Julius Katz

Cancer mortality among patients in New York mental hospitals

Data were obtained on 3365 patients in hospitals of the New York State Department of Mental Hygiene who died between 1955 and 1961 with malignant neoplasm as the primary cause of death. Comparisons were made with corresponding mortality rates for cancer in New York State for the same period. The total cancer mortality of mental patients from cancer was much higher than in similar age and sex groups of the general population of the state; however, most of the excess mortality among the patients was due to the high rates among those with short periods of hospitalization. Patients with 10 or more years of hospital stay had lower cancer rates than the general population, particularly among those 65 years of age or older. The lower mortality may be due to nonspecific environmental factors associated with long periods of hospitalization.

Prevalence of pulmonary tuberculosis in New York State institutions for the mentally ill.

Summary1.Chest X-ray surveys of all the public mental institutions in New York State have been completed.2.Clinically significant pulmonary tuberculosis was diagnosed in 5.6 per cent of the patients in the State hospitals and in 2.4 per cent of the patients in the State schools and Craig Colony.3.The prevalence rates increase with the length of time between first admission and the X-ray survey. They also increase with age, in the hospitals up to age 45, and in the schools at all ages.4.Among patients with time periods up to five years between first admission and X-ray, the prevalence of tuberculosis among dementia præcox patients is in general, lower than, or approximately equal to, the prevalence among patients with other types of mental disease.5.Clinically significant pulmonary tuberculosis was diagnosed among 1.1 per cent of the employees of the State hospitals and 0.7 per cent of the employees of the State schools and Craig Colony.6.Facilities for the segregation of patients with clinically significant pulmonary tuberculosis are inadequate at present, but plans are being made for the provision of well-equipped centers for the segregation and treatment of these patients.

Tuberculosis in a School for Mental Defectives

THIS paper is a report of the results of a tuberculosis control program in the Newark State School for mental defectives, during the twelve years from 1936 to 1948. This school, located at Newark, N. Y., is one of the 27 institutions of the New York State Department of Mental Hygiene. It has a population of about 2,700 patients, all mentally defective, about 40 per cent classified as morons, 45 per cent as imbeciles, and 15 per cent as idiots. Most of the patients remain in the school for prolonged periods of time and have limited contact with the outside, though some have occasional short vacations at home. Because the patients live in such close contact with each other, it is assumed that one open case of tuberculosis can spread the infection to most of the inmates living in the same ward. Whatever contact exists among patients in different wards is comparatively casual and is due to work in the kitchen, laundry, or elsewhere. It is obvious that cooperation of many of the patients in observance of even the simplest sanitary measures is at best limited.

The Control of Tuberculosis among Patients in Mental Institutions-a 10. Year Report.

Summary1.The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported.2.This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis.3.There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state.1. The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported. 2. This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis. 3. There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state. The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported. This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis. There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state.

Incidence of pulmonary tuberculosis among employees in 14 institutions for the mentally ill

1. The danger of development of occupationally-acquired tuberculosis by employees on the general wards of mental institutions is apparently no greater than that by those similarly employed in other hospitals, or in occupations with no known tuberculosis hazard. 2. The tuberculosis incidence rate among employees on the tuberculosis wards is higher than among employes on the other wards of these institutions. 3. The frequency of development of clinically-significant tuberculosis by employees on the tuberculosis wards in mental institutions is probably about the same as that among employes of hospitals for mentally-well tuberculous patients. 4. The results of this study indicate that the phases of the tuberculosis control program in mental institutions which need emphasis are as follows: a. To decrease the relative number of employees exposed to tuberculous patients, the concentration of these patients in a few tuberculosis centers, should be accelerated. b. Employees on tuberculosis wards should be kept under close medical observation with frequent, periodic chest x-ray examinations. c. Training in infectious disease techniques should be given to all nurses, attendants, and other employees working on tuberculosis wards. The danger of development of occupationally-acquired tuberculosis by employees on the general wards of mental institutions is apparently no greater than that by those similarly employed in other hospitals, or in occupations with no known tuberculosis hazard. The tuberculosis incidence rate among employees on the tuberculosis wards is higher than among employes on the other wards of these institutions. The frequency of development of clinically-significant tuberculosis by employees on the tuberculosis wards in mental institutions is probably about the same as that among employes of hospitals for mentally-well tuberculous patients. The results of this study indicate that the phases of the tuberculosis control program in mental institutions which need emphasis are as follows: a. To decrease the relative number of employees exposed to tuberculous patients, the concentration of these patients in a few tuberculosis centers, should be accelerated. b. Employees on tuberculosis wards should be kept under close medical observation with frequent, periodic chest x-ray examinations. c. Training in infectious disease techniques should be given to all nurses, attendants, and other employees working on tuberculosis wards.Conclusions1.The danger of development of occupationally-acquired tuberculosis by employees on the general wards of mental institutions is apparently no greater than that by those similarly employed in other hospitals, or in occupations with no known tuberculosis hazard.2.The tuberculosis incidence rate among employees on the tuberculosis wards is higher than among employes on the other wards of these institutions.3.The frequency of development of clinically-significant tuberculosis by employees on the tuberculosis wards in mental institutions is probably about the same as that among employes of hospitals for mentally-well tuberculous patients.4.The results of this study indicate that the phases of the tuberculosis control program in mental institutions which need emphasis are as follows: a. To decrease the relative number of employees exposed to tuberculous patients, the concentration of these patients in a few tuberculosis centers, should be accelerated. b. Employees on tuberculosis wards should be kept under close medical observation with frequent, periodic chest x-ray examinations. c. Training in infectious disease techniques should be given to all nurses, attendants, and other employees working on tuberculosis wards.

The use of BCG in mental institutions

SummaryThe use of BCG vaccine in mental institutions may, therefore, be summarized as follows:1.Its use for present patients in mental hospitals is limited by the small proportion of non-reactors to tuberculin.2.In schools for mental defectives, it may be used in a considerable proportion of the present patient population.3.The proportion of new patients and new employees eligible for vaccination is not known. Further information is being gathered.4.Non-reactors to tuberculin should not be employed among patients known to have tuberculosis until they have been successfully vaccinated with BCG.The use of BCG vaccine in mental institutions may, therefore, be summarized as follows: 1. Its use for present patients in mental hospitals is limited by the small proportion of non-reactors to tuberculin. 2. In schools for mental defectives, it may be used in a considerable proportion of the present patient population. 3. The proportion of new patients and new employees eligible for vaccination is not known. Further information is being gathered. 4. Non-reactors to tuberculin should not be employed among patients known to have tuberculosis until they have been successfully vaccinated with BCG. Its use for present patients in mental hospitals is limited by the small proportion of non-reactors to tuberculin. In schools for mental defectives, it may be used in a considerable proportion of the present patient population. The proportion of new patients and new employees eligible for vaccination is not known. Further information is being gathered. Non-reactors to tuberculin should not be employed among patients known to have tuberculosis until they have been successfully vaccinated with BCG.