i ie) i j e STA TE : u NIVE £7 fae REPORT ON STATE INSTITUTIONS PREPARED BY OHIO BOARD of ADMINISTRATION COLUMBUS, OHIO SEPTEMBER |}, 1921 mere ioe 4 tr a + P< - 3% REPORT ON Sle INS TLUTIONS PREPARED BY OHIO BOARD of ADMINISTRATION COLUMBUS, OHIO E. C. SHAW, President, E. M. BAER, M: D., I. B. Harris, M. D., D. C. SOWERS, Secretary. Ser eerie), 1921 baOo. Bs A FOREWORD “The only real wealth is people’ The conservation of human life is the soundest economics. To make productive citizens out of the defective, the delinquent and the dependent is not only good morality, but good business. The tragedy of blighted lives has its own appeal to the sentiments of normal men and women. The staggering material loss to Ohio in its unfortunates—25,000 of them in the care of its public institutions—must appeal to the common sense. Today Ohio is little more than HOUSING and FEEDING its delinquents and dependents. It has hardly scratched the surface of vital CURATIVE and PREVENTIVE work. The purpose of this report is to set forth in some measure the tremendous opportunity afforded by Ohio State institutions to provide means for preventing the increase or the inde finite continuance of the human waste which is now a tragedy, and of reclaiming and restoring to productive citizenship the unfor- tunate. STATE INSTITUTIONS ONDER DAE “CONTROL: OF “PHE OHIO BOARD OF ADMINISTRATION HOSPITALS FOR THE INSANE— 1. Athens State Hospital—Opened at Athens 1874 for treatment of in- sane. This institution serves twenty counties in southeastern Ohio. Average daily population, 1921, was 1,288. 2. Cleveland State Hospital—Opened 1855. Serves Cuyahoga, Lake and Geauga counties. Population, 1,771. * 3. Columbus State Hospital—Opened 1838. Serves a group of central counties. Population, 1,934. 4. Dayton State Hospital—Opened 1855. Serves a group of southwest- ern counties. Population, 1,204. 5. Massillon State Hospital—Opened 1898. Serves seventeen north- eastern counties. Population, 1,854. 6. Toledo State Hospital—Opened 1888. Serves a group of northwest- ern counties. Population, 1,874. 7. Longview Hospital—Located at Cincinnati, Hamilton County. Built by Hamilton County and opened 1861. Still owned by Hamilton County but maintained by state. Serves Hamilton County only. Population, 1,502. 8. Lima State Hospital—Opened 1915 for the care of the criminal in- sane. Receives insane criminals from the reformatories and peni- tentiary and dangerous insane persons from other state hospitals. Population, 868. OHIO HOSPITAL FOR EPILEPTICS—Established at Gallipolis 1893 for the care of epileptics. Serves the whole state. First institution of its kind in the United States. Population, 1,568. INSTITUTION FOR THE FEEBLE-MINDED—FEstablished in Columbus in 1857 for the care and training of feeble-minded persons of any age. Cus- todial farm located at Orient, about 16 miles south of Columbus; purchasea in 1898. Combined population of both, 2,501. STATE SCHOOL FOR THE DEAF—Opened at Columbus in 1829 to educate the deaf children of the state. Pupils are admitted between the ages of 7 and 13. Population, 491. STATE SCHOOL FOR THE BLIND—Located at Columbus. Opened in 1837, to educate the blind children of the state. First publicly supported blind school in America. Pupils are admitted between the ages of 6 and 21. Population, 242. OHIO STATE SANATORIUM—Located at Mt. Vernon. Opened in 1909 for the study and treatment of incipient pulmonary tuberculosis and the dis- semination of knowledge concerning its prevention and treatment. Popu- lation, 165. OHIO SOLDIERS’ AND SAILORS’ HOME—Located at Sandusky. Opened in 1888, as a home for the old soldiers, sailors and marines who have received honorable discharge. Population, 734. MADISON HOME—Located at Madison, Lake County. Established to serve as a home for the wives, widows and dependent mothers of soldiers, sailors and marines residents of Ohio. Population, 40. BOYS’ INDUSTRIAL SCHOOL—Located near Lancaster. Opened in 1858 to receive boys 10 to 17 years of age convicted of crime or offenses, and who, in the discretion of the court, would profit by the training and discipline afforded at this school. Population, 1,198. GIRLS’ INDUSTRIAL SCHOOL—Located near Delaware. Established in 1869 for the instruction, employment and reformation of evil disposed, in- corrigible and vicious girls. Any girl between ages of 9 and 18, brought before a court of criminal jurisdiction, may, in the judgment of the court, be committed to this school. Population, 430. OHIO PENITENTIARY—Located at Columbus. Opened in 1834. Average daily population, 1,694. A new penitentiary is under construction at New London, about thirty-five miles distant from Columbus. State Brick Plant—-Located near Junction City, Perry County. Plant was purchased in 1919 for the purpose of providing employment in the manufacture of brick for convicts from the Ohio Penitentiary. Pop- ulation, 98. OHIO STATE REFORMATORY—Located at Mansfield. Opened in 1896 to receive reformable male criminals between ages of 16 and 30. Popula- tion, 1,612. STATE REFORMATORY FOR WOMEN—Located at Marysville, Union County. Opened in 1916 for detention of all females over 16 years of age convicted of felony, misdemeanor or delinquency. Population, 171. BUREAU OF JUVENILE RESEARCH—HEstablished in Columbus, to make mental, physical and other examinations of children committed by the courts to the guardianship of the Ohio Board of Administration. LETTER OF TRANSMITTAL TO THE GOVERNOR Columbus, Ohio, September 1, 1921. HONORABLE Harry L. Davis, Governor of Ohio. SIR: In compliance with your request that this Board should study the needs of the various institutions under its control during its brief tenure of office, we have the honor to submit herewith the report of our observations and recommendations. TIME TO PRACTICE ECONOMY BUT ECONOMY IN TERMS OF PRODUCT The state institutions should, at all times, be operated with the strictest economy. Especially at this time, during reconstruction, when the business of the country is called upon to save and conserve to the utmost, it is imperative that the state should set the example. But we must not practice false economy. We should recognize that true economy must be measured in terms of product. If the personnel of our institutions are not selected and held in terms of their fitness because we are unwilling to pay adequate salary or wage, we are not practicing sound economy; particularly if by a comparatively small increase in expenditure measured in terms of capital invested, we are able to turn out the type of product for which these institutions are created. We secured in our budget appropriation a special fund of $320,000 per annum for the ex- press purpose of providing money for improving the character of personal service throughout all the institutions. It was distinctly understood that this sum would not be distributed pro rata among the officers and employees re- gardless of efficiency, but would be used only for rewarding the efficient, build- ing up the organization and increasing the quality of service rendered. We believe that when the sound business principle back of this plan is thoroughly appreciated, the funds will be made readily available to the Director of Public Welfare for this purpose by those who now have contro] over them. EACH INSTITUTION VISITED BY BOARD Each state institution was visited. State officers, county officers, super- intendents of institutions and private citizens and organizations were con- sulted. A FUTURE POLICY SUGGESTED In the formulation of our conclusions, we have had in mind not only the needs and requirements for the next two years, but the broad lines of general policy which should be followed in the future. We are impressed with the splendid opportunities which lie before the T)epartment of Public Welfare to serve more adequately the people of the state and to do this in an economical manner. NEW BUILDINGS NEEDED It seems apparent to us that the following additional housing facilities are needed: a new feeble-minded institution; additional buildings at the present feeble-minded institutions; a new insane hospital; additional buildings at the hospital for epileptics; barracks for reformatory boys at the Soldiers’ and Sailors’ Home; buildings to relieve the congested condition at Marysville and at the Boys’ Industrial School; and additional buildings at the penitentiary and reformatory. BUILDINGS SHOULD BE SIMPLE, NOT MONUMENTAL ” We believe that enormous sums can be saved by the state by the adoption of the policy that in the future no massive, monumental types of buildings shall be erected and that all future state institutions shall be simple, attractive and sanitary, and be constructed of inexpensive materials. CORRECTIVE, REMEDIAL AND PREVENTIVE TREATMENT SHOULD BE DEVELOPED Our study has convinced us that the state is not spending a sufficient proportion of its resources upon corrective, remedial and preventive work. The state is spending annually millions of dollars to house and care for an ever-increasing number of insane, feeble-minded, epileptic and criminal per- sons, and only a few thousand dollars to study the nature and cause of these conditions and the proper treatment for these unfortunate persons. The one agency which the state has developed so far to do real constructive preventive work, viz., the Bureau of Juvenile Research, has been inadequately supported, both financially and in other ways. We recommend an expansion of the activities of this Bureau so that the state may be guided by scientific knowl- edge in dealing with its human problems. Intelligent treatment of the human beings who come under the care and control of the state must be based upon an understanding of the physical and mental condition and personality of each individual. Such analysis this Bureau is equipped to make. When this is done, the classification, segregation and treatment can be adapted to the peculiar needs of each person. THE FIRST STEP SHOULD BE EXAMINATION OF ALL JUVENILE OFFENDERS We have recommended that the State take only the first step at this time by making complete mental and physical examinations of every juvenile offender committed to a state institution. Ultimately, we believe such ex- amination should be made of every juvenile offender appearing before the juvenile court and still more fundamental will be the need that this examina- tion be given to every school child who is three or more years retarded and is not making satisfactory adjustment to school environment. ULTIMATELY ADULT OFFENDERS SHOULD BE EXAMINED We also foresee the need for this type of examination for every adult offender committed to a state penal institution, and even more valuable will be such examination of all adults appearing before the criminal courts where mental deficiency is suspected. We believe that the greatest success in pro- bation and parole work will not be possible until these fundamental factors are known and determined in each individual case and the decision as to time and conditions of probation and parole made with reference to these facts. PREVENTIVE WORK IN CASES OF INSANITY WOULD RESULT IN BOTH CURES AND ECONOMY We believe our insane hospitals are not meeting the needs of the times. With few exceptions, the medical work is woefully inadequate, and research and investigation is almost entirely neglected. Preventive work has hardly been started. The prompt recognition and correction of medical and surgical diseases, co-existent with disordered mental states, will undoubtedly re- sult in cures in many early cases and improvement in others sufficient to per- mit of their early discharge from the institutions. Money effectively spent to accomplish this result will be a good investment, because the state will reap the benefit of restoring these persons to economic independence, while at the Same time, maintenance cost and capital outlay for additional buildings will be lessened. The cost of maintaining the state hospitals in 1920 was over three million dollars. There were over two thousand eight hundred ninety- five insane patients admitted for the first time in 1920; the next year three thousand more and so on with such succeeding year. These people are our relations, our friends, our neighbors. Their number is ever increasing and will continue to increase unless we begin definite efforts to stem the tide. MENTAL CLINICS AND SOCIAL CONTROL Preventive work can be done by establishing mental clinics where persons in the early stages of insanity can receive advice and treatment; by employ- ing field workers who will discover incipient cases and who will supervise 7 patients after they leave the hospitals. This latter work will enable many cases to be discharged earlier and thus save bed space and maintenance cost. We are recommending that this increased service to the people of the state be started at three or four of the insane hospitals by organizing consulting staffs, conducting mental clinics and by establishing social service follow-up work. This, we believe, is a policy economically sound, as well as desirable for humanitarian reasons. ALL SOCIETY AFFECTED BY PROBLEM OF MENTAL DEFECTIVE The problem of the mental defective dovetails with every other social and human welfare problem. It concerns the home, the schools, the church, the industries, the courts and democracy itself. It is from this group that our juvenile delinquents, our prostitutes (60%), our criminals (15 to 40%, our paupers (15 to 25%), are recruited. A LARGE FEEBLE-MINDED POPULATION IS A MENACE TO SOCIETY It is estimated that there are twenty-one thousand feeble-minded persons in the state, of which number ten thousand need institutional care. The state has provisions for only three thousand. It will be vastly cheaper to train, supervise and institutionalize these persons and prevent their becoming crim- inals and committing depredations upon society than it will be to permit them to become a menace to society by committing crimes, spreading venereal diseases and breeding defective children. For these reasons, we are recom- - mending the immediate enlargement of the Orient Custodial Farm to bring the capacity up to two thousand and the construction of another institution for the feeble-minded in the northeastern part of the state where the popula- tion is increasing most rapidly. OUR PENAL INSTITUTIONS OVERCROWDED We find that all the penal institutions are seriously overcrowded. At the penitentiary about 450 prisoners are confined in the idle house during the day time. IDLE HOUSE AS SUCH SHOULD BE ELIMINATED AS SOON AS POSSIBLE We believe that all those physically able now occupying the Idle House should be put to work and the Idle House as such should be abolished. Ulti- mately it should be used only for those who are physically and mentaly un- able to perform manual work. For present occupancy, it should be put into sanitary and habitable condition without delay and be so maintained. All insane prisoners should be sent to Lima. Su; THE PHYSICALLY ABLE SHOULD BE KEPT AT WORK We strongly recommend that all persons who are physically able, should be kept employed at some productive work, and that efforts should be made to accomplish this at the least cost to the state. We believe prisoners can be used to a large extent in the construction of public work and should be used wherever possible. All tillable land at