in Lunacy would suggest a thorough investigation of this subject by the Governor of the State, which might be done by a commission appointed by your Excellency for this purpose. The possibility of legislation looking toward the reimbursement of the State for the enormous expenditure made necessary in caring for persons who should have been excluded from the State by the United States government is worthy of serious consideration. Very respectfully, THE STATE COMMISSION IN LUNACY, Secretary. In response to the request made by the Commission, the Governor, on March 16, 1912, appointed Dr. Spencer L. Dawes, of Albany, as Commissioner on the Alien Insane. The Commission believes that a thorough investigation of this subject by the above named commissioner designated by the Governor will furnish the basis for action by the Legislature looking toward the reimbursement of the State by the Federal government for the enormous expenditures which have been made necessary by the care of the insane aliens who have been admitted as a result of the inadequate legislative restrictions or in consequence of the inefficient enforcement of existing laws. Dr. Thomas W. Salmon, representing the Bureau of Deportation, and the Hon. Goodwin Brown, of New York city, representing this Commission, appeared before the House Committee on Immigration at Washington on several occasions in support of pending amendments to the Immigration Act of February 20, 1907. The amendments introduced, the importance of which cannot be too strongly urged by this Commission, are as follows: 1. An amendment to section 9 providing that it shall be unlawful for any transportation company to bring insane persons into the United States, and that, if it shall appear to the satisfaction of the Secretary of Commerce and Labor that any alien brought into the United States was afflicted with insanity at the time of embarkation, and that the existence of this disease might have been detected by means of a competent medical examination, the transportation company shall be fined $100 in each case. This section provided for such a fine in the case of idiots, im beciles, epileptics or persons afflicted with tuberculosis, or with a loathsome or dangerous contagious disease, but has not heretofore included insanity. 2. An amendment to section 17 providing that alienists shall be detailed or employed by the United States Public Health Service at all the principal ports of entry for the mental examination of immigrants and be held responsible for such examination and provided with proper facilities for the detection and examination of immigrants in whom mental defect or disease is suspected and authorized to make recommendations as to the facilities needed. 3. An amendment to sections 20 and 21 providing that aliens who have entered the country in violation of the laws, or who have become public charges from causes existing prior to landing, can be deported within five instead of three years, as has been the case heretofore. 4. An amendment to section 21 providing that when, in the opinion of the Secretary of Commerce and Labor, the mental and physical condition of an alien is such as to require personal care, he shall employ a suitable person for that purpose, who shall accompany such alien to his or her final destination, and that the expense incident to such service shall be paid by the United States. 5. The addition of a new section defining as a misdemeanor on the part of agents or owners of steamship companies the refusal to sell tickets for passage to another country, or the refusal to receive for transportation any alien returned from institutions supported by public funds in this country and brought to this country by such steamship company, when the superintendent or chief medical officer of the institution in question shall have certified that such alien may travel with safety to himself and others, and providing that, when necessary, such alien may be accompanied by a suitable nurse, no expense for such return to devolve upon the steamship company. The enactment of such legislation would have a very material effect on the large number of defective and insane aliens now admitted at our ports of entry from foreign countries. The advisability of securing the co-operation of other States and of all organizations interested in such a movement cannot be too strongly urged. On the 18th day of November, 1911, a conference was had by the Commission with Secretary Nagle of the Department of Commerce and Labor in President Taft's Cabinet, and his assistant, Commissioner Cable, Commissioner of Immigration, and members of the Bureau of Deportation. It was very gratifying to the Commission to feel that all these officials were heartily in sympathy with the principle that while this country welcomes all able-bodied immigrants who are free from such physical or mental defects as will make them public charges or the parents of defective children, the importance is clearly recognized of having proper laws effectively enforced to prevent the incoming of such persons as are above mentioned. A further conference was had with Commissioner Williams on the 21st of November, and in December the Commissioners visited Ellis Island where Commissioner Williams gave them every facility for seeing the way in which the very difficult work of inspecting the arriving immigrants is being carried on. THE MEDICAL SERVICE OF THE STATE HOSPITALS During the year ending September 30, 1912, no courses of instruction were conducted at Psychiatric Institute