\ Printed at SING SING PRISON Ossining, N. Y. % / STATE OF NEW YORK-. Il Report of a Special Committee OF THE State Commission of Prisons / Appointed to Investigate the Matter of Mental Disease and Delinquency 19 18 kiftiivTlfM ; k " ' ' 1 / 4 s ■/' * r- ' / < /«:•< o' . ais . ( . I -I ' •fO _ •. J u t (U w 3^5 & X — MENTAL DISEASE AND DELINQUENCY Report of the Special Committee of the State Commission of Prisons appointed to investigate the matter of Mental Disease and Delinquency. To the State Commission of Prisons : At a meeting of the State Commission of Prisons held June 4, 1918, the following preamble and resolution were adopted: Whereas, Investigations in many of the penal and reforma¬ tory institutions covering some years past have thoroughly estab¬ lished the fact that a substantial proportion of the inmates are mentally subnormal, and Whereas, The State Commission of Prisons is convinced that examinations of mental conditions of the inmates of penal and correctional institutions, if properly conducted, will admit of their proper classification and treatment, and Whereas, The material received from these examinations will unquestionably make the problems of administration much easier and more effective, in that better results in the teaching depart¬ ment can be secured by the grading which can be readily estab¬ lished, and improved industrial conditions will result from a more efficient assignment to labor, and Whereas, We believe that the solving of many difficult dis¬ ciplinary problems can be more easily accomplished when the au¬ thorities are in possession of a complete history of the offender and that useless punishment of incorrigibles who are mentally subnormal will be prevented where a proper understanding of them is had, and Whereas, The detection of insanity, the recognition of various less pronounced disorders of the mind, the proper diagnosis of the epileptic and the recognition of his periodical irresponsibility, and the segregation of the defective delinquent can all be accom¬ plished by proper study, and Whereas, The study of mental conditions can also be of great benefit in reducing anti-social conduct and defective reasoning which have brought the prisoner into conflict with the law, in ad¬ dition to which the history thus obtained will make a permanent record of great value in assisting the parole authorities in better determining the matter of release, and would give parole officers a better understanding of the persons whom they supervise to the end that there may be an intelligent treatment of each un¬ fortunate, which would act as a stimulus to those deserving and a protection for the defective and the weakling, it is Resolved, That an investigation be made of the whole subject by a committee of this Commission, the committee to submit a report thereon with such recommendations as may be determined upon. 5 6 ■'Xm Pursuant to the foregoing, a committee was appointed consisting of Frank E. Wade, John S. Kennedy, Sarah L. Davenport, Allan I. Hollo¬ way and George W. Davids. Your committee, assisted by Dr. V. V. Anderson, Medical Director of the Municipal Court of Boston, Mass., a well recognized expert in psychiatry, made a state-wide investigation, as directed, into conditions in the penal and correctional institutions, and into the clinical work connected with the courts, taking the testimony of judges, medical experts, psychiatrists and others, and collecting avail¬ able data and statistics of the mental examinations of prisoners and delinquents in this and other states. Based^ upon such testimony, data and statistics, your committee submits the following report and rec¬ ommendations : SUMMARY An enormous financial burden is carried by every state of the Union in its fight against crime, one of the largest items in the public budgets being for this purpose. The most depressing part of the whole situation is that New York State, with all its vast expenditure of money to detect, try, convict and punish the criminal, is not repressing crime because sixty per cent, of the population of the various penal and correctional institutions of the State have served previous commitments. Of the 2,279 felons received iiito the State prisons during the year 1917, 87 per cent, were repeaters, having served previous commitments. With each new trial of this particular group of repeaters, the State of New York spends approx¬ imately two million dollars. In the recidivist (the chronic repeater) is found the crux of the whole criminal problem. His existence to such a large extent among the inmates of prisons is of itself proof of society’s failure to repress crime or to reform the criminal. Studies show that the most important single factor found associated with chronic criminalism is the abnormal mental condition of the crim¬ inal himself. Well authenticated facts are at hand to indicate that at least 50 per cent, of the inmates of prisons and reformatories in New York State exhibit mental abnormalities, and are in need of much more specialized treatment than is afforded by the ordinary routine methods employed in the average penal institutions; that from 27 to 30 per cent, of such inmates are feeble-minded and only possess the intelligence of the average American child of twelve years or under. In the light of such facts it is futile to simply go on blindly admin¬ istering the law, instead of endeavoring to solve the problem these in¬ dividuals present. Those who have given much thought to the subject feel that the establishment of clearing houses with medical clinics, through which will pass those sentenced to the various penal and correctional institu¬ tions of the State, after prolonged study and effort at reconstruction, to then be distributed to the various penal institutions in the light of the needs of each case, is the best way of handling the problem. Such clearing houses, in enabling the prisons to establish an actual physical segregation of certain types, will in a great measure solve the disciplinary problems of the prisons. By establishing a proper classi¬ fication these clinics will also enable the prison management to better utilize for the reconstruction of the prisoner those agencies already existing in prisons; and will secure a more intelligent treatment of each individual prisoner, making it possible for the administration to return him to society better fitted to take his place as a useful member than he was the day he entered prison. Furthermore, such clinics should be of very great value to the parole authorities in intelligent after-care work with criminals. As “an ounce of prevention is worth a pound of cure,” it is much more profitable for society to undertake measures to prevent criminality, prostitution, insanity and the like, than it is to endeavor to cure it after it has already developed, or to provide ultimate custodial care for those in whom cure is impossible. The establishment of medical clinics in courts will do much towards solving the serious problems mentioned, before they have developed to such a degree as are found in prisons, and when their condition may in a great measure be preventable. But even more important in the prevention of delinquency than any¬ thing else that has been said, is the establishment of clinics in the com¬ munity that will discover the abnormal child who has