STATE OF NEW JERSEY 
 
 REPORT 
 
 OF THE 
 
 NEW JERSEY COMMISSION ON THE 
 CARE OF MENTAL DEFECTIVES 
 
 TRENTON, N. J. 
 
 MacCrelush & Quigley, State Printers. 
 
 1914 
 
23 Se’14 tfAECHTQLD, 
 
 V(4-u\rv 
 
 Q-O'ft . * 1 * 
 
 Members of the Commission. 
 
 JOSEPH P. BYERS, Chairman, . Trenton. 
 
 Commissioner of Charities and Corrections. 
 
 EDMUND E. READ, Jr., Secretary, .Camden. 
 
 JOHN NEVIN, M.D., . Jersey City. 
 
 Member of Board of Managers, State Hospital for the Insane at 
 Morris Plains. 
 
 STEWART PATON, M.D., . Princeton. 
 
 Member of Board of Managers, State Hospital for the Insane at 
 
 Trenton. 
 
 EDWARD D. PAGE, .Oakland. 
 
 ( 3 ) 
 
Digitized by the Internet Archive 
 in 2017 with funding from 
 
 University of Illinois Urbana-Champaign Alternates 
 
 https://archive.org/details/reportofnewjerse00newj_0 
 
Joint Resolution Providing for Appointment of 
 the Commission. 
 
 Whereas, There is urgent need in this State for additional provision fbr the 
 care, custody and treatment of mental defectives, including the insane, 
 epileptic and feeble-minded; and 
 
 Whereas, There is no present reason to hope that the rate of increase in the 
 number of these dependents will diminish; and 
 Whereas, The resources of the State are even now inadequate to provide 
 for those whose mental deficiency has already been determined; and 
 WIhEREas, The overcrowded condition of our present institutions greatly 
 interferes with and militates against the curative treatment of recoverable 
 cases; and 
 
 Whereas, It is incumbent upon the State, in view of the foregoing, to deter¬ 
 mine the manner and method to be adopted in extending the provision for 
 the insane, the feeble-minded and epileptic; therefore, 
 
 Be if resoeved by the Senate and General Assembly of the State of New 
 Jersey: 
 
 i. That the Governor of the State is hereby authorized and directed to 
 appoint, subject to confirmation by the Senate of the State, five persons, 
 citizens of the State, of whom one may be a woman, and one of whom shall 
 be the Commissioner of Charities and Corrections, a representative of the 
 Board of Managers from the New Jersey State Hospital at Trenton, and 
 from the New Jersey State Hospital at Morris Plains, to be known as the 
 New Jersey Commission on the Care of Mental Defectives; and that said 
 commission within ten days after their appointment and confirmation shall 
 meet and organize by the appointment of a chairman and a secretary. For 
 this purpose and for any subsequent meetings held in the city of Trenton, the 
 Department of Charities and Corrections shall provide the necessary facilities. 
 The members of the commission are to serve without compensation, but 
 their necessary expenses incurred in the discharge of their duties, shall be 
 paid out of appropriations made for that purpose by the Legislature. 
 
 It shall be the duty of the said commission to investigate the subject of 
 public provision for the care, custody and treatment of mental defectives in 
 this State, with particular reference to the following: 
 
 1. To what extent is the present public provision for the insane inadequate? 
 
 2. What additional provision is immediately necessary and what further 
 provision is likely to be required in the near future? 
 
 3. In what manner can this additional provision best be made that will 
 insure: (a) early relief; ( b ) economy in construction and administration; 
 ( c ) proper care, curative treatment and custody; ( d ) adequate State super¬ 
 vision. 
 
 4. In what manner, if at all, can the present system of public care of the 
 insane be reorganized so that the highest efficiency with the greatest economy 
 in their care and treatment may be secured? 
 
 (5) 
 
6 
 
 The commission shall similarly investigate the subject of the feeble-minded 
 and the epileptic. 
 
 The results of the investigation of the commission shall be embodied in a 
 report which shall be filed with the Governor on or before March first, 
 one thousand nine hundred and fourteen, and by him forthwith transmitted 
 to the Legislature. The Commissioner of Charities and Corrections and the 
 heads of all institutions in this State shall furnish to said commission 
 promptly, such information bearing upon the work of the commission, and in 
 such form as may be asked for by the said commission. 
 
 Resolved further, That the sum of two thousand five hundred dollars is 
 hereby appropriated for the expenses of said commission, said sum or any 
 portion of same to become available when included in the supplemental or 
 annual appropriation bills. 
 
 This resolution shall take effect immediately. 
 
 Approved April 3, 1913. 
 
REPORT. 
 
 Hon. James F. Fielder, Governor of the State of New Jersey. 
 
 Sir —In pursuance of Joint Resolution No. 5, approved April 
 3d, 1913, the New Jersey Commission for the care of Mental 
 Defectives respectfully report: 
 
 The duty of this Commission as embodied in the Joint Reso¬ 
 lution is to investigate the subject of public provision for the 
 care, custody and treatment of mental defectives in this State, 
 with particular reference to the following: 
 
 “1.—To what extent is the present provision for the insane in¬ 
 adequate ? 
 
 “2 .—What additional provision is immediately necessary, and 
 what further provision is likely to be required in the 
 near future? 
 
 “3.—In what manner can this additional provision best be made 
 that will insure: (a) early relief; ( b ) economy in construc¬ 
 tion and administration ; (c) proper care, curative treat¬ 
 ment and custody ; ( d ) adequate State supervision. 
 
 “4.—In what manner, if at all, can the present system of public 
 care of the insane be reorganized so that the highest 
 efficiency with the greatest economy in their care and 
 treatment may be secured? 
 
 “The Commission shall similarly investigate the subject of the 
 feeble-minded and the epileptic/’ 
 
 In pursuance of the instructions contained in this resolution,, 
 we have visited and examined the New Jersey Hospitals for the 
 Insane at Trenton and Morris Plains, the State Village for 
 Epileptics at Skillman, the Home for Feeble-Minded Women at 
 Vineland, the Essex County Hospital at Overbrook, the Hudson 
 County Hospital at Secaucus, Burlington County Hospital at 
 New Lisbon, the Cumberland County Hospital at Bridgeton, the 
 Camden County Hospital at Blackwood, the Atlantic County Hos¬ 
 pital at Pleasantville, the New Jersey Training School at Vine- 
 land, and in order to carry out the spirit of this resolution, and 
 that we might better acquaint ourselves with conditions in other 
 States, we have visited and examined institutions for the care of 
 insane, epileptic and feeble-minded in the States of Massachusetts, 
 
 (7) 
 
8 
 
 Pennsylvania, Indiana, Wisconsin, Maryland and New York. We 
 have also visited three of the private establishments for the care 
 of those afflicted with nervous or mental diseases within this State. 
 We have also visited the quarters provided for the insane who 
 have been committed to four of the county jails within the State. 
 