on account of the disastrous fire in July. The courses heretofore conducted have been of inestimable value to the service and the Commission recommends that all assistant physicians, before being assigned to duty in the hospitals to which they have been appointed, should spend at least three months at Psychiatric Institute. Interhospital conferences have been held during the year under the management of the director of the Institute at St. Lawrence and Manhattan State Hospitals. Full reports of these conferences will be found in the State Hospitals Bulletin. The Commission believes that the medical work of the hospital should be conducted as far as possible along uniform lines and in full co-operation with the Psychiatric Institute. Inspections by the Commission and the reports of the medical inspector during the past year have shown that the methods of administration and operation of the medical services in the different institutions are not entirely in accordance with this plan. The institutions generally have increased in size very rapidly during the last decade. In 1902 there were 1,112 patients at the Utica State Hospital, 2,258 at Willard, 2,096 at Hudson River, 1,275 at Middletown, 1,809 at Buffalo, 1,386 at Binghamton, 1,683 at St. Lawrence, 617 at Rochester and 2,856 at Kings Park. These hospitals were at that time allowed a first assistant physician and one second assistant physician. The great increase in population and the adoption of new methods have resulted in problems which did not arise ten years ago. Our conceptions of the nature of pathology of mental diseases have radically changed. The methods of studying cases are entirely different and the work done by the medical officers is of a more scientific nature. At the same time the problems of administration have become much greater. The time has passed when the superintendent of a hospital of the average size can be expected to familiarize himself with the symptoms of each of the patients under his general charge. His duties are now largely executive and the supervision of the medical work must be delegated to a considerable extent to assistants under his direction. In a comparatively short time the appointment of directors of clinical psychiatry will be necessary in all of the institutions of larger size. The Commission believes that it would be desirable to entrust the active direction of the medical work of the hospitals to officers so designated, after they have been thoroughly instructed regarding the duties of their position at the Psychiatric Institute, and have satisfactorily demonstrated that they possess the special qualifications required. The director of psychiatry in each hospital should familiarize himself with the methods of other institutions, keeping in close touch with the work of the Psychiatric Institute and taking advantage of every opportunity to keep pace with modern progress in psychiatry. The medical work of the hospitals should be, in a general way, under the supervision of the director of the Institute, who should visit the hospitals at frequent intervals, confer with the superintendent and director of psychiatry and point out any opportunities which may present themselves for the investigation of special problems. If possible, the entire time of one medical officer should be devoted to laboratory work in every institution of 2,000 patients or more. The pathologist should co-operate in every way with the director of psychiatry and with. the work done at the Psychiatric Institute. The equipment of a modern hospital for medical work is not complete without the proper facilities for the re-education and occupation of patients of the deteriorated class. The success of these methods in the treatment of dementia praecox can no longer be questioned. It is believed that much more effective use can be made of hydrotherapy. The hydrotherapeutic apparatus in some of the institutions is used in a very perfunctory manner and without proper supervision on the part of medical officers. While the instruction of assistant physicians at the Institute has resulted in a much greater uniformity in the preparation of medical records, there is still room for improvement in that direction. It is extremely desirable also that special studies should be made of such important subjects as the influence of heredity in the transmission of mental defects and insanity along the lines suggested by Mendel and others. The State hospitals have an abundance of material for the investigation of such questions, which is available in no other place, and the various institutions could engage in different lines of research which under competent supervision would undoubtedly result in accomplishments extremely creditable to the Department. All of these indications strongly suggest the desirability of having some general medical supervision of the different institutions, so that proper co-operation can be obtained. The Commission is strongly of the belief that this supervision should be delegated largely to the director of the Psychiatric Institute. REVISION OF THE COMMITMENT PAPERS The form for petition for commitment, certificate of the justice or judge relating to personal service, the certificate of lunacy, and the order of commitment, which have been used for the commitment of the insane since 1896, have been revised by the Commission during the past year. It has long been felt that material improvement could be made in the forms, which often furnished little information regarding the mental condition of the |