2. NEW YORK—thirteen hospitals (1912-1919): Binghamton State Hospital, Binghamton; Brooklyn State Hospital, Brooklyn; Buffalo State Hospital, Buffalo; Central Islip State Hospital, Central Islip; Gowanda State Homeopathic Hospital, Collins; Hudson River State Hospital, Poughkeepsie; Kings Park State Hospital, Kings Park, L. I.; Manhattan State Hospital, Ward's Island, New York City; Middletown State Homeopathic Hospital, Middletown; Rochester State Hospital, Rochester; St. Lawrence State Hospital, Ogdensburg; Utica State Hospital, Utica; Willard State Hospital, Ovid. 3. Twenty-one hospitals in fourteen other states: ARKANSAS—State Hospital for Nervous Diseases, Little Rock (1917-1918). COLORADO—Colorado State Hospital, Pueblo (1917 and 1918). CONNECTICUT—Connecticut State Hospital, Middletown (1917 and 1918); Norwich State Hospital, Norwich (1905-1918 inclusive). MARYLAND—Springfield State Hospital, Sykesville, 1919; Spring Grove State Hospital, Catonsville, 1918 and 1919. MICHIGAN—Pontiac State Hospital, Pontiac, 1917 and 1918; State Psychopathic Hospital, Ann Arbor, 1917 and 1918; Traverse City State Hospital, Traverse City, 1917 and 1918. MONTANA—Montana State Hospital, Warm Springs, 1917 and 1918. NEW JERSEY—Essex County Hospital, Overbrook, 1918. PENNSYLVANIA—State Hospital Southeastern District of Pennsylvania, Norristown, 1919. SOUTH CAROLINA—South Carolina State Hospital, Columbia, 1918. UTAH—State Mental Hospital, Provo, 1918. VERMONT—Vermont State Hospital, Waterbury, 1917 and 1918. VIRGINIA—Central State Hospital, Petersburg, 1919; Western State Hospital, Staunton, 1919. WASHINGTON—Eastern State Hospital, Medical Lake, 1917 and 1918; Northern State Hospital, Sedro Woolley, 1917 and 1918. WEST VIRGINIA—Spencer State Hospital, 1917 and 1918; Weston State Hospital, Weston, 1917 and 1918. These institutions may, I think, be looked upon as fairly representative of the hospitals of this country. Based on their official reports an analysis has been made of over seventy thousand consecutive first admissions. There is no disposition on the part of the writer to overestimate the value of statistical studies. Our conclusions should, however, be based as fully as possible on facts rather than on abstract theories or individual observations alone. The social, economic and clinical aspects of mental diseases must all be given adequate consideration if psychiatry is to fulfill its obligation to the community and assume a dignified rôle in the advancement of modern medicine. JAMES V. MAY. Boston, Mass., December 15, 1921. PART I GENERAL CONSIDERATIONS MENTAL DISEASES CHAPTER I THE SOCIAL AND ECONOMIC IMPORTANCE OF MENTAL DISEASES