 We have consulted alienists of national reputation in various 
 centres, who have aided us in reaching our decision by their wise 
 counsel, their generous advice and the results of their long ex¬ 
 perience. 
 
 the) insane. 
 
 Public provision for the insane in New Jersey is found at the 
 two State Hospitals, Morris Plains and Trenton, and in county 
 hospitals in the following named counties: Atlantic, Burlington, 
 Camden, Cumberland, Essex, Hudson, Gloucester, Passaic and 
 Salem. 
 
 In the counties of Gloucester, Passaic and Salem a few insane 
 persons are provided for in their respective almshouses. They 
 are for the most part chronic cases that have been under care for 
 years. We are of the opinion that no additional commitments 
 should be made to these institutions. The number of patients in 
 Passaic county is 36, in Gloucester, 7, and in Salem, 7. 
 
 The whole number of insane under public care on October 31st, 
 1913, was 7,097. 
 
 The following table shows the normal capacity of each of the 
 State and county hospitals, the number actually under care on 
 October 31st, 1913, and the excess of patients or accommoda¬ 
 tions at each institution: 
 
 Number 'Excess of Excess 
 Normal Enrolled, Accommo- of 
 
 Institution. Capacity. Oct. 31, 1913. dations. Patients. 
 
 State Hospital, Tren- 
 
 ton, ............ 
 
 State Hospital, Mor¬ 
 
 i,6oo- 
 
 T 552 
 
 48 
 
 812 
 
 ris Plains,. 
 
 1,600 
 
 2,412 
 
 
 Atlantic County, . . . 
 
 120 
 
 105 
 
 *5 
 
 
 Burlington County,. . 
 
 175 
 
 1 77 
 
 . • • .1 
 
 2 
 
 Camden County 
 
 260 
 
 246 
 
 14 
 
 
 Cumberland County,. 
 
 200 
 
 140 
 
 60 
 
 .... 
 
 Essex County, . 
 
 T 525 
 
 1,614 
 
 
 89 
 
 Hudson County, 
 
 500 
 
 801 
 
 . . . . 
 
 301 
 
 Gloucester County,. . 
 
 t 
 
 36 
 
 .... 
 
 . •• 
 
 Passaic County, .. .. 
 
 
 7 
 
 . ... . 
 
 . . . . 
 
 Salem County, ..... 
 
 
 7 
 
 . ... . 
 
 .... 
 
9 
 
 It will be seen from the foregoing that the State is now caring 
 for 1,067 insane persons in excess of the full normal capacity 
 of our State and county hospitals. The serious overcrowding 
 is at the State Hospital at Morris Plains and the county hospital 
 in Hudson county. The latter institution is purely custodial in 
 character. 
 
 The records of the Department of Charities and Corrections 
 indicate that the average yearly increase in the number of 
 insane persons under public care during the past five years has 
 been 237. 
 
 The answer, then, to the first question is that the present 
 public provision for the insane is inadequate properly to house 
 1,067 of the State’s present wards. Additional provision, there¬ 
 fore, for the proper housing, care and treatment of the insane 
 is immediately necessary for 1,067 patients, and we must con¬ 
 template an annual increase of these wards for whom further 
 provision is likely to be required in the near future of approx¬ 
 imately 250 annually. 
 
 THE COEONY SYSTEM. 
 
 The additional provision immediately necessary seems to this 
 Commission to be best furnished by the colony system. This 
 will take care of the immediate and pressing needs of the State, 
 and by reason of its ready expansion will furnish the needed 
 provision for the near future. 
 
 Dr. Owen Copp, in his report to the Minneapolis Conference 
 of Charities and Corrections, 1907, thus described the colony 
 system and its usefulness: 
 
 “The colony would take from the closed asylum the harmless 
 patients suitable for greater liberty and capable, in variable de¬ 
 gree, of industrial re-education. In its simple dwellings, arranged 
 in small and separate groups, according to their condition, occu¬ 
 pation and character of training, they would find the nearest 
 approach to a home, its comforts and freedom. 
 
 “The chief aim of the colony would be the utilization of the 
 enormous waste of physical energy latent in the host of idle 
 dements, unused because of mental torpor, damaged brains and 
 weakened powers of application, but capable of quickening, par¬ 
 tial regeneration and re-development into useful activity. Al¬ 
 though the labor O'f patients with initiative and of others easily 
 induced to perform common duties is quite generally and fully 
 employed, the great task of re-education of the stupid dement is 
 practically untouched so far as it demands special organization, 
 painstaking training and persistency, comparable in a measure to 
 the efforts and methods of industrial education of the congen- 
 
IO 
 
 itally defective and feeble-minded, and promising’ as great return 
 in production and happiness to patients, fully equivalent to the 
 additional outlay for teachers and attendants. 
 
 “The hospital and asylum are more closely related to each 
 other than to the colony, which might have any convenient lo¬ 
 cation within a radius of many males, if necessary to procure 
 a large tract of wild land, rough and stony at the outset, but 
 fertile and diversified in quality after reduction to tillage by the 
 labor of the patients. A limited central organization with a 
 resourceful physician at the head would co-ordinate the numer¬ 
 ous small, separate farmsteads and industrial group, each com¬ 
 plete in its home equipment and interests and managed by a 
 good farmer or mechanic, whose wife should be its house mother. 
 These centres should be mutually independent, but responsible 
 to the resident physician. 
 
 “Some may fear that such an order would be expensive if 
 applied to an unsuitable class of patients such as those 
 requiring strict oversight and much paid attendance. The 
 prerequisites of success are absence of the necessity of more 
 than ordinary supervision, propriety of comparative freedom, 
 capacity for self-help and the probability of productive labor. 
 It should also be kept in mind that the useful application of 
 labor, especially to the current needs of the institution, should 
 take precedence of any production for the outside market or 
 mere occupation and diversion of colonists. 
 
 “These general principles are equally applicable to the care, 
 classification and training of the feeble-minded and the epileptic, 
 if the school and manual training be added to the hospital 
 equipment, with slight modification of the colony and custodial 
 regimes in adaptation to their special needs.” 
 
