suitable for voluntary admission, and their formal commitment was ordered. In passing upon the commitment of voluntary patients it has been my policy to use the greatest possible latitude, as the families of patients in private houses, often offer strong objection to their commitment, and frequently remove them if that procedure is insisted upon. In order to prevent their being removed to surroundings where inferior standards of care exist, I have been most liberal in determining the necessity of their commitment. In addition to the new admission seen, 57 patients demanded, and were granted special interviews. In all of these cases the complaint was concerning detention and in none was the patient considered sufficiently recovered to be discharged from institutional care. During the year in these institutions, 44 patients were placed in restraint, and 2 in seclusion. These measures were adopted at 10 of the institutions, there being no such measures used in the remaining 15. Eleven patients in restraint and one in seclusion were seen during my visit to these houses. While the forms of restraint were those prescribed by your Commission, it would seem to me that such methods of treatment should be abolished. There has been little improvement in the medical work at these institutions. As reported previously, in a large number of these homes the medical examinations are of a stereotyped character and the histories meagre, describing more the physical than the mental condition of the patients. This can only be improved by introducing modern psychiatric methods. A closer relationship should exist between these institutions and our State hospitals. The physicians at these houses should feel free to visit the psychiatric institute, to attend the inter-hospital conferences and to visit the State hospitals, so they can familiarize themselves with the medical work now being accomplished, and thus improve the standards of care, and place the medical work upon a higher scientific plane at their own institution. During the year 134 deaths occurred and but 13 autopsies were performed or 9.7 per cent of the total number of deaths. Autopsies were performed at only four of the twenty-five private houses. In but one institution, namely, Bloomingdale Hospital, is any at tempt made to do systematic pathological work. While it is realized that it is extremely difficult in private cases to secure the necessary permission for autopsy, every possible effort should be made on the part of those in charge of these institutions to elevate the standard of laboratory methods and the pathological work. During the year 473 patients were discharged as recovered, 183 as much improved, 355 as improved and 41 as not insane, a total of 1,052 patients who were able to return to their usual vocations. This number is 70.9 per cent of the total number admitted. Among those discharged as recovered and as not insane, were 343 patients who suffered from alcoholism and drug addiction. A little advance has been made in the employment of patients. At a few of these institutions classes have been established in wood working, chair caning, metal work, rug weaving, embroidery, basketry and raffia work, while at the Bloomingdale Hospital, in addition to those occupations, classes in gymnasium work and folk dancing have been established. These methods should be introduced into all of the institutions. At the close of the fiscal year there were 527 nurses employed in the 25 licensed private houses, of whom 76 or 14.42 per cent were graduate nurses. This is a reduction as compared with the previous year. It is quite essential, in my opinion, that the number of graduate nurses be increased. Fifty-seven of the graduate nurses are employed in 5 of these institutions, leaving the remaining 20 houses with but 19 graduate nurses in all. Chapter 526 of the Laws of 1913, permitting the commitment of an inebriate or a drug habitue, to any licensed private institution for the insane, for a period not exceeding one year, is an advance in the treatment of these cases. Fourteen cases committed under this act, were seen during my visits to those institutions. At one institution two patients suicided, one by hanging, and the other by drowning. At another private licensed house, a patient suicided by cutting his throat with a razor. Two of these suicides were found to be due in part, to the neglect of the employees who had charge of the patients in not keeping them under stricter observation. These employees were dismissed from the service. The coroner investigated all of these deaths. At other institutions, five patients sustained fractures. Investigation of these injuries showed them to have occurred accidentally. During the year, five licenses were granted to establish the following institutions for the care and