Psychiatric Institute- Report of Director of the auditory fibers between the temporal lobes and the internal geniculate bodies. This group of arteriosclerotic cases also gave an excellent opportunity for a differential diagnosis between the syphilitic and nonsyphilitic forms of arteriosclerosis. The results in this direction seem to show, as Dr. Dunlap has pointed out in his report, that degenerative changes in the arterial walls and cerebral tissues generally, of old people, especially when associated, as they usually are, with the presence of dark lymphoid cells in the pia mater and the sheaths of the blood vessels, may present a picture closely resembling the exudative processes seen in the pia and about the blood vessels of the older syphilitic cases. A differential diagnosis consequently may become quite difficult in a number of cases. A study of the Wassermann reaction in these doubtful anatomical conditions, where results were available, suggests that it might be of considerable aid in clearing up these difficulties. The Institute, in harmony with what we consider one of its functions, has this year again had its share in the movement of mental hygiene, partly through lectures which were given, partly through our contribution to the exhibit on mental hygiene at the International Hygiene Congress. We sent large charts on which were illustrated by photographs the chief structural changes associated with insanity. The changes in the staff which took place during the year were few. Unfortunately we have not as yet been able to find a suitable man to assist in the anatomical laboratory. Dr. Charles Ricksher, associate in clinical psychiatry, resigned on February 13, 1912, to take a position in the Kankakee State Hospital, Illinois. He was succeeded by Dr. W. W. Wright, who had previously been at the Buffalo State Hospital, in the capacity of second assistant. He was given the same position here. In conclusion I desire to express my appreciation to your Commission and to the superintendents and other officers of the hospitals, for their support and assistance. To my colleagues at the Institute is due much credit for the excellent work which they have done. Very respectfully yours, September 30, 1912. AUGUST HOCH, Director. TWENTIETH ANNUAL REPORT OF THE STATE CHARITIES AID ASSOCIATION TO THE STATE HOSPITAL COMMISSION NEW YORK, November 1, 1912. To the State Hospital Commission: In accordance with chapter 635 of the Laws of 1893, and amendatory acts, the State Charities Aid Association herewith respectfully submits to your Honorable Commission its twentieth annual report. The report contains, as usual, much matter which is not new to those to whom it is addressed, but which it seems to us desirable to include for the benefit of the large number of persons to whom it is sent, most of whom are not equally well informed. The total number of insane persons in State hospitals and licensed private asylums on October 1, 1912, was 33,972, an increase of 661 over the previous year. Of this total number 31,624 were in the fourteen State hospitals (not including Matteawan and Dannemora), being 573 more than on October 1, 1911. The association's legally appointed visitors to State hospitals now number forty. They have continued to do admirable work during the past year and have presented interesting annual reports. A report on the important work carried on during the past year for the prevention of insanity is given on page 241. LEGISLATION In addition to the annual appropriation bills, several measures of considerable interest were introduced in the Legislature and became law during 1912. Chapter 121 of the Laws of 1912 effects a general amendment of the Insanity Law and makes a number of important changes. It changes the name of the State Commission in Lunacy to State Hospital Commission, and the name of the Board of Alienists to Bureau of Deportation, both very desirable improvements, which have a wider significance than a mere change of name might seem to involve. There are certain other changes, however, in connec State Charities Aid Association — Annual Report tion with the Commission and the bureau that seem to us of doubtful wisdom. For instance, the medical member of the Commission is no longer ex-officio president of the Commission, but the chairman is to be chosen by the members from among their number. The medical member is required to have had his five years' experience in an institution for the insane, which practically limits the selection of this officer to a choice from among hospital superintendents. The requirement that the medical inspector shall have at least five years' experience in an institution for the insane is perhaps less unfortunate than the similar requirement in connection with the medical member of the Commission, but still somewhat unduly limits the area of choice for this important office. The Bureau of Deportation which replaces the Board of Alienists is to consist of a medical examiner and such number of medical or lay deputies as may be necessary, the examiner to have had at least five years' experience in the care of the insane. The former Board of Alienists consisted of three examiners of equal rank. The president medical examiner is appointed by the Commission and may be removed for cause, and may be detailed by the Commission to perform the duties of the medical inspector. To put this office somewhat more directly under