the potentialities for a criminal career even before he has developed delinquent tendencies. INTRODUCTION The price paid by society for its neglect of the criminal has never been adequately estimated. Neither in dollars and cents nor in sorrow and cost of wasted and frequently vicious lives has half the story ever been told. An enormous financial burden is carried by every state of the Union in its fight against crime. State and city budgets give startling evidence of the vast expense which criminality is to society, this being understood to be the largest single item in the public budget. To illustrate: The cost of the detention, indictment, trial or other disposition of the average felon is conservatively estimated at $1,000. The 2,279 felons received into the State prisons during the year 1917, cost the State ap¬ proximately two milion two hundred seventy-nine thousand dollars. Of these individuals 87 per cent, had served previous terms and by their release into the community and return to criminal habits the State spent approximately two million dollars to again dispose of them and continues to spend such each time it undertakes to convict this particular group of repeaters. Nothing can be accomplished in the way of permanent good for all this expenditure, if the criminal has not been deterred from re¬ peating his criminal acts. New York State in 1917 received into its penal and correctional in¬ stitutions 133,047 prisoners, 60 per cent, of whom had served previous commitments. Massachusetts in a given year received into its institutions 25,820 prisoners, 57.4 per cent, of whom were repeaters; the total number of previous commitments being 92,443, averaging six sentences for each recidivist. Justice Rhodes of England wrote in the British Medical Journal, ask¬ ing what could it all mean that of 180,000 convictions in a given year, more than 10,000 had been convicted upwards of twenty times before. Wherever our investigations have led us, the startling and depressing facts of recidivism stand out as a proof of the complete breaking down of the social security furnished by the State, in that it has failed to re¬ press crime through the rehabilitation and readjustment of the criminal. A most hopeful part of the whole situation, however, is to be found in a widespread interest in the entire subject, and the existence of power¬ ful forces bearing in from all sides, tending to greater enlightenment upon the problems of crime. Whether these forces come from- law or medicine, or psychology, or social or public agencies, they have all contri¬ buted to a better understanding of the criminal and the problem he presents. Facts of unquestioned value are already at hand which go far toward explaining much of past failures in readjusting the criminal. In New York State, reports coming from the State Reformatory at Elmira, the State Reformatory for Women at Bedford Hills, and Auburn and Sing Sing Prisons, speak in no uncertain terms of conditions found with such a high degree of frequency among prisoners, particularly among recid¬ ivists, as to make clear a definite relationship between delinquency and mental disease and defect. FINDINGS AT SING SING PRISON Dr. Bernard Glueck, in the first annual report of the Phychiatric Clinic in collaboration with Sing Sing Prison, states that “of 608 adult prisoners studied by psychiatric methods out of an uninterupted series of 683 cases admitted to Sing Sing prison within a period of nine months, 66.8 per cent, were not merely prisoners but individuals who had shown throughout life a tendency to behave in a manner at variance with the behavior of the average normal person, and this deviation from normal behavior had repeatedly manifested itself in a criminal act.” Further, “Of the same series of 608 cases, 59 per cent, were classifiable in terms of deviation from average normal mental health. Of the same series of cases 28.1 per cent, possessed a degree of intelligence equivalent to that of the average Amer¬ ican child of twelve years or under.” FINDINGS IN OTHER INSTITUTIONS AND COURTS Such findings confirm similar reports coming from prisons, re¬ formatories and courts throughout the country as indicated in the tables which follow: 8 TABLE No. 1 Showing Percentage of Inmates of Prisons Exhibiting Some Nervous or Mental Abnormality ’V c 3 2 «3 be e c ® V P « c V E p c 00 3 O > P V C 03 O > 3 « js X 3 (0 E a H C5 LO Tt 1 » IO Tt< fO ■o «-> o ° *3 § 2 -3 03 E CO 3 13 Z eS o i© Eh •—I « O K P < Z o M H P H M H w Z c: oc o c LCCOC 'C SO rH CC I I I I © K o — O w* 3 -H as 02 x 4i z: o 5 k a; CJ HH *H os o £ - 3 I £ * a « S p «H £ © a • • • . Sh P P p O o o o Z - w © * o •— o }? 03 Cm a o 03 *P Pi a o o »t; —CS P . 4 — P 02 ^ a PH * « s® jy be a 2 ^ 02 © —• as CS 03 73 ^ a c 5 i—i <2 a t- o VH o a O DO o P «P be C3 VH a 03 03 r-t ©© o 02 'p a © a: O 03 03 oS a c «P o a © 03 P 03 o IQ -4-> 03 a 03 a a y A 03 -•-> o-i _. © a 'o 03 03 03 03 P o 03 03 -©> a *© O iH “ . as o £ a 03 03 03 a H a o p p a 03 a P o 03 a © a o % § i *5 © •H* o 53 »o 5i 03 P © «e c © fe; ©3 53 .© •a o V* o o © oo © 09 © 09 © © •Si $ ©* © ©6 © t © © CQ ■g * C -u 3 C £ 2 SB 2 « C3 be 2 § o u - p .t; ? -3 03 C ? i W ^ c » O 3 Oh C 3 00 O CC O LO O C 2 ©3 ©J t- X u© Cl oi i- 02 03 a rs «H V Z ■' 3 S 2 E 3 z co Jh Eh 2 O B Eh P < z o >—i Eh P H >—• Eh W Z 8 ac© t- o c Hfl CC »C rH tc LOIOO 00 Cl tH rH Cl CO - - L© a a 03 io P » r —h © a a 5 © 03 33 g a -r " •9 ° o hj u a ©3 y © a hth © y ^ •*■> 73 (h a a © © o A ® a -r—1 -1 3 *M tl IH tl fl b O a 5 o ©3 ©3 a a be 02 -H— | a: | a i © • M «r-H ^S p > •a a © p £ 2 r ' 3 ^| ©© <2J ©-H ^3 \j a LT ^ s-H C -3 • c . H p Tf) ©• ^ p2 © V. w a S o %4 «3 • a >> P F« p r* -h ^ f - • »-H sr _H ■H 3 (» 'w O K s © *Hh, S3 © K.2 02 . • • • I- Dr. _Jess P P P P P PC 1 1 1 1 i© /C ^ IH ©^ 1—| 1 1 1 1 1 1 1 1 1 1 1 1 1 1 i i i i i i ■ i i © a © 1 ^ y Ch c$ ! g a $ «gOjf © _p a ^ j- •0 a p . 4? © *fr* a © p 03 5 »2 o a >> >> Pi Pi © O — 4-> a a a a Pi P © © © © © >»w p a g§ © © ©S P HH u s.6 ■S -4—i a a +J -4-> 02 02 a © a p © «p © be © —

n a © © t* r. a ©l n a . p »*> O ■S •M a 03 3 © w O 03 — tf 4^ h 4 © g 03 g © .a ^ Si o> a —> 02 73 03 © a 9 The foregoing figures indicating percentages of inmates suffering from abnormal mental conditions, show not only the number of persons with intellectual defect but include insanity, epilepsy, psychopathic per¬ sonality, drug deterioration, alcoholic deterioration and other abnormal nervous and mental conditions, which seriously handicap the individual in his ability to adjust himself to the conditions of normal living. All of these mental conditions are matters most important in considering any real constructive attempt at rehabilitating the criminal. One of the most important, if not the most important group of which society needs to take cognizance, is the feeble-minded. They furnish a substantial nucleus to that most expensive body of individuals who clog the machinery of justice, who spend their lives in and out of penal insti¬ tutions and furnish data for the astonishing facts of recidivism—facts which are serving to awaken our social conscience to the need of more adequate treatment under the law for repeated offenders. It is of this group that Dr. Walter Fernald has so well said: “Feeble-mindedness is the mother of crime, pauperism and degeneracy. It is certain that the feeble-minded and their progeny constitute one of the great social and economic burdens of modern times.” The following tables are most significant, showing the percentage of inmates of prisons, reformatories and other correctional institutions, that are feeble-minded: < • V 10 Showing the Percentage of Inmates of State Prisons Found Feeble-Minded « 73 tC © 2 v c 5 u P V fa c • r -1 s 2 v V fa O H g E 00 CD ■ 1C 1C 00 * 73 *w 4) .8 I e » P V 55 § a CO c] c3 c5 § g a I © O £ £ t- © co 00 05 O O 1C o CD "'t 1 CO 05 CD ^ t— o 1C i i H HH i i i i tf i i o K i i M • o • H © M P G O <3 ; © O cS © >> © co o « O, d r—< GJ as © . 