 Your Commission recommends the immediate establishment 
 of three colonies, reasonably accessible to the existing institu¬ 
 tions. Each colony should have connected with it at least five 
 hundred acres of land; more would be advantageous. This 
 land should have an abundance of wholesome drinking-water. 
 It should be located upon roads that would allow of quick con¬ 
 nection with the present institution, either by rail or automobile. 
 The buildings to be erected for the use of the colony should not 
 be of an expensive type; ordinary construction such as is used 
 in dwellings for farm houses would be all that is necessary. 
 We have seen practically no permanent construction in this or 
 any other State that has not within ten or fifteen years become 
 obsolete or at least ill-suited to the rapidly improving methods 
 of custodial care. The system should be planned with special 
 
reference to the ultimate distribution of the wards of the State 
 in economical and easily managed units in various localities, so 
 as to promote the frequent visits of relatives, guardians and 
 friends. The agricultural and industrial activities of each of 
 the centres so established will be attractive to other visitors, and 
 the morale of the custodial activities will, in our judgment, be 
 benefited and stimulated by the nearer association of the citizens 
 so attracted. We would recommend that these colonies should 
 not have over three hundred patients at any one time, and we 
 believe that it is best to erect buildings that would accommodate 
 thirty to fifty and be sufficiently far apart to avoid any danger 
 of a conflagration. Your Commission believes that these colonies 
 would be highly advantageous to the State and to the patients 
 sent to them. Conditions vary in various institutions and they 
 also vary from time to time, and it is impossible for this Com¬ 
 mission to give exact figures as to the proportionate number of 
 patients that can be removed from an institution and be colonized. 
 It would not be wise, in our judgment, to so remove all of those 
 qualified for colony conditions, since some of them, can as 
 well, or better, be cared for under the conditions of occupational 
 treatment already established in several of our existing in¬ 
 stitutions, and they are needed for their economical adminis¬ 
 tration. Probably forty per cent., however, would be a fair 
 figure to be used as a preliminary estimate. These patients 
 would have the advantage of occupation and of out-of-door 
 life, both of which are of use as therapeutic measures. The 
 maintenance cost per capita would be, we believe, reduced to 
 a degree from, the cost of maintenance in the institution, but 
 only to a degree. The patients in the colony would not be 
 self-supporting. We believe that no large proportion of mental 
 defectives can become self-supporting, and to consider the colony 
 plan as a system by which the revenues of the State can be 
 increased would be a great mistake. All that the plan offers 
 from a financial standpoint is a probable reduction in mainte¬ 
 nance and a large economy in installation. The object in having 
 these colonies within a reasonable distance of the existing insti¬ 
 tutions is that the patients at the colony may be easily removed 
 to the existing State hospitals for treatment if through excite¬ 
 ment, sickness or accident such removal becomes necessary. It 
 would further allow of the easy transfer of the products of the 
 colony to the other institutions, if there should be any excess 
 over and above what may be used for the colony itself. 
 
 The colony plan offers advantages for women as well as for 
 men. The outdoor life reduces the probability of tuberculosis, 
 
12 
 
 makes sleep easier and longer, and gives the patient a renewed 
 interest in living. The land need not be of an expensive char¬ 
 acter, in fact it probably would be better to begin with rough 
 land which the patients can gradually break in and improve. 
 We estimate that the cost per bed, including land (providing, of 
 course, that this cheap quality of land is purchased), would not 
 exceed $350; this is dependent, however, on the acreage and the 
 location. 
 
 CONFINEMENT OF THE INSANE IN COUNTY JAIES. 
 
 Blanks have been sent to the sheriffs of all the counties of the 
 State, asking for detailed information relative to the insane who 
 at any time during the course of the calendar year 1913, have 
 been committed to their charge, and returns have been received 
 
 from 18 counties, 
 follows: 
 
 the results of 
 
 Number 
 
 of 
 
 which may be summarized as 
 
 Term of Commitment — Days. 
 
 County. 
 
 Insane. 
 
 Shortest. 
 
 Longest. Average. 
 
 Atlantic, . 
 
 . 2 
 
 42 
 
 79 
 
 60 
 
 Bergen, . 
 
 . 48 
 
 1 
 
 61 
 
 8 
 
 Burlington,. 
 
 . . ... 1 
 
 5 
 
 
 
 Camden, . . 
 
 . 12 
 
 1 
 
 16 
 
 7 
 
 Cape May, . 
 
 
 
 
 
 Cumberland, .... 
 
 
 
 
 
 Essex, . 
 
 . 7 
 
 7 
 
 223 
 
 76 
 
 Hunterdon. 
 
 . 3 
 
 2 
 
 85 
 
 30 
 
 Mercer, . 
 
 . 5 
 
 7 
 
 44 
 
 23 
 
 Middlesex, . 
 
 . 6 
 
 4 
 
 83 
 
 35 
 
 Monmouth, . 
 
 . 6 
 
 4 
 
 82 
 
 21 
 
 Ocean,. 
 
 . 3 
 
 3 
 
 24 
 
 11 
 
 Passaic, . 
 
 . 63 
 
 1 
 
 55 
 
 12 
 
 Salem, . 
 
 . 2 
 
 49 
 
 49 
 
 49 
 
 Somerset, . 
 
 . 7 
 
 1 
 
 15 
 
 5 
 
 Sussex, . . .. 
 
 
 
 
 
 Union,. 
 
 . 26 
 
 1 
 
 57 
 
 9 
 
 Warren, . .. 
 
 . 2 
 
 12 
 
 22 
 
 1 7 
 
 It is evident that a system that will permit of so many persons 
 being confined in penal institutions for faults for which they 
 were not responsible and often charged with no crime, is capable 
 of great injustice and should not be permitted to continue. 
 
!3 
 
 ALCOHOLISM. 
 
 ,* 
 
 Alcoholism is the most prominent single causative agency 
 with reference to crime, pauperism, mental disease and degen¬ 
 eracy. 
 
 Social customs and habits in connection with so-called moder¬ 
 ate drinking are responsible to a degree for the future inebriates 
 and chronic alcoholics. 
 
