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State Hospital, and served in this capacity until January 12, 1912, when he was appointed from the head of the eligible list as medical inspector of the State Hospital Commission. occupied this position until his appointment as superintendent of the Hudson River State Hospital.

Among the articles contributed to medical literature by Dr. Ryon are the following:

"A Study of the Deterioration of Huntington's Chorea." "Standards of Medical Care in the State Hospitals and Licensed Private Institutions in New York State."

"The Care of the Insane Pending Commitment," a report which covered an inspection of practically all the detention rooms and pavilions in the State of New York, with recommendations for their improvement.

He is also the author of the medical inspector's reports for the years 1912, 1913, 1914, 1915 and 1916.

Dr. Ryon is a member of Ogdensburg Chapter, R. A. M., No. 63; Nu Sigma Nu Fraternity; the American Medico-Psychological Association; the Albany County Medical Society; the New York State Medical Society and the American Medical Association.

APPOINTMENT OF DR. HEYMAN AS MEDICAL INSPECTOR AND AS SUPERINTENDENT OF THE MANHATTAN STATE HOSPITAL

Dr. Marcus B. Heyman, who had served as assistant superintendent of the Central Islip State Hospital since December 1, 1912, was appointed medical inspector by the State Hospital Commission on April 24, 1917, the appointment to become effective May 1, 1917. At a meeting of the Commission, held May 22, 1917, he was appointed superintendent of the Manhattan State Hospital, and entered upon the duties of the position on June 1, 1917.

Dr. Heyman has had twenty-seven years' experience in the care of the insane. He was appointed junior physician in the New York City Asylum for the Insane at Ward's Island, April 1, 1890, and was promoted to assistant physician in the same institution on March 1, 1891. He resigned this position to accept appointment as second assistant physician in the South

Carolina State Hospital for the Insane, January 1, 1893. He served in this position two years, and was then reappointed assistant physician in the New York City Asylum. He became first assistant of the Central Islip State Hospital, December 1, 1901, and was promoted to the position of assistant superintendent December 1, 1912.

On the date of his appointment as medical inspector Dr. Heyman was elected a vice-president of the New York State Medical Society.

In December last Dr. Heyman was offered the superintendency of the Arkansas State Hospital for Nervous and Mental Diseases, at Little Rock, but after careful consideration of the matter he decided to remain in the New York State hospital service.

He is a member of the Suffolk County Medical Society; New York State Medical Society; New York Neurological Society; Society of Medical Jurisprudence; American Medical Association; American Hospital Association; American Medico-Psychological Association; and Associated Physicians of Long Island.

APPOINTMENT OF DR. KIRBY AS MEDICAL INSPECTOR

The position of medical inspector left vacant by the resignation of Dr. Heyman was filled by the appointment by the Commission on May 28, 1917, of Dr. George H. Kirby, who had been director of clinical psychiatry at the Manhattan State Hospital since 1908. Dr. Kirby's appointment took effect June 1, 1917.

Dr. Kirby was born in Goldsboro, N. C., February 9, 1875. After preliminary training in the grammar and high schools of his native State, he entered the University of North Carolina, and graduated therefrom with the degree of B. S. in June, 1896. He then entered the Long Island College Hospital and received his medical degree from this institution in May, 1899. After three months' service in the Seaside Hospital for Children in Brooklyn, he was appointed junior physician in the Worcester (Mass.) Hospital for the Insane. At the end of one year he was promoted to assistant physician and continued in such position until May, 1902. He was appointed associate in clinical psychiatry in the New York State Psychiatric Institute October

1, 1902, and served in such position until May 1, 1908, when he was made director of clinical psychiatry in Manhattan State Hospital.

Dr. Kirby's ability as a psychiatrist was recognized by his appointment as instructor in psychopathology in the Cornell University Medical College in June, 1906, and by his later appointment as professor of psychiatry in New York University and Bellevue Hospital Medical College. For several years Dr. Kirby has served on the editorial staff of the State Hospital Bulletin, and for the past two years has been one of the editors of the Psychiatric Bulletin. His investigations and writings have won him an enviable place among the leaders in his profession.

Dr. Kirby is a member of the Ward's Island Psychiatric Society, the Bellevue College Medical Society, the New York Neurological Society, the American Medico-Psychological Association, the American Psychopathological Society, and vice-president of the New York Psychiatrical Society.

As a member of various committees and boards Dr. Kirby is in touch with a wide range of psychiatric activities. He is a member of the National Committee for Mental Hygiene, chief consulting psychiatrist of the New York City Department of Correction, member of the Advisory Board of the Sing Sing Psychiatric Clinic, and recently has been asked to serve on the Medical Advisory Committee of the State Hospital Development Commission.

