more cereals and corn meal. Rice is used to supply the partial lack of potatoes, used both as a vegetable and for desserts, in various forms. Tuberculous patients are given egg-nog between meals. On account of a shortage in male attendants, the experiment is being tried of placing women attendants in the male wards; so far, it has been satisfactory. Religious services are held on Sunday afternoons in the chapel, both Catholic and Protestant denominations being represented. Out-patient department clinics are held in five places-Buffalo, Jamestown, Salamanca, Dunkirk and Olean, once a month. The superintendent or member of the staff, with the field agent or social worker, Miss Armstrong, conducts the clinics and consults with all visitors. Patients on parole visit the clinic for the advice of the specialist. As many as 42 people have visited one of these clinics in an afternoon. There are wants at Gowanda. First of all, $12,000 to purchase the Dodman farm for the fine herd of Holstein cattle. There are now 150 cows, and with the great increase in patients there should be 200 cows. A new barn is needed. A reception hospital for new and acute patients is very desirable. While there are other needs, these seem to be the most pressing. A laboratory and morgue are in the process of construction but not yet completed. (Signed) MARY A. L. BOOKSTAVER, BUFFALO STATE HOSPITAL On our recent visit the State hospital showed its finest summer aspect-the wards airy, delightfully clean and orderly, and many patients enjoying the verandas or working in the shops or gardens. Yet in spite of the most favorable summer conditions, there were too many evidences of the great overcrowding which was made the subject of special comment in our last report. The hospital is caring for 2,262 patients. This means that there are 558 patients (342 men and 216 women) or 32 per cent more than its certified capacity. This condition, to which attention has been called repeatedly, is a source of very real danger to the patients. It mitigates against best results and is a discouraging and unwarranted demand upon the staff. The situation, although managed with great skill, should not be allowed to continue. We have never ceased to regret that the inexpensive summer farm experiment, which was such a marked success, had to be abandoned and we hope that some such outlet, providing a wholesome and helpful change for patients, may again be possible. No one can see the relief and enjoyment afforded by the verandas without feeling that the two wards still without them should be provided with this comfort. An evidence of careful foresight is seen in the fact that all the acreage of the home grounds not occupied by buildings has been brought under cultivation for the purpose of doing all that is possible to increase the food supply. Nine additional acres (making a total of 71) were ploughed up this year and planted with wheat, beans and corn. The balance of the hospital farm is given up to these crops and to barley, oats, parsnips, cabbage, beets and carrots. In this connection we would again urge an appropriation for a root cellar which has long been needed. The patients of the Buffalo State Hospital are taking no small part in patriotic service. Besides the cultivation of all the available land, they have been able to make the following articles for the Red Cross: Eighteen bundles of sponges (12 dozen in each bundle), 46 bundles of applicators (25 in each bundle), 28 binders, 6 dozen chest bandages, 24 jacket bandages, 28 accordion plaited bandages, 25 bundles of compresses, and 45 dozen clinical bandages. More could have been accomplished had materials not given out. The mental hygiene work of the hospital has been fairly active during the past year. Daily clinics are held at the hospital for the benefit of those who wish to consult the staff regarding themselves or their friends, or who seek advice as to the training and protection of feeble-minded children. The number of consultations averages about 60 a month. Lectures on mental hygiene have been given in different localities by members of the staff, the woman physician alone having given about seven in Buffalo and western New York. Preventive work is now supplemented by the out-patient department established a year and a half ago under the care of a visiting nurse maintained by the hospital. Mrs. Loughlin made during the past month some 66 visits, mostly to patients at home on parole. The steadying influence of such a visitor, and of her friendly and expert advice coming at the right moment, results in relieving many cases of mental, physical or other trouble in the families of the patients. Where necessary the patient may be brought back to consult with his physician, but oftentimes return to the hospital is avoided by discovering the intimate causes of worry or breakdown, and by relieving the strain through securing employment or change of surroundings for the patient. During the past year the visiting committee has suffered the loss by death of two of its members, Mrs. John J. McWilliams, and Judge George