vouchers are audited and paid through the Commission's office, with a final audit by the State Comptroller, it will be seen that the old arrangement afforded ample protection to the State. The long delays before a contract can be awarded, the necessity of furnishing surety company bonds regardless of the standing or responsibility of the firm bidding, and the difficulty in preparing contracts and bonds in a form acceptable to the State officials, all render it increasingly difficult to obtain bids from responsible and reputable firms on account of the unnecessary delays, annoyances and expense of the new system. While the purpose of this act, to give the Comptroller an efficient check on all expenditures made on behalf of the State, is highly commendable, such check was already in effect so far as this department was concerned and the new system only causes delay, annoyance and extra correspondence, with no actual additional safeguard. The law should be amended to do away with these practical difficulties in its administration, which were not foreseen at the time it was enacted.

The hospitals should be allowed to exchange or sell products. raised on their own farms and the moneys received for the sale of such products should be turned into the maintenance account of the institution. Neither these funds nor those accruing from steward's sales and miscellaneous receipts should be paid into the State treasury, as is now done in accordance with the requirements of the State Finance Law. The supply bill contains every year an item of approximately $600,000 in amount, reappropriating for the use of the hospitals the funds collected for the care of reimbursing patients. This gives rise to apparently a very large increase in the appropriations made for the purpose of maintaining the hospitals, and which is entirely unnecessary. This money should be expended under the direction of the institution and retained in the hands of the State hospital treasurer without being paid into the State treasury, with a subsequent reappropriation by the Legislature.

CARE OF THE INSANE PENDING COMMITMENT

An inquiry into the provisions made by the several counties of the State for the care of the insane pending commitment conducted during the year by Dr. Walter G. Ryon, medical inspector,

and Dr. John I. McKelway, medical deputy in the Bureau of Deportation, shows that twenty-nine counties have made no provision whatever for the temporary care of the insane and that many of the places provided by the other counties are inadequate and otherwise unsuitable.

The facilities found for the detention of the insane in thirty-two counties are described by Dr. Ryon as follows:

Albany County. Such insane pending commitment as are not cared for at home are sent to Pavilion F, a psychopathic ward in connection with the Albany General Hospital.

The pavilion consists of a two-story brick building, the lower floor being occupied by women and the upper by men. The wards are made up of day rooms, dormitories and single rooms, and in connection with each is a section where disturbed and noisy cases are cared for. The nursing force consists of nine nurses, of whom three are graduate nurses. In addition to these there is a night supervising nurse and two special nurses, the number of special nurses varying from time to time, according to the requirements of the patients. Patients are admitted to the pavilion voluntarily, in addition to those sent there by the Commissioner of Charities for examination or pending commitment. The present capacity of the pavilion is 31. The wards are comfortably furnished, the fire protection good, and the standard of care is far above the average.

Broome County. In the city of Binghamton rooms have been provided in the Municipal Building. These rooms are situated on the second floor in the rear of the probation officer's office. The only entrance to the hallway on which these rooms are situated is by a dark and circuitous wooden stairway. The quarters consist of two rooms on either side of the hallway, at the end of which is a room containing a bath, toilet and lavatory for the use of all. The rooms are so situated on the hall that they face each other across a hallway of about ten feet. In the door of each room is an iron-barred opening and the doors of the rooms on either side so face each other that patients would be able to see across the hall into the opposite rooms. In addition to this the partition between each of the rooms contains an opening about three feet square, which is also guarded with iron bars, so that the patients in the adjoining room can easily see into the one next. There are no curtains or other screens of any sort to prevent this. The rooms are heated by steam and lighted by electricity. The windows are guarded outside. There are no fire escapes whatever from the rooms and no evidence of fire pro

tection of any sort, there being no standpipes or fire extinguishers about. In fact the only exit from these rooms in case of fire is through this dark stairway into the probation office and thence down the front stairway to the street, so that in case a fire should take place in the front of the building, the rooms would be completely cut off. Meals are brought to the patients from a restaurant outside. I was accompanied by one of the police officers when visiting the rooms and he informed me that they were never used for patients. He says that the patients are generally kept in the general office room of the police department pending commitment. On account of the close proximity of the Binghamton State Hospital, it is rarely, if ever, that they are kept very long in the building. He did admit, however, that during the past year one man patient had been detained in a cell in spite of the fact that the above rooms were provided. The rooms are poorly located for the purpose for which they were designed. Each room is furnished with necessary beds and furniture.

