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 Rational committee for mental hygiene, "lev; York 
 
 /ar #ork and other special activities. 
 
 
 
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 COLLEGE OF 
 
 PHYSICIANS AND SURGEONS 
 
 LIBRARY 
 
WAR WORK 
 
 AND OTHER 
 
 SPECIAL ACTIVITIES 
 
 OF 
 
 The National Committee for Mental Hygiene, Inc. 
 
 FOREWORD BY 
 CLIFFORD WHITTLNGHAM BEERS 
 
 Founder and Secretary 
 
 PRINTED FOR PRIVATE DISTRIBUTION 
 
WAR WORK 
 
 AND OTHER 
 
 SPECIAL ACTIVITIES 
 
 OF 
 
 The National Committee for Mental Hygiene, Inc. 
 
 FOREWORD BY 
 CLIFFORD WHITTINGHAM BEEES 
 
 Founder and Secretary 
 
 PRINTED FOR PRIVATE DISTRIBUTION 
 

CONTENTS 
 
 Foreword .... 
 
 I. War Work .... 
 II. Care and Treatment of the Feeble-minded 
 
 III. Public Care and Treatment of the Insane 
 
 IV. Study of Conditions in a Community 
 
 Y. Studies of the Mental Factors in Crime 
 
 Psychopathic Clinics at Sing Sing Prison and the 
 Children's Court in New York City 
 
 VI. Uniform Statistics on Mental Diseases 
 
 5 
 7 
 11 
 14 
 23 
 24 
 
 26 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/warworkotherspecOOnati 
 
FOREWORD 
 
 In a talk I had with Mrs. Edward H. Harriman a while ago, 
 she said, " When you tell of the need for funds for your work at 
 the meeting held in my home, be sure to say that giving to an 
 efficient and needed organization is not charity, but an invest- 
 ment which pays dividends in the form of benefits to mankind, 
 that is, it is constructive philanthropy, not charity." 
 
 At the recent meeting, which you honored with your pres- 
 ence, I said a great deal about the need for funds for use in 
 developing and maintaining the general work of The National 
 Committee for Mental Hygiene ; and I told of the dividends in 
 the form of ''benefits to mankind" that had been secured 
 through its general work. I was not able, however, because of 
 lack of time, to give deserved emphasis to the extra dividends 
 secured by the organization through its ability to administer 
 special gifts for special purposes which have been donated and 
 will, without doubt, continue to be given from time to time if 
 the National Committee can maintain its machinery of opera- 
 tion on an effective basis. 
 
 Some of the special work carried out under appropriations 
 which are not available for general expenses are : War work 
 in behalf of the soldiers and sailors who are developing nervous 
 or mental disorders while serving the Nation at home or 
 abroad; surveys and special studies relating to the feeble- 
 minded and to the insane ; demonstration studies in the psycho- 
 pathology of crime, such, for instance, as the maintenance and 
 supervision of the mental clinic at Sing Sing Prison, and the 
 clinic connected with the Children's Court in New York City ; 
 and special statistical studies, which are already helping to 
 bring about the long-needed adoption of uniform statistics 
 throughout this country with reference to mental diseases. 
 
 This pamphlet contains a succinct account of these special 
 activities and is based on material written originally by Dr. 
 Thomas W. Salmon, Medical Director of The National Committee 
 for Mental Hygiene, who has been granted leave of absence to 
 serve as a Major in the Medical Officers' Reserve Corps of the 
 
 [5] 
 
United States Army in France, where he is in charge of the 
 care and treatment of the members of the Expeditionary Forces 
 who develop nervous or mental trouble while in the service. 
 The report takes on the added value of an impartial and objec- 
 tive summary because, with the exception of a few paragraphs, 
 it was compiled by Mr. Edwin R. Embree, Secretary of the 
 Rockefeller Foundation, for use in informing the members of 
 that organization of the results accomplished by the National 
 Committee with the appropriations given to it by the Founda- 
 tion for the special purposes mentioned. 
 
 Requests have been made recently to The National Com- 
 mittee for Mental Hygiene to undertake additional special 
 studies with reference to the mental factors in important social 
 problems. Unless adequate financial support is secured, how. 
 ever, for the maintenance of its general work, it will be almost 
 impossible to administer any additional special gifts for special 
 purposes, as no part of these gifts is available for the general 
 overhead expenses of the organization. In a word, the National 
 Committee is in danger of being placed in a position similar to 
 that of many an educational institution which, while receiving 
 gifts for special purposes, oftentimes has to struggle to keep 
 its administrative machinery in effective operation. Contribu- 
 tions and pledges towards the general expenses are, in conse- 
 quence, indispensable to the continued success of The National 
 Committee for Mental Hygiene. 
 
 Clifford W. Beers. 
 
