During the year the number of admissions of persons for the first time was 661, of which 513 were men and 148 women. Of the total number admitted 550 were citizens by birth, 68 were citizens by naturalization, 27 aliens, and 16 whose citizenship was unascertained. According to race, 157 were African (black), 1 American Indian, 8 English, 2 French, 15 German, 2 Greek, 8 Hebrew, 3 Irish, 6 Italian, 9 Mexican, 4 Pacific Islanders, 1 Portuguese, 1 Rumanian, 12 Scandinavian, 1 Slavonic, 3 Spanish, 1 Welsh, and 10 race unascertained. The races above mentioned show 17 different classes. The outstanding event of importance at the hospital was the letting of a contract for the construction of a medical and surgical hospital. This building will provide for 200 beds for the treatment of acute medical and surgical conditions. Its construction has already been started, and in accordance with the terms of the contract the final date for its completion is July 25, 1930. The building equipped and running will in every way be a modern medical and surgical hospital, and as such marks a distinct advance in the equipment of hospitals for the care of the mentally deficient. Other events of importance on the physical side of the institution were the purchase of a triple combination pumping engine for fire protection capable of pumping several streams of water over the highest buildings on the reservation and the engaging of three fulltime firemen in connection with the service; the purchase of a new, up-to-date ambulance with a carrier which will permit the carrying of patients in comfort to and from the operating room and the various clinics, as well as the hospital building; and a complete survey of the power house and equipment, upon which will be based a plan for the future development of a heating and lighting power plant for the institution. The total number of employees in the hospital on June 30, 1929, was 1,298, an increase of 27 over the prior year. There were 338 appointments and 311 separations during the year. The personnel turnover of the permanent employees has been materially decreased. At the same time the hospital has secured a higher type of employee because of the keen competition which exists at the institution. Nearly a thousand letters were received during the month of June from applicants for training in the hospital school. The Red Cross unit continues to function in a most valuable way for the welfare of the patients. It is particularly helpful in the hospital in making contacts with the relatives and friends of patients who live outside of the District of Columbia, in assisting follow-up work of discharged patients who are not in the District, assisting patients in the preparation of pension claims, tracing of lost relatives, lost property, assisting relatives and friends who are visiting, and in many other ways being of general usefulness in the matter of the relationship of the patient to the hospital. Particular events of the medical service have been the continuation of the successful treatment of paresis by malarial inoculation; the continuation of the work of improving the condition of chronic patients in the back wards; and, in cooperation with certain members of the staff of Johns Hopkins University, the inauguration of a treatment of carcinoma by a new method which, in the very limited time that it has been in operation, has seemed to show encouraging results. The most important single need of the hospital is additional beds. The hospital is not only in a very crowded condition but the population is increasing very rapidly, the lowest estimate being that it is overcrowded by more than 500 patients. To relieve the situation it has been planned to provide for a 1,600-bed extension to the hospital, of which the medical and surgical building constitutes the first 200 beds. Included in the estimate for the coming year is an item for the addition of 740 beds, which will comprise a receiving building for men, a receiving building for women, and a tuberculosis building; also an item for necessary additions to the power, heat, and lighting plant. The training school had 11 graduates this year-2 nurses and 9 psychiatric aides. Also 49 attendants successfully completed the three months' course required of them. The affiliated course in psychiatric nursing was continued for students of the Army School of Nursing, Sibley Memorial Hospital, Homeopathic Hospital, Emergency Hospital, and George Washington University Hospital School of Nursing. The hospital had affiliations for its student nurses with Children's Hospital, Sibley Memorial Hospital, Emergency Hospital, Episcopal Eye, Ear, Nose, and Throat Hospital, and arrangements are completed for affiliation with the Instructive Visiting Nurses Society. The hospital continues to emphasize the need for a complete revision of the lunacy legislation in the District of Columbia. In discussing this matter the superintendent states that— On February 7, 1927, the Secretary of the Interior transmitted to the chairman of the Committee on the District of Columbia, House of Representatives, bills changing the method of admissions to St. Elizabeths Hospital. These bills were introduced in Congress, and bore the numbers H. R. 17045 and H. R. 17137 of the second session of the Sixty-ninth Congress. The main changes of the existing legislation were: Provision for voluntary commitment for treatment, on request of patients, with provision for discharge on three days' notice. Provision that insane taken into custody by the police or other officials shall not be subjected to trials as are criminals, but may be held in the hospital and treated, and not tried except upon their requests or that of their relatives, guardians, or friends. If a trial is demanded by an insane person, his guardian, or friends, or by court, upon petition, the insane person shall be heard by the court, and not subjected to trial by jury unless the insane person, his relatives, guardian, or friends demand it. Temporary commitment or detention is provided for, with provision that during such temporary commitment, and prior to formal commitment, the person may be released upon certificate to the District of Columbia by the superintendent of the hospital or by two physicians in regular attendance at any other hospital that the person is not insane or has recovered his or her reason. Provision for the automatic restoration of civil rights of patients discharged from the hospital on certificate of the superintendent