every way contributing to the total hospital program and in the many details of patient care. Public School 619, Bronx Public School 619, Bronx, is a unit of the division of child welfare of the board of education. It is located on North Brother Island and serves the patients of Riverside Hospital exclusively. Although it is a unit of the board of education, it is closely affiliated with the hospital. The professional staff of the hospital assists in formulating programs for students in the school, and the school serves as an additional treatment area for patients. In addition to their classroom activities, teachers are assigned to the therapeutic teams, they attend the team meetings, contribute their observations, and obtain recommendations from the therapy staff with regard to the student-patient needs. The teachers are especially selected because of their ability to work with disturbed youngsters. In addition, the teaching staff receives orientation from the various professional staffs in the hospital so as to improve their understanding of the patient and so as to assist them in coping with the problems which the patients create. In addition to the classes in the school building, classes are maintained on the ward for patients undergoing withdrawal and study. The school has served as an educational source for many departments in the board of education. During the past year many groups of school principals, guidance counselors, attendance officers, school court representatives, and other members of the school system have visited the school and the hospital and have gained knowledge and insight with regard to drug addiction and disturbed adolescent youths. Padden, the principal of the school, estimates that in all about a thousand persons visited the school and hospital during the year 1954 and received this type of knowledge and orientation. Psychiatry MEDICAL SERVICES Mr. The psychiatric staff consists of one senior psychiatrist, 2 junior psychiatrists, and 6 session psychiatrists. One junior psychiatrist position is vacant due to the difficulty of obtaining psychiatrists at the present time at the salary offered. The six staff treatment teams mentioned before are each headed by a per session psychiatrist. This psychiatrist meets once a week with the entire staff team, i. e., with the junior psychiatrist, psychiatric resident, medical resident, psychiatric social worker, psychologist, nurse, occupational therapist, recreatitonal therapist, and school teacher. Occasionally the vocational guidance counselor, chaplain and dietician may attend the meetings. At these meetings the progress of individual patients is discussed, changes in treatment program may be initiated, decision for discharge is made. The per session psychiatrist at other times does individual therapy, he supervises therapy given by the psychiatric social worker and psychologist to patients assigned to that team, and in other ways exercises leadership and supervision with regard to that treatment team and the patients assigned to it. The senior psychiatrist conducts diagnostic conferences, participates in the planning for patient activities, and maintains overall supervision of psychiatric therapy and patient welfare. Approximately 460 patients have been seen in 4,000 psychotherapeutic sessions during the past year. Approximately twothirds of the treatment was psychologists or psychiatric social workers. Among the research activities being conducted by the psychiatric staff is an E. E. G. study being done by one of the psychiatrists. Another psychiatrist is investigating the effect of serpasil and its ability to relieve anxiety and tension. He is also conducting a followup study on discharged patients. The general medical care of the patients is maintained by two house physicians and a per session internist. Although the patients are in relatively good health and are ambulatory, they have many complaints requiring a great deal of attention on the part of the staff in order to allay their anxiety and relieve them of their discomforts. All patients receive complete medical study and care. Severely ill patients are transferred to Lincoln Hospital. Severely disturbed patients are transferred to Bellevue Hospital. We have received extremely good cooperation from both of these hospitals. Dentistry Almost all patients have poor teeth and require a great deal of dental care. This is given to them by the 3 per session dentists who attend the hospital 2 sessions each, weekly. Engineering The two hurricanes which hit this area this summer caused considerable damage to the electrical lines and electrical equipment, as well as other damage to the hospital. Temporary repairs are made to electric lines, however, the electric lines are old. One of the electrical lines to the mainland is out of order so that electrical services are from one circuit only and this circuit is in poor condition. The engineering division has managed to maintain the hospital in good working condition. This at times has been difficult since many of the power lines, water lines, steam lines, and the buildings are old and require constant maintenance. Stores Operation of the stores division was made somewhat difficult for over half the year by difficulties in operation of the ferry. The ferry slip at North Brother Island and the ferry slip at