the prison farm should be brought under cultivation as rapidly as possible, employing as many prisoners as can be profitably employed. We believe that additional industries should be de- veloped within the institutions. To us, the argument seems absurd that the employment of three or four thousand persons in various industries and occu- pations in our penal institutions will have any appreciable effect upon the stability of any industry in the state. MORE MEN SHOULD BE EMPLOYED AT THE BRICK PLANT The management of the brick plant should be reorganized. As soon as this results in an economical operation of the plant, it should be enlarged in accordance with the appropriation granted, so as to employ two or three times the number of prisoners now employed. WOMEN’S REFORMATORY IS BADLY OVERCROWDED This institution is now required to house twice the number of inmates for which it was originally built. Additional buildings are needed to permit the segregation of inmates. There is urgent need for workshop facilities which will give ample employment to all the inmates. PENAL INSTITUTIONS SHOULD PROVIDE FOR SEGREGATION We believe that before proceeding with the construction of the new penitentiary, a study should be made of the present penal population to the end that the buildings contemplated may be constructed in a simple, sub- stantial manner and in a manner which will best serve the purposes for which they are erected. We believe that only a certain proportion of the prison population requires the costly cell-block type of construction. Another por- tion of the population can be adequately and safely housed in a different type of building which can be erected at less cost. ° NO ATTEMPT NOW MADE TO DETERMINE MENTAL DEFICIENCIES OR DISEASES OF PRISONERS In none of the penal institutions is any scientific attempt being made to 9 study and understand the prisoner as a sick or abnormal being and to corre- late mental and physical diseases with the nature and cause of the crime. Authentic studies show that from fifteen to forty per cent of our penal popu- lation are feeble-minded, yet this fact is not applied or recognized in our pres- ent criminal procedure. Thorough physical, mental and personality examinations are not made as a matter of routine procedure in our criminal courts or in our penal institu- tions. We believe it would be true economy to do this, and ultimately that the Bureau of Juvenile Research should undertake this work. GREATER COORDINATION AMONG DEPARTMENTS WOULD PREVENT CRIME AND INSANITY We have been impressed with the inter-relationship which exists among the various social problems with which the Department of Public Welfare has to deal and consequently the need for a closer coordination of its several de- partments and greater cooperation between it and other state departments, particularly the Department of Health. : RELATION BETWEEN ILL HEALTH AND INSANITY Much mental disease is said to be the result of general physical illness and its prevention depends upon the success with which the general health of the population is maintained. A large part of insanity, in all probability, results from physical ill health, infection, malnutrition, and intoxication, alcoholic or drug, and all of these causes are preventable. The problem of the preven- tion of paresis, which is responsible for about one-fifth of all the male ad- missions to the hospitals for the insane, is a part of a larger problem of the prevention of syphilis. RELATION BETWEEN MENTAL DEFICIENCY AND INSANITY The problem of mental deficiency is closely linked up with the problem of insanity and criminality. A large group of admissions to our insane hos- pitals is due to defective mental development. A large proportion of the boys and girls annually committed to our in- dustrial schools and of the men and women committed to our penal institu- tions are feeble-minded. Estimates range from fifteen to forty per cent. RELATION OF DIVISION OF CHARITIES TO DEPARTMENT OF PUBLIC WELFARE We believe that it should be the function of the division of charities to gather all available facts regarding personal and family history and environ- mental conditions with respect to every insane and feeble-minded or criminal person who comes under the supervision of the state. 10 These facts should be used in determining methods of treatment and care and in reaching conclusions regarding the return of the person to the com- munity. The division should also be responsible for the supervision, in their homes and in the community, of all persons who leave state institutions. STATE SCHOOLS SHOULD TRAIN WORKERS TO CARE FOR DEFECTIVES The state university and normal schools can perform a valuable service by training teachers, students, social workers and prospective physicians in preventive medicine, psychiatry, mental hygiene and in the methods of deal- ing with the mentally defective and sub-normal. THREE COMMISSIONS RECOMMENDED (a)—To study penal institutions; (b)—To study the problem of the blind; (c)—To consider purchase of Longview Hospital. We have recommended the appointment of three commissions to study and report upon several problems which we feel need more investigation than we were able to give during our brief tenure of office. The Director of Pub- lic Welfare should be ex-officio a member of these commissions. (a)—A commission to study the whole penal problem and particularly to revise the plans for the new penitentiary, based upon an analysis of the present penal population and the best practices in other states. (b)—-A commission to study the blind problem to de- termine the most fruitful avenues of employment to the blind and to outline the scope and activities of the state school for the blind. (c)—A commission to determine whether the state should purchase Longview Hospital, and upon what basis. These special ‘commissions should have no administrative duties and should cease to function upon the completion of their reports. The reason they are recommended is because it seems unreasonable to expect that the Director of Public Welfare, with all his administrative duties, would have time to make such studies. Respectfully submitted, E. C. SHaw, President, E. M. Barner, M. D., I. B. Harris, M. D. D. C. Sowers, Secretary. na MAIN PRINCIPLES EMPHASIZED Throughout this report certain principles are emphasized: 1—The necessity for economy, but economy in terms of product. 2—The cooperation of the work of the institutions with other departments, such as the State Department of Health. 3—The expansion of control, so that the intelligence and skill centered at the institutions may reach to defectives throughout society. 4—The expansion, by such control, of preventive work, so that the population of institutions may be decreased. 5—The classification of inmates of the institutions, to secure segregation of types, and to assist the curable. 6—The improvement of facilities for curables and the enlarge- ment of a capable personal staff to secure above results. 7—The improvement of the material fabrics. 8—Economy of operation. 9—Provisions for the future expansion of the work in accord with the best methods now available. 12 SUMARY OF REPORT ON STATE INSTITUTIONS GENERAL— The state institutions are, on the whole, attractive, well built institu- tions appropriately designed for their functions. There are, however, sev- eral exceptions to this general statement, such as the cottages, and particu- larly the central dining room, at the Massillon State Hospital, the central din- ing room at Orient and the plans for the new penitentiary at London. We regard these elaborate and ornate monuments as extravagances, in particu- larly poor taste, since they. merely accenuate the state of misery and wretch- edness of the people they house. We believe these mistakes should be avoided in the future and an effort should be made to design simple, attract- ive, low-priced buildings which would possess all the essential elements of utility and yet be without offense to good taste. The state institutions are inadequate from the standpoint of meeting the needs of the state in the matter of housing its wards. Five of the insane hospitals—Cleveland, Columbus, Longview, Massillon and Toledo—are filled to capacity. Cleveland is woefully overcrowded and at Longview 240 inmates are sleeping on the floors. As a result, a large num- ber of cases in urgent need of hospitalization are prevented from receiving it. In order to receive new cases, many patients are sent out still unrecovered. The facilities at the institution for feeble-minded are adequate for less than one-third of the total number needing institutional care. There is serious over- crowding and double celling at the penitentiary, Men’s Reformatory and Women’s Reformatory. The budget for the state institutions for the next two years, makes pro- vision for additional housing facilities; it provides for the purchase of land for a new insane hospital and for a new institution for the feeble-minded, as well as for buildings and equipment at other institutions. One of the most serious shortcomings of our state institutions was found to be the inadequacy of the medical situation; the ex- amination, care and treatment of patients is inadequate and there is an almost total lack of scientific research and preventive work. This has resulted in our state hospitals remaining comfortable cus- todial institutions for the mental cases, but has prevented them from becom- ing modern psychopathic hospitals where intensive efforts may be made to improve and cure these cases. Furthermore, it has prevented in the penal institutions the application of modern methods dependent upon the segrega- tion and treatment of mental and physical disease in its relation to crime. 13 We have made provision in the budget for an improvement of this work in connection with our insane hospitals, feeble-minded institution and industrial schools. - We believe that all insane patients should be handled by attendants or nurses from the state hospitals instead of by sheriffs and deputies. Every effort should be made to prevent the commitment of non-resident patients to our state hospitals. Wherever possible, they should be deported to their place of residence at the expense of the state or county. BUREAU OF JUVENILE RESEARCH— The function of this Bureau is to determine whether a child is normal, sub-normal, feeble-minded, or psychopathic; to determine the cause of the abnormal functioning of mind or body and to suggest a course of treatment to correct the condition, where possible. At present it makes complete physical, mental and other examinations of only such children as are sent to it by a few of the juvenile courts of the state for examination, and as are referred to it voluntarily by parents or by public or private organizations. We recommend the expansion of this Bureau in order that it may ultimately become the central research laboratory for all the problems connected with the management of our state insti- tutions. It should be the agency which is responsible for the proper ex- amination, segregation, treatment and management of all the wards of the state. We recommend that the Bureau be organized at once to make thorough mental and medical examinations of every child committed to the two industrial schools. We earnestly recommend that no child be admitted to these schools without such an examination. We recommend also that the medical division be expanded so as to correct phys- ical defects discovered upon examination. The successful operation of this plan will require the close coordination of the social investigators of the Department of Charities with this Bureau. They should be responsible for placing and supervising the. normal children who will be returned to the community. Ultimately, we believe the Bureau should make character, personality and physical analysis of every adult offender committed to state penal insti- tutions and of every adult person considered for parole. We recommend the erection of a 50-bed hospital at the Bureau in order that the additional facilities necessary for this enlarged program of work may be available. DEPARTMENT OF PARDON AND PAROLE— We recommend that the work of this department be closely linked up with the work of the Bureau of Juvenile Research, Department of Charities, and the superintendents of the correctional and penal institutions. 14 DEPARTMENT OF CHARITIES— We recommend that this department be given office quarters at the of- fices of the Department of Public Welfare, in order that certain economies of operation may be effected by consolidation of certain departments and that closer coordination of activities may be secured. CENTRALIZED SUPERVISION AND CONTROL OVER STATE WARDS IN THE COMMUNITY— We suggest that ultimately it may be found desirable to centralize and coordinate the various activities within the Department of Public Welfare which have to do with the supervision of the wards of the state in their homes and in their communities, into a single division or department. We suggest that serious consideration be given to the possibility of extending the scope of activities of the division of charities to include this work, or the coordina- tion of some of the activities of the department of charities with the work of the department of pardon and parole, to form such a department. STATE HOSPITALS FOR THE INSANE— We believe there should be a complete and. definite segregation of the chronic insane patients from the hopeful curable cases and that different types of supervision and control should be employed in dealing with these two groups. The chronic insane patients who are in good physical condition and who require long continued care should be segregated and housed in suitable buildings and be employed in farming, dairying, and gardening work. This would permit of the development of real psychopathic hospitals whereby the medical and nursing staffs could concentrate their efforts and interests upon the curable cases. We recommend that steps be taken at once to organize consulting staffs at our state hospitals. The start should be made at three or four of the hospitals located in the larger cities. Clinics should gradually be developed by each hospital for the purpose of giving advice and treatment to early cases of nervous mental diseases of the community. Some changes in the organization of hospital administration should be effected so as to relieve the medical superintendents of a large amount of the routine work involved in the management of the physical plant. Field workers should be employed at state hospitals for the purpose of securing information regarding family histories and environment of patients and for supervising patients after they leave the hospitals. Efforts should be made to use, as far as possible, the field investigators of the Department of Charities. 