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The sanitary condition of the institution was examined on February 15, 1917. As a result of this investigation certain insanitary conditions were found to exist and the report on the inspection contained the following conclusions and recommendations:

Conclusions and recommendations

1. That in view of the insanitary condition of the building, causing insanitary conditions in certain respects:

(a) The floors, walls and ceilings he repaired where necessary.

(b) That painting be done in the wards and water sections where necessary. 2. That in regard to plumbing:

(a) The obsolete plumbing fixtures in use at the institution such as the long hopper wash down closets, be removed and modern sanitary fixtures be provided instead.

(b) That more fixtures be provided in the various wards of the institution in accordance with the requirements indicated above in

this report. 3. That since the heating and ventilating facilities are apparently unsatisfactory in some cases these be remodeled or he replaced where necessary, and that better facilities for storing and handling the coal be provided at the institution.

4. That, if the present or a greater number of patients is to be cared for at the institution, more room be provided by erecting new buildings or additions to the present ones to relieve the overcrowded condition.

5. That the water softener he put in efficient service as soon as possible.

(Central Islip) Central Islip State Hospital The Central Islip State Hospital is located at Central Islip, Suffolk county, N. Y., about 40 miles from New York city. The area of the grounds is about 1,000 acres. There are forty-one occupied buildings arranged in two groups, known as the North and South Colonies.

The hospital admits as patients insane persons, except criminal insane, from the boroughs of Manhattan, Queens and Bronx and from the counties of Nassau and Suffolk. At the time of the inspection the total population of the institution was 5,916, made up as follows: patients 5,081; staff, 38; other employees, 797. The certified capacity of the institution is 4,017 persons.

An examination of the sanitary condition of the institution was made on December 29 and 30, 1916. As a result of this examination certain insanitary conditions were found to exist and the report on the inspection contained the following conclusions and recommendations:

Conclusions and recommendations 1. That the quarantine quarters be put in a sanitary condition and be properly equipped with heating, plumbing and other facilities, or that new quarters properly constructed and equipped be provided.

2. That, in view of the possibility of the pollution of the present general well water supplies becoming actively dangerous, the deep well water supplies he developed as rapidly as possible.

3. That the pump he removed from the shallow well near the main entrance.

4. That the use of drinking cups in common hy patients. attendants and vistors be discontinued and drinking fountains be installed in their place.

5. That the use of towels in common hy patients, attendants and visitors be discontinued and individual towels be used in their place.

6. That, in view of the insufficient number of plumbing fixtures in some parts of the institution as pointed out in the body of the report, better

plumbing facilities be provided where needed. In this connection I would also recommend that adequate toilet facilities for visitors be provided.

7. That, in view of the overcrowded condition of many of the wards, more room be provided either by constructing additions to the present buildings or by erecting new ones.

8. That steps be taken to improve the method of sewage disposal either by carrying out the recommendations made by this Department in the reports of 1910 and 1914 or by the design and construction of other disposal works, plans for which should be approved by this Department as required by Section 14 of the Public Health Law. In this connection I would also recommend that, in order to promote efficient operation of the disposal works, the sludge which is removed from the settling tank be disposed of on a properly constructed sludge bed; the sewage irrigation area be ridged in winter and an electrically driven pump be installed at the South Colony sewage disposal pumping plant.

9. That the insanitary privies located about the grounds be abolished. Where it is unavoidable that privies be used, I would recommend that they be constructed with tight removable receptacles for the excreta, be provided with seat covers and doors and be screened from flies and bo maintained in a sanitary condition,

10. That the floor in the main kitchen and scullery of the North Colony he repaired.

11. That the paint be renewed and new plastering be done where this is necessary

12. That the insanitary conditions at the bone mill be improved as rapidly as possible.

13. That the garbage both at the storage hin near the piggery and where dumped in the trench near the bone mill be kept covered.

(Gowanda) Gowanda State Homeopathic Hospital The Gowanda State Homeopathic Hospital is located in the town of Collins, Erie county, N. Y., on the Salamanca Division of the Erie railroad, about 2 miles north of the village of Gowanda. The area of the grounds owned for use in connection with the institution is 500 acres. The buildings consist of the main group comprising the administration building and the wards, the farm group consisting of the farm house, barns and necessary accessory buildings, and numerous isolated buildings located near the main group including the superintendent's residence, nurses' house, amusement hall, etc.