 [6] 
 
I. WAE WORK IK MENTAL HYGIENE 
 
 The war work of the National Committee for Mental Hygiene 
 was inaugurated in April, 1917, as a result of a special study- 
 made by Dr. Thomas W. Salmon, its Medical Director, and by 
 Dr. Pearce Bailey and Dr. Stewart Paton, members of the 
 organization. 
 
 It became possible to inaugurate war work promptly, 
 because of the timely gift of Miss Anne Thomson of Devon, 
 Pennsylvania, who generously contributed $15,000 for this 
 special purpose to the National Committee for Mental Hygiene, 
 shortly after war was declared. Her gift financed this work 
 until October 1, 1917, since which time it has been carried on 
 under a special grant of $25,000 made to the National Commit- 
 tee by the Eockefeller Foundation. 
 
 In May, 1917, Dr. Salmon, under a special appropriation 
 from the Rockefeller Foundation, went to England and made 
 a special study of mental disorders and war neuroses in the 
 British Army. His report and his counsel have been of funda- 
 mental assistance to the Surgeon-General in making plans for the 
 treatment of nervous and mental cases in the American Army. 
 
 When Dr. Salmon went abroad in May, 1917, Dr. Pearce 
 Bailey became Chairman of the War Work Committee of the 
 National Committee, and Dr. Frankwood E. Williams, Associate 
 Medical Director of the organization, became Vice-Chairman. 
 In July, 1917, Dr. Bailey accepted a commission in the Medical 
 Reserve Corps of the Army and became adviser on psychiatry 
 and neurology in the office of the Surgeon-General at Washing- 
 ton, with rank of Major, which has lately been changed to 
 Colonel. Until recently the active war work of the National 
 Committee has been directed by Dr. Frankwood E. Williams, 
 who has now accepted a commission in order to assist Col. 
 Bailey at Washington in work relating to the reconstruction 
 and rehabilitation of soldiers invalided home because suffering 
 from nervous or mental disorders. The war work of the 
 National Committee is expanding rapidly and is now under the 
 direction of Dr. Charles L. Dana, Chairman of its War Work 
 
 Committee. 
 
 [7] 
 
With its Medical Director, Major Salmon, in charge of the 
 neuro-psychiatric work of the American Expeditionary Forces 
 in France; with the first Chairman of its War Work Com- 
 mittee, Col. Bailey, in charge of the Division of Psychiatry and 
 Neurology in the office of the Surgeon-General at Washington ; 
 and with its Associate Medical Director, Dr. Williams, in charge 
 of important duties in the same office at Washington, it would 
 seem that the National Committee for Mental Hygiene is ren- 
 dering very direct aid to the Government in the prosecution of 
 the war. Needless to say, its members find satisfaction in this 
 new proof of its value as a social agency. 
 
 PROBLEM 
 
 One of the striking facts of the war is the large number of 
 soldiers suffering from " shell shock " or war neuroses. The 
 amount of nervous and mental disease is unprecedented. One- 
 seventh of the discharges from the British Army have been 
 from these causes — one-third of the discharges, if the wounded 
 are excluded. 
 
 Specific problems involved in view of this situation are : 
 
 1. Elimination from military service of the mentally 
 and nervously unfit. 
 
 2. Care and treatment of those likely to succumb or 
 actually incapacitated. 
 
 3. Reconstruction and return to the army or to civil 
 life of those nervously or mentally disabled. 
 
 WAR PROGRAM OF THE NATIONAL COMMITTEE 
 FOR MENTAL HYGIENE 
 
 The program of the National Committee for assistance to 
 the United States Government, inaugurated in April, 1917, 
 includes : 
 
 1. Creation of Division of Psychiatry, Neurology and 
 Psychology in Medical Corps, U. S. A. (Col. Pearce Bailey in 
 charge of Division, Major Robert M. Yerkes, head of Psycho- 
 logical Section). 
 
 (a) Obtaining psychiatrists and neurologists to take 
 commissions in work in their specialty in the Medical 
 Corps. Over 300 already in service, others daily accept- 
 
 [8] 
 
ing commissions. Practically all correspondence prelimi- 
 nary to issuance of commissions has been carried on by 
 National Committee. Current scientific literature is 
 regularly supplied to this Corps by the Committee. 
 
 (6) Establishment of special schools in military neuro- 
 psychiatry for reserve officers. 
 
 2. Exclusion from Army of mentally and nervously unfit. 
 
 This is the first attempt of any nation to raise an 
 army free from those unfit nervously and mentally, as 
 well as physically. 
 
 In this the National Committee has given special 
 assistance by 
 
 (a) Studying conditions in Allied armies and making 
 reports which brought about present order of exclusion. 
 