15 CLEVELAND HOSPITAL— The $200,000 appropriation for land for this institution should be used to purchase a tract of land large enough to form the nucleus for the develop- ment of a new institution. Not less than 1,000 acres should be purchased. The new institution should be located in the northeastern part of the state where the population is increasing most rapidly. This new institution can be used to house certain types of inmates from the Cleveland Hospital in suitable buildings erected on the new site. Ultimately the present institution at Cleveland should be used as a psychopathic hospital, a medical and surgical hospital and as an infirmary for terminal cases. COLUMBUS HOSPITAL— From time to time the Director of Public Welfare may be called upon to consider the advisability of leasing or selling a part of the lands belonging to this institution to other departments of the state for one purpose or another. In our judgment, the best interests of the state would be served by preserving intact these lands until such time as the demands on the hospital make it seem wise to abandon same for the erection of a larger institution farther out in the country where adequate lands might be available through the funds de- rived from the sale of this valuable site. DAYTON HOSPITAL— This institution has already made considerable progress in the medical care of patients, in the establishment of an important clinic in the city of Dayton and in follow-up work. Funds should be made available for increasing this type of endeavor, for developing occupational therapy and for providing additional nurses and at- tendants, and for developing the medical, curative and preventive work which has been started at this institution. The small farm colony now existing for chronic insane cases, that are no longer benefited by medical treatment, should be greatly enlarged. The building at present used as an infirmary should be remodeled at once into a hospital building for medical and surgical purposes. LONGVIEW HOSPITAL— We recommend the appointment of a commission to investigate and de- termine whether the state should purchase Longview Hospital, and if so, at what price. INSTITUTION FOR FEEBLE-MINDED— We recommend that additional buildings be erected without delay at Orient which would bring the total capacity up to 2,000. We recommend the construction of a new institution for the feeble- minded located in the northeastern section of the state. 16 We recommend that serious consideration be given to the establishment of farm colonies for feeble-minded boys and girls. We suggest the possibility of using the three cottages for delinquent girls at the Columbus institution as a training school from which the girls would be graduated to the colonies. We recommend the drafting and enactment of a comprehensive mental deficiency law making it possible to commit the feeble-minded to the Depart- ment of Public Welfare. We recommend the establishment of a training school for special class teachers for the feeble-minded at the state institution for feeble-minded. OHIO STATE SANATORIUM— We believe this institution should be operated as an educational institu- tion primarily and that there should be a more definite cooperative arrange- ment with the state department of health. The institution should serve as a training school for tuberculosis patients as well as a hospital for study and research for the medical and nursing profession of the state. Clinics in the special phases of the disease should be organized and conducted here. Because the hospital is limited in its capacity, thereby depriving a large number of patients of its benefits, we suggest the possibility of opening a fresh air tent colony during the summer and fall months. STATE SCHOOL FOR THE BLIND— We recommend the appointment of a commission to study and report upon the blind problem. OHIO SOLDIERS’ AND SAILORS’ HOME— We recommend the erection of suitable barracks at this institution to house the reformatory boys employed here. - PENITENTIARY— We recommend that all prisoners, who are physically able, be kept em- ployed at some productive work, and that efforts be made to accomplish this at the least possible cost. Suitable inexpensive buildings might readily be built within the prison enclosure to house the necessary expansion of workshop facilities. We recommend that the idle house, as such, be abolished as soon as possi- ble and its occupancy be limited to those who are mentally and physically in- capable of being usefully employed. The idle house should be put in a sani- tary and habitable condition at once. We recommend the enlargement of the printing department so that it may handle a larger amount of the state’s printing. We recommend for consideration the possibilities of establishing more honor camps outside the institution. 20BA 17 We believe that prisoners can be used to a large extent in the construc- tion of public works and should be used wherever possible. All tillable land at the prison farm should be brought under cultivation as rapidly as possible, employing as many prisoners as can be profitably employed. We recommend that the educational facilities be expanded. NEW PENITENTIARY— We recommend the appointment of a commission to study the whole penal problem in Ohio and other states, for the purpose of formulating 4 con- structive program for the development of our penal institutions and more particularly, to revise the plans for the new penitentiary. This seems to us desirable on account of the increasing knowledge of the relationship between feeble-mindedness, psychopathic states, and criminality which has been devel- oped during the past ten years. Pending this report, we recommend that the exterior walls of the admin- istration building be built and a permanent roof installed over the structure. All further work on the buildings to await the report of the commission. MEN’S REFORMATORY— Provision should be made whereby the superintendent may transfer the worst boys to the penitentiary, thereby limiting the population to the reform- able prisoners. ‘The double-celling might be relieved to some extent by the erection of dormitory type of buildings within the enclosure, for housing the group of prisoners who could be safely placed in dormitories. Workshop facilities should be increased as the population increases so as to keep every inmate employed who is physically able. WOMEN’S REFORMATORY— We recommend the erection of a cottage for colored girls and a cottage for the matron at once. | A cell block for detention purposes should also be erected. Facilities for the employment of women within the institution need to be provided so that every inmate who is physically able and not employed in the operation of the institution, may be usefully employed. A building is needed in this state for housing female defective delin- quents. Whether this should be erected at Marysville, or at the new feeble- minded institution, needs consideration. BOYS’ INDUSTRIAL SCHOOL— We recommend that one or more cottages at this institution be used for segregating feeble-minded boys until such time as facilities are provided else- where. We believe that a serious effort should be made to carry out the recom- mendations of the Educational Survey made under the direction of the state superintendent of public instruction. 18 The removal of the fire hazards in some of the older dormitory buildings should receive immediate attention. GIRLS’ INDUSTRIAL SCHOOL— A full-time resident physician should be employed. A new reception cottage should be built and, if possible, the present re- ception cottage should be used for colored girls. As far as possible, the recommendations of the Educational Survey should be carried out. The fire hazard, due to locking girls in their rooms in the cottage for col- ored girls, should be eliminated. In adjusting damage claims with the city of Columbus, forseen to re- sult from the construction of the new Scioto dam, it should be borne in mind that the buildings and machinery thereby put out of commission are not in- adequate for the institution. The splendid sulphur springs should be saved if possible. 19 REPORT ON STATE INSTITUTIONS As the result of five months of close study and observation of the admin- istration of our state institutions, we are convinced that their future progress and development depend in a very large measure upon the wisdom, foresight and good judgment with which they are administered during the next eighteen months. Due to your mani- fest desire to improve the character of service rendered in the state institu- tions and your helpful and sympathetic attitude toward our Board, we were encouraged to formulate and present a budget which would meet some of the most pressing and obvious needs of the state. The only reason for asking for a larger budget during the next biennium was the conviction that the affairs at the state institutions had reached a point where relief was imperatively demanded. The expenditures for maintenance of the physical plant and equipment had been so meager for several years, that at several institutions the situation is really serious. The cumulative effect of years of inadequate mainten- ance expenditures was particularly noticeable at Cleveland and Dayton Hos- pitals and at the Boys’ and Girls’ Industrial Schools. The need for addi- tional housing facilities for the, feeble-minded, insane, epileptic and crim- inals was also apparent. It was equally obvious that the state should greatly extend and develop its medical and curative work, and Anaugurate programs of prevention, which would tend to reduce the amount of insanity, feeble-mindedness and crime. The plans proposed by us in our budget request for meeting these needs, met with your approval and the approval of the legislature. The budget makes provision for correcting some of the most serious conditions at the in- stitutions; it provides for a modest building program, to increase the hous- ing facilities for the feeble-minded, insane and criminal groups, and it makes provision for beginning the development of more intensive medical, curative and preventive work. The total amount granted by the legislature through regular appropriation and tax levy, was $18,223,284, of which $16,973,284 will be available during the biennium ending July 1, 1923, and $1,250,000 will become available after that date. The granting of this budget carries with it a grave responsi- bility for its proper expenditure and at the same time, presents an unus- ual opportunity for the inauguration of programs which will more fully meet the state’s responsibilities. 20 SPECIAL FUND PROVIDED TO IMPROVE CHARACTER OF PERSONNEL AND QUALITY OF PRODUCT OF STATE INSTITUTIONS The state institutions should, at all times. be operated with the strictest economy. Especially is this imperative in times like the present when every citizen and every business is called upon to save and conserve to the utmost. We should recognize, however, that true economy must be meas- ured in terms of product. If the personnel of our institutions are not selected and held in terms of their fitness because we are unwilling to pay adequate salaries or wages, we are not practicing sound economy, particularly if by a comparatively small increase in expenditures measured in terms of capital invested, we are able to turn out the type of product for which these institutions were created. With this thought in mind, we secured in our budget ap- propriation a special fund of $320,000, per annum, for the ex- press purpose of providing money with which to improve the character of personnel and the quality of service rendered throughout all the institutions. It was distinctly understood that the sum would not be distributed pro rata among the officers and employees re- gardless of merit or efficiency, but would be spent only upon the recommenda- tion of each superintendent, approved by the Director of Public Welfare, and would be used only for rewarding the efficient and building up the organiza- tion, thereby making it possible to improve the quality of service rendered. In order to guard against the unwise expenditure of this fund by a di- rector of public welfare who might be incompetent or unsympathetic toward the program, the fund was placed under the guardianship of the Board of Control. Now that a sane, competent and sympathetic Director of Public Welfare has been appointed, it is hoped and expected that the Board of Control will not exercise too stringently its preroga- tive. It is hoped that this money will be freely available to the Director of Public Welfare to enable him, without handicap, to quickly and effectively build up the personnel of the various in- stitutions to the end that preventive and curative methods may be reflected in the product of the several institutions. It is hoped that the Board of Control will consider its duty with regard to its guardian- ship fulfilled when it has assured itself that these funds are used for no other purpose than that for which they were appropriated. IMPORTANCE OF PREVENTIVE AND CURATIVE WORK Your commission is not in sympathy with any program which contem- plates the extravagant expenditure of money upon the derelicts of society, either physical, mental or moral. We believe there are a number of such persons that should be definitely and permanently segre- Al gated from the community and put to work so as to be self-sup- porting. We believe that methods should be adopted to put an ~ end to the repeaters of both criminal and defective types. Those who are physically or mentally unable to support themselves should be re- moved from the community and institutionalized or colonized in such a way as to result in a minimum expense to the state. We believe that the morally and physically diseased should be so controlled as to prevent their mingling in the community to the detriment of the health and well-being of society. While the question of unsexing may be repugnant and possibly cannot be given serious consideration for years to come, other methods approximately as effective should be applied to this class of moral and physical defectives. On the other hand, we believe the state will be practicing the highest type of economy when it makes every reasonable effort and expenditure looking to the cure of all those persons who can be cured and restored to society, and to the prevention of the acquirement of physical, mental and moral attributes which miti- gate against their becoming useful members of the community. If the state is to allow these things to continue unchecked, this commission can see no end to the demands upon the state treas- ury to provide those facilities necessary to protect its citizens from the depredations of the increasing number of criminals, de- fectives and degenerates. Elsewhere in this report we have endeavored to indicate where and how a start may be made to develop a remedial and curative type of control and we strongly recommend such a program be adopted as the controlling idea in the discharge of the state’s responsibilities to its unfortunates and defectives. THE BUILDING PROGRAM We wish to offer a word of caution and advice with respect to the prose- cution of the building program. We believe the wards of the state should be housed in simple, comfortable, attractive, sanitary buildings and not in the costly, elaborate structures of the massive monu- mental type, like some of the cottages at Massillon and Orient. Such struc- tures, in addition to their excessive cost, are objectionable because they are out of proportion and harmony with the distressing state of the patients they house. We believe that simple attractive low-priced buildings can be designed gnd built which will possess all the elements of utility and yet be without offense to good taste. They should be substantial and well built so that maintenance charges will not be excessive; the architecture should be simple and the construction of inexpensive ma- terials. Instead of spending vast sums of money on expensive, ornate build- ings, we believe it would be true economy to spend more money on 22 medical care and treatment, field work, research and crime pre- vention. If these sums are wisely expended, there should result a lessened need for additional buildings to house inmates. BUREAU OF JUVENILE RESEARCH This Bureau, if rightly organized and administered, seems to offer a great opportunity for real constructive work along the lines of prevention of feeble-mindedness and crime, and of reduction in the cost of caring for state wards. The primary function of the Bureau is to make thorough mental, phys- ical and other examinations of all minors who, in the judgment of the Juvenile Court, require state institutional care and guardianship and to make recom- mendations as to the proper disposition of these children. Such investigations will disclose three general groups of children: the normal, the feeble-minded and the psychopathic. The disposition of these different groups of children should be as follows: The normal children should be returned to their homes or suitably placed in other homes at the discretion of the Superintendent of Charities and remain under his supervision. This plan will be best for the welfare of the child and most economical for the state, since the state indus- trial schools will be relieved of the cost of maintaining these normal children.