PATIENTS UNDER TREATMENT IN THE STATE HOSPITALS

At the beginning of the fiscal period there were 35,213 insane patients in the civil State hospitals, 1,402 in the hospitals for the criminal insane, and 966 in the private licensed institutions; a total of 37,581.

The admissions for the period, excluding transfers, numbered 8,805 in the civil hospitals, 204 in the hospitals for the criminal insane, and 398 in the private institutions; a total of 9,407. There were 6,877 first admissions to the civil hospitals, 166 to the hospitals for the criminal insane, and 297 to the private licensed institutions; a total of 7,340. The readmissions for the period numbered 1,928 in the civil hospitals, 38 in the hospitals

for the criminal insane, and 101 in the private institutions; a total of 2,067.

The total number of patients under treatment during the year, excluding transfers, was 44,018 in the civil hospitals, 1,606 in the hospitals for the criminal insane, and 1,364 in the private institutions, making a total of 46,988. Excluding transfers, 3,794 patients were discharged from the civil hospitals, 76 from the hospitals for the criminal insane, and 297 from the private institutions; a total of 4,167. There were 3,912 deaths in the civil hospitals, 59 in the hospitals for the criminal insane, and 80 in the private institutions; a total of 4,051.

At the close of the fiscal year, June 30, 1917, there were remaining on the books 36,357 patients in the civil hospitals, 1,433 patients in the hospitals for the criminal insane, and 974 patients in the private institutions; a grand total of 38,764. The increase of patients in the civil hospitals was 1,144, in the hospitals for the criminal insane, 31, and in the private institutions, S. In all the institutions together there was a net increase during the fiscal year of 1,183 patients.

The average daily patient population in the civil hospitals was 35,728, an increase of 982 over that of the preceding fiscal period.

Of the 36,357 patients remaining on the books of the civil hospitals June 30, 1917, 33,152, or 91.2 per cent, were entirely supported by the State; 3,040, or 8.4 per cent, paid partial cost of maintenance, while 165, or 0.45 per cent, were admitted under the special provisions of section 89 of the Insanity Law.

The average daily number of patients on parole during the year was 1,504, an increase of 158 over the average of the previous fiscal period.

RESULTS OF TREATMENT

The cases discharged from the civil State hospitals, exclusive of transfers, numbered 3,794. Of these 1,706 were discharged as recovered; 792 as much improved; 844 as improved; 360 as unimproved; and 92 as not insane. The total discharged benefited by treatment was 3,434.

The recovery rate based on first admissions was 24.8 per cent; on all admissions, 19.4 per cent; and based on total under treatment, 3.9 per cent. The rate of patients benefited by treatment

based on first admissions was 49.9 per cent; based on all admissions, 39 per cent; and based on total under treatment, 7.8 per cent.

There were 1,155 patients discharged by transfer. The larger part of these transfers was due to the overcrowding of the metropolitan hospitals. Manhattan State Hospital transferred 557 patients; Central Islip, 399; Kings Park, 78; and Brooklyn, 46. Most of these patients were sent to upstate hospitals.

GENERAL OPERATIONS

The entrance of our country into the European conflict has seriously affected the administration of the hospitals. Food supplies have risen in price and some necessary commodities have been obtained with much difficulty. The call for men to serve in the army has taken a large number of attendants from the hospitals, and the Red Cross work has enlisted many of the hospital nurses. The demand of the military authorities for physicians trained in psychiatry has been responded to by several of the men on the medical staffs of the hospitals. The vacancies thus caused in the several departments in the hospitals have been exceedingly hard to fill, and at the close of the fiscal year many of them remained unfilled. The scale of wages of employees in the hospitals being fixed by law, it has been impossible to meet the competition of munition factories and the other industries that have been stimulated by the demand for military supplies. The situation will be relieved by chapter 286 of the Laws of 1917, which provides for a substantial increase in the wage scale, to take effect January 1, 1918. During these trying days the Retirement Fund of State Hospital Employees, by furnishing an incentive to the experienced attendants and nurses to remain in the service, has proved of great assistance to the hospitals.

Owing to the scarcity of materials and labor, building operations at the hospitals have progressed very slowly. "Mabon Hall," a reception building for 150 men, and "Keener Hall," a building for 200 women patients at the Manhattan State Hospital, were completed and occupied in the spring of 1917. "Wagner Hall," a building for 300 women patients at the Binghamton State Hospital, was completed and opened for patients in June,