 (6) Preparing examinations which make this exclusion 
 effective. Over 12,000 men have been excluded to date 
 (May 1, 1918) by these examinations. The importance of 
 eliminating those in any way unfit is even greater for 
 American than for European armies because of shipping 
 scarcity. 
 
 3. Care for those likely to succumb or actually incapaci- 
 tated : 
 
 (a) Preparation of plans for special neuro-psychiatric 
 wards which are being attached to military hospitals in 
 cantonments and in the field. 
 
 (&) Selection and standardization of equipment for 
 these wards. 
 
 (c) Eecruiting skilled nursing personnel, both women 
 and men. The names of about 1,400 men, who Lave had 
 experience in civilian institutions in nursing patients with 
 nervous and mental disorders, have been furnished for 
 assignment to such service in the army. The names of 
 several hundred women who have had experience with 
 nervous and mental cases have also been furnished to 
 the Government, a large number of whom are now on duty. 
 
 Plans for care of the Expeditionary Force include preparation 
 for prevention of nervous and mental disorders by presence of 
 neurologists and psychiatrists as observers, who will withdraw 
 temporarily for treatment those showing first signs of break- 
 down. The ultimate " shell shock " is but the end of a long 
 train of shocks and it has been demonstrated that trained 
 
 [9] 
 
observers can in many cases prognose the situation and prevent 
 the expected result. Plans also include early diagnosis and 
 prompt treatment of those who succumb, the return to service 
 of those who, as a result of this prompt and scientific care, 
 recover, and the continued treatment of those seriously ill. 
 
 4. Eeconstruction : 
 
 (a) Recommendation of changes in military regula- 
 tions for discharge and transfer home of men suffering 
 from nervous and mental diseases. Eegulations are 
 now in harmony with best civil practice. 
 
 (6) Obtaining co-operation of States in receiving arid 
 care for men discharged for mental causes. To date 
 (May 1, 1918) forty-four States have agreed to co operate. 
 
 (c) Recruiting skilled occupational and special work- 
 ers for reconstruction of the discharged men. 
 
 The War Work Committee of the National Committee 
 for Mental Hygiene is advising authorities at Columbia 
 University and at Vassar and Smith Colleges, with refer- 
 ence to special occupational therapy courses, where 
 women are to prepare themselves for reconstruction work 
 among soldiers invalided home because of nervous or 
 mental trouble. 
 
 In this pamphlet it is impossible to do more than outline the 
 war work done and planned to date (May, 1918). Those 
 desiring detailed information, however, and news of new 
 developments, may secure it for the asking from the National 
 Committee for Mental Hygiene, 50 Union Square, New York. 
 
 [10] 
 
II.* CARE AND TREATMENT OF THE 
 FEEBLE-MINDED 
 
 Problem : 
 
 The widespread prevalence of f eeble-mindedness has within 
 only recent years been generally recognized as a sonrce of 
 wretchedness to the patient and to his family and as a contrib- 
 uting cause of crime, prostitution, illegitimacy, intemperance 
 and other complex social diseases. 
 
 Method of Attacking the Peoblem : 
 
 While there is much still to learn about feeble mindedness 
 there is at present a sufficient body of indisputable facts to 
 warrant the adoption of an extensive program for dealing with 
 these defectives. There is definite medical and social knowl- 
 edge to determine. 
 
 1. The existence of feeble-mindedness in the vast 
 majority of cases presented for examination. 
 
 2. That the best method of prevention is continued 
 institutional care. 
 
 3. The kinds of institutional care which are best for 
 the individual and for society. 
 
 4. Methods of dealing with feeble-minded children in 
 the school. 
 
 5. Conditions under which the feeble-minded may 
 with comparative safety be permitted to remain in the 
 community. 
 
 Not knowledge, nor general interest, nor a wish to deal with 
 the problem is lacking, bat, in nearly every state, a framework 
 of law and an administrative mechanism based solidly upon it 
 that will make it possible to carry out measures already gener- 
 ally agreed upon. 
 
 ♦Sections II to VI are extracts from a report to the Rockefeller Foundation by 
 its Secretary, on special work carried out by the National Committee for Mental 
 Hygiene under special grants from the Foundation. 
 
 [11] 
 
To overcome this lack the Foundation has provided funds 
 which enable the National Committee for Mental Hygiene to 
 contribute the services of well trained physicians to act, when 
 invited, as surveyors and advisors to State Commissions on 
 Provision for the Feeble-minded, when appointed by Governors 
 or State Legislature. 
 
 Such assistance has been given to Commissions in Kentucky 
 and Maine and is planned in Mississippi and Louisiana. 
 
 KENTUCKY 
 Service rendered 1917 
 
 Cost : About $4,000. 
 
 Invitation : Kentucky Commission Provision for the Feeble- 
 minded. 
 