'SoP a3 co 73 W P 03 M © a a> £ tt£ p p oa p _ 03 © © rj 4-1 W 02 © CO (-1 —j' © 2 £ S ° 'S s« s © g ej G .Si ft a -© © * * i-3 *5 ft •<5 C0 P ft {H fc H a © a “Z § §~~ co d n £| © baft _s G «> -T< £3 02 E fcrv G CO bX) jz co © S S3 “ 1 G —' © 3 5 £ r! w ft ^ G G © 5 £2 22 Sp > ft © -4-J c3 g _ G ga ft G 4- J ^ ■■ © a .a 5- o-ofl O G g 03 K <3 ^ i-s -<1 c-1 02 © I £ © 73 G G O «w © Pi 03 G © © u © a 1C t- CM © T3 c3 a G © © •Q © > o3 .G CO © •H © G ■j— i CO © p © ■d £ >» p 4J fl G O © © G3 G O G3 bfl G O Pi .G co a o CO • rH P ft co © 03 a -m a .a © «G % 73 G •H a •*£» S © 02 © 73 bo © * 'P (3 i © Ok c 1 V 2 I fa H i—i « ffl S ◄ 55 O HH H P H H w 2 ic 05 c 0) w 5- i 0) Oh to O to c •5 CO l~ o 3 0) V a CO Cl CO CO Cl TjH CO CO 0) bo _ rt 12 ■M C C 3 01 O g 0) & to V to C I _Q) 3 0) a 10 CO -f ci (M cd rn ,3 CO Cl CO CO o »o CD r~—i .o CD fe. s o 3, 50 CO 3 O -< «W o S-c a> P £ 3 £ *3 .£ ; 5 3 m 0) CO 3 O H i—i P5 O ffi Eh C3 fc o HH Eh & Eh COWIOO O CJ Cl O iH Cl rH Eh W £ 50 K to t-i o «w ■g f-i O -M P u O P> 03 3! O P a> • r—< 50 £>4 ffi O 03 PS O CD 33 r—H o u P P ‘o a m r o o3 p ~ • . »rH 5 O « . Q«j i I I i to P bJ pH £ m a o t£ >5 O f-i o3 K*J u 03 •r4 4-1 a CD S3 •H 4 -> 3! a> -W • f—H a » O - O >5 o.tj a h'h’ 55 I? o O p to -»-> 50 to DO a 4-) 05 to H DO O 50 P Pi a p 'o O H 6 H J W 'p ! |44 r© <0 &H 'SS §S © to rSS to 20 to> $£ •«» e Eh *5S> V 44, 80 - 4 , ■54 IS s 80 to 44* to i <* H Eh h*4 « o a Eh a Dh CD s? ^ w C w (Jh s4 i3 (-5 i 'l I I 05 I t>> I o I ^ 1 w ; O- P ; CO »H ^ >» p' O t-i DP C _ ft i r—t w PD ?4 <3J NH *4J toJ ^ <1) P dh 'to 3c H— P P o 0 4 h 50 D IH C3 ^ ft •*-< ►3^5 h O £3 'w a ^ P O to o P PS HH o © r^ ^ .2 2 U O -i-> PS 50 O P 02 to P 5 o 4— ft) 50 PS 9 p p o 50 to P w 50~ O «H O o ps o 02 l! pH • r-H P £ * CH 0) o Z - 4 —> Cj M 02 02 3| 02 02 12 From the foregoing tables 31.4 per cent, of inmates of reformatories, training schools, workhouses and penitentiaries are found to be feeble¬ minded. It is clear from Tables I and II that within the prisons, reformatories, penitentiaries and workhouses throughout the country is found a large group of prisoners who exhibit nervous and mental abnormalities, who are mentally crippled or mentally ill. Fifty per cent, of the inmates of these institutions require much more specialized and much more indivi¬ dualized treatment than is afforded by the ordinary routine methods em¬ ployed in the average penal institution. • This is not a sentimental con¬ sideration but a practical matter of social security. Laying aside the humane element involved, the paramount interests of society are jeopar¬ dized if we ignore the well known facts of individual differences. * In Tables III, IV, V and VI this point is illustrated. The feeble¬ minded delinquents, found, as the foregoing tables will show, are from 27 to 29 per cent, of the inmates of penal and correctional institutions throughout the country. Just what sort of a problem the seriously delin¬ quent feeble-minded person may present is seen from the following study undertaken in connection with the Municipal Court of Boston: The careers of 100 feeble-minded delinquents were intensively studied; the case histories were taken from the court files alphabetically, no other selection being required than that each individual should have been diagnosed feeble-minded. The 100 persons in this particular group were arrested 1,825 times; record cards dating further back than five year* were not gone into though many had such old court records. The futility of employing for this group measures intended for those capable of profiting by experience is shown from the following facts : These delinquents in court were discharged after short periods of de¬ tention or judicial reprimand a great many times but they returned with unfailing certainty to be handled over again. They were placed on proba¬ tion 432 times, but had to be placed on inside probation, that is, within institutions non-penal in character, 118 times. Of the remaining proba¬ tionary periods they had to be surrendered to the court 220 times, making in all not quite one successful probationary period apiece for each of .these 100 individuals. The chances were better than four to one against any one ©f these individuals conducting himself normally for a six months’ proba¬ tionary period. The court, in addition to probation for these individuals, tried penai treatment. They were sentenced 735 times, their sentences aggregating in fixed time 106 years imprisonment, exclusive of 250 indeterminate sentences to the reformatories. But this did not in any way suffice to change the course of their careers. Finally as an explanation of all this maladjustment, examination dis¬ closed that each one of these 100 persons possessed a degree of intelligence equivalent to that of the average American child of 12 years or under. About 75 per cent, had the mental level of children under 10 years. In¬ vestigation into the past histories disclosed the astounding fact that 75 per cent, had never been legitimately self-supporting. Worst of all, so far as society’s responsibility is concerned, 73 per cent, of these persons, though having ample opportunities for common school education, beginning school at the usual age and leaving at the age of 14, 15 and 16 years, were never able to get beyond the fifth grade in school. How much more profitable would it have been to have recognized at this time the condition from which these persons were suffering when a chance really existed in each and every one of these cases for some ad¬ vance along the lines of proper habit training, and to have saved all of this economic waste, protecting society as well as these individuals them- aelves from their weaknesses and making them useful members of the community, or placing them in a limited environment suited to their special needs. 