* The feeble-minded children should be committed to the feeble-minded institution where they will receive adequate schooling and training adapted to their mental capacity. Experience shows that the needs of these children are more effectively met by placing them among children of their own class than by placing them among normal children, and further- more, the state will be saved the expense of conducting and maintaining ex- pensive schools and equipment for this group which can profit but little from such training. Studies made of the inmates of the Boys’ and Girls’ Industrial Schools in 1912 and 1913 showed that 46% of the boys and 59% of the girls examined were feeble-minded. If the percentage is as low as 25%, this means that over 400 children are annually being sent to the industrial schools who should be sent directly to the feeble-minded institution, where the per capita cost is $40 per year cheaper than at the Boys’ Industrial School and $114 cheaper than at the Girls’ Industrial School.** This plan would re- sult in a net annual saving of $23,000, the feeble-minded children would be benefited, and the character of service rendered at the industrial schools would be greatly improved. *The per capita operating expenditure at the Boys’ Industrial School in 1920 was $249 and at the Girls’ Industrial School, $322. Under the proposed plan of placing normal children in their own or foster homes, under supervision, the only cost to the state would be the pro rata expense per child of the field worker employed in this work. Probably several hundred children could be suitably placed in this way every year. **The annual per capita operating cost at the feeble-minded institution in 1920 was $208. At the Boys’ Industrial School the cost was $249 and at the Girls’ Industrial School $322. 23 The psychopathic children should be sent to the industrial schools at Lancaster and Delaware to receive the benefits, for one year or more, of the excellent training and discipline afforded at these schools. Such changes in training and discipline could be made as would best meet the needs of these children. The Bureau should also furnish the Superintendent of Par- don and Parole with the results of its investigations into the character and mentality of every child being considered for parole. This information, supplemented with the facts relating to the home environment of the child furnished by the Department of Charities, and the record of the child’s school work and conduct supplied by the superin- tendents of the industrial schools, will furnish the basis for an intelligent functioning of the Department of Pardon and Parole. A second function of the Bureau is to receive any minors for observation from any public institution, private charitable institution or person having legal custody thereof. This part of the work is preventive in character; it seeks to aid parents and public authorities in the management of children who have abnormal tendencies. By enabling parents and teachers to under- stand, recognize and combat successfully slight deviations from normal thinking and living, it may be possible to prevent criminal careers for those with criminal tendencies or the development of grave forms of mental disease. Many children, even of good heredity and environment, show wayward tendencies or maladjustment to school work or to social conventions. Exam- inations frequently show this to be due to abnormal functioning of the mind— either acute or chronic. The knowledge of this fact often enables parents to re-arrange the child’s daily program so as to remove undesirable conditions, thus restoring the child to normal, or where this is not possible, protect the child from falling into serious errors of conduct. School principals and teachers can also arrange their work or reclassify the children in such a way as to greatly increase the efficiency of the school and improve the condition of each child. Although established in 1914, the Bureau has never functioned as the law requires. During the past two years, only 450 children have been sent to the Bureau by the Juvenile Courts for examination, while 3,600 children have been committed to the industrial schools, who, according to law, should have been examined by the Bureau. RECOMMENDATIONS FOR IMMEDIATE ACTION— We recommend that the staff and facilities of the Bureau be increased so that every child committed to the industrial schools at Lancaster and Delaware may be given a thorough examina- tion before being sent there. Likewise, each child, on being paroled, should be similarly examined. ‘This will mean that about 3,600 children will have to pass through the Bureau annually. 24 The medical division of the Bureau should be headed by a competent well-trained neuro-psychiatrist of recognized standing and ability, who should have a medical assistant, a dentist, and one or more nurses in his department. Many mental manifestations are closely related to physical disorders and no attempt to improve these various abnormal mental states is complete if the physical derangements are ignored. He should plan and develop a consulting staff of expert physicians, surgeons and other specialists. We recommend at this time the erection of a 50-bed hospital at the Bureau in order that many of the physical defects discovered upon examina- tion may be corrected and treated there. The work now being done for public school authorities and parents should be continued and expanded. The cost of carrying out these recommendations is estimated at $50,000. This sum is about $20,000 in excess of the amount granted by the legislature. In view of the favorable report of the legislative investigating committee of the House, we believe the Director of Public Welfare is justified in transferring the additional sum required from the amount al- lotted for minor officers and employees. We recommend such action. The report of the legislative committee reads as follows: Jolumbus, Ohio, June 29, 1921. “To the Hon. Harry L. Davis, Governor of Ohio. DEAR GOVERNOR: House Resolution No. 48 authorizes the Speaker of the House of Representatives to appoint a committee to investigate the State De- partment, namely: The Bureau of Juvenile Research. In compliance with this resolution passed by the 84th General Assembly the Speaker, Rupert R. Beetham, named W. C. Wendt, of Franklin County, Chairman; Harry M. Carpenter, of Jefferson; Stephen J. Benner, of Vinton; J. W. Lentz, of Monroe; Harry F. Brown, of Fayette. After a thorough investigation of this department the above named committee submits to your Honor the following report: We believe that the Bureau of Juvenile Research is one of the most important, most valuable and far-reaching of any department in the State, and Ohio may be justly proud of the forward step she has taken in this work. While it has been suggested by some that this investigation was for the purpose of injuring or destroying the department, yet, we as- sure your Honor that our efforts and aims are wholly for the assist- ance and strengthening of the Department. We fully endorse the comprehensive plans of the present Board of Administration to reorganize the Bureau of Juvenile Research so as to increase its range of activities in the matters of diagnosis and care of defective and psychopathic conditions, particularly in refer- ence to the wards of the State and to increase the medical staff and to supply adequate equipment so that all physical defects may be cor- 25 rected and the patients be restored to the best possible state of health before commitment and that a follow-up work be done in the institu- tion to which they are placed. This Department, acting as a central Clearing House for the State. In the past where corrective work, especially in the rural districts, has been costly and very unsatisfactory, as laboratory tests are not made in smaller places. All this should be done at the department laboratory. We would recommend that future legislatures appropriate from time to time as conditions warrant sufficient funds that all Depart- ments of this Bureau may be adequately equipped to carry on the work which may come under their Department, thereby saving sums of money expended in our institutions who might and should have been corrected in early life, We would further recommend that the present Psychopathic wards of the Bureau be enlarged to care for such mental cases as ' would, otherwise, require temporary commitment in a state hospital. To extend the usefulness and stimulate the publicity throughout the state that all Probate Judges who have as yet not been reached assign their patients and work hand in hand to reap the benefits which it so bountifully affords. We also recommend that parents who have children deficient in schoo] work send them to this department for examination so that proper guidance may be recommended and certain efforts along special educational work may be made in order to correct, as near as possible, the deficiencies of these individuals. We recommend that the activities of the State Board of Charities be transferred to the Juvenile Department, thereby saving unneces- Sary expenditures and duplications. The Juvenile Research perform- ing the corrective work and the State Board of Charities the placing of these children. We are convinced that Dr. Goddard is a scholar of high attain- ment and unquestionable ability in carrying on dcientific psycholog- ical investigations whom we found lacking in executive powers from which we believe he should be relieved in order that he may devote his entire time to scientific work. The evidence offered in this investigation fully substantiated the value of the Medical Department, which, under the direction of Dr. Transeau, rendered most efficient and helpful service. We recommend that, if possible, the civil service standing be re- instated to the former members of the staff. In conclusion, we believe if our recommendations and suggestions are followed this department will render greater service to the de- linquent children of the state. Your very truly,” We believe the state will sustain a distinct loss if the services of Dr. Goddard are not retained. The action of the legislature, reduc- ing his salary from $7,500 to $4,000, may make this difficult, but we believe some method can and should be devised to retain his services. A reasonable amount might be allowed for maintenance in addition to the $4,000, since all the superintendents of institutions receive maintenance for themselves and families. 26 RECOMMENDATIONS FOR FUTURE DEVELOPMENT— In the course of the normal development of the Bureau, it is to be hoped that it may have a representative in each of the centers of population to ex- amine and study youthful offenders before they are brought into court and before sentence is passed. It is suggested that the type of study which the Bureau is now organized to make for juveniles might ultimately be extended with beneficial results to include adult offenders. DEPARTMENT OF PARDON AND PAROLE— We recommend that the work of this department be closely linked up with the work of the Bureau of Juvenile Research, De- partment of Charities, and the superintendents of the correc- tional and penal institutions. The Bureau of Juvenile Research should make thorough mental and medical examinations of every person considered for parole. This work should be started at the industrial schools and grad- ually extended to the reformatories and penitentiary. The Department of Charities should furnish information regarding the home conditions and en- vironment of the offenders. The superintendents of the various institutions should furnish the record of the inmates’ work and conduct while in the insti- tution. DEPARTMENT OF CHARITIES— We recommend that this department be given office quarters at the offices of the Department of Public Welfare, in order that certain economie’ of operation may be effected by consolidation of certain de- partments and that closer coordination of activities may be secured. The bookkeeping work involved in the collection of maintenance costs from in- mates of state institutions, it would seem, might well be consolidated with the work of the fiscal department. Other economies might result from the con- solidation of stenographic work. CENTRALIZED SUPERVISION AND CONTROL OVER STATE WARDS IN THE COMMUNITY— We suggest that ultimately it may be found desirable to centralize and coordinate the various activities within the department of public welfare which have to do with the supervision of the wards of the state in their homes and in their communities, into a single division or department. We sug- gest that serious consideration be given to the possibility of ex- tending the scope of activities of the division of charities to in- clude this work or the coordination of some of the activities of the department of charities with the work of the department of pardon and parole to form such a department. 