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 (b). This category comprises patients admitted with a previous record of admission to, and discharge from any institution for mental defective sand epileptics.

3. . All patients who are removed from the custody of the institution are designated as separations. Separations, other than transfers, are the result of discharge or death. The nature of the classification of deaths and discharges is indicated below:

(a). These represent patients who are formally removed form the custody of the institution. Such patients may be discharged directly from the institution or from extramural care. However, since practices with respect to placing patients on or removing them from extramural care vary so widely from institution to institution so as to introduce a serious lack of comparability within each of these classes, tables on the characteristics of discharged patients are presented for directed discharge and discharges from extramural care combined.

(b). . These represent patients who die while in the institution or while in extramural care. No data are reported with respect to the age and diagnostic characteristics of patients who die in a given year.

4. . Those admissions and separations representing patients shifted within the same State from the supervision of one State institution for mental defectives and epileptics to another, without a formal discharge, are designated as transfers. Since transfers do not represent additions to the total patient population of institutions within a given State and presumably have already appeared at some time in statistics on admissions, they are not given detailed consideration in this report.

Tabulation of Patients with both Mental Deficiency and Epilepsy

In tabulating patients with both mental deficiency and epilepsy, institution officials were requested, as in previous years, to classify patients according to the primary cause of admission. The rules for such classification are as follows:

1. If the case history shows that the patient was primarily mentally effective and that epilepsy developed at a later date, the patient should be reported on the schedules for mental defectives.

2. If the case history shows that the patient was primarily epileptic and that mental deterioration developed at a later period, the patient should be reported on the schedules for epileptics.

3. In all cases where epilepsy is definitely present, and where insufficient data are available to determine the patient's previous mental status, even though mental deficiency is now established, the patient should be reported on the schedules for epileptics.

Patients who are reported as "neither mentally defective nor epileptic" are indicated in tables on movement of patient population under the heading "other" and are not included in any other tables.

Characteristics of First Admissions

. Mental defectives admitted to institutions may be characterized both by clinical diagnosis and by mental status.

Classification by clinical diagnosis attempts to specify the etiology of, or the organic nervous diseases accompanying the mental deficiency. The classification used is based on that prepared by the American Association on Mental Deficiency in cooperation with the National Association for Mental Health, Inc., and published by the latter in the "Statistical Manual for the Use of Institutions for Mental Defectives" in 1946.

Mental status is indicative of the degree of intellectual impairment and is characterized as follows:

(a). A mentally defective person usually having a mental age of less than 3 years or, if a child, an intelligence quotient of less than 20.

(b). A mentally defective person usually having a mental age of 3 to 7 years, inclusive, or if a child, an intelligence quotient or from 20 to 49, inclusive.

(c). A mentally defective person usually having a mental age of 8 to 11 years, inclusive or, if a child, an intelligence quotient of 50 or more. As a result, the upper limit for a diagnosis of mental deficiency should be an intelligence quotient of 69. However, this limit is not to be adhered to where medical, social and other factors would clearly indicate that the patient is mentally defective.

. The diagnoses used for epileptic first admissions are based on those adopted by the National Epilepsy League. The major categories are as follows:

(a). Cases in which the epileptic seizures are symptoms of a definite disease process, toxic condition, or structural defect.

(b) : Cases in which the seizures are not associated with a disease process toxic condition, or structural defect.

Characteristics of Discharged Patients

. The classification of mental defectives by condition on discharge is made with reference to their ability to support themselves outside of the institutions. In