13 RELATION BETWEEN MENTAL DEFECT AND DELINQUENCY So far in this report we have endeavored to emphasize two things: First: That the recidivist is the real problem in the prevention of achieve m hlm WG haVe failed t0 accom P lish that which we set out to Second: That an important and probably the most important under- ymg causitive factor in this failure to profit by such experience is the* defective mentality by which he is so commonly handicapped. In this connection studies made by Dr. y. V. Anderson of a group of 100 immoral women and a group of 100 drunken women showed that among the im- woral women 39 per cent, of first offenders, 47 per cent, of second offenders and 84 per cent, of recidivists were suffering from some form of mental and nervous handicaps; that among drunken women 35.4 per cent, of first offenders and 82.2 pep cent, of recidivists exhibited some nervous or mental abnormality. The relation between the mental condition of these persons and the frequency of their offense is obvious. SITUATION IN NEW YORK STATE TABLE No. VII Showing Percentage of Inmates of Certain New York Penal and Re¬ formatory Institutions Exhibiting Nervous and Mental Abnormalities : INSTITUTION AUTHORITY Sing Sing Prison-Dr. Bernard Glueck_ Auburn Prison-Dr. Frank L. Heaeox___ Clinton Prison-Dr. V. V. Anderson_ Auburn State Prison (for women)__Ma'ble Fernald Ph. D_ Westchester County Penitentiary-Dr. Bernard Glueck_ New York State Dr. Frank L. Christian Reformatory -and Dr. John R. Harding New York State Re¬ formatory for Women—Mable Fernald Ph. D._^___ Percentage exhibiting, nervous and mental abnormalities 59 61.7 60 25 Feeble-minded^ 57 58 31.9 Feeble-minded: The existence of mental disease and deterioration, intellectual defect, psychopathic personality, epilepsy and the like, in a fairly large proportion of the inmates of these institutions makes clear and obvious how futile 1 it is to merely go on blindly administering the law instead of endeavoring to solve the problems these individuals present. A similar situation in treating disease would consist in sending all 1 sick persons to hospitals to be given the same treatment, fixing in advance* the length of time they were to remain there and then sending them out without any reference to whether they were well or not. Are we not following similar lines in locking up criminals and then turning them out, and then locking them up and turning them out again, without any reference to whether our purpose in locking them up had been attained; or whether they were any better fitted to assume their normal relation to society on the day they left prison than they were the day they entered it? Even where scientific studies and classifications have been undertaken, if these have not been made the basis for treatment, nothing in the way of benefit to the individual or security to society can be said to have been accomplished by such investigations. The mere knowledge of the existence- of these conditions, the mere labeling of a certain number of prisoners as intellectually defective or mentally diseased or deteriorated, or psycho¬ pathic, is not enough. Such knowledge should be made the basis for treat¬ ment. Constructive efforts should be made to rehabilitate these persons in 14 the light of the needs of each individual prisoner; not only of his disabil¬ ities, but of his capabilities and his adaptabilities. The machinery of the penal institutions should be so organized as to enable it to carry into effect such recommendations as would be suggested. But as indicated from the foregoing tables, such a heterogeneous group as is to be found in all penal institutions, composed as it is of types re¬ quiring entirely different lines of treatment, would preclude the possibility of carrying out such a program in every one of the units of a penal system in a great State like New York, so that those who have given thoughtful consideration to the problem feel that the situation could be handled best by establishing clearing houses with medical clinics, through which would pass those prisoners sentenced to prison and reformatory institutions. CLEARING HOUSE AT SING SING Every sentenced male felon first should be admitted to the clearing house now being provided at Sing Sing Prison. Here he should be kept under observation for a period of three or four months, studied physically and mentally, given the very best in the way of modern medical treatment, placed under intensive vocational study and training for such a period of time as will be necessary to enable the administration to define clearly the problem which he presents. Soon after his admission he should be presented at the medical clinic for a rigid and thoroughgoing physical and mental examination. The most approved clinical and laboratory facilities known to modern medicine will be used in these examinations. The aim will be not only the physical rehabilitation of the prisoner and the delineation of those underlying caustive factors responsible for his delinquent career, but also to outline the abilities of each prisoner in order to determine whatever qualities he may possess, the cultivation of which might enable the penal administration to restore him to his normal relation to society as promptly and as permanently as possible. Undoubtedly many criminal careers are due less to inherent biological defects in makeup than to the repeated exposure throughout life to un¬ favorable environmental and developmental conditions, forming in this way, many of the character traits and personality difficulties so commonly responsible for delinquent behavior. The most important phase therefore of the examination at the clinics would be a study of the personality and life history of the individual. While psychological tests must necessarily be given and a cross section view wiH be most helpful, nevertheless the greatest emphasis should be placed on the careers of these individuals as seen in the light of modern psychiatric knowledge of behavior. It is no doubt needless to add that inasmuch as the very nature and purpose of this clearing house is essentially medical, that all its clinical activities should be under medical direction. Further, it may be well to emphasize that no one phase of the work such as sociological, phycholog- ical, psychiatric and physical should constitute an independent unit, if anything like a well rounded study and an intelligent and understanding treatment of each individual is aimed at. Only by making each one of these various aspects a co-ordinate part of a comprehensive scheme in the study and treatment of each and every individual prisoner, can successful results be obtained. As stated before, the average length of sojourn at the reception prison will be three or four months; some will not require so long a period, while in other cases a clear definition of the problem they present will necessitate a much longer period than three or four months. It will then be possible to supply to other prisons “a stream of healthy, sane, able-bodied pris¬ oners” who have received treatment for physical defects and disease, whose mental condition has greatly improved and who because of prolonged and intensive vocational study and training, will be able to acquire in other prisons skill in that trade or occupation best suited to their abilities. Those discharged from the clearing house should be distributed to the bther pris¬ ons in the following manner: 15 First: All cases of tuberculosis should be transferred to the tuber¬ culosis hospital at Clinton Prison. Second: Those sentenced to the reformatory at Elmira will be trans¬ ferred to that institution. This in no way would interfere with the power of the court to commit to Elmira, as- only the insane and those of the defective delinquent group, requiring very special care and treatment would be transferred elsewhere. Third: The younger and more normal male felons receiving state prison sentences should, be transferred, as Dr. Glueck has said, “after hav¬ ing been well started in acquiring the trade for which they are best suited, as determined by scientific inquiry into their capabilities,” to either one of the two industrial prisons of the State, Clinton or