 From a sociological standpoint divergent views are held as 
 to the proper method of treatment of alcoholics and inebriates. 
 The penologist claims that punitive measures should be insti¬ 
 tuted. Others go to the other extreme and claim that all such 
 persons are diseased and fit subjects for medical treatment. There 
 are some who say that the habit is one that can be controlled 
 by the habitues if they wish to make the effort. It is probable 
 that there are cases which come under each division, but the 
 fact remains it is largely a medical question, and as such is 
 peculiarly complex. 
 
 In connection with the commitment of these cases to penal 
 institutions, the report of the Board of Prison Commissioners 
 of Massachusetts, for the year 1908, is interesting. During 
 that year, 201,779 persons were committed for simple drunken¬ 
 ness, and of this number 13,548 had been committed from two 
 to fifty times previously. When it ds taken into consideration 
 that a very large percentage of these cases are returned to some 
 sort of an institution following the first incarceration, the punish¬ 
 ment by jail, work-house or penitentiary sentences would seem 
 an absurd practice, and, so far as statistics show, remarkably 
 inefficient as a curative measure. 
 
 It is unquestionably true that many of these people present 
 pathological lesions, hereditary taint or other predisposing 
 causes, and in this connection the statistics obtained from the 
 State Hospitals at M'orris Plains and Trenton, and the Essex 
 and Hudson county institutions for the insane, are illuminating. 
 We have selected these institutions because of the larger number 
 of inmates under treatment, and the accessibility of statistics. 
 
 The Morris Plains Hospital, during the years 1911, 1912 and 
 1913, had 176 persons committed for alcoholism and alcoholic 
 psychoses, 125 men and 51 women. Of these twenty-one per 
 cent, give hereditary history. The average age at commitment 
 was 42.23, and the average duration of treatment 8 months and 
 * 27 days. 
 
J 4 
 
 COMMITMENTS OE ALCOHOLICS TO' STATE HOSPITAL AT 
 MORRIS PLAINS. 
 
 
 Men. 
 
 
 
 Year. 
 
 Total 
 
 Admissions. 
 
 Alcoholics. 
 
 Percentage of 
 Alcoholics to 
 Total Admissions. 
 
 I 9 IT . 
 
 . 269 
 
 46 
 
 I7.IO 
 
 I9I2, . 
 
 . 300 
 
 47 
 
 15-67 
 
 I 9 I 3 » . 
 
 . 274 
 
 32 
 
 11.68 
 
 Total, . 
 
 . 843 
 
 . 125 
 
 14-83 
 
 
 Women. 
 
 
 
 1911.1. 
 
 . 270 
 
 22 
 
 8.15 
 
 1912, .. . . 
 
 
 18 
 
 6.62 
 
 1913, . 
 
 ... 264 
 
 11 
 
 4.I7 
 
 Total, .. . . 
 
 
 5 i 
 
 6-33 
 
 The Trenton State Hospital shows 236 commitments of alco¬ 
 holics during the same period. The average duration of treat¬ 
 ment in this institution for acute mental disturbance due to 
 alcohol, and for simple inebriety, was five to six weeks; and for 
 sub-acute mental disturbances due to alcohol, six months to one 
 year. Hereditary predisposition appears in cases in which in¬ 
 formation was available in 52% for the past six years, and 85% 
 showed alcoholism in antecedents in one parent or both. In 
 a great majority of cases this institution is able to show a patho¬ 
 logical make-up for some predisposing causes to alcoholic in¬ 
 dulgence. 
 
 commitments oe alcoholics to state hospital at TRENTON. 
 
 
 
 Men. 
 
 
 
 
 Year. 
 
 Total 
 
 Commit¬ 
 
 ments. 
 
 (Alcoholic ) Inebriate - 
 
 Total Alco¬ 
 holic and Ine¬ 
 briate. 
 
 Perce ntage of 
 Alcoholics 
 to Total 
 Admissions. 
 
 I9II, - 
 
 . 244 
 
 41 
 
 29 
 
 70 
 
 28.7 
 
 1912, . ... . 
 
 . 282 
 
 42 
 
 3 1 
 
 73 
 
 25-9 
 
 1913 , .... 
 
 . 280 
 
 56 
 
 37 
 
 93 . 
 
 33-2 
 
 Total, . 
 
 . 806 
 
 x 39 
 
 97 
 
 236 
 
 29-3 
 
 
 
 Women. 
 
 
 
 1911, . . . . 
 
 • 152 
 
 8 
 
 4 
 
 12 
 
 - 7-9 
 
 1912, . . . . 
 
 . 206 
 
 10 
 
 4 
 
 14 
 
 6.8 
 
 1913, 
 
 . 20i8 
 
 8 
 
 11 
 
 19 
 
 9.1 
 
 Total, . 
 
 . 566 
 
 26 
 
 19 
 
 45 
 
 7-9 
 
i5 
 
 In 1911, 147 patients were admitted to the Hudson county in¬ 
 stitution, of whom 5 women and 19 men were alcoholics. In 
 1912, of 230' patients admitted, 9 women, and 32 men were alco¬ 
 holics; and in 1913, of 270' patients admitted, 15 women and 46 
 men gave alcoholic histories; making 126, or 19.5 per cent, in a 
 total number of admissions of 647 in which over-indulgence in 
 alcohol appears as a direct cause. 
 
 The Essex County Hospital, during the period mentioned, ad¬ 
 mitted 142 alcoholics, 106 male and 36 female, all of whom were 
 committed as “insane.” The statistics show hereditary taint in 
 direct or collateral branches, or. pathological lesion where in¬ 
 formation was obtainable, in 44 cases. 
 
 The age period during which most of these cases in all of the 
 institutions were committed was between 301 and 60 years. The 
 reasons for this must be obvious. 
 
 The statistics of the mentally sub-normal would undoubtedly 
 show hereditary taint in a larger number than in the insane. It 
 is a well-established fact that epilepsy in the offspring is produced 
 by chronic alcoholism in the parent. 
 
 In view of these facts, the question of institutional treatment 
 for chronic alcoholics and inebriates as a separate problem should 
 receive serious consideration at the hands of the executive and 
 legislative branches of the State government, as well as, perhaps, 
 in a more satisfactory manner, by other means which may be 
 devised to devote continuous effort along scientific lines so as to 
 determine how to secure the best results. Many cases that are 
 sent to jails, work-houses and penitentiaries are those who, later 
 on, fill our hospitals for the insane, almshouses and institutions 
 for criminals, and it is the belief of this. Commission that under 
 proper conditions a large percentage of these might be reclaimed, 
 restored to their families and become useful citizens. In any 
 event, the present method of caring for these cases in this State 
 is far from satisfactory. During the period of treatment, such 
 cases could, by proper employment along agricultural and indus¬ 
 trial lines, be made practically self-supporting. The percentage 
 of this class, capable of productive occupation, would naturally 
 be larger than in the case of mental defectives. 
 