East 134th Street, Bronx, required repair so that for over 6 months all supplies brought to the hospital had to be handled by hand at either the New York side or the North Brother Island side or both. Some of the patients were very helpful in assisting in this handling of supplies. However, it did create a difficult situation for the stores division. Dietary The dietary division is faced with the problem of maintaining an interesting and varied menu for patients, some of whom are in the hospital for a prolonged period of time. Many of the patients are Puerto Rican and their interest in food is different from those of the majority of the patients. This has contributed to some lack of satisfaction in some of the patients with the menu served. Despite these difficulties they have managed to maintain a menu which has met the needs and taste of most of the patients. At times actual operation have been made difficult by fog which interfered with the ferry service and made it impossible for some of the personnel to come to work or to leave from work at the scheduled time. SPECIFIC PROGRAMS AND ACTIVITIES Therapeutic leave program The public health law, by which means patients are put under the jurisdiction of the hospital, authorized the hospital to maintain that jurisdiction for a period of 3 years. This observation and treatment may be in the hospital or it may be in the outpatient department of the hospital. It may be discontinued prior to 3 years on the recommendation of the hospital. Experience at the hospital has confirmed previous observations that very few patients are permanently benefited by a single period of hospitalization. Experience at the hospital has indicated that patients require prolonged periods of treatment and that often the patients benefit by a period in the community even though the patient may return to drugs during that period in the community. It has been the observation of the treating staff that when such patients are returned to the hospital they are better motivated and better able to benefit from a treatment program. It is the observation of the treating staff that a prolonged period of association of the patient with the hospital is necessary. However, it does not seem to be necessary for this entire period to be spent in the hospital. Therefore, in order to formalize the relationship of the patient to the hospital as a continuous treatment experience, the therapeutic leave program was inaugrated. This program indicates that the period of treatment in the hospital was only part of the total treatment necessary. When the patient leaves the ward that patient still continues as a patient of the hospital, though treatment is now conducted at the aftercare clinic. Some patients who are suitable for it may receive frequent psychotherapy sessions at the aftercare clinic. Others who would not be suitable for intensive followup will be seen less frequently and some of the contacts might be merely of a general nature to check on the patients' progress and to plan further therapy as the situation develops. If necessary, because of community pressures and the fear on the part of patients that they will return to drugs or if the patient does return to the use of drugs, that patient then may return to the hospital as a continuation of the treatment as an in-patient. At the aftercare clinic, many of the patients who are seen are patients carried on the therapeutic leave census. A number of the patients seen are patients who were discharged before the thrapeutic leave program was initiated and who attended the aftercare clinic on a voluntary or compulsory basis and are not on therapeutic leave census. As the number of patients discharged increases, the number of patients attending the aftercare clinic is increasing. Additional activities have been understaken at the aftercare clinic, such as the dispensing of medication by the physicians attending the clinic. A nurse was assigned to the aftercare clinic for each night in order to check on the patients' physical condition, assist the doctors, and check on medication dispensed. This has strengthened the aftercare clinic in its operation. The social workers, psychologists, and vocational counsel or who attend the aftercare clinic are being paid by a special grant provided by the Rockefeller's Bros. Foundation. The Rockefeller's Bros. Foundation made this grant as a temporary demonstration project. They now feel that the project is a success, that the type of services offered have been shown to be necessary and useful, and they are planning to withdraw their grant and not renew it in the next fiscal year. A request was included in the hospital budget for 1955-56 for funds to cover the clinic services for social workers, psychologists, and vocational guidance personnel on a per session basis. This is extremely essential since we know that the patients must have the support of the treating personnel after they leave the hospital. It would not be possible to staff the aftercare clinic unless these per session positions are made available. It is hoped that the budget requests will be granted in the budget of 1955-56. Patient council It has been observed that the attitude of the majority of patients is often influenced by the attitude of certain leaders among the patients. In order to have this leadership among the