Auburn. Fourth: The older normal prisoners and those found incapable of learning a trade should be transferred to the agricultural prisons, Great Meadow and Wingdale, where they can make themselves most useful to the State in some form of agricultural occupations. Fifth: The insane who require treatment of a more or less permanent nature in hospitals for the insane, should be transferred to the Danne- mora State Hospital for the Criminal Insane. The more recoverable types should remain at the reception prison under proper treatment in a spec¬ ially constructed pavilion. Sixth: There remains a very large group known as the defective delinquent group. The term “defective delinquent” is used here in a sense similar to that in which the term “insane” is used, being more of a legal than a strictly medical classification. In this group are included the in¬ tellectually defective delinquent, the psychopathic delinquents, the epileptic delinquents and the like. Those individuals belonging to this group, who after prolonged and careful study and training are found incapable of reconstruction to a degree Which would justify their release into the general community, should be committed to an institution specially suited to their particular needs, an institution for defective delinquents. As the following table indicates, about 15 to 20 per cent, of prison and reformatory inmates may well be segregated into such an institution: TABLE No. VIII Showing Percentage of Inmates in Certain Prisons and Reform¬ atories Regarded as Segregate INSTITUTION AUTHORITY Percentage regarded as segregable Auburn Prison (N.Y.) _ Sing Sing Prison (N.Y.) New York State Reform¬ atory (Elmira San Quentin Prison (California) - Massachusetts Reform- _Pr. Frank L. Heacox- _Dr. Bernard Glueck- Drs. Christian & Harding Report of San Quentin Prison _ Dr. Guy Fernald- atory for Men- assachusetts Reform¬ atory for Women_Dr. Edith Spaulding 17.9 15 to 25 17 17.9 15.5 24.8 The more adjustable members of this “defective delinquent” group who show capacity for reconstruction to a degree that would justify their later release into the community under close and intensive super¬ vision should be retained at the reception prison for prolonged training as a special group and later transferred to the industrial and agricultural prisons for further training. The intellectually defective members of this group not regarded committable to the institution for defective delinquents * 16 -who may have little difficulties of personality, may furnish little trouble, aud may well be made self supporting and later restored through intelli¬ gent parole to the community. The psychopathic members of the defec¬ tive delinquent group, the neurotic, unstable, emotional, temperamental individuals suffering from serious difficulties of personality, furnish a problem far less easily solved. Those who do not break down completely under confinement and require treatment as insane, those who do not have to be committed to the institution for the defective delinquents, may be given the advantages afforded from prolonged training and may well, through the education of their inhibitions, learn to control their im¬ pulsive tendencies and emotional outbreaks to such a degree as to enable them later to be incorporated into the community, achieving more or less enduring adaptation to their industrial environment and protected from the stresses and temptations to relapse by adequate social supervision. It would be like elaborating the obvious to call attention to the close relationship such a program bears to a real indeterminate sentence. It is generally accepted that but for the defective delinquent group the punishment problem would almost disappear in prisons; that these indi¬ viduals are the source of all disciplinary measures required. It is quite evident then that proper classification would not only be of immense value in this direction, but, what is of the greatest impor¬ tance to the prison management, it would enable those agencies already existing in prisons, such as self-government, education, industrial training, •etc., to be used more effectively. CLEARING HOUSE AT BEDFORD HILLS All that has been said relating to the need of a clearing house for the sentenced male felons of New York State may be restated with equal, if not greater emphasis in regard to the female inmates of the State penal ;and corrctional institutions. The well recognized menace that venereal disease is to the general public and the high frequency of those conditions as are found among delinquent women, is a matter for serious consideration. In 440 cases studied at the New York State Reformatory for Women at Bedford Hills, 48 per cent, gave positive reactions to the Wasserman test for syphilis. Of 289 prostitutes studied by the Baltimore Vice Commission 63.7 per cent, showed syphilis. At the Reformatory for Women at Framingham, Mass., 75. per cent, of the population were suffering from gonorrhea. At the New York Reformatory for Women at Bedford Hills 73 per cent, showed the presence of gonorrhea. The relationship that these two conditions bear to feeble-mindedness need not be enlarged upon here. Venereal disease and feeble-mindedness form a combination as productive of human wretchedness and misery as any scourge that has ever afflicted mankind. Twenty-three per cent, of the women at the Reformatory at Framingham, Mass., who were fit subjects for permanent segregation on account of mental defect, showed 90 per rent, of gonorrhea and 60 per cent, of syphilis. At least 30 per cent, of the population in representative penal in¬ stitutions for women in New York State are feeble-minded, as indicated in table No. IX. No satisfactory figures were obtainable showing how large a number of the women prisoners were suffering from other patho¬ logical, nervous and mental conditions, such as mental disease or deteriora¬ tion, psychopathic personality, epilepsy and the like. However, the high percentage of feeble-mindedness is of itself causing many institution •officials to feel as stated in the report of the State Hospital Development Commission, that “the really reformable type is becoming in certain re¬ formatories an almost unknown quantity and the defectives already so large that the question arises whether it would not be better to make one or two of these institutions actually ‘defective delinquent’ institutions and continue the others as reformatories with a population that is really .Teformable.” 17 TABLE No. IX Showing percentage of Feeble-minded Women Found in Certain Penal and Correctional Institutions in New York State INSTITUTION N. Y. State Reformatory (Bedford Hills)_Dr. State Prison for Women (Auburn) _Dr. N. Y. County Penitentiary. Dr. N. Y. City Workhouse_Dr. Inwood House (N.Y. City).Dr. Western House of Refuge for Women (Albion N. Y.)