The hospital receives as patients insane persons, except criminal insane, from the counties of Cattaraugus, Chautauqua, Erie and Wyoming and patients from any part of the State for whom homeopathic treatment is desired. At the time of the inspection the total population of the hospital was 1,455, made up of 1.236 patients and 209 attendants. The certified capacity of the hospital is 998 patients.

An examination of the sanitary condition of the hospital was made on February 14 and 15, 1917. As a result of this investigation certain insanitary conditions were found to exist and the report covering in detail the results of the inspection contained the following conclusions and recommendations:

Conclusions and recommendations
That with respect to the water supply:

(a) In view of the limited yield and questionable quality of the present supply the development of an adequate supply of water of unquestioned sanitary quality be completed as soon as possible.

(b) That the water from the Reservation springs which are open to surface wash and the run-off from ravines be wasted and that until this is done the water be piped from the points at which it issues from the ground to the air lift chamber and the springs and air lift chambers be made and be maintained inaccessible for dipping out water.

(c) That the Reservation springs and air lift be enclosed by a fence.

(d) That the gravel pit he surrounded by a fence.

(e) That the concrete reservoir near the laundry and power house be covered.

(f) That the force main from the springs be so extended as to discharge near the corner of the reservoir diagonally opposite the suiction main.

(g) That the water used to operate the elevators at the institution be wasted. 2. With reference to sewerage:

(a) That plans for the separation and treatment of the sewage be prepared and submitted to this Department for approval as required by Section 14 of the Public Health Law.

(b) That the privies be abolished whenever possible. Where it is necessary to use privies I would recommend that they be so located as not to pollute a water supply, be properly constructed so as to be

inaccessible to flies and be maintained in a sanitary condition. 3. That additional plumbing fixtures be installed where needed, in accordance with the standard indicated in the body of this report.

4. That in view of the overcrowded conditions at the institution new buildings or additions to the existing buildings be provided in order that no dormitory may have less than 600 cubic feet of air spare per bed and not less than 50 square feet of floor space per bed in addition to at least 40 square feet of day room space per patient.

5. That the hospitals and dining rooms be effectively screened against flies.

6. That the manure pits he screened or covered.
7. That the milk cans be sterilized daily.

(Kings Park) Kings Park State Hospital The Kings Park State Hospital is located at Kings Park, Long Island, on the Wading river Branch of the L. I. R. R., about 45 miles from the Pennsylvania Railroad station in New York city. The main buildings of the hospital are about 1 mile from the north shore of Long Island. The area of the grounds owned for use in connection with the hospital is about 834 acres. There are 62 occupied buildings, 35 of which are used as wards for patients and the others for employees quarters, dining rooms, workshops and other purposes. The hospital receives as patients insane persons, except criminal insane, from the Borough of Queens and the counties of Vassan and Suffolk. At the time of the inspection the total population of the hospital was 5,166, made up of 4,312 patients and 774 employees. The certified capacity of the hospital is 3,397 patients.

An examination of the sanitary condition of the hospital was made on March 20, 21, and 22, 1917. As a result of this investigation certain insanitary conditions were found to exist and the report covering in detail the results of the inspection contained the following conclusions and recommendations:

Conclusions and recommendations 1. That, in view of the unsatisfactory condition of some of the buildings, especially the older buildings, as pointed out in this report, the necessary repairs be made to put them in a satisfactory condition or new buildings of a modern type be built.

2. That, in respect to the water supply, added storage of sufficient capacity to furnish water at a sufficient pressure for fire purposes be provided at once. 3. That, in regard to sewerage and sewage disposal:

(a) The discharge of sewage from the superintendent's residence and from the residence of the ground's supervisor, directly into Long Island Sound, be discontinued and the sewage from these buildings be discharged through the sewage disposal plant, or be disposed of in properly constructed subsurface irrigation systems.

(b) The sink water from the cottages be discharged into the sanitary sewers.

(c) Proper disposal be made of the drainage from the piggery and from the barn.

(d) The size of the sewage disposal plant be increased as soon as possible to such an extent that it will be adequate to care for the present and immediate future needs of the hospital.

(e) The sludge removed from the sludge drying bed be placed in a suitable dump and that such dump be located above high water mark on account of the danger of polluting the river. If it is desired to use the sludge for agricultural purposes, it should be placed on land where no crops for human consumption would be grown for two or three years.