27 Such a division should investigate the home conditions of insane patients, advise the hospital superintendents with regard to sending patients home on trial visits and supervise the patients after they leave the hospital. These field workers, as they go about the community, should be alert to de- tect cases of insanity in its early stages and endeavor to secure proper treat- ment at the mental clinics. The department should be responsible for the supervision of all mental defectives in the community who are in need of it and not otherwise provided for. It should discover feeble-minded persons who are a menace to the com- munity and have them diagnosed and committed to institutions. It should supervise, as long as it is necessary, persons who have received training in the feeble-minded institution, when they return to the community. The department should also be responsible for the home and community supervision of all persons paroled from the correctional and penal institu- tions. To what extent this work should actually be performed by state em- ployees and field workers, or to what extent by local machinery and local in- vestigators, we are not prepared to say at this time. We are simply endeav- oring to sketch briefly the scope of activities without attempting to specify in detail how it should be worked out. If effectively performed, this work should result in enormous financial savings and, at the same time, be of immeasurable ser- vice to the people of the state. Community supervision for the insane, which would discover early cases, would tend to reduce the number, and increase the number of cured cases, thereby reducing the maintenance cost and the need for additional buildings. Similar results would arise by permitting the earlier discharge of insane patients, which would be possible if there was adequate home supervision. Effective community supervision of the feeble-minded and mentally de- ficient would tend to reduce the number of juvenile delinquents and crim- inals and increase the number of these subnormal individuals who would be- come community assets instead of community liabilities. This would save the state in maintenance expense and capital outlay expenditure for new feeble-minded institutions and for new correctional and penal institutions. STATE HOSPITALS FOR THE INSANE The eight insane hospitals of the state cared for a daily average popula- tion of 12,087 during the year 1920 at a total cost of $3,084,388, or $255 per patient per year. Five of these hospitals—Cleveland, Columbus, Longview, Massillon and Toledo—are practically filled to capacity. The Cleveland State Hospital is so overcrowded that grave chances are taken in the discharge of patients. At Longview, the institution 28 is so overcrowded that 240 patients are sleeping on the floors. On the other hand, at Athens and Dayton hospitals, the average daily population has been steadily decreasing since 1915; Athens from 1,442 to 1,282, and Dayton from 1,300 to 1,210. Some little temporary relief might be afforded by making some changes in the boundaries of hospital districts. For example, Clark county, containing the city of Springfield, might be at- tached to the Dayton district. Belmont county might be attached to the Athens district. Careful study might disclose other similar changes. MEDICAL WORK SHOULD BE EXTENDED— We believe the time has come in Ohio when the people of the state are ready and willing to support a comprehensive, far- sighted program designed to make our state hospitals the best medical centers in the state for the care and treatment of the insane. The salary increases, granted to all managing officers, the special fund provided for improving the personnel, and the additional funds allowed for buildings and equipment, indicate a desire on the part of the legislature to further such a program. The immediate next steps in the development of this program appear to be the following: 1. Classification and Segregation of Patients— Patients in the institutions should be classified as nearly as possible into two groups: First, the chronic established insane, and second, the recent, hopeful, curable cases. The provision for the care and treatment of these different groups should be adapted to the particular needs of the two different types. The chronic patients who are in good physical condition, who require long continued care and will profit little by intensive medical treatment, might be housed in dormitory types of buildings on farms and be employed in farming, dairying and gardening work... The recent, hopeful, curable cases, many of whom may be expected to recover if properly treated, should be given the best medical treatment afforded in modern hospitals. The facilities for hospital treatment and intensive medical and surgical work should be pro- vided so that every person committed to an insane hospital, may receive the very best medical treatment which it is possible to give. Statistics show that the majority of the recoveries occur within the first four or six months. 2. Consulting Staffs— Ultimately each hospital should have associated with it in a consulting capacity the best specialists in the state; the staff should include the leading specialists in psychiatry, surgery, internal medicine, eye, ear, nose and throat, etc. Every patient who enters the hospital should be givena thorough mental and medical examination. All physical defects and disorders should be promptly corrected and treated. We 29 recommend that a start be made at three or four of the hospitals which are located in the larger cities and if the plan meets expectations, it can later be extended to all the hospitals. 3. Changes in Administration— It would seem wise to make some changes in the organization of the hos- pitals tending to relieve the medical superintendents of a large amount of routine work connected with the operation and upkeep of the physical plant, the management of the farm, garden and dairy and the detailed adminis- trative work connected with purchasing, storekeeping, etc. In some institu- tions the chief clerk might assume more of these duties. This plan would leave the superintendent free to devote most of his time and energy to the medical and curative work of his institution. 4. Mental Clinics— In the normal development of the above plan, clinics could gradually be developed by each hospital for the purpose of giving advice and treatment to mentally disturbed patients in the early stages. The laws should also be amended removing the present restrictions as to the number of voluntary patients that can be received in state hospitals and provision should be made for committing patients for observation to state hospitals for a period of ten days or more. 5. Field Work— A further development of this work should be the use of a corps of trained field workers who would save the valuable time of the medical staff in securing and writing histories; they would make actual investigations of home and living conditions, thereby aiding materially in the accuracy of the diagnosis and would supervise patients after they left the hospital; their investigations would furnish a fact basis for reaching decisions regard- ing the time and conditions of parole. Adequate field work would prove to be a real economy because it would permit the earlier parole of many cases, thereby reducing the population of the institu- tions and the cost of maintenance. The consolidation of the Department of Charities with the Department of Public Welfare should make it possible to work out some plan for using the field investigators of the Department of Charities in this work. STATE CONTROL OVER COMMITMENTS— The Cleveland Hospital and Health Survey makes ae comment regard- ing the present commitment procedure: “To those who are accustomed to methods more in accordance with those used with other sick persons, this handling of children and adults with mental diseases, feeble-mindedness and epilepsy by sheriffs and court attendants is abhorrent. It is a relic of a period in the de- velopment of the public attitude toward illness that has no more place 30 in an enlightened community today than Salem witchcraft. The sim- plest, kindest, and least expensive method is to have nurses and at- tendants from the institutions to which patients are to be committed come for them and convey them there by the skillful and kindly methods that their training so admirably fits them to use. No other method would be tolerated by those who had seen the one suggested in actual operation.” We recommend that this reform be effected at the earliest possible moment. NON-RESIDENTS— The number of non-residents admitted to our hospitals during 1919 was 100, and during 1920, 114. The total number of deportations for the two years was 15. The average maintenance cost per inmate for a year in our hospitals is $255. The total number of non-residents in the several institu- tions at any given time is at least 175. These inmates cost the state $45,000 a year for maintenance and occupy facilities at the in- stitutions representing a capital outlay of over $190,000. It is evident it would be good business for the state to pay the expense of transporting these non-residents to their place of residence wherever it is possible to do so and to take steps to prevent the commitment of non-residents in the first instance. Efforts should be made to secure the cooperation of the probate judges in making more complete and thorough investigations to de- termine place of residence and in transporting non-residents directly from the counties before commitment to the state hospitals. The law should be amended making it mandatory for all probate judges to trans- port all insane non-residents and aliens to their places of resi- dence and authorize the expenditure of county funds for this purpose. CLEVELAND HOSPITAL— This institution shows the neglect of years. Many of the build- ings are old and in poor repair. The growth of the city has made land so valuable that the hospital cannot expand on its present site. The institu- tion is now woefully overcrowded and yet it serves the section of the state where the population is increasing most rapidly. Two-thirds of the total increase in the population of the state occurred in ten counties in the northeastern section of the state and one-third occurred in Cuyahoga county. The legislature concurred in the view of your Board that immediate action was necessary and appropriated $200,000 for land for the Cleveland Hospital and granted additional amounts for buildings and equipment. A new insane hospital will soon be required to meet the needs of the northeastern section of the state, which is increasing in population so rapidly. We believe it would be showing good business judgment to keep in mind the need for a new institution, when purchasing 31 land to relieve the Cleveland situation, and purchase a tract of land large enough to form the nucleus for the development of the new institution. If possible, a tract of 1,000 acres should be procured. If a site can be found within a radius of 30 or 40 miles of Cleveland, it can be used as a farm colony for the chronic established insane of the Cleveland Hospital until such time as a new institution can be built. We would recommend the erection of suitable buildings on the new site for the housing of patients from the Cleveland Hospital who are in good physical condition, who require long continued care, and who will profit by the facilities for outdoor living. This plan will enable these people to supply the institution with needed farm produce. Since the present institution is inadequate for the needs of the state and it is impossible to develop it as a general hospital on account of the limitation of land supply, we recommend that it be used as a reception hos- pital, acute medical and surgical hospital, diagnostic clinic, lab- oratories and as an infirmary for terminal cases. It would be- come the clearing house for the insane patients in this section of the state. With the development of this plan, there should gradually be organized a consulting staff, mental clinic, and adequate field work. COLUMBUS HOSPITAL— The state highway department has sought to purchase or lease a tract of land belonging to this institution for a site for a highway garage and repair shop. We believe that the best interests of the state would not be served by such a transaction. The institution needs all its available land for the outdoor recreational needs of its inmates and especially needs the valuable garden land for growing produce. , This institution would seem to us to be well situated for the development of a consulting staff, mental clinic and after care work. Columbus is not only an important medical center, but is the seat of the state university as well. DAYTON HOSPITAL— At this institution the medical, curative and preventive work has been developed to a very commendable degree. We would recommend that Dr. Baber be encouraged in this work by giv- ing him reasonable allowance for the development of his plan. In addition to the specific appropriations granted in the regular budget, we would recommend the following: Remodeling the old infirmary building so that it may be used as a medical and surgical hospital. Erection of suitable buildings on the farm to which the quiet chronic cases may be transferred. 32 LONGVIEW HOSPITAL— This institution is owned by Hamilton county, but operated by the state. Since 1900, Hamilton county has expended $612,141 for additional buildings and equipment and has recently authorized a bond issue of $500,000 for mak- ing improvements at the institution. The institution is badly overcrowded (240 persons are sleeping on the floors) and additional land and buildings are urgently needed. Legislation has been passed permitting the Board of Administration to purchase the in- stitution from Hamilton county for $1,500,000, or to lease the institution for $60,000 rental charge per year. We recognize the validity of Hamilton county’s claim, that since Ohio has adopted the policy of state care for the insane, there is no reason from this standpoint why the county should continue indefinitely to provide the physical plant for the care of the insane in that section of the state. It is not clear to us, however, that the state would be justified in paying $1,500,000 for the Longview property. It might be found that the state could spend such a sum to better advantage by erecting a modern new institution better adapted to the needs of the state and more suitably located. In the few months time which your Board has been in office, it has not been possible for it to make a sufficiently extensive investigation of the whole matter to enable it to arrive at a definite recommendation. We believe the question should be settled as soon as possible and therefore recommend the appointment of a commission to investigate the problem from the three viewpoints: first, the value of the institution to the state for hospital purposes; second, the cost of erecting a modern new institution in that section of the state; and third, whether or not Hamilton county’s claims are justified. | We recommend the development of a consulting medical staff, and mental clinics by this institution. This should be comparatively easy in a city like Cincinnati, which has a splendid medical school and a large general hospital. INSTITUTION FOR FEEBLE-MINDED The problem of the feeble-minded is of far-reaching social significance. Mental deficiency lies at the very root of crime, juvenile delinquency, prosti- tution, pauperism and race deterioration, and is a significant school problem. No complete survey of the wh.ole state has yet been made to determine the actual number of feeble-minded persons in the state or the percentage of them which require institutional care. Such estimates as have been made are based upon the ratio of feeble-mindedness to total population as de- termined by local surveys in several counties and cities, and by studies of the dan Che. Be 33 number of draftees rejected on account of mental deficiency. Recognized authorities place the number of feeble-minded in the state at, at least, 21,000 (4 per 1,000), of whom not less than 10,000 re-. quire care in special institutions. The institution for the feeble-minded comprises the institution at Colum- bus, which has a capacity of about 1,500, and a custodial farm located at Orient, about sixteen miles distant, which has a capacity of about 1,000. Additional buildings now under construction at Orient will care for 500 addi- tional inmates which will bring the total capacity of the institution up to 3,000. Ohio, therefore, has facilities for less than one-third of the total number needing institutional care. The present institution has a large waiting list and only the most flagrant cases can be admitted. INCREASED FACILITIES A WISE INVESTMENT— It is recognized that it would be an economic blunder to attempt to build institutions capable of housing all feeble-minded persons. Not all mental de- fectives need institutional care. In fact, many of them can be permitted to remain in the community without danger to the public welfare; others require intelligent supervision and training in institutions for a time only; and others require permanent custodial care. It seems reasonable to suppose, however, that money spent in providing additional facilities for the feeble- minded, who are a menace if permitted to go unrestrained, would be a wise investment and true economy for the following reasons: Many of these feeble-minded individuals are the same persons who con- stitute our chronic repeaters and who are already dealt with by fines, proba- tion and short term sentences in our county and state institutions.