-Dr. Number of Percentage cases examined Feeble-minded 335 31.9 AUTHORITY Mabel Fernald_ Mabel Fernald_ Mabel Fernald_ Mabel Fernald_ Mabel Fernald_ Jessie L. Herrick._ 76 25 105 26.6 95 42.7 69 15.1 185 33.5 We feel that the establishment of a clearing house, and a reception prison at the New York State Reformatory for Women at Bedford Hills through which would pass all sentenced women felons and those of lesser offenses selected by the Courts of the State, is the most intelligent solu¬ tion of the serious problem now presented by the delinquent women in New York State. The Laboratory of Social Hygiene might well be de¬ veloped into an institution for this purpose. All of us are familiar with the serious consequences resulting from too long a delay in receiving into proper institutions feebleminded girls after they have developed marked delinquent traits, and especially is this true during the child¬ bearing age. Such a clearing house would function for those institutions handling the women prisoners of New York State in the same way that the clearing house at Sing Sing would function for men. It is further suggested that in order to make effective the findings in this clearing house, a proper arrangement of the various other insti¬ tutions handling women prisoners be made. In this connection it is sug¬ gested that the State Prison for Women at Auburn be transferred to the State Farm for Women at Valatie, after being made more secure; that the Reformatory for Women at Bedford Hills be made the State Institution for Female Defective Delinquents; that the House of Refuge for Women at Albion be used only for those who are found capable of profiting by the training afforded and capable of being reconstructed to such a degree as would enable their restoration to the community. CLEARING HOUSES FOR THE DEPARTMENT OF CORRECTION OF NEW YORK CITY New York City, because of its extensive population, may be considered apart from the rest of the State, but all the facts deduced for the estab¬ lishment of clearing houses at Sing Sing Prison and the Reformatory at Bedford Hills bear with equal force upon the needs of the Department of Correction of New York City. For the year ending June 30, 1917, 71,528 prisoners were received in New York City institutions. A large army of physically and mentally handicapped individuals are being bandied about from institution to in¬ stitution, locked up and turned out again and the process is repeated over and over. We are of the opinion that there should be established on Blackwell’s Island two clearing houses, one for male prisoners and one for female prisoners, utilizing the old penitentiary for men and the Workhouse for Women, which plan is now under way. These institu¬ tions should be equipped with all the modern facilities suggested for the State clearing houses. Through those two institutions should pass all the prisoners sentenced to institutions under the management of the New York City Department 18 of Correction, and after proper study and treatment, and the character of prtyblem which each individual presents has been carefully outlined, they should be distributed to each of the City’s correctional institutions in the light of the needs of each case. It will be obvious that owing to the large number of mental defectives that will be found at these clearing houses, incapable of profiting by the ordinary methods provided in the existing machinery of the Department of Correction, that two special institutions, one for male defective delin¬ quents and one for female defective delinquents will be required. PAROLE AND “AFTER-CARE” The object after all in this more intelligent and more humane atti¬ tude towards the criminal is to so reconstruct his personality that he may be restored as promptly and as permanently as possible to his normal relation to society. In order to determine how far the Prison Admini¬ stration has succeeded in this object, each individual prisoner when he becomes eligible for parole should be returned to the reception prison where he will be further observed, in order to determine how well this object has beeen accomplished. Much light on his fitness for parole and on the measures to be adopted in the after-care work given the case will be obtained through the knowledge gathered in the investigations made at the clearing house. Too much emphasis cannot be laid on this phase of the prisoner’s treatment. Reformation of the offender is never fully accomplished within prison walls. At best such an environment is arti¬ ficial. The unusual success obtained in after-care work with the insane by certain phychopathic hospitals where, through the agency of a social service department many formerly mentally ill patients have been satis¬ factorily adjusted to the conditions of normal living, may well serve as an example for after-care treatment of criminals, in connection with such clearing houses as are proposed. The period following the release of the prisoner is a critical one for him and may be fraught with most serious consequences to society. PREVENTION THROUGH COURT CLINICS Prevention is better than cure. Would it not be more sensible, more economical and more humane to prevent insanity, pauperism, prostitution, criminality and the like than to spend vast sums in undertaking to cure, or when this was impossible, in providing ultimate custodial care? It needs no argument to convince the average thoughtful person, that from the vast and grim procession of petty offenders passing through our lower courts, is recruited the greater portion of criminals eventually ‘found in the prisons of this country. The large number of “repeaters” who have spent a greater portion of their lives in and out of prison, whose conduct was in a measure due to serious abnormal conditions from which they suffered, such as mental disease or deterioration, feeble¬ mindedness, etc., could have been discovered long before .they were sent to prison, at a time when deterioration in the mentally ill and serious crimi¬ nal tendencies in the mentally defective would have been more or less preventable. The State cannot afford to waste human material in such a manner or knowingly allow human material to cause waste to other human beings in the community. v Studies have already been made calling attention to the frequency with which this same group of mentally disabled individuals is to be found in the courts. In a study made in 1917 by the psychopathic laboratory of the Police Department of New York City, of 502 selected cases, 58 per cent, suffered from some nervous or mental abnormality. A study of female offenders by Dr. Clinton P. McCord at Albany showed 56 per nent. exhibiting nervous or mental abnormalities. A study of 81 women examined in the night court of New York City by Dr. Mabel Fernald 19 showed 25.4 per cent, feeble-minded. A study of 1,000 offenders by the Medical Service of the Municipal Court of Boston showed 23 per cent, feeble-minded, 10.4 per cent, psychopathic, 3.17 per cent, epileptic and 9 per cent, mentally diseased and deteriorated. Of the 1,000 cases referred to, 456 or 45.6 per cent, exhibited abnormal mental conditions. Every one of these 456 persons is a potential and probable candidate for ulti¬ mate custodial treatment. We believe it would be practical economy to undertake proper ad¬ justment of such individuals at a time When their condition may be re¬ coverable, or serious delinquent tendencies preventable, rather than to wait until such deterioration has taken place or criminal habits have become so firmly fixed as to warrant custodial treatment. How closely the problem of the mentally defective and diseased delin¬ quent affects our courts, how seriously it hampers them in performing their protective function is impossible, within the limited space available in this report to satisfactorily