 Work in charge of : Dr. Thomas W. Haines, who served as 
 Secretary to the Commission while making the study. 
 
 Report: Existence of pauper idiot act, an anachronism 
 dating from 1793, which, by giving a yearly allowance to the 
 parents or custodians of a feeble-minded person, places a 
 premium on the birth or presence in the home of mental 
 defectives. 
 
 People of Kentucky have failed to understand the problem 
 of feeblemindedness because, through lack of dependable data, 
 it had not been defined. 
 
 Dr. Haines's report gives for the first time a fairly complete 
 body of facts in regard to the feeble-minded in the State, 
 including an estimate of their number and location, their part 
 in accentuating and perpetuating other disturbing social 
 problems, and a review of the confusing and costly methods 
 now in use in that State in dealing with these defectives. 
 
 Results : Eecommendations presented to the Legislature by 
 the Commission and enacted into law : 
 
 (a) To abolish the Pauper-Idiot Act. 
 
 (b) To enact new legislation to provide for the identification, 
 special training, custodial care, and supervision in the com- 
 munity, of the feeble-minded. 
 
 (c) To establish additional institutions. 
 
 [12] 
 
MAINE 
 
 Service rendered for one year beginning 
 September, 1917 
 
 Estimated cost : $7,500. 
 
 Invitation : Governor of Maine, who has appointed a State 
 Commission on Provision for the Feeble-minded. 
 
 Work in charge of: Dr. Guy G. Fernald, Psychiatrist at the 
 Massachusetts ^Reformatory at Concord (on leave of absence). 
 
 Report : Work still in process. 
 
 Expected Results : The report when finished will be used by 
 the Commission in its work before the Legislature. 
 
 Work already done has aroused interest in the plan for 
 organizing a State Society for Mental Hygiene. 
 
 [13] 
 
III. PUBLIC CARE AND TREATMENT OE 
 
 THE INSANE 
 
 Problem : 
 
 The care of the insane in different parts of the United 
 States shows the widest variation, and in most places has 
 failed to keep pace with the great advances recently made in 
 the care and treatment of other classes of the sick. 
 
 In many states insane patients receive only custodial 
 care, persons with curable mental diseases often failing 
 to recover on that account. 
 
 In other states many of the insane are in poor farms, 
 jails and prisons; under such conditions neglect and 
 cruelty are common. 
 
 In only a few states are all of the insane cared for in 
 state hospitals, most of which are overcrowded. 
 
 Political appointments are made in some institutions, 
 and in many states entire change in hospital organizations 
 follows changes in the state administration. 
 
 Often recoverable cases are held in jails or other 
 places of detention during the early, critical period of 
 illness, and when at last transferred to hospitals are 
 taken by policemen or county officials, women patients 
 often being in charge of men. 
 
 The internal arrangement of hospitals and the classifi- 
 cation of patients are often inadequate, they are rarely 
 standardized, medical staffs are usually too small, nursing 
 services are crude, attendants are underpaid and insuffi- 
 cient in number ; facilities for instruction of nurses and 
 attendants are often wholly lacking and the use of 
 mechanical restraint is far too common. 
 
 In most states little or no scientific study of patients 
 is made, consequently individual treatment is impossible, 
 there are no standards for proper case records and no 
 opportunities for medical research. Appreciation of the 
 value of trained occupation instructors, social service 
 workers and recreation directors is spreading too slowly. 
 
 Facilities for instruction in psychiatry are meager 
 and postgraduate training in psychiatry is practically 
 unobtainable. 
 
 [14] 
 
Legal requirements vary. In some states patients 
 must be publicly tried by jury in open court and be 
 " convicted " of insanity before admission to a hospital is 
 possible. 
 
 Prevention of mental disorders receives little atten- 
 tion. Much is known concerning their nature and causes 
 which might be employed in preventing them. 
 
 Method of Attacking the Problem: 
 
 Accurate, impartial and scientific surveys of actual condi- 
 tions in given states form the basis upon which effort for 
 improving conditions must rest. 
 
 Such surveys, carried out by the National Committee, with 
 the support of the Eockefeller Foundation, have been com- 
 pleted in California, Colorado, Cook County (Illinois), Con- 
 necticut, Georgia, Louisiana, New York City, Pennsylvania 
 (supplementary), Tennessee and Indiana. Before funds for 
 surveys were appropriated, Dr. Salmon had arranged for and 
 supervised surveys in Pennsylvania, South Carolina and Texas, 
 expenses being met by local organizations or the National 
 Committee. 
 
 In addition to the concrete results, described on following 
 pages, there is also the fundamental accomplishment of accurate 
 reports of conditions as they exist. On the basis of these 
 reports, improvement in conditions may be expected to continue 
 for many years. 
 