the Commission seems a change that is undoubtedly in the best interests of the service. We are disposed to believe that medical deputies for the work would be more suitable and more effective than laymen, and we trust that in building up the staff the Commission will make adequate provision for the medical service. In connection with the State hospitals a very desirable change has been made in the striking out of the provision which has been in force for the past ten years, requiring the Commission's approval of the superintendent's appointment of a steward. There seemed to be no adequate reason for excepting this office from the other offices in a State hospital which are filled by the appointment of the superintendent from lists furnished by the Civil Service Commission. The establishment of by-laws to govern the hospitals is no longer a duty of the managers, but of a committee of superintendents appointed by the Commission, and subject in State Charities Aid Association Annual Report its action to the approval of the Commission and the quarterly conference. Some very desirable amendments have been made to the sections providing for the commitment, detention and discharge of the insane. One amendment makes it the duty of Bellevue and Allied Hospitals and the department of public charities of New York city to send a medical officer attached to the psychopathic wards to the place of residence of the alleged insane person when the proper information is received from a relative of this person or from certain specified authorities to the effect that the person is apparently insane. "If, in the judgment of the chief resident alienist of the respective psychopathic wards or of the medical examiner thus sent, the person is in immediate need of care and treatment or observation for the purpose of ascertaining his mental condition, he shall be removed to such psychopathic ward for a period not to exceed ten days, and the person or persons most nearly related to him, so far as the same can be readily ascertained by such trustees, or commissioner, shall be notified of such removal." This amendment obviates the necessity of having the patient placed under arrest or brought into court and is an important step in substituting the physician and the hospital for the police officer and the court in dealing with cases of alleged insanity. Among those who can sign the petition for the commitment of a patient is now included "an officer of any well-recognized charitable institution or home." This facilitates action in connection with homeless persons or those who, while not actually in the charge of public poor law officials, are properly objects of charity and are known to charitable and philanthropic societies. In order to relieve the State hospitals of the care of patients who can properly be supported in private institutions, the superintendent of a State hospital is authorized to recommend to the Commission the removal of such a patient to a private institution and the Commission is given power to compel such a removal. A new provision is also made regarding the discharge of patients from licensed institutions and providing for the transfer of patients to State hospitals. Licensed institutions for the insane are required to furnish lists of their voluntary cases, and such State Charities Aid Association — Annual Report cases are to be examined by the Commission. On the whole, these amendments to the Insanity Law improved the law substantially and made many long needed changes. Chapter 43 of the Laws of 1912 legislates into effect a new and better schedule of officers' and employees' salaries and wages. The Insanity Law gives the Commission the power to prepare and modify such wage schedules and we have always considered it unfortunate that the Legislature should interfere with the exercise of this power and should take upon itself the regulation of such details as the salaries of officers and employees of State institutions. Since, however, the Legislature has seen fit to do this, it is gratifying that the changes made should be made in accordance with the recommendations of the Commission and the hospitals and should be in the interests of better compensation for the underpaid and overworked servants of the State in this department of the State service. A bill providing a new site for the Utica State Hospital, chapter 48 of the Laws of 1912, appropriates $115,000 for a site to be selected at such a point as the State Hospital Commission may determine, under the authority granted by chapter 760 of the Laws of 1911. Chapter 448 of the Laws of 1912 amends the Public Health Law in relation to surgical operations for the prevention of procreation. It provides for the appointment of a board of examiners, consisting of a surgeon, a neurologist, and a general practitioner, who are to consider feeble-minded, epileptic, criminal and other defective cases in the several State hospitals for the insane and other State institutions, and take measures for their sterilization when it is considered that their defect or disease is of a hereditary character and is likely to be transmitted to their offspring. NEW ACCOMMODATIONS NEEDED On October 1, 1912, there were 31,624 patients in the fourteen State hospitals for the insane, exclusive of those for the criminal insane. The stated capacity of these institutions as fixed by the State Hospital Commission was 26,753, making a total over |