ing necessary the construction of new buildings every year, as well as the erection of additional hospitals, shows no prospect of any material reduction in the amounts which will be necessary for future development of the State institutions. The expenditures which are necessary for these purposes are so great that the Commission firmly believes that it would be wise for the Legislature to submit the question of a bond issue to the people of the State during the immediate future. The per capita cost of building during the last fifteen years, including power-houses, bakeries, storehouses, laundries, reception buildings, staff houses, superintendents' and stewards' residences and buildings for chronic patients, tuberculosis pavilions, etc., as nearly as can be estimated, approximates $890. However, this has not covered the expensive work of establishing a new institution as no new hospitals have been started during that period. As nearly as can be determined at the present time, the increase in the hospital population, together with the accommodations necessary for the overcrowding in the existing institutions, may necessitate provision for 20,000 patients during the next twenty years. The estimates of the State Architect's office as to the cost of future construction, covering the complete establishment and equipment of four new hospitals, would strongly indicate the necessity of a per capita expenditure of $1,730 for this work. The Commission would, therefore, recommend a bond issue of $27,000,000 which would probably provide for the needs of the hospitals during the ensuing twenty years. This would make a very material reduction in the large appropriations annually necessary to cover construction, improvements and equipments and would have resulted in a reduction in the net legislative appropriations of $1,842,000 of 1912, had a bond issue been voted by the people of the State during the preceding years. The fact that with the utmost economy the expenditures made necessary in the care of the insane approximate one-fifth of the total revenue of the State would strongly indicate the absolute necessity of resorting to some other means of providing for the buildings which will be needed in the future for the care of the insane. The increased cost of all commodities promises to necessitate appropriations for maintenance alone which will be a considerable drain upon the revenues of the State, without contemplating any additional construction. ESTIMATES FOR THE YEAR 1913-1914 In compliance with the statute, the Commission submits below estimates of the total amounts required for the maintenance of the State hospital system, of the Commission's Bureau of Deportation, of the scientific and teaching branch of the State hospitals (the Psychiatric Institute), and the State Hospital Commission for the year beginning October 1, 1913. It estimates that for the year beginning October 1, 1913, the average daily number of patients will be 33,000 and the average daily number of officers and employees, 6,400. The Commission respectfully requests an appropriation for maintenance of $7,051,850 to cover the fixed charges, viz., all items of maintenance, including the salaries and wages of employees, clothing, medical supplies, etc. A part of this total can be provided froin the receipts of the board moneys and miscellaneous receipts of 1914, now estimated at $600,000, leaving the amount to be incorporated in the appropriation bill $6,451,850, the difference being adjusted in the supply bill of 1914. For administration expenses, including the maintenance of the State Hospital Commission, the Psychiatric Institute, the Bureau of Deportation and salaries and expenses of inspectors and special agents, the Commission will require $216,000. For construction account For fire protection as recommended by the State Total for construction, extraordinary repairs $3,614,000 00 150,000 00 $3,764,000 00 INSPECTION OF THE STATE HOSPITALS In addition to the inspections made by the Commission, the medical inspector, in accordance with the established custom, has visited all of the State hospitals, as well as the private institutions, at least four times during the year, making such special additional investigations as have been required. The medical inspector, as will be shown by his report, has made special studies of the methods of treatment in vogue at the various hospitals, as well as the methods of administration and the work done by the medical officers. He has made the customary examination of all patients admitted during the year and reported to the Commission such cases in his opinion, did not necessitate hospital treatment. In many instances it has been found that the mental condition of patients admitted was such as to warrant their care at home. as, Frequent inspections of the various institutions have been made during the year by the inspector of buildings, whose report will be found in another place. His services have been of great value in supplementing the information furnished by the superintendents to the Commission in regard to the estimates submitted for new buildings and equipment, alterations in heating plants, etc. He has had special supervision of the extensive alterations at the Kings Park State Hospital, which have included the installation of water tube boilers, a central hot water system, a vacuum system, use of balanced draft and other