 Brief summaries of surveys supported by the Foundation in 
 twelve states and communities follow in the order in which the 
 studies were made. 
 
 SOUTH CAEOLINA 
 
 Surveys made January, 1915 
 
 Cost : Services of Dr. Salmon and some $900 advanced by 
 Governor Manning, later repaid by State grant. 
 
 Invitation : Governor of South Carolina, who was urging 
 upon the Legislature new laws and a liberal appropriation. 
 
 Survey in charge: Dr. Arthur P. Herring, Secretary of 
 Maryland Lunacy Commission, Dr. Salmon supervising. 
 
 [15] 
 
Report : Shockingly low standard of care. 
 
 Results : One month after report State Legislature appro- 
 priated $500,000 for complete remodeling of the only State 
 hospital and for placing its management on a scientific and 
 modern basis, and enacted new and modern statutes regarding 
 the insane. 
 
 Hospital standards transformed from those of 1850 to those 
 of the present day. 
 
 An institution that was a continual source of scandal and 
 disgrace up to three years ago has now become a cause for 
 pride to the people of the State. 
 
 TEXAS 
 
 Survey made November-December, 1915 
 
 Cost : Dr. Salmon's services, and his traveling expenses, 
 amounting to about $500, paid by the National Committee. 
 
 Invitation : Individuals connected with State University 
 and with State Conference of Charities and Corrections. 
 
 Survey in charge : Dr. Salmon. 
 
 Report: Published in Dr. Salmon's notable monograph 
 " The Care of the Insane in a County Poor-Farm." 
 
 Results : Dr. Salmon recommended to local agencies that 
 Texas establish a new State hospital for white patients and 
 remodel for the colored insane an abandoned prison, as this 
 would remove from jails, lock-ups and poor farms the several 
 hundred there confined and suffering hardships. 
 
 The State Legislature in 1917 acted upon Dr. Salmon's plan, 
 and appropriated $400,000 for a new hospital for the white 
 insane to accommodate 1,000, and $200,000 to remodel the aban- 
 doned prison and to erect a new building for the negro insane. 
 
 The State Architect of Texas has consulted the National 
 Committee regarding plans for the new State hosirital. 
 
 TENNESSEE 
 Survey made October-December, 1915 
 
 Cost: $3,071.87. 
 
 Invitation : Tennessee State Board of Control. 
 
 Survey in charge : Dr. Sidney D. Wilgus, who had been 
 superintendent of several large state hospitals, former Chair- 
 
 [16] 
 
man of New York State Board of Alienists. Dr. Salmon super- 
 vised the survey. Supplementary study of almshouses in 1916 
 by Dr. H. S. Hurlburt. 
 
 Report : State care at very low standard. County care of 
 even lower standard. 
 
 Detailed reports of conditions given to public by Tennessee 
 authorities. 
 
 A significant suggestion of the report is the establishment 
 of a psychopathic hospital in connection with the Medical School 
 of Vanderbilt University, to serve as a model not only for 
 Tennessee but for the entire South. 
 
 Results : Tennessee Board of Control has adopted sugges- 
 tions for improvement in state institutions which are to be put 
 into effect as rapidly as funds permit. 
 
 Agitation to have legislature change laws regulating com- 
 mitment. 
 
 State Society for Mental Hygiene — Chancellor Kirkland of 
 Vanderbilt, President — established as direct result of survey. 
 
 PENNSYLVANIA 
 
 Survey made in 1914-1915, Supplementary Survey 
 in Winter, 1916-1917 
 
 Cost : Original survey, Dr. Salmon's services and $5,000, 
 paid by Pennsylvania Public Charities Association; supple- 
 mentary survey, $1,421.51, paid by Foundation. 
 
 Invitation : Committee on Mental Hygiene of Pennsylvania 
 Public Charities Association, sanctioned by Committee on 
 Lunacy of State Board of Charities. 
 
 Original Survey in charge : Dr. C. Floyd Haviland, Dr. Sal- 
 mon supervising ; supplementary survey in charge Dr. William 
 Sandy, an experienced psychiatrist. 
 
 Report : Deficiencies of the mixed system of county and 
 state care. 
 
 Results : Public Charities Association provided with facts 
 for use in its campaign for legislation looking toward complete 
 state care for insane and correction of existing defects. 
 
 A not insignificant result of the survey is training and vision 
 given Dr. Haviland, who was in charge with Dr. Salmon of 
 original survey and who now, as Superintendent of the Con- 
 necticut State Hospital in Connecticut, is developing that 
 institution and rendering most sympathetic help in obtaining 
 results from Connecticut survey. 
 
 [17] 
 
CALIFOBNIA 
 Survey made February-May, 1916 
 
 Cost: About $2,800. 
 
 Invitation : State Board of Charities and State Lunacy 
 Commission. 
 
