11. (974) A case of dementia praecox, from Brooklyn State Hospital. So far, both grossly and microscopically, nothing recognized as abnormal has been seen.

12. (975) A typical case of general paralysis from Kings Park State Hospital. This case had been treated by intra-ventricular injections at Trenton in 1916 and 1917 (Dr. Cotton). No evidence, external or internal, of the track of a needle was found. The patient, a woman, was a high diver, led an irregular life, and began to drink early.

13. (976) Adeno-carcinoma of hypophysis from Hudson River State Hospital. This was a case of marked acromegaly first noticed about eleven years before death; his mental processes became slow about a year after the acromegaly was observed. Case published by Dr. Merriman.

14. (977) Probable old syphilis of the central nervous system. from Manhattan State Hospital. Lymphoid cells, more or less bunched, were found in the pia mater of cerebrum and cerebellum, also about some of the blood vessels in the substance of the cortex, the basal ganglia and medulla oblongata. Moderate intimal thickening in large blood vessels. The clinical diagnosis varied from "cerebellar intoxication" (German Hospital) to possible lethargic encephalitis (M. S. H.) The past history (4 children all dead, an "abortion," a psychosis of 5 years' duration, a 2 plus Wassermann, and 27 cells) together with the histological findings are consistent with a diagnosis of syphilis, but the case is not free from doubt.

15. (978) Organs from a case of suspected poisoning from Central Islip State Hospital. The liver showed marked fatty, changes; the kidneys were essentially negative.

16. (980) An epileptic from Central Islip State Hospital. Arteriosclerosis with much thickening of small vessels of the cortex; rarefication about the deeper-seated vessels. Moderate colloidal deposits in the globus pallidus.

17. (981) General paralysis with tuberculosis of the pancreas, from Central Islip State Hospital. Tuberculosis bacilli

demonstrated.

Reports have been sent in practically all of these cases except the Manhattan cases in which the results have been verbally stated. About 10,000 slides have been prepared in the laboratory partly in furtherance of the study of Huntington's chorea. The publication of this investigation will, we hope, soon be accomplished.

SEROLOGICAL LABORATORY

During Dr. Morse's absence in military service, Miss Koch, acting serologist, has been in charge of this work. On account of the low wages paid to laboratory helpers it has been impossible to keep a helper for any length of time. With few exceptions the hospitals have continued to send specimens regularly for the Wassermann test. During the year we received and reported on 1,316 spinal fluids and 1,631 blood specimens, a total of 2,947 Wassermann reactions.

The following tabulation shows the number of specimens received from the different hospitals which utilize the institute laboratory for the Wassermann work:

Wassermann specimens received from State hospitals, July 1, 1918, to June

In addition to carrying on the serological work, Miss Koch has continued her studies on the chemistry of the nervous system.

The publication of the results of a comparative analysis of brains of cases of paresis, Korsakow's disease and dementia praecox has been delayed. This study will, however, appear soon.

VISIT TO THE HOSPITALS

Owing to my absence in military service during most of the year, no visits were made to the hospitals. A trip taking in all of the hospitals is planned for the fall and thereafter at regular intervals visits will be made by myself or the assistant director.

COURSES OF INSTRUCTION

It was not possible to arrange any course for hospital physicians during the year. As soon as feasible, however, we desire to put in operation the plan of instruction outlined in last year's report. During the year the following lectures and clinics were given by the Institute staff:

Eight clinics to a group of 20 flight surgeons from the U. S. Army Aviation Field at Mineola by Dr. Harrington.

Four clinics in psychiatry for the senior medical students of the College of Physicians and Surgeons by Dr. Cheney.

Lecture to the Smith College Class of psychiatric social workers on "The Physical Causes of Mental Disorders" by Dr. Cheney. Lecture to the Smith College Class of psychiatric social workers on "The Etiology of Shell-Shock" by Dr. Harrington.

Lecture to the Smith College Class of pyschiatric social workers on "The Benign Affective Psychoses" by Dr. Kirby.

