service of that hospital. This list has not yet left the printer's hands. These are the two most noteworthy attempts to classify occupations with a minimum of guesswork and to make them more valuable statistically.

An occupational chart has been prepared by us and has been thoroughly criticised and is complete with the exception of an occupational list. It has been deemed expedient not to institute this additional history form until the classification of a reasonably standard occupational list has been decided upon.

During the past year the city of Buffalo has opened a large sanatorium at Perrysburg to accommodate 150 patients. As a result of this, the number of patients discharged during the year from Erie county is 100 less than the previous year. The most notable increase in the admission of patients has been from New York City. In the small counties there has been a uniform increase in the admission rate. It is the usual experience that local county hospitals tend to cause a cessation of applications for Ray Brook for a period. Certain county officers refuse to apply for Ray Brook if the local county hospital or sanatorium has vacancies. These refusals are usually temporary and are adjusted as the work of control expands.

The completed hospital has a capacity of 308. For a period the census was operated in excess of the allotted bed capacity of

the hospital. This was found unsatisfactory and a few vacancies are maintained for disinfection and emergency purposes.

TREATMENT.

The essential treatment was not changed. It consists of regulated rest, exercise and diet, with life in the open air. The strongest emphasis has been placed on rest. The exercise ability has been used for the purpose of economy, to lessen the cost of maintenance wherever possible.

LABORATORY.

The laboratory was occupied during the summer months by Dr. Oswald Avery, Dr. Benjamin White and Dr. Harold W. Lyall of the Hoagland Laboratory. An endeavor was made to obtain some information by means of complement deviation in human tuberculosis. In addition to this an accurate Wasserman system. was established, as a part of the laboratory service. The direction of the investigation extended beyond the time allotted to the work and will be continued and published in due course.

PROGRESS OF THE YEAR.

No large special funds were appropriated to correct the defects of the present hospital plant, but many minor changes and improvements were progressed under maintenance. The banks and fills about the water storage reservoir have been graded and sodded; the courts and yards have been cleared of debris and the usual interior repair work progressed under maintenance. The entire water section system of the hospital has been excellently painted, the infirmaries of the old east and west pavilions and the entire new MacDonald pavilion has been painted. The property of the institution is in good condition.

Medically a Committee on Coöperation has been established by the Board. This Committee has assembled facts bearing upon the relation of Ray Brook to the existing organizations working in tuberculosis. It has been the idea to bring about a closer relation between Ray Brook and the existing organizations working in tuberculosis, so that the selection of case medically would be better and

so that the endeavor of the patient could be more satisfactorily directed upon his return home, if he was in need of further assistance or advice. Quite effective organizations now exist in Buffalo, Rochester, Troy, Albany and New York City. The nucleus for effective organizations is present in many of the less populous centres. The opportunity for assistance should be offered to every patient, so that the patient may have the privilege of availing himself or herself of it, if it is necessary. The preliminary work of the committee has about been accomplished and the committee is ready to cooperate with such organizations as can effectively advance the welfare of the patient.

NEEDS OF THE HOSPITAL.

The essential needs of the hospital are listed in Appendix A and complete argument for them is attached. To the casual visitor, the most obvious need is an improvement of the roads and grading of the grounds. To the more intimately informed, the absence of a satisfactory system of fire protection is most impressing. The hospital property is now worth $550,000 with no adequate protection for fire. All of the details for incipient fire have been attended to, but the need for a comprehensive fire protection is the single most important item. The financial statement is appended. The cost of maintenance is always of interest to those that finance the hospital and is of interest in comparison with the cost of similar service elsewhere. The present weekly cost is $9.27. During the last year the hospital has been operated economically and effectively in spite of high prices. The most expensive item of the previous year, the heating and lighting department, has exhibited the wisdom of the expenditure in the correction of construction defect in that department and has been responsible in the lowering of the per capita cost $1.71 per week. Nine dollars and twenty-seven cents probably represents the minimum weekly per capita cost. With the certain necessity for adding new departments to the hospital which will become fixed charges, the probable minimum cost will be about $10 per week.

In conclusion, I wish to express my appreciation to the members of the clergy who have continued their visits to us through