that they are cured or that further treatment is unnecessary or undesirable. The proposed legislation recommended, it is believed, would make unnecessary so many writs of habeas corpus, and would make the release of patients to those competent to care for them simpler. The proposed legislation would be in keeping with previous attempts to secure legislation amendatory of those portions of the District Code which deal with admissions, detention, and release of patients in the Government Hospital for the Insane (St. Elizabeths Hospital). In the report of the Comptroller General of the United States (H. Doc. 605, 69th Cong, 2d sess.), suggestion is made that additional legislation on this subject is desirable. A committee of medical advisers which made a survey of the hospital under the direction of the Secretary of the Interior made a number of recommendations for remedial legislation, but did not undertake to draft a measure for this purpose. The design of the bill suggested was to provide a method more in keeping with the modern humanitarian and medical attitude toward this class of patients, and along lines which have proved effective in several of the States and in other countries. Since the original of this proposed act was drafted, new ideas have arisen which we believe should be incorporated, such as that some provision should be made for emergency commitment. At the present time, we understand, there is a committee appointed by the District Commissioners, or the Public Welfare Board of the District of Columbia, which is preparing a draft of a bill to replace the District Code for the admission of mental cases. The proposed bill by the committee from the District would not affect the commitment to a hospital of that class of persons certified by heads of departments and establishments under existing law. The committee probably will not take any action on the second bill that was introduced in the House of Representatives proposing to regulate the commitment to and discharge from St. Elizabeths Hospital of persons certified by heads of departments and establishments under certain existing laws. This proposed law should receive consideration irrespective of what action is taken by the committee mentioned. Every effort should be made to secure modification of the present laws governing admissions to St. Elizabeths Hospital. In 1924 a Royal Commission on Lunacy and Mental Disorder was appointed to inquire, as regards England and Wales, into the existing law and administrative machinery in connection with the certification, detention, and care of persons who are, or are alleged to be, of unsound mind, etc. They made their report, and in commenting on it a London correspondent says: "Every facility should be afforded to the mentally ailing to submit voluntarily to treatment; but when compulsory detention is unavoidable, the intervention of the law should be as unobtrusive as possible." This, we think, expresses the objective which should be sought. FREEDMEN'S HOSPITAL Freedmen's Hospital and Asylum was established as such under the War Department by the act of March 3, 1871 (16 Stat. 506), and subsequently transferred to the Interior Department by the act of June 23, 1874 (18 Stat. 223). Prior to 1871 the hospital was under the control of the War Department as an adjunct of the Freedmen's Bureau, which was established approximately 64 years ago, principally for the care of the refugees who came to Washington in large numbers following the close of the Civil War. The activities of the hospital in recent years have enormously expanded owing to the ever-growing requirements for the care of the sick and injured, with a consequent increase in the cost of operation year by year. The need of a modern obstetrical ward still exists; its urgency is more pressing year by year as the difficulties increase with the efforts to maintain a modern maternity service with inadequate facilities housed in a ward originally designed for general medical cases. The floor space is poorly adapted for the care of such cases, on account of which the necessary equipment can not be installed to advantage or placed in accordance with the best ideas suggested by modern methods. The release of the ward now used for this work will afford the necessary increase of pediatric patients, which must be forthcoming, not only for teaching purposes but in order to meet the requirements of the State nursing boards of registration. The various clinics conducted in the out-patient department are poorly, improperly, and inadequately housed. During the preceding fiscal year 25,272 patients were treated in this department in small rooms, badly appointed, lacking the necessary complementary laboratory facilities. The medical students of Howard University are dependent solely on this hospital for clinic material, which under existing conditions can not be satisfactorily developed, both from the standpoint of the patients and the needs of the medical school as a teaching asset. Moreover, a clinic building would effect a distinct saving, in that many patients could be treated without the necessity of having them admitted into the hospital. This building would also permit the development of a real physical therapy department. This service is now attempted in a limited way in unsuited quarters and, of course, is unsatisfactory. A new ambulance is required, the present vehicle having been in use more than six years and requiring considerable expenditure for its upkeep. Two technicians are also required, one to operate the electrocardiograph and the basal metabolism instruments and one to assist in the pathological and bacteriological laboratories, where at present many valuable investigations are delayed and some eliminated on account of a lack of personnel. An additional clerk, a cook, and several laborers are also required to meet the growing needs of the institution. The school of nursing has made marked progress during the last year. The quality of service rendered the patients by the nurses has much improved. There were graduated May 31, 1929, in the Andrew Rankin Memorial Chapel at Howard University, 32 nurses, making a total of 482 graduates holding diplomas from the school. Remodeling and enlarging buildings (available for expendi- Total, unexpended balances__ 26, 288.75 31, 084. 83 549, 873.58 63, 110. 07 11, 057. 04 47, 528. 44 13, 185.90 159, 647.54 219, 099. 51 875.00 514, 639. 06 474.76 471.56 352. 46 1, 170. 81 2,469, 59 32,900. 49 35, 370. 08 |