patients exerted in a positive useful fashion, a patient council was organized. This patient council meets with the administrative heads of the hospital once a week, discusses patient and hospital policies and problems, and exerts its influence on the general population so as to reinforce the therapeutic staff. The patient council consists of 2 representatives from each of the 6 groups of patients corresponding to the 6 treating staff teams. Orlentation program During the first 30 days a patient is in the hospital, that patient is undergoing withdrawal from drugs and study by the therapeutic staff. Psychological studies, social work history, psychiatric workup, physical examinations, X-rays, and other necessary study procedures are being performed. The patient is participating in occupational therapy and school activities on the wards, as well as recreation on the wards and on the grounds. In order to properly acquaint the patient with the hospital, its program, the opportunities which it offers and the interest of the staff in the patient welfare, an orientation program has been instituted. During this period orientation talks are given to the patients on the withdrawal ward by the medical superintendent, senior psychiatrist, director of nursing, directors of occupational therapy, recreation, social service and psychology, the principal of the school, the chaplain and members of the patient council. This series of orientation talks has resulted in many a patient who initially was reluctant to stay in the hospital for a full therapeutic period, acquiring an interest in therapy and express a willingness to undergo a period of rehabilitation in the hospital. It has also resulted in better patient behavior and improvement in the attitude of the patient toward the hospital program. Movie program Most of the patients have poor information with regard to general health and hygiene, work situations, mental health, sex hygiene, and other matters of general interest. Many of these matters are covered in the school program and in therapy. However, in order to survey the whole field with the patients and to be sure that all patients obtain some information in these areas, a movie program has been begun. These movies are to be shown every second Saturday morning, i. e., those Saturday mornings when we have no visiting hours. Movie subjects to be included would be general health and hygiene, mental health, Vocational training films, sex hygiene films, and other films of a similar nature. The patient population is then separated into discussion groups. Parents-Friends-Staff Association The families of most of the patients are disorganized. They are in need of advice, support, reassurance, and any assistance which can be given them in meeting their problems. A great deal of the difficulty of discharged patients is due to the lack of understanding on the part of the family to receive them properly after they are discharged from the hospital. In order to provide the necessary understanding and guidance and to improve the cooperative effort of parents and staff, a Parents-Friends-Staff Association was organized. This organization meets once a month. The meetings have been fairly well attended. At the meetings we have had as speakers: Inspector Terranova, Judge Murtagh, one of our staff psychiatrists, Dr. Wayne Barker, as well as mental health movies, discussions of the hospital program and discussion of drug problems. The effect of this has been very beneficial for those parents who attend. Every effort is being made to interest all the parents of patients in the hospital and parents of persons who have been in the hospital, as well as other persons in the community who would be benefited by attending such meetings. Supporting agencies The lay advisory board for Riverside Hospital has been extremely helpful in providing advice, guidance, and support to the staff with regard to many matters. Most of the members of the lay advisory board are active in other aspects of drug addiction and juvenile delinquency, as well as general community problems. They have, therefore, as individuals been able to advise the administrative and other members of the staff with regard to problems which have arisen. As a group they have been extremely helpful in assisting the hospital in its general planning and programing and maintaining proper communication with the community. The committee on drug addiction among preadults of the welfare and health council has been active with the hospital and has been helpful in the same manner as has been the lay advisory board for Riverside Hospital. Volunteers Riverside has been fortunate in having had the cooperation of the Junior League of the City of New York, many of whose members have served as volunteers for Riverside Hospital in the hospital, at the intake clinic, and in the aftercare clinic. They have also served to inform the community of the hospital's needs. Other volunteers have been active with the recreation department. It would be important to have a director of volunteers. There are many individuals and agencies who would be anxious to participate in the work which is being done at the hospital if they had a person at the hospital to whom they could relate. Unfortunately each of the members of the staff at the hospital has a full-time job and is unable