discuss. However, a limited view of the situation as it is seen in the average lower courts may be obtained from the follow¬ ing table showing selected groups of problem cases studied by the Medical Service of the Municipal Court of Boston: TABLE No. X Showing Relationship of Mental Defect and Disease to Selected Types of Problem Cases in Court. ( DIAGNOSIS 100 100 Immoral 100 100 Drunken 100 Drug Users Women Shoplifters Women Vagrant# Normal _ ___ 18.5 p. C. 20 p. C. 22 p. C. 11 p. C. 2 p. C. Dull Normal _ _ 20 32 12 21 8 Feebleminded __ 28.5 30 25 32 36 Epileptic _ _ _ _ 1.5 6 10 8 2 Alcoholic deterioration— __ __ 2 __ 7 12 Drug deterioration __ — 14.4 2 __ — __ _ 4 Psychopaths 14.3 23 10 8 Psychosis _ _ 2.8 i c 8 11 28 Total exhibiting ab¬ normal mental conditions _ 61.5 p. c. 48 p. c. 66 p. c. 68 p. c. 90 p. c. It may be seen from fable No. X that among the problem cases passing through our lower courts, a strikingly large number of abnormal individ¬ uals is to be found; individuals unfitted to profit by measures intended for normal persons and as a consequence return to the court over and over again forming the very nucleus to recidivism. There is no question more closely linked up with the fundamental duty of the criminal courts, the protection of society from anti-social acts, than the proper disposition of those who through no fault of their own, are suf¬ fering from such mental handicaps, and who, because of such mental con¬ ditions, are liable to become a burden and a menace to the community. This fact is being fully appreciated by judges throughout the country and in many places attempts are being made to secure proper medical assistance. In two cities, Boston and Chicago, special medical clinics have been already officially created within the municipal courts, which are con- tributary to a better understanding and a more intelligent treatment of offenders coming before these courts. It is not to be expected that such medical clinics in the courts can ever take the place of clearing houses in the prisons; such opportunities for prolonged observation and investigation into the causitive factors un¬ derlying careers, not to mention the advantages afforded from intensive vocational training and physical and mental rehabilitation of the prisoner, 20 cannot be secured in the short time allowed by the study of a case in the lower courts. What these clinics can do, and most effectively do, is to act as a net or sieve for the court, to determine beforehand those who, because of constitutional defects and mental handicaps, are less likely to profit by the routine measures employed by the court in dealing with delinquents, and who, because of such pathological conditions, carry the. potentialities for delinquent careers. Through the use of such clinics no longer will feeble-minded and mentally diseased and deteriorated persons be tried out again and again on probation and after that has failed, sen¬ tenced for short periods of confinement in jails, lockups and houses of correction, losing thereby whatever opportunities there might have been for restoring to health the mentally sick and preventing character deter¬ ioration and criminal tendencies in the mentally defective. Such clinics will be as ^a ray of sunshine in the gloom which sur¬ rounds the lives of the criminal insane, for years before such mental ship¬ wrecks have taken place. The early manifestations of their condition will have been noted on the appearance of these individuals as petty of¬ fenders in the lower courts, and through the agency of such clinics, meas¬ ures will be set in motion towards restoring them to normal health. Through the establishment of - such clinics, the feeble-minded—the “mental children”—passing through adult courts whose so-called crimes have been more the consequence of neglect and ignorance on the part of the community than any innate wickedness on their part, will be dealt with squarely on the basis of their needs as well as their deeds. But this is only a part of the helpful service furnished by such medi¬ cal clinics within the courts. The large percentage of criminals suffer¬ ing from physical disabilities is attested by reports coming from penal institutions throughout the country. During the administration of Dr. Katharine B. Davis, arrangements were made for the same physical ex¬ amination as that required for admission to the United States army of all inmates of New York city correctional institutions. The Reformatory for Male Misdemeanants of New York City where the inmates average barely 20 years of age, only 8 per cent, passes the required physical exam¬ ination. In the penitentiary where the average age is greater, only 5 per cent, passed the required examination. In the workhouse where those who are “down and out” are to be found in large numbers, only 1 per cent, passed the required examination. All studies that have been made of offenders passing through the lower courts show a startling number of individuals suffering from acute and chronic physical disease such as tuberculosis, Bright’s disease, asth¬ ma. heart disease, syphilis and gonorrhea. The vital importance of the early recognition of these conditions cannot be overestimated. Their re¬ lationship to an individual’s industrial efficiency and through this to his delinquency, may be seen from the following study made by Dr. Anderson: A group of 1,000 delinquents was studied with the purpose in view of determining what part, if any, routine physical examinations might play in the disposition of a delinquent’s case in court and later in the institutions of reconstructive measures while on probation. It was found that 85 per cent, of those in good or fair physical condition had been and were still self-supporting, while only 18 per cent, of those found to be in poor or bad physical condition had been and were still self-supporting. That 96 per cent, of those regularly employed were found in good or fair physical condition, while only 4 per cent, were found to be in poor or bad physical condition. That 86.3 per cent, of those who were rated as “never worked” were found to be in poor or bad physical condition. The chances of being self- supporting were more than four to one in favor of the individual in good physical condition. Further, 47 per cent, of these individuals, practically every other person was suffering from syphilis or gonorrhea. Only positive laboratory findings were included. 