Cayuga County. The Department of Charities of the City of Auburn has provided a detention ward in the city hall which is located on the second floor above the portion occupied by the police department. The room is in charge of the health officer, who notifies the police authorities when it will have to be used. It is then cleaned and put into condition by the janitor of the building. There are accommodations for but one patient. The room is of sufficient size, has barred windows on two sides and has both bath and toilet. It is heated by a hot air radiator, but this being insufficient, there has been provided a gas stove attached to a pipe extending for several inches into the room, the stove being in the room occupied by the patient. The accommodations provided for the attendant are outside of the room and separated therefrom by a screen door. This arrangement is undesirable, as a violent or suicidal patient may readily injure himself or others. Whatever attention is devoted to the patient is given by an attendant hired for the purpose as an emergency assistant. The meals are brought in from a restaurant outside, thirty cents a meal being the allowance. As yet it has never occurred that a male and a female patient were awaiting commitment at the same time, but should this happen it is probable that one of the cells would have to be used for the detention of the male patient.

Chautauqua County. In this county a padded cell has been provided in the city lockup at Jamestown, and a padded room provided in the O. E. Jones Hospital at that place, while other cases are cared for at the Chautauqua almshouse.

Cortland County. Patients have been cared for at their homes and at the general hospital in the city of Cortland. The board

of supervisors contemplate remodeling and furnishing three rooms and bath room, with room for a nurse, in the building formerly occupied by the insane, which is located on the county farm, about two miles from the city of Cortland. The building is steam heated and clectrically lighted from the power house situated on the property, and is entirely separate from the almshouse. These rooms when finished will afford very comfortable accommodations. Arrangements will also be made to provide suitable attendants and a trained nurse employed in the hospital ward of the county house is also available.

Erie County. The city of Buffalo, the second city in size in our State, has provided a psychopathic pavilion, the location of which is a disgrace to the commonwealth. This pavilion is located on the second floor of police station No. 3, and consists of two rooms, one containing four beds for men and the other three beds for women. In connection with each room there is a toilet and a small lavatory, but there are no bathing facilities whatever either in the form of a spray or tub bath. The rooms are heavily haired at the windows and have a barred door similar to those used in jails in addition to which there is an ordinary wooden door on the outside. These rooms are so arranged that, in case the wooden doors should be left open, the different sexes can see into each other's room, and the arrangement is such that the women patients are obliged to pass the door of the men's department before they can enter their own.

Next to the women's department, separated by a wall, is the large toilet section and bath room of the station house. Here policemen go at all times of the day and night, making considerable disturbance and consequently awaken any patients who happen to be there. There are no provisions for preparing food at the pavilion, and meals for the patients are brought from a nearby restaurant. The nursing service consists of three policemen, two of whom are fortunately graduate nurses from the Buffalo State Hospital, the third being an inexperienced man. When women patients are received they are looked after by an inexperienced woman, who was formerly a police matron, who sleeps in the women's department, remaining there night and day while women patients are there.

The physician in charge of the pavilion is a man of experience in the State hospital service, and has made every possible effort within his power to improve the existing conditions without avail. All of the patients admitted to the pavilion are required. to have their names entered upon the police blotter. The pavilion is destitute of any furnishings, the floors are bare and the general appearance quite forlorn. The location of this pavilion is a vio

lation of the statute and it should be removed to a more suitable place.

Greene County. Here no provisions have been made except that a room has been set aside at the county house and adequate attendants employed.

Kings County. Patients from this county are cared for at the psychopathic ward of the Kings County Hospital. This pavilion consists of a two-story building of fire proof construction. Men patients are housed on the first and the women on the second floor of the building. There are five day and three night nurses on duty in each department, and in addition there is a special officer on night duty in the men's ward and a special night nurse in the women's department. The building has a capacity for about forty patients. The majority of the patients are brought to the pavilion upon the petition of their relatives, an ambulance being sent for them, or else they are brought in the emergency ambulance which brings what few cases they have from police stations. The pavilion is in charge of an experienced alienist and the nursing force is presided over by a nurse of long experience in State hospitals for the insane. Food for the patients is cooked at the main kitchen of the hospital and conveyed to the pavilion, where warming tables are provided. Restraint is used in the form of camisole, protection sheet, and by means of sheets tied about the ankles and shoulders and then to the bed. This might be lessened to a considerable degree if the nursing force assigned to the pavilion could be increased. At present a certain number of nurses are assigned, and in case of the absence or illness of any of these, there are no others substituted. The standard of care at the pavilion is very good. At the present time there is being constructed an addition to the pavilion which will accommodate about eighty patients, and in the new building it is planned to install continuous baths and a complete hydrotherapeutic apparatus.

Monroe County. The detention wards, of which there are two, are located in the basement of the Monroe County Hospital, Rochester. On the male side there are ten rooms with barred windows and screened openings in the doors, with toilet facilities adjacent. On the female side there are six rooms of the same general construction. Nursing on the male side is under the charge of male attendants; on the women's side the nursing is done by female. nurses. The rooms seem to be suitable for the care of the patients. At the present time, however, there is a movement on foot to establish a pavilion in connection with one of the general hospitals of the city.