to properly assume the position of a director of volunteers which is in itself a full-time job. Community education The staffs of the hospital and of Public School 619 have been active in community education. The major activity of the year was a conference at the hospital conducted on May 20, 1954. Other visitors during the year included groups of educators, legislative committees from Massachusetts, Michigan, and Ohio; visitors from such faraway places as Norway, Japan, India, and Palestine: and numerous other individuals and groups who came to the hospital and the school in order to learn more about drug addiction and the problems of adolescent youths. In addition, the staffs of the hospital and the school lectured to numerous groups at a number of conferences. The director of social service lectured at over 15 different meetings. The superintendent of the hospital at seven. The principal of Public School 619 at a large number of meetings. Mr. Padden, the principal of Public School 619 is conducting a series of lectures and conferences for teachers. The various division heads are participating in this series of lectures and conferences. Staff education Staff education is continuous with regular weekly conferences within professional staff and monthly conferences of the entire professional staff. EXHIBIT No. 30 PROBATION FOR A CURE An analysis of 85 drug addict cases committed to the United States Public Health Hospital for treatment as part of probation September 1955 Morris Kuznesof, United States probation officer, southern district of New York Current thinking on the problem of drug addiction holds that the addict is a physically and psychologically sick person. For at least 25 years, medical authorities have urged the courts dealing with addict offenders to provide treatment instead of punishment only. In the original law which established the two United States narcotic farms at Lexington, Ky., and Fort Worth, Tex., provision was made for addicts to receive treatment through (1) voluntary admission, (2) admission by commitment for cure as a condition of probation and (3) while serving a prison term. The purpose of this paper is to set forth the experience of one Federal court with cases of addict defendants granted probation with commitment for a cure of addiction as a special condition. The data considered is from the probation office files of the United States District Court for the Southern District of New York. The findings shed light on the effectiveness of "probation for a cure" as a treatment method. Over the years since Lexington and Fort Worth were established, the medical officers in charge have made earnest pleas for more probationer patients. Several years ago, Dr. John D. Reichard said, "Persons who are primarily criminals and only incidentally addicts, and those who have shown no interest in their own care or rehabilitation, should be sent to a different type of institution. The energies of the hospital staff should be utilized on the socially operable and not wasted on those who cannot be rehabilitated-the ideal method of treating and handling addicts not of the confirmed criminal type is to place them on probation for a period of 3 to 5 years (26). It is noted that Dr. Reichard asked for patients who were socially operable, that is, patients who were not confirmed criminals. Some years later, Dr. Victor Vogel (34) who succeeded Dr. Reichard, made a similar statement. Dr. Reichard, and those who succeeded him felt that the treatment would be successful only when the patient realized the seriousness of his condition, wanted help, was willing to accept treatment and was not handicapped by the criminal habits of thought and behavior or intimate association with other criminals or addicts. SCOPE OF THIS STUDY The records of addicts sentenced in this court reveal that cases have been disposed of in the following ways: 1. Probation, on condition of voluntary commitment to a narcotic farm. 2. Probation, without the condition of such voluntary commitment. 3. A prison term, to be followed by probation. 4. A prison term, with no probation. Since the purpose of this study was to determine, if possible, whether "probation for cure" was effective, several hundred cases were reviewed for the criteria of: (1) Receipt of probation, (2) receipt of treatment at the USPHS narcotic farms with discharge as cured within the meaning of the law, and (3) receipt of probation supervision following discharge. The calendar years 1949 through 1953 were covered. In this time there were 85 cases which met these conditions. The 85 cases involved 83 different individuals to whom probation was granted (two of them twice) on the condition of voluntary surrender for treatment. Three were granted in 1949, 15 in 1950, 23 in 1951, 26 in 1952, and 18 in 1953. Hospitalization for this type of case is usually 135 days, which was the length of time each patient stayed at the hospital before being pronounced cured. Data on cases prior to 1949 were not readily usable due to the infrequency with which "probation for a cure" was imposed by the court. During succeeding years the judges have used this type of sentence more frequently, hoping thereby to encourage the rehabilitation of narcotic addicts. This was in line with the theory that, "Narcotic addicts are sick people, objects of pity who |