 This is the preventive age.in medicine, and if prophylaxis is 
 to be applied in mental diseases, the hereditary elements re¬ 
 moved or improved, pauperism and its attendant evils decreased, 
 criminality attributable to vicious surroundings, environment 
 and the excessive use of stimulants diminished, if any or all of 
 these things are to be accomplished, alcoholism, wherever and 
 however possible, should be eliminated. 
 
 9 
 
j6 
 
 PRIVATE SANATORIA. 
 
 The present law relative to private sanatoria gives a right of 
 license and inspection to the Commissioner of Charities and Cor¬ 
 rections, only with respect to institutions nominally caring for 
 the insane. In the judgment of your Commission no person 
 should be permitted to operate within this State a sanatorium 
 for the care of patients of any degree of mental alienation with¬ 
 out being similarly subject to license and inspection. 
 
 There are undoubtedly many persons in the State now held 
 in practical custody and classed as neurasthenics, dipsomaniacs,, 
 etc., who are actually and in fact of unsound mind. In our 
 judgment the Commissioner of Charities and Corrections or his 
 agents should have the power of inspection at any time, and 
 of any institution where nervous patients of any class are under 
 treatment. 
 
 PSYCHOPATHIC CLINIC OR RECEPTION HOSPITAL. 
 
 Insanity and feeble-mindedness are conditions that are the 
 result of disease and therefore the problem relating to the care 
 of those afflicted with these disorders are primarily medical. 
 
 The old type of institution called Asylum is a relic of bar¬ 
 barism and intelligent communities are rapidly replacing it by 
 modern hospitals constructed and organized upon a basis that 
 facilitates the adoption of methods directed towards preventing 
 the occurrence of nervous and mental disorders, or of taking 
 active measures to relieve the symptoms when once they have 
 developed. From an economical standpoint a hospital, even ir 
 spite of the greater initial cost, represents an effective agency 
 for conserving the brains and the money of the community 
 when compared with the asylum to which patients are sent 
 after they have reached the chronic or incurable stages of their 
 disease. 
 
 We recommend the establishment of a reception hospital or 
 psychopathic clinic with accommodations for at least fifty pa¬ 
 tients, to be established at an initial cost of not over $100,000. 
 
 This institution should be within easy reach of one of the large 
 centers of population, should have a relatively large staff of 
 physicians and nurses, and in it ample provision should be made 
 not only for giving to the patients the benefits of the resources 
 of a well-equipped modern hospital, but it should also become 
 a centre in which instruction may be given to members of the 
 
medical profession as well as to the general public in regard 
 to the nature, causes and methods of preventing the incidence 
 of nervous and mental diseases. In a hospital organized along 
 these lines opportunities should be given to competent persons 
 to carry on research work with a view to determining important 
 facts regarding the nature and development of these diseases. 
 Only in institutions in which opportunity is given for carrying 
 on original investigation to determine more fully than is yet 
 known the nature of insanity, the causes that give rise to it, 
 and the methods of preventing its occurrence, will it be possible 
 to enlist the services of competent and highly trained physicians 
 to assist the State in the solution of the most important prob¬ 
 lems which now confront humanity. 
 
 Some of the advantages to the State following the erection 
 of a psychopathic clinic would be the following: 
 
 (1) An increasing number of individuals upon the appear¬ 
 ance of the first symptoms of a mental breakdown would be 
 admitted to the clinic as voluntary patients, receive treatment, 
 and be discharged. Under present conditions the same per¬ 
 sons refrain from applying for admission until the disease has 
 advanced so far that they become permanent wards of the State. 
 
 (2) An institution of this character under the directorship 
 of a thoroughly trained alienist would at once become a centre 
 of education. The medical profession would have opportunities 
 offered them for becoming familiar with the incipient stages 
 of nervous and mental diseases and would, as is the case in 
 communities' where clinics of this type already exist, encourage 
 patients to seek for advice and treatment at an early stage in 
 the disease. 
 
 The alienists would also be greatly assisted in their efforts 
 to get at the causes leading to insanity by the information ob¬ 
 tained from physicians in general practice, and also 1 by the 
 employment of trained social workers whose duty it should be 
 to make a study of the environment and social condition in 
 which patients have lived prior to the incidence of insanity. In 
 many cases it would be possible, if the home conditions were 
 known, to assist individuals to readjust their lives and thus 
 aver disaster. 
 
 (3) The psychopathic clinic should be a centre to which 
 teachers in the public schools would carry many of their prob^ 
 lems relating to the education not only of the mentally sub¬ 
 normal, but of the emotionally abnormal children. 
 
 (4) Cases of individuals involving the discussion before the 
 courts of their legal responsibility could readily be more thor- 
 
i8 
 
 oughly examined here and with far less expense to the State 
 than under the present method of procedure. 
 
 (5) Facilities for research and greater diversity O'f work 
 would be furnished to the staffs of the several State hospitals. 
 
 We would recommend that post-mortem examinations be 
 allowed in all instances. 
 
 Research should be carried to the ordinary physician, and we 
 recommend that from time to time physicians be invited to attend 
 lectures and clinics, and that meetings of county medical societies 
 be held in the State institutions. 
 
 In the State with which the name of Dorothea Dix is so 
 intimately associated there exists an additional incentive for the 
 carrying out of an aggressive, intelligently planned and executed 
 campaign to control the startling incidence of nervous and 
 mental disorders, including feeble-mindedness. A policy of pro¬ 
 crastination, or of merely temporizing in supplying the funds 
 necessary to build a psychiatric clinic and thoroughly equipping 
 the two State hospitals for carrying out the modern treatment 
 of the insane, and for facilitating the scientific study of cases, 
 will, if continued for many years, necessitate an enormous in¬ 
 crease of the sums spent to maintain hospitals defective in con¬ 
 struction as well as organization, and entail in addition a still' 
 larger economic loss to the community. 
 
 REORGANIZATION. 
 
 Your Commission believes that the present system of the public 
 care of the insane can and should be reorganized, so that a 
 higher efficiency with a greater economy in their care and treat¬ 
 ment may be secured. We find that in many of the states which 
 we have visited there is a commission of lunacy or a board of 
 guardians who have very broad supervisory and advisory 
 powers. In every instance it seems to be productive of good 
 results for the patients under the care of the State. 
 