 Survey in charge : Dr. George H. Kirby, then Clinical 
 Director, Manhattan State Hospital, now Director of New York 
 State Psychiatric Institute. Dr. Salmon supervised the survey. 
 
 Report : Standards of custodial care good with some excep- 
 tions. Hospitals badly overcrowded. Small number of physi- 
 cians, psychiatric work backward. Poor system of temporary 
 care in jails and other places in charge of sheriffs. 
 
 Results : Introduction of bill into Legislature providing for 
 establishment of psychopathic hospital in San Francisco (not 
 passed but to be fought for again.) 
 
 Steps for reduction of overcrowding in State institutions, 
 providing additional accommodations at five of the six State 
 institutions, liberal allowance for building at new State hospital. 
 
 Appointment of well-trained psychiatrists as Clinical Direct- 
 ors in two State hospitals, reorganization of medical work, 
 larger number of physicians provided. 
 
 Adoption of modern classification of metal diseases. 
 
 CONNECTICUT 
 Survey made July-August, 1916 
 
 Cost: $1,449.12. 
 
 Invitation : Connecticut State Board of Charities. 
 
 Survey in charge : Dr. Sidney D. Wilgus, Dr. Salmon 
 supervising. 
 
 Report : Conditions which have been remedied in part as 
 outlined below. 
 
 Results : Help to State officials and Connecticut Society for 
 Mental Hygiene, in formulating amendments to existing statutes 
 governing commitment and care of insane which were passed 
 by General Assembly of 1917. 
 
 Further results, including complete state care, likely to 
 follow use of report. 
 
 [18] 
 
LOUISIANA 
 Survey made in 1916 
 
 Cost: $1,534.72. 
 
 Invitation : Louisiana Society for Mental Hygiene and State 
 Board of Prisons and Asylums. 
 
 Survey in charge : Dr. Arthur P. Herring, Secretary of the 
 Maryland State Lunacy Commission, Dr. Salmon supervising. 
 
 Report: As general throughout South, standards of care 
 for insane very low. 
 
 Chief defects lack of facilities for study and treatment of 
 early and acute cases of mental disorder, lack of institution for 
 feebleminded and epileptic, absence of central supervision of 
 institutions, and existence of commitment law tending to ex- 
 clude patients from hospitals rather than to facilitate their 
 admission. 
 
 Eecommendations include establishment of state psycho- 
 pathic hospital in connection with the Medical Department of 
 Tulane University. 
 
 Results : It is believed that data secured will lead to correc- 
 tive legislation. 
 
 GEOBGIA 
 
 Survey made in 1916 
 
 Cost: $1,523.92. 
 
 Invitation: Governor of State and Board of Managers of 
 State hospital. 
 
 Survey in charge : Dr. Eichard H. Hutchings, a native of 
 Georgia, for several years Superintendent of St. Lawrence State 
 Hospital, Ogdensburg, N. Y. Dr. Salmon supervised the survey. 
 
 Report: One only State hospital, sheltering more than 
 4,200 patients, including insane, inebriate, feeble-minded, of 
 both sexes and races. This had grown up without plans except 
 to add buildings of cheapest construction with funds saved 
 from allowance for support. 
 
 Becommendation for provision for another institution for 
 insane near Atlanta and an institution for feeble-minded. 
 
 Results: Written report, submitting plans for reorganiza- 
 tion requested by Trustees of State hospital, was approved and 
 will serve as basis for future improvements. 
 
 Movement is under way to organize State Society for Mental 
 Hygiene. 
 
 [19] 
 
NEW YOEK CITY 
 Survey made September- October, 1916 
 
 Cost: $1,689.00. 
 
 Invitation : Committee on Mental Defectives appointed by 
 Mayor Mitchel to suggest changes in New York City practice. 
 
 Survey in charge : Dr. George H. Kirby, Dr. Salmon super- 
 vising. 
 
 Report : Conditions which have been for the most part 
 remedied as noted below. 
 
 Results : The changes, noted below, made by the Mitchel 
 city administration, were based on facts, conditions and recom- 
 mendations brought out in the report : 
 
 (a) Psychopathic clinic established in the Depart- 
 ment of Correction for the mental examination of all new 
 prisoners with funds provided by the city ; a visiting 
 board of specialists in nervous and mental diseases and 
 drug addiction appointed. 
 
 (b) Funds allowed for the reconstruction of a build- 
 ing to be used as a clearing house which will provide 
 permanently for a psychiatric clinic in the Department 
 of Correction. 
 
 (c) Clinic for atypical children removed to Randall's 
 Island, providing much better facilities for the examina- 
 tion of patients, additional examining clinics in Bronx 
 and Queens Counties. 
 
 (d) Psychopathic ward at Staten Island farm colony 
 reorganized and put under medical supervision. 
 