(f) The final settling tank be cleaned out and placed in use and operated efficiently and if necessary, another sludge bed be constructed below the final settling tank for the drying of sludge from this tank.

(g) The final effluent from the disposal plant be sterilized with liquid chlorine, or other suitable disinfectant, in order to prevent contamination of the waters of Smithtown Bay and its tributaries.

(h) The gas vents of the Imhoff tanks be kept clear of scum.

(i) The use of privies be discontinued wherever possible, and where it is necessary to use a privy, it be located where no water supply will be polluted, be properly screened against flies, and he maintained

in a sanitary condition. 4. That, in view of the inadequacy or unsatisfactory condition of some of the plumbing fixtures :

(a) More fixtures, such as water closets, lavatory bowls and baths, be provided in all places where needed in accordance with the standard given in this report.

(b) All fixtures in an unsatisfactory condition or not operating satisfactorily be repaired or be replaced by others of a suitable type. 5. That, in view of the overcrowded condition of the hospital, more room be provided either by additions to the present huildings or by erecting new ones. This can be accomplished to some extent by removing the partitions between some of the single rooms in certain of the wards and converting them into larger dormitories, thus making the excess space in the single rooms available.

6. That, in regard to the milk supply, a steam sterilizer be provided at the dairy for sterilizing the milk cans, pails, and other utensils as soon as possible.

(New York City) Manhattan State Hospital The Manhattan State Hospital is situated on Ward's Island, in the city of New York, and may be reached by ferry from the foot of East 110th street. There are 47 occupied buildings, 20 of which are used as wards for patients and 10 as quarters for officers and attendants. The remainder include the assembly hall, 2 churches, 3 work shops, 3 power houses, and various accessory buildings. The area of the grounds is 245 acres.

The hospital receives as patients insane persons, except criminal insane, from the boroughs of Manhattan, Richmond and Bronx, in the city of New York. The certified capacity of the hospital is 3,699 patients. At the time of the inspection there were 5,236 patients and 530 attendants at the hospital, making a total of 5,766.

An examination of the sanitary condition of the hospital was made on March 22, 23 and 24, 1917. As a result of this investigation certain insanitary conditions were found to exist and the report covering in detail the results of the inspection contained the following conclusions and recommendations:

Conclusions and recommendations 1. Owing to the unsatisfactory arrangement and condition of some of the buildings I would recommend :

(a) That all buildings be repainted and repaired where they are not in good condition.

(b) That proper drains be provided and other necessary provisions be made to eliminate the dampness from the buildings known as Old Branch and New Branch,

(c) That better provisions be made to admit light and air to these buildings, or that other day rooms be provided. 2. That in view of the inadequacy of the plumbing fixtures in most of the wards of the institution and to their unsatisfactory type in most

cases

(a) Additional fixtures be provided in all cases where needed in accordance with the standard given in the body of this report.

(b) The old and obsolete fixtures be replaced by modern sanitary

ones.

3. That with reference to sewerage

(a) Screens be provided to prevent rags and similar material that is thrown down the flush closets by the patients from reaching the sewers.

(b) The sewer outlets be extended so that they discharge under water at all times.

(c) The insanitary toilet near the bake shop be discontinued and modern sanitary plumbing fixtures be provided for this building.

(d) The use of privies be abandoned wherever possible and modern flush closets be installed in their places. Where it is necessary to use a privy, I would recommend that it be located where a water supply will not be endangered, be made inaccessible to flies and be

maintained in a sanitary condition. 4. That in view of the very overcrowded condition of the institution, giving insufficient air and floor space in nearly all the wards, additional wards or buildings be provided or the present excess of inmates over the certified capacity be transferred to some other institution.

5. That more satisfactory quarters be provided for employees.

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(Ogdensburg) St. Lawrence State Hospital The St. Lawrence State Hospital is located in the city of Ogdensburg, about 3 miles northeast of the center of the city, on a point of land which extends into the St. Lawrence river. The area of the land owned for use in connection with the hospital is 1292.25 acres. There are 55 occupied buildings. About 25 of these are used as wards for patients, the remainder being used as employees quarters and for industrial and other purposes.

The hospital receives as patients insane persons, except criminal insane, from the counties of Clinton, Essex, Franklin, Jefferson, Lewis, Onondaga,

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