treatment of the insane, making a total of 25 licensed private houses, now subject to the direction and inspection of your Commission: December 24, 1913, Dr. Bolton's Home, Beacon, N. Y., James R. Bolton, M. D., physician in charge. January 8, 1914, Oak Grove Farm in connection with West Hill, Flavius Packer, M. D., physician in charge. March 12, 1914, Greenmont on the Hudson, Ralph Wait Parsons, M. D., physician in charge. April 28, 1914, Spring Hill Sanitarium, Hastings-on-the-Hudson, D. W. MacFarland, M. D., physician in charge. August 27, 1914, Pleasantville Sanitarium, Pleasantville, N. Y., Daniel H. Arthur, M. D., physician in charge. A new license was also issued to the Dr. Combes Sanitarium Company of Corona, N. Y., for Dr. Combes Sanitarium, Edward T. Murray, M. D., physician in charge. In the notes of my visits to the private licensed homes, already filed with your Commission and at the institutions, suggestions have been made concerning improved methods of housekeeping, necessary repairs and improvements of the nursing service and of the medical work. UNLICENSED PRIVATE HOUSES Five visits were made to four unlicensed institutions. At three of these houses insane patients were found and were ordered discharged. At one institution a case of involution melancholia was found locked in a room alone. This patient was very much depressed and agitated and should have had a nurse in attendance constantly. At another house a patient suffering from acute hallucinosis was found alone in her room. There was no nurse in constant attendance upon this patient. Either of these patients had excellent opportunity to injure themselves had they so desired. A report of each visit was made and filed in the office of your Commission with the suggestion that these institutions be proceeded against under Section 1122 of the Penal Law. For the continued support and advice of your Commission, extended to me in the performance of my official duties, and for the many courtesies shown by those connected with the institutions visited, I extend my thanks and appreciation. Respectfully submitted, WALTER G. RYON, Medical Inspector. REPORT OF THE RETIREMENT FUND FOR STATE HOSPITAL EMPLOYEES ALBANY, N. Y., December 15, 1914. To the Honorable, the Retirement Board for State Hospital Employees, Albany, N. Y. Gentlemen: In accordance with Section 110, Chapter 59, Article 5, of the Laws of 1912, I respectfully submit herewith the report of the Retirement Fund for State Hospital Employees for the fiscal year ending September 30, 1914. CASH STATEMENT At the beginning of the fiscal year, October 1, 1913, the balance of cash on hand was $86,138,12, to which are added receipts for the fiscal year of $90,610,11, in all amounting to $176,748.23. Disbursements of $24,985.40 were made, leaving on hand a balance of cash amounting to $151,762.83. BALANCE SHEET AND OPERATING STATEMENT The amount of contributions due the fund on account of the September, 1914, payrolls is $5,750.75. The interest accrued on the bank deposit to September 30, 1914 is $1,386.66. There is also an amount of $73.16 due from an employee who has been retired but has not as yet received an annuity. There are annuities payable amounting to $10,318.34, which for the greater part represent the annuities due for the quarter ending September 30, 1914. There are also accounts payable amounting to $462.55, representing all known accounts unpaid on September 30, 1914, including refunds of contributions. Including the above amounts the reserve account is $148,192.51. EXPENDITURES The items of expenditure as shown by Table No. 1 may be explained in detail as follows: Annuities. This amount represents the payments to retired employees. This is the main object of the fund, and the amounts paid each year will increase in proportion to the number of employees retired. Accounting and Clerical Services-Salaries. This amount represents the expenditure for the clerical help necessary in the accounting of the fund. Office Expenses. This amount represents the cost of all filing facilities, printing, blanks and other miscellaneous expenses. Employees' Contributions Refunded. This amount represents the payments made necessary by moneys being contributed to the fund in error, refund of contributions in cases of death of participants, and all other refunds of like nature. RETIREMENTS There have been, since the Retirement Act went into effect, 160 applications for retirement; of this number 26 have become void, either being withdrawn or caused by death. The Retirement Board has taken favorable action on 130 applications; of this number 11 have been canceled by death or by request, and 33 of the total number were retired on account of physical disability. The average annuity is $357.04. The law governing the operation of the fund is not clear on |