 We find, especially in some of the county institutions, that, 
 unfortunately, partisan politics plays a part in their administra¬ 
 tion, and that in too many cases officers and employees are 
 selected by reason of political influence rather than for their use¬ 
 fulness to the patients in their charge, and that this works 
 against the care and cure of the mentally sick. We believe that 
 it is necessary to do> away with all partisan politics of every 
 kind connected either with State or county institutions having 
 the care of the mentally defective wards of the State. Under 
 competent State control this could be accomplished. 
 
i9 
 
 We find that in some of the institutions, both county and State, 
 there is a dual system of control, a physician and a warden. 
 We believe that this is not for the best interest of the patients or 
 the institutions, and we recommend that the wardens be made 
 subordinate tO' the medical superintendents. 
 
 The attendants who serve in the various institutions are not, 
 as a class, capable of rendering the most efficient service, and 
 we recommend therefore that effort should be made by increased 
 wage, by better accommodations at the institutions, by shortened 
 hours and by more diversified amusement and interest, to attract 
 to the service of the State a higher grade of men and women 
 than we find at present in its service. 
 
 We recommend that in all the institutions there should be 
 separate quarters for the nursing staff. A general complaint that 
 we find is that nurses do not remain long owing to the fact that 
 in some, not in all of the institutions, the nurses when off duty 
 are nevertheless in the same atmosphere and environment as 
 when on duty, and as a result lose interest and are induced to 
 seek other employment at a time when their services are becom¬ 
 ing most serviceable to the State. 
 
 We recommend either that enlarged power be given to the 
 Commissioner of Charities so that he may have a broader super¬ 
 vision and the help of a trained psychiatrist, or else that a com¬ 
 mission be appointed that shall have both advisory and super¬ 
 visory functions. 
 
 We believe that in such a system of State supervision as we 
 have suggested there would be a greater degree of co-ordination 
 of experience of superintendents and a better understanding 
 between the various institutions. Each institution is now acting 
 too much as an independent unit, and there is a lack of co-opera¬ 
 tion, of sympathy, and understanding, which is adding to the 
 expense of the State and in no way helping in the treatment of 
 the patients. In our judgment it is a function of the State Com¬ 
 missioner or commission, to which we have referred, to co- 
 ordinate the work of all the institutions of the State and to bring 
 them into close co-operation with one another. 
 
 transfer of patients. 
 
 The present system, or lack of system, of transfer is so com¬ 
 plicated and burdened with red tape that it works seriously against 
 the interests of the State’s wards. More should be left to the 
 judgment of the Commissioner or the Commission in control, 
 and the law should be simplified accordingly. 
 
 y 
 
20 
 
 deportation op ATIENS. 
 
 Our attention has been called to the large number of aliens, 
 especially insane aliens, in our public institutions. Immediate 
 action should be taken in this matter as suggested in the annual 
 report of the Commissioner of Charities and Corrections for 
 
 1913, from which we quote as follows: 
 
 “I again call your attention to the very great desirability of 
 providing for the employment of at least two deporting agents, 
 who under the direction of this Department shall give their 
 whole time to investigation of alien and nonresident persons 
 in the care of the State, with a view to their deportation or 
 removal. The fact that one-third of our insane population 
 under public care is of foreign birth, and that there are some 
 hundreds in our insane hospitals whose residence within the 
 State has not been established, would certainly justify an at¬ 
 tempt on the part of the State to rid itself of the constant and 
 growing expense for the care of those who have no claim 
 legally or morally upon its benevolence.” 
 
 the PEEble-minded. 
 
 The present public provision for the care of the feeble-minded 
 in New Jersey is made at the State Home for Feeble-Minded 
 Women and at the Training School for Feeble-Minded Boys and 
 Girls, both at Vineland. 
 
 The present normal capacity of the Home for Feeble-Minded 
 Women is 250. The number of inmates on October 31st, 1913, 
 was 301. The overcrowding here is in much the same degree as 
 at the Morris Plains and Hudson County Hospitals for the 
 Insane. A new building is to be occupied in the early spring of 
 
 1914, which will afford additional accommodations for 100. 
 Applications now on file in the office of the Commissioner of 
 Charities and Corrections, including transfers of certain inmates 
 from the State Home for Girls and the State Reformatory for 
 Women, will immediately fill to its capacity the new building 
 when it is ready for occupancy. The rate at which additional 
 accommodations have been provided in the past at the Home 
 has not kept pace with the applications received for admission. 
 
 The present provision is therefore inadequate inasmuch as it 
 will probably be impossible to give prompt consideration to new 
 applications made after March 1st, 1914. These applications 
 upon which it is highly important that immediate action should 
 
"be taken will, in all probability, have to be held until some fur¬ 
 ther provision is made. 
 
 The present buildings do not provide proper classification and 
 segregation of inmates. Provision should be made for the erec¬ 
 tion of two additional buildings to accommodate ioo inmates 
 ■each, one of these buildings for the lowest grade, idiots, and the 
 second for the intermediate grade, imbeciles. This will require 
 additional dining room and kitchen facilities. 
 
 There is no available and authentic data as to the number of 
 feeble-minded women within the State who ought to be cared 
 for at this institution, but we believe that provision should be 
 miade within the next five years for increased capacity to a 
 maximum of 800 women, to include all degrees of feeble-minded 
 and all ages. This provision should include accommodation for 
 not less than 100 idiots and imbecile girls of any age. 
 
 At the present time no provision is made by the State for 
 feeble-minded children under the age of six years, and no pro¬ 
 vision of any sort is made for children of low grade of any age. 
 
 The State has for many years utilized a private institution, 
 the New Jersey Training School for Feeble-Minded Boys and 
 Girls at Vineland, for the care of a limited number of feeble¬ 
 minded children. This school, however, is limited in capacity, 
 and it is not contemplated by its managers that that capacity 
 shall be increased. 
 
 There are at the present time in this school 450 inmates, 350 
 of whom are wards of the State. These 350 children include 
 all of the feeble-minded class for whom public provision is now 
 made, except the very few girls cared for at the Home for 
 Feeble-Minded Women. There are now pending in the office 
 of the Commissioner of Charities and Corrections 125 applica¬ 
 tions for admission of feeble-minded children to the Training 
 School at Vineland. Included in these applications there are 68 
 cases that have been classified as custodial and are, therefore, not 
 eligible for adtnission to the school. For this class there is no 
 State provision. In addition to these there are 125 applications 
 that have been withdrawn on account of the applicant becoming 
 too old for admission. In some cases applications have been 
 pending for more than ten years. 
 