* The community is already caring for these people at vast yearly expense as feeble- minded children in our public schools, juvenile courts, reformatories and orphanages or as feeble-minded adults in our county jails, state prisons, crim- inal courts, and county infirmaries. Figures compiled by the state auditor show that the state spends ten mil- lion dollars each year in the prevention, detection and punishment of crime. The Juvenile Protective Association of Cincinnati estimates that the trials and commitments of Cincinnati’s feeble-minded delinquents alone cost the city and state over $2,597,468 a year. Many of the feeble-minded are more prolific than the average popula- tion and large numbers of their children become public charges on account of *Authentic studies made in various institutions throughout the country show that the percentage of mental defectives among prisoners as a class varies between 15% and 40%. Among one class of prisoners viz., repeaters, the percentage is much higher. A_ study of 100 repeaters at the Indiana State Prison showed that 80% had nervous or mental abnormalities. These prisoners averaged at least four commit- ments in each case. A study of 100 immoral women in the Boston Municipal Court showed that 84% of the repeaters were suffering from some form of mental handicap, and that the women averaged 18 arrests each. A study of 268 recidivists by the Psychopathic Clinic of the New York Children’s Court gives the following result: J , Mental Deviates Feeble-minded Of) those: with’ One DrevIOUS! COULE ECOL sss \.cutns oe ais 0's nda dnas 2 lee eerie 82.9% 24.5% Of those with: two: Previdus “COUrE PECOIUB. «scarce neesc ce ence sep apa eavee set 91.6% 22.9% Of those ‘with three; previotis, court pecordsS..0:.. 65. saves ascamideeeesuoee eee ees 90.9% 48.5% 34 their mental defects. Furthermore, many of the feeble-minded women con- stitute a serious health menace to the community, through the spread of venereal diseases. The success of any state-wide program for the care of the mentally defective, including the extension of the work of the Bureau of Juvenile Research, will depend upon having increased institutional facilities for feeble-minded. It will be of no use to dis- cover, classify and register large numbers of feeble-minded persons who need permanent care unless there is some place to send them. RECOMMENDATIONS— We recommend that additional buildings be erected without delay at Orient to house 500 inmates, which would bring the total capacity of Orient up to 2,000.* We recommend also the immediate erection of a new institu- tion for the feeble-minded located in the northeastern section of the state.** The appropriation budget for the next biennium contains an item of $200,000 for land for a new institution. We recommend the selection of a site of not less than 1,000 acres. FARM COLONIES— The success of the colony method of handling feeble-minded persons in New York state, where it has been in operation for fifteen years, would seem to justify an experiment along similar lines in Ohio. We would suggest also that serious consideration be given to the plan of using the two cottages for delinquent girls and the new cottages shortly to be erected at the Columbus institution as a training school where the capacity and ability of defective girls may be developed through the proper application of vocational training, to the end that they may become self-supporting. It might also serve as an educational center where parents, teachers and citizens are shown the possibilities and value of this type of effort, and where research and experimentation could be made in the methods of handling defective girls. This institution might perform a very useful piece of work by training special. class teachers for the feeble-minded in the public schools. Cooper- ative arrangements might be made with the state universities and state normal schools to supply instruction to teachers in the training and discipline of mentally defective children, and the feeble-minded institution might afford the opportunity for field training and practical experience. *While the consensus of opinion among the leading state superintendents of feeble-minded institutions in other states, is that there should be one acre of land per inmate and that the ideal capacity of an in- stitution should range between 1,000 and 1,500, we believe that the capacity of an institution housing low grade feeble-minded, such as the custodial farm at Orient, can safely be extended much beyond this limit. **The total increase in population for the state was 992,273; 664,000, or 67%, occurred in the ten counties located in the northeastern section of the state, and 306,000, or practically one-third, occurred in Cuyahoga county. 35 OHIO STATE SANATORIUM The present sanatorium appears never to have functioned in the way it was planned. The law creating the institution provided that it should be for. the treatment of persons suffering from incipient pulmonary tuberculosis, and be an experimental school of instruction for the ultimate purpose of discover- ing and disseminating throughout the state the best means for the treatment of patients afflicted with tuberculosis. It has been operated as an ordinary sanatorium, caring for about 700 patients a year and with an average daily population of 180. When we consider that there are perhaps 25,000 people in the state who have active tuberculosis, it is apparent that this small insti- tution, operated purely as a curative institution, can have very little effect upon the problem. It is also important to note that only 151 of the 542 ad- missions last year were in the incipient stage. We suggest that this institution can be of tremendous value to the state if operated as an educational institution. It should be organized as a training school for tuberculosis patients, their friends and the public. We can see tremendous possibilities for good if each year 600 or 700 people leave the institution and go back to their own homes and communities thoroughly informed as to the nature and the best methods of arresting the disease and with the air of hopefulness and con- fidence which modern knowledge about the cause and cure of the disease now justifies. Definite cooperative arrangements should be established between the institution and the state department of health. Through the organization of competently conducted clinics, the institution should also serve as a training school for the med- ical and nursing profession of the state in the care and treatment of tuberculosis, and as a place for experimentation and research. We believe the scope of the institution should be enlarged to include not only pulmonary tuberculosis, but all forms of tuberculosis. In the event that the enlarged educational program, as outlined above, reveals the need for additional facilities for the treatment of tuberculosis patients, we would suggest the possibility of establishing a summer camp for the accommodation of incipient cases. STATE SCHOOL FOR THE DEAF This school was established to educate the deaf children of the state. It receives children from seven to twenty-one years of age. About 500 pupils attend the school annually. It has been the policy of the school for several years to advise parents of deaf children located in the larger cities, to send their children to the day schools which are maintained by the public school 36 system in these cities. This seems to us a wise policy, since by this method the facilities of the state school are largely reserved for the deaf children from the rural sections who would not otherwise receive the advantages of an edu- cation. The plan has also resulted in helpful cooperative relationship be- tween the state school and the day schools. The course of instruction is well adapted to meet the peculiar needs of the deaf children. The four most important vocations for boys taught at the school are: printing, woodwork, painting and baking. The girls are instructed in all kinds of sewing, crocheting, cooking, millinery and housework. We wish to emphasize the statement of the superintendent that there should be some re- adjustment of the industrial training course. For example, tailoring and shoemaking are now practically obsolete trades and should be supplanted by more modern occupations. The plans now under way to install a tire repair school should be encouraged. This school was founded in 1829 on ten acres of land which was then in the country. Evidently the intention of the founders was to give it a rural environment, as would be expected in any boarding school for children. That was almost one-hundred years ago. The school has long since out- grown its buildings and is now in the center of the capital city, surrounded by all the city influences, without sufficient recreation grounds and no oppor- tunity for country life. Neither can it expand and enlarge itself according to the demands of changing economic conditions. The majority of the pupils come from the farms, but no opportunity is offered for farming or learning the trade of agricultural pursuits. It would seem but a reasonable request of those interested in the education of the deaf children that a new site be purchased and buildings in keeping with modern thought of caring for chil- dren be erected thereon. To this site should be attached several hun- dred acres of good farming land. The pupils coming from the farm could then be trained in the vocations which would be useful and helpful to them when returning to their homes after graduation. As it is now, most of the graduates knowing nothing about farming, congregate in the cities. Such a farm could be made to furnish most of the food products, not only for the State School for the Deaf, but a surplus for the State School for the Blind. But aside from the economic advantages, the center of a large city with small acreage is not considered a suitable place for a boarding school. It will not be long before the enhanced value of the present plant will make it possible, to a very large degree, to pay for the purchase of a site in the country and the erection of suitable buildings. We recommend that when this time arrives, steps be taken to give this worthy school a new location. 37 We feel that the work of this school deserves commendation for the high grade product which it is turning out. The boys and girls, upon graduation, take their places in the community as independent, self-supporting, thrifty good citizens. STATE SCHOOL FOR THE BLIND During its brief tenure of office, your Board was not able to evaluate the work being done by the State School for the Blind, but it feels that this problem is one of sufficient importance to justify the appoint- ment of a special commission to study and report upon the whole subject dealing with the blind. The course of instruction in the blind school should be studied with respect to its value in training pupils to become useful and self-supporting men and women. The commission should en- deavor to determine the most fruitful avenues of employment which are open to the blind and should include within its scope the work of the Ohio Commis- sion for the Blind. It should undertake to determine to what extent the day schools for the blind in our city public school systems are meeting the problem and should outline the scope and activities for the state school. OHIO SOLDIERS’ AND SAILORS’ HOME The population of this home is decreasing year by year, due to the death of the old soldiers. Last year there were 167 deaths. The average daily population for the year was 861. The increasing age of the inmates prevents them from doing much work about the institution. During the war, boys from the reformatories were sent here to do work about the institution, due to the inability of the management to secure sufficient civilian attendants. The work of these boys appears to have proven eminently satisfactory and we be- lieve the plan should be continued. This plan results in the saving of $69,000 a year in salaries which would have to be paid citizen employees and it gives the boys healthful work in a good environment. The quarters for the reformatory boys should be greatly improved. Sixty-five boys were being housed in a cottage normally accommodating twenty-five. Beds were placed in the basement and attic. A few months ago this building was destroyed by fire, but fortunately without loss of life. ~ We recommend the erection of suitable barracks to house about one hundred reformatory boys. These should be attract- ive, sanitary and of pleasing appearance, but erected at low bed cost. We believe that the food and living conditions for these boys should be of such a character that they would consider it a privilege to be sent to this institution. Such a plan would enable the management to exercise better con- trol over the boys, fewer boys would escape and the result should be a better grade of service rendered the old soldiers. 