21 Certainly something more than intelligent advice, short terms of con¬ finement in prison, general supervision in the community and securing employment, is needed to solve the problem presented by the delinquent whose physical endurance is rapidly diminishing under a progressive Bright’s disease, or the delinquent who is scattering syphilis and gonorr¬ hea broadcast into the community. These may be conditions of more vital importance to his future welfare and the community in which he lives than any other consideration. The help such medical clinic will be to the court in determining th* presence of such conditions land securing the proper protection to the community and treatment of the individual is obvious. It is not necessary in such a program to emphasize the part played in the prevention of delinquency by the juvenile court. Dr. William Healy, Director of the Judge Baker Foundation of Boston, has well said: “The determinants of delinquent careers are the conditions of youth. Observers in many quarters are united in stating that almost all recid¬ ivists, confirmed criminals, show plainly their tendencies at least by late childhood. The factors then that turn the individual toward misbehavior are those already present in childhood.” This very fact and the presence of feeble-mindedness and other nervous and mental abnormalities among delinquent children, and the splendid work done in connection with juvenile courts by Dr. Healy in Boston, Dr. Helen Montague in New York City, and others, have convinced those who have given serious consideration to this phase of the subject, that the financial saving in the prevention of delinquent careers, resulting from such studies and reconstructive work as have been done through already established clinics more than justify the financial outlay for their maintenance, to say nothing of its humanitarian aspect. So important are those beginnings of delinquent careers as found in childhood in their relation to the whole question of criminality, that a thoroughgoing study of each delinquent child brought into court is an ideal which the State can most profitably set itself to attain. The establishment throughout the State of mental clinics to accomplish such aims will prove to be an investment paying back in dollars and cents saved from the expense of courts, prisons, reformatories and almhouses; an investment not only inthe prevention of crime and poverty, but in the joy and happiness coming from well adjusted human lives. (Such clinics functioning not only for the courts, but for the schools and the entire com¬ munity, will be a center from which radiate influences tending to prevent much of the social, mental and moral wrecks of the coming generations. Undoubtedly from existing knowledge as to the development of per¬ sonality traits and mental characteristics it will be possible, through the study of the peculiar, retarded, abnormal and subnormal children in the schools and in the community to set in motion measures for the develop¬ ment of desirable character traits and in the inhibition of undesirable ones; and to select very early in their careers those children in need of very specialized treatment. It is evident in the larger cities, particularly in New York city, owing to the great number of delinquents passing not only through the adult courts but the juvenile courts, that special clinics attached to those courts will be necessary. We note with approval that a comprehensive plan for mental clinics is being worked up into a state wide program by the New York State Commission for the Feeble-Minded. Through utilizing the Lockwood Law, the abnormal and backward child in school will be carefully studied and suitable measures applied for his re-adjustment before he has become a delinquent child or an industrial failure. The various clinics throughout the State should be supervised and their activities directed, as the State Commission for the Feeble-Minded, plans, by a state board to govern all such clinics. An important part of 22 \ this whole program for the prevention of delinquency would be undertaken by the establishment of a psychopathic hospital in New York City as has been proposed by the State Hospital Development Commission. Such an institution would serve to prevent many individuals from becoming perma¬ nently disabled by mental disease, and throughout the community serve as a stimulus for better mental hygiene. It also would be of practical service in the prevention of delinquency, in that many individuals who would otherwise become serious problems for the courts and penal insti¬ tutions of the state, would through the activities of such an institution be enabled to adjust themselves to the conditions of normal living. In conclusion the Committee desires to express its appreciation to Dr. Anderson for his very valuable assistance in the investigation and in the preparation of this report, and to the National Committee for Mental Hygiene for its co-operation and advice. RECOMMENDATIONS First: That all males convicted of felony and noit released under suspension of imposition or execution of sentence pass through the pro¬ posed clearing house at Sing Sing Prison, and thence be distributed to each of the state prisons and the New York State Reformatory at Elmira in the light of the needs of each case. Second: That all sentenced female felons and those convicted of offenses of a lesser degree than felony selected by the court, pass through a clearing house to be established by the State at the New York State Reformatory for Women at Bedford Hills, and from this clearing house, after a period of study and reconstruction, be distributed to other state institutions for women in the light of the needs of each case. Third: The prompt establishment of the proposed clearing houses on Blackwell’s Island to function for the Department of Correction of New York City in the same way as the Sing Sing and Bedford Hills clear¬ ing houses function for the state institutions, coverting the peniten¬ tiary into a clearing house for men and the workhouse into a clearing house for women. Fourth: The establishment of a state institution for the care and treatment of male defective delinquents, providing for their commitment, release and transfer. The Eastern New York Reformatory at Napanoch is suggested. Fifth: The establishment of a state institution for the care and treatment of female defective delinquents, providing for their commit¬ ment, release and transfer. The New Y6rk State Reformatory for Women at Bedford Hills is suggested. Sixth: The establishment of an institution in connection with the Department of Correction of the city of New York for the care and treat¬ ment of male defective delinquents. Seventh: The establishment of an institution in connection with the Department of Correction of the city of New York for the care and treat¬ ment of female defective delinquents. Eighth: That all children brought before the court, charged with de¬ linquency or improper guardianship, be examined mentally, the examinations to be made either in a. clinic attached to the court, or in a central clinic to be provided, and those found feeble-minded to be committed tw> proper institutions if in need of institutional care. Ninth: That all adults convicted of offenses less than felony *und all adults convicted of felony and released under suspension of imposition or execution of sentence, be examined mentally in the discretion of the judge at a clinic attached to the court or at a central clinic. 23 Tenth . The establishment of mental clinics throughout the State a* p anned by the State Commission for the Feeble-Minded, and the establish ment of a psychopathic hospital in New York City as proposed by the State Hospital Development Commission. Eleventtt: The creation of a state board to supervise and direct the activities of these mental clinics, thereby securing proper standardization in the way of methods used and results obtained. Twelfth: That the Legislature be requested to enact such legislation as will put these recommendations into effect. Respectfully submitted. FRANK E. WADE JOHN S. KENNEDY, SARAH L. DAVENPORT, GEORGE W. DAVIDS, ALLAN I. HOLLOWAY. Commissioners. Albany, N. Y. December 3, 1918.