Southwestern Insane Asylum.

J. GORDON SPRINGER, M. D., SUPERINTENDENT.

This Institution is located at San Antonio, Bexar County, the hospitals and grounds being on the crest of a most attractive elevation overlooking the beautiful San Antonio River and the city from the south. A more ideal location for an institution of this kind could hardly be found.

Number of patients treated during the year ending August 31,

1920

Average daily population.

.2468 .1946

Southwestern Insane Asylum.

REPORT OF SUPERINTENDENT.

Hon. S. B. Cowell, Chairman, The State Board of Control, Austin, Texas.

DEAR SIR: I respectfully submit for your consideration, the Twentyninth Annual Report of the operations of the Southwestern Insane Asylum for the fiscal year ending August 31, 1920. In addition, there is submitted clinical reports and statistical tables relating to patients for the past year. The present Superintendent assumed charge of the Institution on December 1, 1919, succeeding Dr. Beverly Young, who resigned on that date.

On September 1, 1919, 2031 patients, 973 males and 1058 females, were in custody of the Institution. There were admitted during the year 339 patients, 267 first admissions and 63 readmissions. The total number treated during the year was 2468, which was a daily average of 1946. The per cent of recoveries calculated on the number of admissions was 20.35. The per cent of deaths calculated on number treated was 6.239.

In compiling the Twenty-eighth Annual Report, the patients who had ben on escape for a period of twelve months or more were discharged, leaving only 18 patients on escape September 1, 1919. We are still carrying these old escapes of last year, that the State may not be put to the expense of retrying the case should it become necessary to return the patient. These hold-overs from last year, together with 22 this year, give us 40 on escape; however, many of these escape patients were trusties with outside privileges, and many of them capable of making their own living. There were on furlough September 1, 1919, 85 patients. On August 31, this year, we had on furlough 197 patients. All patients who are harmless, who are incurable and whom their relatives wish to take home on furlough, are permitted to go. This astisfies their friends and relatives and saves the State the expense of their maintenance.

INCREASED COST OF MAINTENANCE.

The high cost of all commodities has been a serious handicap in the administration of all institutions. The management of a hospital of this kind must be viewed from an economic as well as a humanitarian standpoint. It is not the proper treatment, from a therapeutic viewpoint, to give every insane patient all he can eat. It is really detrimental in many instances. Neither is it economy to fatten hogs on food that was intended for human beings. We have adopted a course of rigid economy throughout the entire Institution along this line during the last six months.

MEDICAL ADMINISTRATION.

Regular meetings of the staff have been held three times a week for the examination and diagnosis of new cases and for the discussions of general hospital matters.

As a routine, all patients are vaccinated on admission. A Wasserman test has been made on patients whose history and symptoms justify it, and when serum is positive, the spinal fluid is examined. In all cases of syphilis, unless contra-indicated, treatment is given.

The X-ray has been of assistance in confirming the diagnosis in cases of fracture and in suspected cases of tuberculosis. The pathological laboratory is in charge of Dr. McLean, who came to us from Kelley Field where he was engaged as pathologist for the hospital at that place.

Drs. Burkes, Guttery, Gough and Davis, in addition to their regular duties, give weekly lectures to the nurses in training.

HYDROTHERAPY.

We are somewhat inadequately provided for with hydrotherapeutic equipment in connection with our reception service. However, this form of treatment has been utilized as far as possible when indicated, especially with patients who are troubled with insomnia or marked psychomotor activity.

OCCUPATIONAL THERAPY.

All up-to-date institutions are giving much more attention to this form of treatment of the mentally sick than formerly. Every patient who is physically able to work is interested in some form of light occupation. Some with the object of improvement so as to become better members of the Hospital population, others with the object of returning them to community life. "Every man's task is his life preserver."

AMUSEMENTS AND DIVERSIONS.

The Friday night dances have been held regularly, with the exception of a few weeks during the intensely hot weather. The moving pictures are a source of much amusement to a great number of patients, many of whom do not attend the dances, but who become intensely interested in the pictures; forgetting themselves and their unhappy state, at least for a time, and leading their minds out along lines more nearly normal.

TRAINING SCHOOL FOR NURSES.

Good nursing is more essential in the care and treatment of the insane than drugs. We are making every effort to supply an adequate number of pupils to meet our necessities.

SHORTAGE OF HELP.

The lack of help has been a serious handicap in the management of the Institution. We have at all times been short of help, and at times this has been almost alarming. At times it has been impossible to obtain a sufficient number even to assure the safety of the patients, much less the exercise, entertainment and employment so necessary to their welfare.

There are so many industries that offer better advantages and compensation, that the hospitals necessarily suffer. If these conditions