38 Several complaints reached our Board relative to the character of the food served at this institution and the unsanitary condition of the kitchen, pantry and storerooms. We recommend that this matter be given some at- tention. PENAL INSTITUTIONS Ohio has three penal institutions—the penitentiary at Columbus, the Men’s Reformatory at Mansfield and the Women’s Reformatory at Marys- ville. The reformatory was built and opened in 1896 in response to the humanitarian demand that young offenders should not be confined with the hardened criminals. It receives all male prisoners between the ages of 16 and 30 years who are not known to have been previously sentenced to a state prison, and males between 16 and 21 convicted of felony. The court may sentence males between the ages of 21 and 30 if it deems them amenable to reformatory methods. The Reformatory for women was opened in 1916 and is used for the de- tention of all females over 16 years of age convicted of felony and misde- meanors. There is serious overcrowding and double-celling in all of these institu- tions. * There is no question but that steps should be taken to relieve the present overcrowded conditions at these institutions; it is, however, just as important that these plans shall be formulated with due regard to the financial condition of the state and that consideration shall be given to modern principles and practices in dealing with these individuals. A fact of importance is the comparatively short time spent by criminals in our institutions. There were 494 life termers at the penitentiary on June 21, 1921, which constituted 21% of the population. All the rest have an opportunity to secure their release and be returned to society after a period of a few years. The average term served by penitentiary prisoners who are paroled is about two years, but the average term of re- formatory prisoners is about 1 year and 4 months. The comparative brief time which the average prisoner spends in an in- stitution makes it desirable that this time shall be intensively occu- pied in acquiring such education and training as will better fit him to return to the community at the expiration of his sentence. The routine of prison life should be so planned as to give to each prisoner the *The maximum inmate capacity of the penitentiary is 1,932, based on two inmates occupying each of the 860 cells. The average daily population for the year 1920 was 1,984. This was possible because a number of men worked and slept outside the institution in various camps. The maximum inmate capacity of the Men’s Reformatory will be 2,016 when the new cell block is completed, which capacity is based upon two inmates occupying each of the 934 cells. The average daily population for 1920 was 1,634, which meant that about two-thirds of the cells were occupied by two inmates. The Women’s Reformatory was built to accommodate 99 inmates. The average daily population during 1920 was 155 and the highest number present has exceeded 200. The population of the penal institutions has been increasing for several years. At the two reformatories, the increase has been steady. At the penitentiary the maximum average daily population was reached at 2,000 in 1918, and during 1919 and 1920 there was a decline, but during 1921 the population at one time reached 2,037, and average for the year was 1,694. ao maximum amount of instruction, training in habits of industry, and in worthy use of leisure time, and in measuring up to the responsibilities of community life. Dormitories located within the prison walls might be used to house certain types of prisoners at considerable less cost than the cell block type of construction, and to test out the capacities of prisoners to enjoy greater freedom and greater responsibili- ties. Later, promotion could be made to farm colonies and in- dustrial and construction camps located outside the institution. The real task of the penal institution is to prepare the inmates to return to normal life equipped to remain free and useful citizens. This result can be best secured by insuring that every man and woman lives a well ordered life, performs a full hard day’s work and contributes thereby to his own self-support. IMPORTANCE OF CLASSIFICATION AND SEGREGATION— An outstanding fact revealed by all investigations of the penal problem is that a large percentage of the criminals committed to our penal institutions have either been in the institutions here, or have served sentences in other institutions. The number of these repeaters varies from 25 to 60%. They serve their regular sentence and are released, repeat their offenses and are committed again and again. In Ohio 28% of the prisoners sentenced to the penitentiary and 46% of those sentenced to the Men’s Reformatory are repeaters.* *The following table gives the facts regarding repeaters at the Ohio Penitentiary during the past five years as furnished by the institution: Peniten- Repeaters Showing Number Tot YEAR Total tiary : of Previous Commitments Re a fd Admitted First 4 + aie aia Offenders l 2 | og! ai eg l ele peaters| Fe 5 on i , 7 | ¥ EG ca a aie fC | OT Fee Ae ae a 889 647 921 Writ dale | | ea eee ee 1917 ....... ease ok Sarena) CIOS 724 70 | 233] 52/21) 6] 1|..| 1] 314 | 30 Dt cee | 1086 851 73 | 178, 37) 10| 6| 4 235 | (22 DD Saeed “obtty nf prnett 1059 816 . | 77| 168] 48, 14] 6| 5| 1] 1] 243 | 23 1920... 26. 6s ie cee eeeeeeeeeeee| 815 499 | 61 | 228] 53) 20/13) 1] 1 316 | 39 Totals .....++++-. Pony | 4887 sey OES | 978) 234 82 | 38] 12] 3] 3] 1350 its Percentages: ficu sacs | 72 | 20) 5 ae Tet el, 2 cl eet eee 28 | | | | The following table gives the number of first offenders and repeaters at the Ohio Men’s Reforma- tory as furnished by the institution: | Repeaters Showing Number YE Total First |. | of Previous Commitments Total 7 AR P | % Jee PA fe PERS, oe Re- Yo Admitted Offenders | 6or | ters| 1 9 | 3 | 4 | A) or peaters oe oe i) ere a Y ] i me ates Nahe I : | | BGk sos sn 0 0s oa ee 840 455 s4 | 133 130' 791 291 13l.. .. 384 | 46 IOI7.. 2 oes tote a seneeerecoens 1118 570 | 1841960139] 233)" aol a eee 548 | 49 1918 a. : Or. Psy ars. 810 418 52 | 136} 126 86] 19} 18 7 392 48 1919 ee se 1324 720 547} 308) 1195.5 (60) 16), 25) suee ee 604 46 PZ meting: state ate 9, sisia es ONE eae 1051 601 o7 | 247) 138. 41) 15} 15).. ...- 456 43 GPOfAISa) densa os reas ee 5143 2764 .---|1008) 785 399 112) 73 7 | 2384 Partentacch i.2.. hee ele 54 20; 15. 8 2 Meee | 46 | | Sufficient investigations have been made into the character, mentality and personality of criminals to definitely establish the fact that a certain percentage of criminals are such because they are not normal in- dividuals. Because of mental inferiority or of mental or nervous abnormali- ties they think and act differently from normal people and hence come into conflict with the established social order. From special studies made of inmates in institutions through- out the country, we know that from 15 to 40% of the prisoners in penal and reformatory institutions are feeble-minded, and from 50 to 60% are suffering from some form of nervous or mental disease or defect.* In the light of these facts, it seems reasonable to expect.that mental ex- aminations of our prison population would show that perhaps 25% of the inmates are so feeble-minded as to require their removal to an institu- tion for the feeble-minded. Another percentage of the population will doubt- *The percentage of ‘inmates of state prisons found to be feeble-minded or having nervous or mental abnormalities are shown in the following table: CLASSIFICATION OF INMATES OF STATE PRISONS* Percentage | No | Per- found to yeas any nr... centage have INSTITUTION AUTHORITY Cases | Peeble-/nervous or Studied Minded|mental_ab- normalities Sing Sing Prison, N. Y. -.---++-+se1sss0+ > J Dr. Bernard Glueck .. -- 608 21.8 59 Auburn Prison, N. Y. .---:seeses teeters: Dr. Frank Heacox.---- 459 35.6 61.7 Mass. State Prison (men).-... .-++.:.00++++ acer be a ereag and } 300 | 22 34.9 Joliet Penitentiary, Ill. ..-. -----+2+ seers Louisa and Geo. Ordahl 49w 28.5 BA oy ast Auburn Prison (women) ..- +--+. ++ssssse0+ Mabel Fernald, Ph. D . 7T6w, 25 fl uis oy ener Indiana State Prison..... .-+-- sesssee seeees Dr. Paul Bowers. ..------ 100 23 | 45 San Quentin, Calif... -. .-. serree seers PV RAE on eerie ee oe 150 30.7 sas, Sasa WAMU WV ISs ooh sks este Fee Fe 53s ese ne Dr. V. V. Anderson .----- 570 2 59.0 Georgia State Prison (men) .---- «+--+ +--+ | Dr. V. V. Anderson ..--- 216 175 65.8 Georgia State Prison (women) ...----+----+- | Dr. Vv. V. Anderson -.---- 126 42.8 |.---ee eee Delinquency, New York, 1918. *Report on Mental Disease and The percentage of inmates of reformatories found tobe feeble-minded or having nervous or mental abnormalities is shown in the following table: CLASSIFICATION OF INMATES OF REFORMATORIES* | Percentage | nes VEG found to INSTITUTION AUTHORITY £ases Feeble. = io aa j>tualeci\tinded|mental ab- normalities en ee ee ee ane | N. Y. St. Reformatory for Women, Bedford | ) eM Hladee hese e Ss a eeentes i) oe Sando .s. ) oocial Hygiene Labeane : Dr. V. V. Anderson ..-- 112 24.1 | 68.7 Fulton Co. Reformatory, Ga. ..- --+-+++++++: | Dr. V. V. Anderson...-. 113 15.0 52.2 | | *Report on Mental Disease and Delinquency, New York, 1918 4] less be found to be normal, or nearly so, and will probably profit by a period of intensive industrial training. Another group, the defective delinquents, who constitute the bulk of the repeaters, will be found to profit little by their prison experience and upon release will repeat their offenses and have to be recommitted. This group comprises the proven criminals, gunmen, thieves, firebugs, vagabonds of all kinds, and the abnormal individuals who can never be anything else, who are set free each year to commit depredation upon the community, and for this group, permanent segregation in cus- todial institutions where they can be made to be self-supporting seems the only rational plan. NO ATTEMPTS NOW MADE AT CLASSIFICATION— At the present time there is no thoroughgoing routine method of determining the mental capacity and characteristics of inmates in our penal and reformatory institutions which might form the basis for adapting the facilities of the institutions to individuals. This is vitally necessary in planning the development of the work within the present institutions and in formulating plans for the new prison now under construction. It seems logical that this work should be done by expanding the facilities of the Bureau of Juvenile Research to handle the adult offenders as well as juvenile offenders. Facilities for the examination, diagnosis and classification of the adult offenders might be provided at the penitentiary where the possibilities of escapes would be reduced to the minimum, GENERAL RECOMMENDATIONS AFFECTING ALL PENAL INSTITUTIONS— We believe that all prisoners who are physically able, should be kept employed at some productive work, and that efforts should be made to accomplish this at the least cost to the state. Prisoners should be kept busy, both physically and mentally. Men and women who get into institutions because they failed to do their day’s work properly outside, should be compelled to perform a day’s work within the prison. Men who have no trade or occupation should be taught one. Those whose criminality is largely the result of wrong use of leisure time, should acquire right habits. Facilities for manual and industrial work and training within the institutions require enlargement and extension so that oppor- tunity may be given every able-bodied person to do a full day’s work. The assignment of men and women to work in the industries should, as far as possible, be based on a knowledge of each one’s capabilities and voca- tional aptitudes, together with some consideration of the possibilities of their being able to support themselves at the occupation acquired in the prison when they return to community life. In the development of prison indus- 42 tries, the possibility of paying prisoners sufficient wages to enable them to support their families or dependents should be considered. We recommend for consideration the establishment of more honor camps outside institutions, where prisoners will have the oppor- tunity to test their capacity and ability to obey the rules of the camp as they will be expected to obey the laws of the state when released. Living condi- tions in these camps should be of such a character that the men will wish to be sent there. Every man or woman worthy of being out on honor should be given the opportunity. The argument frequently urged against the employment of prisoners in industries and camps is that it results in unfair competition, both from the standpoint of price and labor supply. We believe that the number of prisoners actually employed in any given enterprise and the vol- ume of product will be so small as to have no serious effect upon the stability of any industry. More emphasis needs to be placed upon the educational work at our penal institutions. Night schools need to be organized, not only for illiterate adults, but for all able-bodied persons who have mental capaci- ties to profit therefrom. Libraries need reorganization and extension. All of this educational work should come, as it does in normal life, in connection with and after a full day’s work. PENITENTIARY— We believe that all prisoners physically and mentally capable should be employed at some productive work. The idle house, as such, should be abolished, and work should be provided for all those physically able; the population of the idle house should be limited to the handicapped and infirm. The building should be put in a sanitary and habitable condition. Increased Workshop Facilities— The penitentiary now has 13 manufacturing departments within the in- stitution which furnish employment for about 640 men. Time did not permit us to investigate the character of these industries to determine their suitability to the needs of the prison population. Some of them, however, such as the knitting mill, woolen mill and cotton mill, would seem to the casual observer, to be better adapted to women than to men. Some of these might be transferred to Marysville, where more facilities for the employment of the women are badly needed. Suitable inexpensive buildings might readily be built within the prison enclosure to house the neces- sary expansion of workshop facilities. In selecting new industries, careful consideration should be given to the value of the training to the men themselves and the possibility of the men being able to support their families by their labor while in prison. We believe that the printing department could be enlarged so that a much larger amount of the state’s printing work might be done here. 43 Industrial and Construction Camps and Farming— We recommend the establishment of more honor camps out- side the institution. Prisoners can be employed to large extent in the construction of public works and should be used wherever possible. All till- able land at the prison farm should be brought under cultivation as rapidly as possible, employing as many prisoners as can be profitably employed. The educational facilities need to be expanded. Night schools should be organized. We believe it would be a wise expenditure of state funds if the penitentiary employed the best qualified teachers in the state to teach prisoners. BRICK PLANT— The state plant for the manufacture of brick is located at Junction City. The physical plant, as far as it goes, is apparently well adapted and well located for the purpose and should, under proper control, prove to be a very useful and profitable undertaking. The present type of management is, however, in our opinion, at fault. The management needs re- organization. The plant is now operated as a guarded camp where some hundred prisoners from the penitentiary are employed. The warden of the penitentiary is responsible for the maintenance and discipline of the prisoners and the superintendent of the brick plant is responsible for the manufacturing processes. ‘This dual method of control leads to friction between representa- tives of the warden and the superintendent and is ill-adapted to efficient pro- duction. Some radical changes are necessary. The reorganization should seek to prevent all possibility of conflict of authority to the end that the best manufacturing methods may