modern methods, which it is hoped will result in a large saving in the expenditures required. The inspector of supplies, as will be shown by his detailed report in another place, has made numerous visits to the hospitals and in many instances has rejected supplies which have not complied with the requirements of the Commission or the contracts made with the purchasing committee. The services of these inspectors have been of great value in furnishing expert opinions based upon personal observations of the conditions existing in the various institutions. The amount of work which devolves upon the Commission has rendered the assistance of such inspectors indispensable. APPOINTMENT OF STATISTICIAN On the 3d day of November, 1911, Dr. Horatio M. Pollock was appointed statistician and editor. Dr. Pollock stood at the head of the eligible civil service list. His degree of Doctor of Philosophy was received from the University of Leipzig, Germany, after two years of post graduate work. He is a graduate of Union College, where he received the degrees of B. S. and M. S. His work consists largely in making statistical studies relating to mental disease, the care and treatment of the insane, and the movement of patients all with a view to securing such information as will be of help to the State, both in the care and treatment of the insane and the prevention of insanity. He also edits the publications of the Commission. APPOINTMENT OF DR. SOMERS Dr. Elbert M. Somers was appointed superintendent of the Long Island State Hospital at Flatbush, on the 17th of January, 1912. Dr. Somers, who is forty-two years old, after graduation from the Clinton Grammar School, spent one year at Hamilton College, afterward entering the medical department of the New York University, receiving the degree of M. D. in 1893. After serving as interne in the Christ Hospital, Jersey City, Dr. Somers entered the State service at the St. Lawrence State Hospital in 1894, reaching the position of first assistant, after passing through the lower grades, in September, 1903. After passing a competitive civil service examination, the doctor was appointed to the position of medical inspector of the State Commission in Lunacy on June 1, 1911, from which position he was promoted to the superintendency of the Long Island State Hospital. APPOINTMENT OF DR. RYON Dr. Walter G. Ryon was appointed medical inspector of the State Commission in Lunacy January 17, 1912, succeeding Dr. Elbert M. Somers. He received his education in the public schools of Ogdensburg, graduating from the Ogdensburg Free Academy in 1892. He was graduated from the College of Physicians and Surgeons (Columbia University), New York city, in 1896. He entered the State hospital service in August, 1896, as interne at the Manhattan State Hospital. In 1897 he was promoted to the grade of junior physician and transferred to Central Islip State Hospital. He was promoted to assistant physician in 1900 and was transferred to the St. Lawrence State Hospital, Ogdensburg, in 1903. April 1, 1911, he was appointed first assistant physician at the Willard State Hospital. APPOINTMENT OF COLLECTION ATTORNEY The collection of funds resulting from charges made by the Commission for private and reimbursing patients in the various hospitals is of such great importance that the Commission has deemed it advisable to delegate the supervision of that work to a special collection attorney. In accordance with this plan Mr. William G. Dargan was appointed to that position February 19, 1912. It is the expectation of the Commission that as a result of his activities much more money will be collected by the special agents, who will be placed under his charge, and that a greater interest can be developed in this important work on the part of the hospitals. It will be his duty to determine whether or not the special agents have made every effort possible to collect moneys from those legally liable for the maintenance of patients in the State hospitals and he will be held responsible by the Commission for the efficiency of the agents in question. During the year ending September 30, 1912, the amount collected from the sources enumerated above amounted to $500,475.82. It is thought by the Commission that, as a result of the activities of the collection attorney and the renewed interest on the part of the hospitals, this fund can be very materially increased during the coming year. AMENDMENTS TO THE INSANITY LAW Acting on recommendations made by the legislative committee appointed by the conference, the Commission during the past session of the Legislature submitted amendments to the Insanity Law, some of which have been far reaching in their importance. One of the most important changes proposed was in the title of the Commission, which was to be designated as the State Hospital Commission instead of the State Commission in Lunacy. This amendment is in keeping with the modern conception of insanity. Every effort has been made during the last decade to eliminate the words asylum," "lunatic" and "lunacy" from the statute and from the reports of the proceedings of the hospitals and the Commission. The word "lunacy" is a relic of the past and has accordingly been discarded. It was thought that the designation "State Hospital Commission" could be appropriately applied to the body which has jurisdiction over the State hospitals. This is, further |