO-* COt^CO co-^i* *< i ^=nss o H CO rH >o" 1 1 1 rm CO COOCOOOOO iO CN I GO 1-1 T " H (M { co ^j OIM-^ oo co o 1 |s ssa O5 W ' o i V) o H (N rH 8 s i J CO Oi CO COO 00 rHCOrH CO O l^ rH O t^ O5 o 1 ^ EH CO 0 (MOOrH S5 1-1 s .S : : : : : : ; '. ; ; '. ro M 1 y|ij \ Hi ;i : : || :| H ^ d 2 ; S : j"S 2 o *f -2 a g 2^5 Si.1 3 a >>>>>> a >>>>. a -Q _Q - '^ *C5 ^ "^ "^ Iri "c* SSS^S g g g g =2 1 ^ Illll EH OOQ :tl o I ro I e Females Total 1 s O3 "o H "cS 1 s 3 o H 1 3 OJ 1 "3 H Females J c3 i-l Females Total 00 ^0) 2 s ^| <*! C5IN Tf4 iO rf< M CD 00 Tt< O r-t Oi-l N J t>LO rH b- (M O rH CO -OOcN iO H to f4 coi-H o co eo^Ob-co b- O 00 Ol ^ IO (N b-i-H COT-IOO COOO (N CO iO i * CO t> 10 <* ro 10 O5 CO - CO rH rH i I 00 lOOO Tf< rH ^ Oi O t^iOiN T)< IOOOO5 ^ (N rHOr- b- Ot^ 00 COt-OJ a "as 8 O OOOiN 8 CO OrHCC rH OCDCN O rH o 1 t>. wooeo od odeo'oi C3 OS lOCOCO 5 "'S o 8 OS t^CCOi o ^ 00 O CO t~ 00 CON o rH COt-rH COrH 1 (M N I-HQOO3 ^COrH o 8 O ee CO1>C3 COrH o 8 t^ MCCl^ t-' O5 T)< 00* I t^ (NiOcO o 8 00 o>go6 o 8 i 13 -* c 8-0 2 S :ll 3S o REPORT OF SPECIAL COMMISSIONER 113 1 1 CO JO J^^J rH t^ lOt^ o 1 5 CO rH MrH CO 00 t>-iO 8 g H " IN 1 (M OS Females t^ rH O5^ CO O3 O iO rH ... rH CO 8 CO 1 1 O O3 rH CO 8 r-> 1 1 XS3 rH ^ r^ dH (N o 1 CO CXI Tt ** rH o PH I 1O O O3 CO O3 CO rH CO 00 PH t^ O 8 5 of ^ PH rn" fc ^ ^ 8 *^H 'yTi feS a si! 3 g**, O O3 CO O3 fT t^ O3 COCO P CO rH COrH Q CO rH CO CO 00 COCO O CO CO *CO o 8 *$ 3 10 CO COO 10 rH 8 rH 00 CO OO 10 O t^rH > 1 |||!|H 1 %! .s -g a :3 *T ii 3 1 j|| ji| |J|j||| ^ E H ll lie 1 Slrt 1 1 H ^S s SS ? 1 -- ^^ a 02 gl | "3 3 n S'S ^S"!? o 'd-S^ S.^'S^ s 8 lIlioPoSl ^ '| l^g |'^ | H H % ^ H j S S H 1 14 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE F^-j CO 00 >O Tt* Tf 00 * Tt< s "o r? OC^t O CO Tj O 00 rH OOIC (N CN t^CO t^ 00 1 H . o -3 ^ 2 Females CO COJOrH rHCO rH (N 05 OCOOO rH rH 00 CO CD r o 8 . CO ^Ot- g g 00 rHCOOO o oT "3 CO 0CO O5 rH 00 COOO rH CO CO IOCO t> 00 8 o H 1-1 ti> ja CO J * 00 S 2 522 o 8 a 3 Jil ;* j (jj 1 : 1 s 1 1> : * OT fe * S-2 02 s ^"a :"S : 52 'S ^ 1 :'3 : 1 i ' a .a 1* ^-S ^ "3 ^ * ^ 0) p.g : % ' 5'J ^ 1 H ! E- i 1^ ^1 : II i| 1 10 M inn llllj W *) 3 llfll iiSii a ^. 2 i^ I H pa^SP E^S I^H OF SPECIAL COMMISSIONER 115 1 3 05 rH COCO i 5 4 ) 1 (M 2 s O CO CO CO lO S 4 u 1 O 1-1 N "5 d ^ 1 \ 05 Females O5 IN COOO rH OOIN >0 CO (N 1 1 : 1 i-H O5 CO l> ^H lOCM 00 8 (N O5 05O LO (N < 8 CO ^CO o >O lO OOr-l I - V-H 1 00 I CMOS CO lO O5i-H 8 00 lO CO "tf o CO lO t~O t" 1 < 8 lO CO t^iO 00 LO 1-1 rf 00 8 i-i M O t> o CO *i "5-^ 00 8 t- t- coco - CO 8 05 TP ^CO CO (N 00*0 8 10 O5 OcO o co CM co t^ 8 CO 00 r-100 - - sr 8 (N 1-1 t^O w S* 8 (N 00 >0O * N S 00 8 0> T rHCO CO CO *O ^ 8 Vithin 3 years after entry in United States tfore than 3 years, but within 5 years after entry in United States tf ore than 5 years after entry in United States Pime unascertained o EH 116 ALIEN INSANE IN CIVIL HOSPITALS OF NEW YORK STATE CM rH O H g 1 - 1 1 1 1 1 ** 1 1 1 I !? J 1 1 J H < 02 1 1 m 3 1 H CO -H COrH >O C3COCO o; l>0>0> t^ INOC iH t~ OO'QOO o 8 ill a ^ -.a ?j z" an-*< 1 8 a 8 S .15 o.S o_c K ai8i -a clip- "in Ifall KEPORT OF SPECIAL COMMISSIONER 117 1 s I 0 TJ4 . b- (NO |s. O T44CO rH I-I CO CO O) O Or-l oo ... rH ^4 O3 rH>0 rH b" o 8 CO 1 1 tn a> ooi^- O 00 ^ CO N GO g O rJ4 rHIO l> Oo' rH !> o I .In 1 CO O O^ CO N KS T}4 TJ4 IO MOO co' o' oo' t^ I 1 H O3 1 1 i> o a>-# ^ CO CO OS O (N l> COCO i-< T4 iO CO CO O> CO * O t-'l> I 1 .2 <* 1 CO O <*< i-4 (s, CO CO03 CO i-l rH O O I-4TJ4 >O r(< O 00 1^. of 1 B ^ rt cs C^ rH 1 * a 1 C<> ^4 O500 CO rH ,-(0) i-t 1-4 O3 CO IO 00 rHCO CN W 00 rHt>. o "x^ s-g^ S? 5 s 1 TJ4 CO tOCO H -* "*O5 _ t>- N" pi, o- S '55 .22 -5 i Females ^j 2 SS2? 00 O 00 00 O t^- CO rJ4cO t>. . ... rH IO OS t> t> 1 1 ^ 1 1 C^ I> t^iC S . 1 ^^ rH 1> 00 COCO 8 ^ .Q CO H t 1C QN 44 o 0-* * (N lOiN ^4 t> CO COrH CO CO CO O(N ft t 1 I'* 2 S2 rH o I 1 5 t> r-l I>(N 10 1-H -*4-l>.t~-T-(t>-(NOiCDO5rt r-l,-Nr-lr-(i-l,-l