Address to the Tompkins County Medical Society at Ithaca on "Mental Disorders in Relation to Demobilization of the Army " by Dr. Harrington.

Lectures to the New York War Service Class for Reconstruction Aids in Occupation Therapy by Drs. Kirby, Cheney and Harrington.

Lectures to the mental hygiene classes at Columbia University and Teachers College by Drs. Kirby, Cheney and Harrington. Regular course of lectures and clinics on psychiatry to the third year students at Cornell University Medical College by Dr. Kirby.

An advanced course in clinical psychiatry for a small group of Cornell medical students by Drs. Kirby and Cheney.

Regular course in neuropathology for medical students at the University and Bellevue Hospital Medical College by Dr. Dunlap. The following papers have been published:

"A Clinical Study of Psychoses Characterized by Distressed Perplexity," Archives of Neurology and Psychiatry, April, 1919, Dr. Kirby in collaboration with Dr. Hoch. "Mental Disorders in the Field" Mental Hygiene, April, 1919. Dr. Harrington.

"Mental Disorder Considered as a Psychological Reaction" Mental Hygiene, April, 1919, Dr. Harrington.

"Future Work of the Psychiatric Institute" State Hospital Quarterly, August, 1918, Dr. Kirby.

66

Responsibilities of the State Hospitals in the Treatment of Neuro-Syphilis in Both its Latent and Active Forms," State Hospital Quarterly, August, 1918, Dr. Cheney. "Suggestions for a Study of the Pathology of Dementia. Praecox" State Hospital Quarterly, November, 1918, Dr. Dunlap.

"The Endocrine Glands in Dementia Praecox" State Hospital Quarterly, February, 1919, Dr. Harrington. "A Review of Reported Brain Changes in Dementia Praecox" State Hospital Quarterly, May, 1919, Dr. Cheney. Conferences were held several times during the year with the Medical Committee of the State Hospital Development Committee and with the State Architect in reference to plans for the projected psychiatric hospital for New York City.

On April 18, 1919, a conference of the clinical directors of the State hospitals was held at the Institute. Various topics were discussed bearing on the work in clinical psychiatry. The staff meetings and the general plan of medical organization of the hospitals.

It is hoped that with a return to more normal conditions the teaching and research work of the Institute may be resumed and developed along the lines already indicated. We are encouraged to believe that better facilities and more financial support will be provided at an early date.

I wish to thank my associates and all those connected with

the Institute for their cordial co-operation and faithful performances of their duties. To the superintendent and officers of the Manhattan State Hospital we are indebted for their friendly co operation and assistance in many ways.

I am especially grateful for the interest and support which your Commission has extended to us in our work. As a result we look forward confidently to an increasing field of usefulness for the Institute in relation to the State hospital system.

Very respectfully,

GEORGE H. KIRBY,

Director.

REPORT OF THE BUREAU OF DEPORTATION

To the State Hospital Commission:

The medical examiner respectfully submits herewith the annual report of the Bureau of Deportation, New York State Hospital Commission, for the year ending June 30, 1919.

The general summary of the activities of this office is based upon a series of statistical tables which are appended to the report proper.

The Federal immigration authorities removed by deportation 87 aliens from the State hospitals, certified for deportation by the Bureau of Deportation, a substantial increase over each of the preceding two years (actually 322 per cent), yet a pitiful number when we refer to the reports of other years and more so when we consider that on June 30, 1919, there were in the several State hospitals, reported by your Bureau and awaiting the action of the Federal authorities, 849 deportable aliens, many of whom had been admitted in the early part of the war (1914-1915).

In addition to the aliens deported 55 were repatriated at their own request. In this connection it is a subject for economic congratulation to note that but 9 of these asked the State to pay the cost of repatriation, while 46 provided their own transportation asking our good offices in securing passports, tax exemption certificates and steamship tickets. As the cost of travel has greatly increased the average cost of repatriation is now about $140 per patient; the cost to the State of the 55 repatriations was therefore not more than $1,260 out of a total cost of $7,700 expended for this purpose.