tion, through the establishment of the outdoor dispensaries provided for by the Laws of 1913. The Commission is convinced that so long as every disbursement on account of the insane is properly accounted for, the public will support its efforts in these directions. It invites the scrutiny of every taxpayer to its detailed statement of expenditures, and stands ready to support every item therein listed.

In its last annual report the Commission presented reasons for the storing of food supplies during September, the last month of the fiscal year, sufficient to carry the hospitals well into the first month of the succeeding year. The purchasing branch of each hospital cannot get into effective action until it has had time to examine the revision of its requisitions by the Hospital Commission, and these are rarely returned before the 5th of October. Specifications must then be prepared, bids tabulated and the hospitals must face the almost invariable delays incident to the shipment of goods from distant points. The Commission regrets that the necessity again arose at the close of the year of reducing hospital supplies to practically the vanishing point. Earlier in the year it had, by reduction of payrolls, sought to avoid deficiencies in the different hospital appropriations, but, in themselves, these reductions would not have been sufficient. It was impossible under these conditions to maintain the former standard of care, and certain of the hospital authorities protested against the Commission's drastic though necessary action in reducing the quantity of supplies.

The Commission hopes and believes that adequate appropriations will be granted during the coming legislative session to obviate any repetition of the conditions here described. It welcomes a thorough analysis of the hospital disbursements by proper authority, and urges members of the Legislature, through their committees, to make a fair comparison of results achieved by the State care system of New York with that of other states and countries.

As indicated above greater efforts than ever before have been necessary to guard against a deficiency at the close of the year. With our colossal hospital system and the statutory requirement that estimates of the funds necessary for maintenance and build

ings shall be filed with the State Comptroller practically twelve months before the commencement of a given fiscal year, it becomes no easy matter to prepare an accurate forecast. Unexpected additions to the hospital population occur, the prices of staples mount steadily upward and the Legislature continues to change the wage schedule of the State hospital service. The Commission had fully expected that, following the precedent of many previous years, all of the moneys received from paying patients and miscellaneous sources (which annually average nearly $550,000) and paid into the treasury would be appropriated and made available to supplement the original appropriation of $6,451,850 made by chapter 792 of the Laws of 1913 for the annual maintenance of the State hospitals. However, the exigencies of the year, required a reduction of this amount by the Legislature to $275,000. Obviously, the most strenuous efforts were required during the last six months of the year to meet this unexpected condition. The hospitals were promptly informed of the reduction and were requested to take steps at once to keep within the statutory appropriations. The Commission suggested that none of the vacancies in the hospital working staffs reported by the hospitals be filled, and in certain instances where the disbursements of the first half of the year had seemed excessive and to threaten a deficiency, the suggestion was made that as it was most undesirable to reduce the dietary standard it would be necessary to reduce the number of employees then in service. Such reductions in force were promptly made. Before the close of the year, however, through other readjustments, it was possible to restore many of the faithful employees whose services had been dispensed with.

The Commission renews its recommendation that the hospital maintenance fund should no longer be burdened with the support of the Joint Purchasing Committee, but that a special legislative item should be incorporated in the Commission's administration budget to cover this branch of its service. The necessity of this change is further emphasized by the reduction made in the hospital maintenance appropriation during the current year. A similar recommendation is submitted with reference to the salary and expenses of the collection attorney.

DECREASED APPROPRIATIONS

The Commission appeared before the newly created State Board of Estimate, comprising the Governor, Lieutenant-Governor, president, pro tempore of the Senate; the Speaker of the Assembly, the State Comptroller, the Attorney-General, and the Commissioner of Efficiency and Economy, late in December, 1913, to present the needs of the department in the line of appropriations for both maintenance and extraordinary building extensions. Minute inquiry was made by the board as to the necessity of each item of the Commission's budget and full statements were furnished. The Commission regrets, however, that its request for an adequate fund for the commencement of new institutions and the extension of present establishments was not granted. Through the subsequent disapproval of the Frawley bond issue bill, elsewhere referred to, the Commission was left without even a prospect of additional funds to meet the present perilous overcrowding of its hospital wards. In view of these conditions, the maintenance of the high standard of the past seems impossible. There was a net increase of 758 to the hospital population during the year, and before the close of the coming year by reason of decreased deportations, consequent upon the suspension of ocean transportation lines, the congestion of the alien insane in the wards of our hospitals will probably be much greater, and a net increase of from 1,000 to 1,200 may be anticipated. With such additional overcrowding of hospital wards is sure to come a lowering of the recovery rate and a marked lessening of the comfort of patients.

ADDITIONAL CONSTRUCTION DURING THE YEAR

Mention was made in the Commission's last report of the legislative appropriations for providing additional accommodations for our hospital population. At the Manhattan State Hospital, $365,000 became available through appropriations of 1912 and 1913; at the Middletown State Hospital $60,000 from an appropriation of 1911; at the Binghamton State Hospital, $225,000 from an appropriation of 1913; at the Kings Park State Hospital, $80,000 from an appropriation of 1913; and at the Hudson River State Hospital, $40,000 from an appropriation of 1911.