be employed and ' proper discipline maintained. Improvement in the prepartion and service of the food, provision for reasonable orderly recreation and comfortable sleeping quarters would involve no particular increased expenditure and would very much simplify the main- tenance of discipline and economy of production at the plant. As soon as reorganization results in efficient production, the plant should be increased in accordance with the provision made in the budget so that two or three times as many prisoners may be employed. Some plan should be evolved to overcome the prejudice against prison products. NEW PENITENTIARY— We believe that an analysis of the penal population of the state, showing the number which are normal, feeble-minded, psychopathic, and a survey of best practices in other states, will reveal the desirability of making radical changes in the plans for the new penitentiary. While at the time these plans were formulated they may have represented the most advanced ideas with re- spect to prison construction, the present day knowledge of criminality in its re- lation to feeble-mindedness is so far in advance and the understanding of psy- 44 chopathic states has been so increased by our war experiences that plans for prison construction evolved even 5 years ago can hardly be expected to rep- resent the best thought today. The present plans reveal a lack of appreciation of the need for providing different housing facilities for different classes and types of prisoners; the plans apparently contemplated housing all the pris- oners in cells, the most expensive type of construction, and employing most of the prisoners in industrial departments. We believe that only a certain percentage of the prison population requires the costly cell type of construction. A portion of the population can be adequately and safely housed in a different type of building which can be erected at considerable less cost. The type of construction and the elaborateness of the interior decora- tions, seem to be entirely out of proportion with respect to a well balanced financial program for state institutions and with respect to the needs and pur- poses of such an institution. We believe a less expensive type of con- struction would adequately meet the needs of the criminal popu- lation of the State. The original estimates of cost by architects based on 1916 prices was $7,256,310; more recent estimates based on crurent prices would place the total cost at perhaps double this figure. The total construc- tion cost to date is about $500,000. The state has many more pressing demands for its funds than for a new penitentiary, built upon monumental lines, to house the end product of social wreckage. We believe further that huge capital outlay expenditures for housing criminals to be unwise because we believe that many important changes will occur in the methods of handling criminals in the next few decades which will materially affect and influence the type of buildings required. If we build our prisons to last twenty or twenty-five years instead of building them to last 75 to 100 years, we can better adapt our prison construction to changes in penological viewpoint, without excessive waste, and at the same time free large sums of money for preventive work. We recommend the appointment of a commission to study the whole penal problem, in Ohio and in other states, for the pur- pose of formulating a constructive program for the development of the state penal institutions and particularly to revise the plans for the new penitentiary. In revising these plans, we wish to call attention to the need for sep- arate institutional facilities for the permanent care and custody of male defective delinquents, which need will become more apparent, when once the scheme of classifying prisoners is inaugurated. Another big question which needs consideration, is whether or not the state should establish a farm for male misdemeanants, to which of- fenders who are now sentenced to confinement in county jails and work- houses for 60 days or more, might be sent. A percentage of men now 45 sentenced to the reformatory might perhaps be properly sent to such a farm. Pending the report of this commission, we would recommend that only such work be done at the new penitentiary as is necessary to preserve the work executed, and protect the materials on hand from deterioration. Sufficient skilled mechanics should be employed to insure that all work done is up to standard. The organization is defective and ill-adapted to efficient handling of the work in hand; there should be a single head responsible for the custody and discipline of prisoners as well as for actual construction. MEN’S REFORMATORY— We suggest that provision be made for transferring the worst inmates to the penitentiary. The management estimates that if 10 or 12% of the worst inmates could be segregated, about three-fourths of the trouble at the reformatory would be eliminated. This plan would facilitate the work of the institution in becoming a real reformatory, as it would then house only the reformable cases. There is sufficient room within the walled enclosure to permit the erec- tion of a dormitory and we suggest that consideration be given to the feasibility and practicability of housing a certain percentage of the inmates in this less expensive type of building and thereby relieve some of the double celling. Sufficient expansion of the industries should be made from time to time to avoid any cause for idleness among the inmates of the re- formatory. We question the wisdom of depriving the reformatory inmates of to- bacco, believing that its deprivation tends to encourage other practices and habits which are far more detrimental than smoking or chewing tobacco. WOMEN’S REFORMATORY— This institution needs additional housing facilities badly. The school room is used as a dormitory and the operating room is used as living quarters for the matron. Beds are placed in corridors and many rooms house two in- mates. There are no cells where the worst cases can be locked up when the occasion requires it. Following a recent uprising at the institution, the worst cases had to be taken to the county jail for detention. The cottage for colored girls and the cottage for the matron, provided for in the budget, should be erected at once. We recommend also the erection of suitable cell blocks for detention purposes. Facilities for the employment of women within the institu- tion need to be provided. Elsewhere in the report we have suggested the possibilities of transferring some of the manufacturing industries particularly _ suited to women, from the penitentiary to this institution. The commission on Penal Institutions, suggested elsewhere, should make recommendations for the development of this institution. 46 We wish to point out, however, that the state must soon consider making provision for the housing of female defective delinquents. Whether additional facilities should be provided at Marysville or at the new feeble-minded institution needs consideration. The care and custody of de- fective female delinquents is very largely a state problem, because of their feeble-mindedness and because of their being a health menace to the com munity through the spread of venereal diseases. The common method of handling female sex offenders at the present time is for the court to fine them and then permit them to go back on the streets and work out their fine. Some courts endeavor to drive them outside their jurisdiction, while a few cities have established detention homes where they are held and given medical treatment before being released. A more reasonable method of dealing with this group would seem to be examination before sentence, and if found to be feeble-minded, and for that reason a menace, commitment to an institution for permanent custodial care where they cannot spread venereal disease nor breed defective children. This institution should provide the necessary facilities to make it self-supporting through the labor of its inmates. CORRECTIONAL INSTITUTIONS BOYS’ INDUSTRIAL SCHOOL— If the plans develop as outlined in this report, this institution would eventually become the training school for the boys who require ex- tended observation, training and treatment. The normal boys would not be sent here and the feeble-minded boys would be sent to the feeble-minded in- stitution. This plan would preserve the facilities of this institution for the abnormal, the psychopathic, and the difficult problem cases. Pending the building of greater facilites for the feeble-minded, we sug- gest the possibility of segregating the feeble-minded boys who might have to be sent here for a year or so, in one or more cot- tages at this institution, so that whatever changes may be required in educa- tional and vocational work, in discipline, in physical and mental treatment, might be started at once. The educational survey made under the direction of the state superin- tendent of public instruction points out the need for expert educational lead- ership, additional teachers, better trained teachers, additional equipment, vitalized curriculums and an expansion of the provisions for physical training, and education in personal and public health and sex hygiene. We believe a serious effort should be made to carry out these recommendations. We also wish to suggest the need for more adequate medical supervision and the employment of a dentist. It has occurred to us that additional trades might be taught to ad- 47 vantage, such as electrical wiring, plumbing, etc., in the acquirement of which the boys might be able to perform much useful work about the institution. The removal of the fire hazard in some of the older dormi- tory buildings should receive immediate attention. GIRLS’ INDUSTRIAL SCHOOL— This institution has apparently lacked adequate supervision. The cot- tages reveal a lack of careful planning and in many cases the sanitary ar-_ rangements are inadequate. In the cottage assigned to colored girls, the girls are locked in their rooms at night by a turnkey and no provision exists for automatic opening of their doors in case of fire. This should be corrected. A full-time resident physician should be employed to look after the health of the 450 girls in the institution and to direct and supervise the recreational activities. A new reception cottage is needed, and funds should be set aside for this purpose. The present reception cottage might be kept for colored girls if it will not be too close to the water’s edge after the new Scioto dam is completed. Adequate provision should be made for the segrega- tion of venereal disease cases. Serious consideration should be given to the recommendations contained in the educational survey of the institution. A trained supervisor of instruc- tion should be employed, who is an expert in elementary and vocational edu- cation of subnormal girls. The curriculum should be adapted to the needs of the types of girls who are sent to the institution and industrial and manual work should be a prominent feature. When the Scioto dam is completed, a considerable part of the grounds, including the power plant, laundry and sewage disposal plant, will be flooded. In adjusting damage claims with the city of Columbus, it should be borne in mind that these plants are not inadequate for the institution as it exists today. Special effort should be made to preserve for the use of the institution, if possible, the valuable sulphur springs now serving it. IMPROVEMENTS IN BUSINESS ADMINISTRATION NEW FORM OF STATE BUDGET DESIRABLE— We believe the classification of items in the appropriation act is too de- tailed to permit the most efficient administration of funds by department 48 heads. In fact, a department head is hampered in the exercise of his busi- ness judgment, because the legislature predetermines the way in which he is to spend the funds during the biennium. Under this plan the legislature rather than the department officials administers the department. A less de- tailed appropriation act would give the administrative official some leeway in which to use his judgment in meeting new and unforeseen conditions and in securing the maximum of return for the money expended. The present classification does not produce information which is of greatest value either to the individual departments, or the legislature. The information now obtained has little administrative value. For example, the cost of repairing state institutions, or the cost of the various operations such as that of the laundry, power house, etc., can not readily be obtained without duplication of bookkeeping work. The frequency with which transfers have to be made in ‘order to operate departments and institutions consumes much time and effort on the part of officials in securing transfers, and causes unnecessary bookkeeping work. In any event, we believe it would be worth while for the Department of Public Welfare to install a new scheme of classifying expenditure which would afford the information required for the successful administration of the department by making possible an expression of cost in terms of product. AGRICULTURAL ROTARY FUND— It would be desirable to have an agricultural rotary fund similar to the manufacturing rotary fund. Receipts from the sale of live stock, and farm and garden produce would be credited to this fund and expenditures could be made for the improvement of the herds, farms and orchards belonging to the state institutions. Such a plan would afford an additional incentive to super- intendents to produce products of good quality, because each institution would reap the benefit of its own good management and husbandry. INSTITUTIONAL RECEIPTS— Each institution receives a small amount of money each year from the inmates or their relatives for clothing and incidentals furnished. If the Director of Public Welfare were allowed the use of this money or an equiv- alent sum to improve the medical and curative work at the institutions, the character of service rendered could be much improved. DEPARTMENTAL CONTROL OF BUSINESS ACTIVITIES— The purchase of all lands for the state institutions should be made only upon the approval of the Director of Public Welfare. 49 The erection and design of all buildings for state institutions under the control of the Department of Public Welfare should be made under the direc- tion and supervision of the Director of Public Welfare. The authority of the Director of Public Welfare should be supreme, if it is not already so, in all matters relating to the discipline and management of state institutions. We believe the volume of purchasing at the Department of Public Wel- fare is so large as to warrant and require a separate purchasing department. The law authorizing commitment of boys directly from the juvenile court to the Boys’ Industrial School should be amended to provide for com- mitment to the Department of Public Welfare. Furthermore, the law gov- erning the admission and discharge of boys should be changed to vest final control over these matters with the Director of Public Welfare. 50 Date Due | a | | | | | pea | =a + 4———+— case -+ “+ a ease aed] Pas. | | | | ‘ | | | | | | | | | | | | | | re S ae te | a ‘oaaat| = l be | | | | i | | | i | | | | : | ee 1 | | | | | | | | | J | | Pee | | ties | a eI The Ohio State Unive wii 9913 1 oT Ne i MA LE SEC mm?) ba aa