 Existing conditions in the care of the mentally sub-normal, a 
 term which we prefer to use in place of the term- “feeble-minded,” 
 do not materially differ from those in the care of the insane. 
 It is estimated that there are 5,000 of these persons in the State 
 not subject to any State care, a large proportion of whom are a 
 menace to the welfare of the communities in which they now 
 
22 
 
 live. Besides this there is an undetermined number of similar 
 cases in the rising generation whose mental condition cannot be 
 determined except after more careful methods of testing shall 
 have been provided in the public schools. 
 
 The extent to which this is now being done is shown by the 
 following report prepared at our request by Dr. Calvin N. 
 Kendall, Commissioner of Education: 
 
 “The number of classes for Defective Children, three years or 
 more below the normal, together with number of children in 
 each class, as reported by city and county superintendents, Feb- 
 
 ruary ist, 1914: 
 
 Number of 
 
 Number of 
 
 
 Classes. 
 
 Children . 
 
 New Brunswick. 
 
 . 2 
 
 27 
 
 Millburn,. 
 
 . 1 
 
 15 
 
 South Orange,. 
 
 . 1 
 
 13 
 
 West Orange, . 
 
 tr 
 
 15 
 
 Summit,. 
 
 . 2 
 
 3° 
 
 Wildwood,. 
 
 . 1 
 
 LS 
 
 Atlantic City, . 
 
 .6 teachers 
 
 75 
 
 Garfield,. 
 
 . 1 
 
 13 
 
 Lodi, .. . . 
 
 . 1 
 
 15 
 
 Hackensack, . 
 
 . 3 
 
 45 
 
 Elizabeth, . 
 
 2 
 
 39 
 
 Paterson,. 
 
 . 4 
 
 5° 
 
 Bloomfield, . 
 
 2 
 
 i5 
 
 Englewood,. 
 
 . 1 
 
 15 
 
 Princeton, . 
 
 . 1 
 
 23 
 
 Plainfield. 
 
 . 4 
 
 60 
 
 Vineland,. 
 
 . 1 
 
 i5 
 
 Perth Amboy,. 
 
 . 1 
 
 15 
 
 West Hoboken, . 
 
 2 
 
 15 
 
 Camden,. 
 
 
 T05 
 
 Long Branch,. 
 
 . 1 
 
 15 
 
 Hoboken,. 
 
 . 4 
 
 44 
 
 Newark,. 
 
 . 15 
 
 218 
 
 (No class has more 
 
 than 15) 
 
 Newark—Blind Class, . . . 
 
 . 1 
 
 TO 
 
 East Orange, . 
 
 . 3 
 
 40 
 
 Morristown, . 
 
 . 1 
 
 14 
 
 Asbury Park, . 
 
 . 1 
 
 15 
 
 Bayonne,. 
 
 .5 teachers 
 
 74 
 
i. 
 
 2 3 
 
 (No more than 15 in a class) 
 
 Passaic, . 
 
 
 3 
 
 47 
 
 Somerville, . 
 
 
 1 
 
 14 
 
 Bound Brook,. 
 
 
 1 
 
 14 
 
 Montclair.. 
 
 
 8 
 
 99 
 
 Newton, . 
 
 
 1 
 
 12 
 
 Orange,.. 
 
 
 2 
 
 30 
 
 Kearny,. 
 
 
 1 
 
 i 5 
 
 Pemberton Township,. 
 
 
 1 
 
 i 5 
 
 Trenton, . 
 
 
 17 
 
 246 
 
 Jersey City,.. 
 
 
 8 
 
 121 
 
 Jersey City—Blind Class, . . . . 
 
 
 1 
 
 4 
 
 Lambertville, . 
 
 - 
 
 1 
 
 15 
 
 1,677 
 
 Any plan for the care of the mentally sub-normal must be 
 reasonably economical, effective and capable of early applica¬ 
 tion, and it must be satisfactory to parents and guardians, as well 
 as to the public. 
 
 From infancy to school age most sub-normal children can best 
 be cared for in their own homes and maintained by their parents; 
 the few exceptions should be sent to institutions. Mentally sub¬ 
 normal children in the school districts have the same right to 
 public education and training as is provided by the Constitution 
 “for the instruction of all the children in this State between the 
 ages of five and eighteen.” They may be divided into three 
 classes: 
 
 a. Epileptics. 
 
 b. The sub-normal in city school districts. 
 
 c. The sub-normal in rural communities. 
 
 It is now clearly understood that the kind of education ade¬ 
 quate to sub-normal children not too defective to be trainable is 
 different from that now' given to normal children. It must be 
 chiefly sensory and motor. Such children have little capacity for 
 intellectual training and limited practical use for what they may 
 be able to acquire. The best results are found in the develop¬ 
 ment of their capacity for useful and productive industrial work. 
 As soon as possible, therefore, those who are mentally sub¬ 
 normal should be separated from the normal, and from merely 
 backward children in schools and classes. When segregated and 
 under control these sub-normal classes employed in systematic 
 and industrial labor can contribute to their own maintenance in 
 a larger degree than has heretofore been deemed possible. 
 
 > 
 
24 
 
 Only by expert examination can these children be separated 
 from those who are normal; the difference, however, becomes 
 apparent to parents and teachers as the children grow older. In 
 the more populous communities special classes for the mentally 
 subnormal have been established in a small way. In our judgment 
 it is the duty of the State to effect a very much more general use 
 of the special classes. As the children so instructed become old 
 enough for definite diagnosis to be made, those in whom this 
 condition is a permanent one should be transferred to the State 
 custodial institutions, except in the rare cases where they can be 
 provided for at home. The majority of them after adolescence 
 are troublesome. They are awkward, headstrong and difficult 
 of management in the schools. No matter what their years they 
 cannot go beyond the primary grades. Outside of the school 
 they are in mischief and crave a notoriety accompanied by wrong 
 doing. They are over-sexed and practice indecencies or worse, 
 and are the big, awkward, misunderstood, pitiable and dangerous 
 companions of little children. 
 
 In the smaller school districts where there are not enough of 
 such children to form a special class, they should be sent to 
 training schools maintained by the State, or to institutions like 
 the school at Vineland. The study of such cases should be 
 continuous, both in the public schools and institutions, so as to 
 provide constantly improving methods for their care and 
 guidance. 
 