 (e) Bellevue Psychopathic Ward enlarged and moved 
 into new quarters. The old alcoholic and prison wards 
 abandoned and new accommodation provided in other 
 hospital buildings. As a result of these changes, the 
 number of beds in the Psychopathic Department nearly 
 doubled. 
 
 (/) Psychopathic hospital, which seemed likely to be 
 recommended by the last city administration, has been 
 taken up by the State Hospital Development Commission, 
 who recommend the establishment of a hospital for 200 
 beds in New York City. Dr. Salmon and Dr. Kirby 
 appointed on the Medical Advisory Board of the State 
 
 [20] 
 
Hospital Development Commission. Governor Whitman 
 has recommended appropriation of $10,000.00 for plans 
 and studies for a Psychopathic Hospital. 
 
 (g) Eeorganization and direction of the work of the 
 Psychopathic Laboratory of the Police Department under 
 the direction of Dr. Salmon, Dr. Kirby and Dr. Gregory. 
 
 COLOEADO 
 
 Survey made December, 1916-January, 1917 
 
 Cost: $1,497.80. 
 
 Invitation : Survey Committee of State Affairs. 
 
 Survey in charge : Dr. Samuel W. Hamilton, formerly in 
 New York State Hospital service, Dr. Salmon supervising. 
 
 Report : Good general conditions. No almshouse care. De- 
 fects in the single State institution easily dealt with. 
 
 A State care act had just been passed upon popular 
 initiative. 
 
 Eecommendations include establishment of psychopathic 
 hospital in Denver in connection with the Medical Department 
 of the University of Colorado. 
 
 Results : Crystallization of feeling already alive for proper 
 care of insane. 
 
 Correction of minor defects in the State institution basis for 
 continued advance. 
 
 COOK COUNTY, ILLINOIS 
 Survey made in 1917 
 Cost: $6,336.20. 
 
 Invitation : City Club of Chicago and Illinois Society for 
 Mental Hygiene. 
 
 Survey in charge : Dr. Herman Adler, then of the staff of 
 the Boston Psychopathic Hospital, now Director of Juvenile 
 Psychopathic Institute, Chicago. 
 
 Report : Now being prepared, includes statement of condi- 
 tions already largely remedied as noted below. 
 
 [21] 
 
Results : The following improvements in Chicago and Cook 
 County were made on basis of facts, conditions and recom- 
 mendations brought out by this report : 
 
 (a) Eeorganization of Cook County Psychopathic 
 Hospital, putting it on a modern basis ; 
 
 (b) Kaising standards of care and treatment in hos- 
 pital and systematizing work in general ; 
 
 (c) Establishment of special mental clinic for chil- 
 dren; 
 
 (d) Stimulation of local interest in mental defect 
 and psychopathic conditions in relation to social 
 problems; and coordination of agencies working in this 
 field. 
 
 (e) An important, indirect influence has been the 
 reorganization of the administration of the State hospitals 
 and the criminological service, so that the penal institu- 
 tions and State hospitals are now under direct scientifical 
 supervision. 
 
 INDIANA 
 Survey made October-December, 1917 
 Cost : About $2,500. 
 
 Invitation: State Board of Charities and Governor of 
 Indiana. 
 
 Survey in charge : Dr. Sidney D. Wilgus, Dr. Salmon super- 
 vising. 
 
 Report : Now being prepared. 
 
 Results : Data is desired by State Board of Charities and 
 the Indiana Society for Mental Hygiene to secure needed legis- 
 lation and increased institutional facilities. 
 
 [22 1 
 
IV. STUDY OE CONDITIONS IN A 
 COMMUNITY 
 
 Problem : 
 
 The prevalence and significance of mental diseases and 
 deficiencies in given communities must be determined before 
 adequate provision to meet conditions can be made. 
 
 States or counties attempting to make adequate provisions 
 often do so either with no survey of conditions or with one 
 made without completeness or by faulty methods. 
 
 Method op Attacking the Problem: 
 
 One method of assistance is to make a scientific, intensive 
 study of a given community. 
 
 Such a study — in Nassau County, New York — was made by 
 the National Committee with Foundation support. 
 
 NASSAU COUNTY, N. Y. 
 DEMONSTRATION INTENSIVE SUEVEY 
 
 Survey made during four months in 1916 
 
 Cost: $10,000. 
 
 Survey carried out by staff of six physicians and seven social 
 workers, under supervision of advisory board of National Com- 
 mittee for Mental Hygiene and Dr. Salmon. 
 
 Report: Information obtained regarding 4,368 persons in 
 certain areas selected for intensive study; 625 found to be 
 feeble-minded, retarded, or epileptic, 356 insane. 
 
 Results : Facts and conditions accurately reported which 
 are of value in considering problems of other communities. 
 