A. Lewis. Mrs. McWilliams had previously served on the Board of Managers of the State hospital, and was therefore thoroughly conversant with the aims and activities of the institution. Judge Lewis possessed marked qualifications for a member of the visiting committee. For many years he served as trustee on a number of State and other charitable institutions, and was at one time an important member of the prison parole board. (Signed) FANNY H. BARTOW, MANHATTAN STATE HOSPITAL A visitor from the central office reports a number of improvements at Manhattan State Hospital during the past year, most important of which are a new power house, just completed; a reception building for women, and another for men, very recently opened. These reception buildings are of the most modern and approved type. They are provided with all the equipment for continuous baths and hydrotherapy. They will reduce the overcrowding by housing 350 patients. The system of recreation and amusements provided for patients has been completely reorganized. A moving picture machine has The been installed and out-of-door movies once a week are a summer feature. The band has been rejuvenated and as a result cheerful music is to be heard daily in one building or another. women's industrial department has a large victrola at its disposal which is kept up-to-date by the purchase of a dozen new records every month or two, and the women are thus able to combine work with pleasure. Miss Jestley, the matron of the industrial department, was delighted to report the fulfillment of one of her long delayed plans-she is now able to subscribe to all of the interesting women's magazines and thereby add greatly to the happiness of the women on the wards. A resident dentist has finally been secured for the hospital. He is to have an office in the women's reception building. Manhattan State Hospital is to be congratulated on the productiveness and attractiveness of its truck gardens. Every spot has been utilized. Beets take the place of cannas and foliage plants. The coloring is quite as decorative and the beets far more useful. The ground around one of the new buildings is growing a fine crop of lima beans, and an unsightly mound of dirt which was not removed in time to escape the resourceful farmer has become a glorified melon patch. One of the most serious situations which the hospital has to face this year is the shortage of physicians and attendants. On the date when this inspection was made there were 61 vacancies among women nurses and attendants and 24 among the men. The figures have run as high as 100 vacancies at a given time. This condition is due to a combination of causes including the shortage which the war makes among the nurses and employees generally, the poor pay and long hours of a State hospital, and the unusually large number of opportunities elsewhere. The very efficient social worker at the hospital has had an unusually busy year. Her work is increasing in volume and in importance. When one stops to consider the population of Manhattan and the number of cases requiring supervision which are paroled yearly, it is easy to see that one worker cannot possibly cover the ground adequately. In the past year 113 cases were assigned to the social worker for home supervision in addition to all her other duties, such as obtaining employment, securing case histories and investigating the homes before parole. For these 113 cases it was possible to make only 199 visits, which means that the vast majority of the patients were seen in their homes only once during the year. An out-patient clinic which should be located at a more convenient and accessible point than Ward's Island, a clinic where patients could see the doctor and the social worker at definite intervals, would also add greatly to the effectiveness of the social service department. REPORT OF THE BUREAU OF STATISTICS Submitted by Horatio M. Pollock, Statistician and Editor To the State Hospital Commission: I beg to submit the following report of the Bureau of Statistics for the fiscal year ending June 30, 1917: EDITORIAL WORK The editorial work conducted by the Bureau has been increased by the enlargement of the State Hospital Quarterly and by the assignment to the Bureau of the compilation of the Commission's annual report. EXHIBITS The Bureau conducted the Commission's exhibit at the State Fair September 11-16, 1916, and assisted in the preparation and arrangement of the exhibit of the hospitals and the Commission at the meeting of the American Medico-Psychological Association, in New York City, May 29 to June 1, 1917. Both of the exhibits attracted much attention. Elaborate plans were made by the Bureau early in the year for a unique exhibit at the State Fair of 1917, but their execution was prevented by the use of the State institutions building on the fair grounds by the Federal Army. STATISTICAL WORK In addition to the preparation of the annual statistics of the insane in the State hospitals and private licensed institutions and of the finances and administration of the State hospitals which |