 In our opinion all public school children should be tested at an 
 early age to determine their capacity for continued instruction 
 in the classes which are normal to their age and condition; and 
 this without reference to whether the problem is one of the city 
 or the country. In the institutional care of the sub-normal the 
 colony system should prevail; there should be plenty of land to be 
 cleared or tilled, and the girls should have the opportunity of 
 occupation in house work, horticulture and house industries. 
 The boys may be employed in the building trades, in the pro¬ 
 duction of some textiles, and even in printing. In the little we 
 know about the care of the sub-normal wards of the State, one 
 fact is prominent, that employment is not only agreeable to the 
 patients but has a distinct therapeutic value. 
 
 The rapidly increasing number of those recognized as sub¬ 
 normal, and of that portion of them in which State care is 
 necessary as a protection to the community, calls for a rapid 
 increase of the facilities of the State for institutional care. 
 Colonies should be established in small units in different sec¬ 
 tions ; and we are pleased to note that a beginning has been made 
 
V 
 
 25 
 
 in Cumberland and Burlington counties. What we have said 
 of the colony system with regard to the insane applies with equal 
 force to the colonies for those who are mentally sub-normal, both 
 as to economy and efficiency of installation and maintenance. 
 
 EPILEPTICS. 
 
 The present normal capacity of the State Village for Epileptics 
 at Skillman is 450. Additional buildings are now in course of 
 erection that will increase this capacity to 600. There are now 
 24 applications on file at the Village for strictly custodial cases, 
 300 other cases on the waiting list, and more than 1,000 on 
 record at the Village without application papers. Of the latter 
 number 332 are in the insane hospitals of the State, 35 in alms¬ 
 houses, 9 in penal and reformatory institutions, and 27 in the 
 homes for feeble-minded. 
 
 The commission recommends that the Epileptic Village at 
 Skillman be made the custodian of all epileptics; that epilepsy be 
 made the dominant element in committals to it, and that no 
 patients other than epileptics be committed thereto; that there 
 be erected at Skillman such new buildings as may be necessary 
 for the housing of the epileptic insane and the epileptic feeble¬ 
 minded, and that when the present village has reached its full 
 capacity additional provision be made on the colony plan, either 
 there or elsewhere in the State. 
 
 For the information which has been generously given us and 
 which we have used in the preparation of this report, we ac¬ 
 knowledge our obligations to: 
 
 Dr. Britton D. Evans, Superintendent, State Hospital for 
 the Insane, Morris Plains. 
 
 Dr. Henry A. Cotton, Superintendent, State Hospital for the 
 Insane, Trenton. 
 
 Dr. Frederick Peterson, Columbia University, New York. 
 
 Dr. W. W. Russell, Superintendent, Bloomingdale Asylum, 
 New York. 
 
 Dr. Thomas W. Salmon, Director of Special Studies, Na¬ 
 tional Committee on Mental Hygiene, New York City. 
 
 Dr. William Mabon, Superintendent, New York State Hos¬ 
 pital, Wards Island, N. Y. 
 
 Mr. A. C. Wright, New York City. 
 
 
26 
 
 Mr. Clifford W. Beers, New York City. 
 
 Dr. Owen Copp, Philadelphia. 
 
 Dr. Guy Payne, Superintendent, Essex County Hospital for 
 the Insane, Cedar Grove, N. J. 
 
 Dr. David F. Weeks, Superintendent, State Village for Epi¬ 
 leptics, Skillman, N. J. 
 
 Dr. Robert Chase, Superintendent, Friends’ Asylum, Frank- 
 . ford, Philadelphia. 
 
 Dr. Thomas Prout, Summit, N. J. 
 
 Dr. E. E. Southard, Professor of Nervous and Mental Dis¬ 
 eases in the Medical School of Harvard University, Boston. 
 
 Dr. Walter E. Fernald, Superintendent, Massachusetts School 
 for the Feeble-Minded, Waverly. 
 
 Mr. Amos W. Butler, Secretary, State Board of Charities, 
 Indianapolis, Ind. 
 
 Dr. George F. Edenharter, Superintendent, Central Indiana 
 Hospital for the Insane. 
 
 Rev. Francis H. Gavisk, Member of the Board of State Char¬ 
 ities, Indianapolis, Indiana. 
 
 Mr. M. J. T'appins, Secretary, State Board of Control, Madi¬ 
 son, Wis. 
 
 Prof. E. R. Johnstone, Superintendent, Training School, Vine- 
 land, N. J. 
 
 Dr. Madeline A. Hallowed, Superintendent, Home for Feeble- 
 Minded Women, Vineland, N. J. 
 
 Mr. J. A. Starkey, Superintendent, Camden County Hospital 
 for the Insane, Grenloch, N. J. 
 
 Dr. J. A. Smith, Physician in Charge, Camden County Hos¬ 
 pital for the Insane, Grenloch, N. J. 
 
 Mr. T. L. McConnell, Superintendent; Dr. J. H. North, Phy¬ 
 sician, and Dr. C. A. Potts, Neurologist, Atlantic County Hos¬ 
 pital for the Insane, Pleasantville, N. J. 
 
 Mr. David Elwell, Superintendent, and Dr. T. J. Smith, Phy¬ 
 sician in charge, Cumberland County Hospital for the Insane, 
 Bridgeton, N. J. 
 
 Mr. C. C. Deacon, Superintendent, and Dr. R. N. Parsons, 
 Physician, Burlington County Asylum, New Lisbon, N. J. 
 
 Dir. Charles Gorst, Superintendent, Wisconsin Hospital for the 
 Insane, Madison. 
 
 Dr. Milton J. Greenman, Superintendent, Wistar Institute. 
 Philadelphia. 
 
27 
 
 Dr. Adolph Meyer, Professor of Psychiatry, Director of Henry 
 r Phipps Psychiatric Clinic, Baltimore. 
 
 Prof. H. H. Donaldson, Wistar Institute, Philadelphia. 
 
 All of which is respectfully submitted. 
 
 (Signed) JOSEPH P. BYERS, 
 
 JOHN NEV 3 N, M. D., 
 
 EDWARD D. PAGE, 
 
 STEWART PATON, M. D., 
 EDWARD E. READ, Jr., 
 
 The New Jersey Commission on 
 the Care of Mental Defectives. 
 Trenton, February 26th, 1914.