 Standards fixed for similar surveys elsewhere. Most 
 thorough study ever made. 
 
 [28] 
 
Y. DEMONSTRATION STUDIES IN THE 
 PSYCHO-PATHOLOGY OE CRIME 
 
 Problem : 
 
 Approximately 500,000 persons, according to the latest 
 United States Census Eeport, annually pass through the cor- 
 rectional and penal institutions of this country to resume their 
 lives, for better or worse, in the community. Of 600 admissions 
 to Sing Sing Prison during a recent period of nine months 
 more than two-thirds had already served one or more terms in 
 prisons and reformatories. 
 
 Institutional restraint has proved its failure to prevent 
 relapse into criminal courses. 
 
 Method of Attacking the Problem: 
 
 It is becoming evident that before correction can be at all 
 efficacious there must be dependable knowledge of the individual 
 weakness and needs of the offender. Without such knowledge 
 correction and reform, blindly applied to assorted masses of 
 prisoners, serve only too frequently to give permanence to 
 criminal tendencies rather than to develop good citizens by 
 correcting causes of misconduct and tendencies to offend. 
 
 The Foundation is supporting demonstration studies of the 
 underlying causes which lead to crime by psychiatric clinics at 
 Sing Sing Prison and at the Children's Court in New York City. 
 
 PSYCHIATRIC CLINIC AT SING SING PRISON 
 Conducted 1916 to 1918 
 
 Cost: From July 1, 1916, through 1918, $25,000. (It is 
 expected that the State of New York will soon assume support 
 of the Clinic). 
 
 Invitation : Superintendent of Prisons. 
 
 WorTc in charge : Dr. Bernard Glueck, supervised by an 
 Advisory Board appointed by the National Committee. 
 
 [24] 
 
Report : Intensive study to date of over 600 admissions to 
 Sing Sing. 
 
 Results : Additional light on psycho-pathology of crime ; 
 importance of study of individual rather than the crime — data 
 shows that a very high percentage of prisoners are defective or 
 disordered mentally. 
 
 Direct stimulus to establishment of a reception prison for 
 New York State, which has been approved and is under con- 
 struction, in which criminals may be sorted, classified and sent 
 to prisons or hospitals where they will receive best curative 
 treatment or permanent detention from further evil to society. 
 
 Plan furthered for providing institution for mentally defec- 
 tive (feeble-minded). 
 
 Other states already influenced in prison policy by results 
 of Sing Sing clinic. 
 
 PSYCHIATEIC CLINIC IN CHILDREN'S COURT 
 IN NEW YOEK CITY 
 
 Conducted 1917-1918 
 
 Cost: $8,920 from July 1, 19 L7. to end 1918, to provide 
 psychiatric service in addition to that furnished by city for 
 Children's Court in New York City and branch in Brooklyn. 
 
 Invitation : Judge Hoyt of Children's Court. 
 
 Staff : Consists of medical director, two assistant psychiat- 
 ists, one psychologist, one social worker on full time, two social 
 workers on half time and two stenographers. 
 
 Work of the Clinic : Psychiatric examination of children at 
 designation of the Judge, study of home conditions, family and 
 environment. Work done in close co-operation with j)robation 
 officer of court. 
 
 Results : Cases are treated by Judge in light of full facts, 
 with a view to protecting community and to curing rather than 
 simply punishing the young offender. 
 
 Data collected by these studies may well serve as basis for 
 valuable scientific research. 
 
 [35] 
 
VI. UNIFOEM STATISTICS 
 
 Problem : 
 
 Necessity for uniform statistical information concerning 
 mental diseases, if this information is to be of any value. At 
 present widest variety of nomenclature used in different states 
 and different institutions. Work of United States Census 
 Bureau wholly incomplete. No other agency has attempted to 
 make any statistical compilation of national scope. For 
 adequate progress in treatment there must be general 
 knowledge of 
 
 1. Forms of mental disease occurring in all parts of 
 country. 
 
 2. Movement of patients in every hospital of insane. 
 
 3. Cost of maintenance of patients. 
 
 4. Personal and family history of patients. 
 
 Method of Attacking the Problem: 
 
 The Committee on Statistics of the American Medico- 
 Psychological Association, Dr. Salmon, Chairman, has made 
 definite recommendations concerning establishment of uniform 
 statistics. The Rockefeller Foundation has agreed to support 
 for 1918 the work of the National Committee in bringing such 
 uniform statistics into existence and having them adopted 
 throughout the country. It is estimated that it will require five 
 years to make this work effective, and it is tacitly understood 
 that the Foundation will finance this activity for the period 
 mentioned. Several states and the Surgeon-General of the 
 United States Army have already agreed to adopt the proposed 
 uniform statistics. 
 
 [26] 
 
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