institution? She is now 32 years old, having spent but ten years in the community. At the expiration of her present sentence she will return to it again, as unfit as she has always been to care for herself.

Her tendency to escape and her excessively immoral tendencies have made her a very troublesome patient wherever she has been.

CHART VII.

Chart VII (B. M.) shows a feeble-minded woman who came to this institution twenty-three years ago. If at that time the proper diagnosis had been made and she had been given custodial care, she would not have returned to us within the last year in the company of a bright girl of only 21.

CHART VIII.

Chart VIII represents the court record of the family of a feebleminded, epileptic woman. The first line of each group shows the number of times the individual has appeared in court, while the second line shows the disposal of the case. It will be seen that with 57 arrests there were only 23 sentences. This demonstrates the unsatisfactory results of our present penal system which is not based on laboratory studies.

CHART IX.

Chart IX (P. J.) shows record of a family in which there is insanity, feeble-mindedness, alcoholism and criminality. This case demonstrates the instability resulting from nervous and mental defect which is so often the foundation of criminalistic behavior.

CHART X.

Chart X (W. W.) shows the history of a woman who has had forty-five sentences. She is neither feeble-minded nor insane, so could not have been committed permanently to any institution. Nevertheless, her record shows she is unfit to live in the community. A truly indeterminate sentence is the only method by which such a case can be controlled adequately and the community be protected.

CHART XI.

Chart XI (D. F.) shows the toll paid by society through its charitable institutions for a psychopath who is neither feebleminded nor insane. Besides the institutional aid shown, there has been much help given by private individuals which it is impossible to estimate. Thirty different institutions have given help or shelter to this woman and her immediate family.

Is there not economic waste through lack of co-operation demonstrated by this chart?

CHART XII.

Chart XII (R. R.) shows the close association between insanity and criminality, and demonstrates the instability which is often the foundation of delinquency. Among five members of this family there are twenty-three commitments to insane hospitals and sanitoria, four arrests and one sentence.

CHART XIII.

Chart XIII shows the heredity of two illegitimate children (twins). They were adopted by private families at the age of two and did not see or hear of each other again until they met at the Reformatory for Women, to which they were both sentenced for the same charge-vagrancy-within the same month. This would seem to prove the inheritance of criminalistic characteristics were it not for the underlying factor of epilepsy, which is present in both cases. Their antecedents were a family of paupers who for a period of fifty years had been cared for largely by the State. The mother, who at the age of 41 is still in the city almshouse, had been sent fifteen times to state institutions and has spent over twenty years of her life in them. As will be seen from this chart, almost every member of the family has been confined at some time in a state institution. Besides this, for years at a time they have been furnished with state aid.

The two girls-interestingly enough-show no intellectual defect. This is apparently true of the mother, of whom it was said, "She is bright enough, but as you can see for yourself, is not like other folks."

The question of how it would be possible to segregate permanently social inefficients who do not show intellectual defect, is a very grave one.

A few years ago this case would have been considered proof of the direct inheritance of criminal traits; now we recognize the importance of underlying factors which, in this case, appears to be epilepsy.

CHART XIV.

Chart XIV (W. B.) shows the history of a dependent family over a period of years, a white woman who came to us knowing nothing of her parentage, and through sociological investigation was found to have belonged to a colored family in which there was some Indian blood. This chart gives one some idea of the work the State does in placing these children in private families and keeping them under supervision until 21 years of age.

The lack of inhibitions, which may have been partly racial characteristics, may have accounted for the delinquency and illegitimacy which is found in this family. The woman, whom we have been able to examine, showed good intellectual capacity in spite of her delinquency.

The method which has here been described we would consider in the line of an experiment. It is to be hoped that if it should prove of any value in demonstrating situations found, that its further use will suggest other and more efficient methods of utilizing the symbol.

ARE THE DISCIPLINARY CASES IN A REFORMATORY IDENTICAL WITH PSYCHOPATHIC CASES?

ALBERTA S. B. GUIBORD, M. D., LABORATORY OF SOCIAL HYGIENE, BEDFORD HILLS, N. Y.

My object in presenting to you this paper is to demonstrate what I am convinced is a fact, what indeed I suppose many of you also believe, that the term "disciplinary" as applied to chronically troublesome inmates of correctional institutions is for the most part a misnomer; that it should be displaced by the term

"psychopathic" and that those cases commonly designated disciplinary should be studied and diagnosed in accordance with modern psychiatric conception and receive therapeutic instead of punitive treatment. This conclusion is based on certain personal experience which it seems necessary to state as introduction.

In the summer of 1913 I had my first acquaintance with the methods of a correctional institution. At the request of Dr. Katharine Bement Davis I spent three months at the State Reformatory for Women at Bedford Hills, N. Y., making preliminary studies for the Laboratory of Social Hygiene. Later I returned for the period of one year which has recently been completed. Having had previous experience only with hospitals of general nature or for the insane, I may be said to have approached the problem with a hospital viewpoint. My automatic reaction towards a case reported as "giving trouble" was "what is the diagnosis of the case and what treatment shall be applied to correct the abnormal manifestation"? With this approach it is only fair to mention that frequently I was surprised to find no wide and varied methods of treatment in vogue but a somewhat stereotyped and narrow system of so-called "punishments", varying in degree from deprivation of certain articles of diet or of recreation privileges to the application of handcuffs or confinement for longer or shorter periods in a skylighted brick room in a building set apart for the purpose.

The term punishment which at first caused an instinctive shudder was soon seen to have acquired in its minimum application a very mild meaning indeed. Yet the fact that abnormal and to my view clearly psychopathic manifestations of behavior were met with prescriptions of punishment instead of by measures of treatment appealed to me as unscientific and unproductive of beneficial results. To be sure I was not alone in this idea. Dr. Davis believed that a relatively large group of girls who were constant sources of trouble in the institution, turbulent, unreasonable and complex, were abnormal products of one sort or another. To throw light on this very subject indeed was one of the objects of the establishment of the Laboratory of Social Hygiene.

From investigations carried on during a period of one year and three months the subjects in the Bedford State Reformatory appear quite definitely to fall into four distinct groups as follows:

I. ACCIDENTAL OR CHANCE CASES: Practically normal in mental makeup but through some chance combination of circumstances beyond their control, a purely extrinsic cause, have blundered into the hands of the law. For example, foreigners ignorant of language and customs, individuals sporadically under influence of alcohol or misled some way through no fault of their own into breaking the law.

II. MENTAL DEFECTIVES: Persons whose intelligence tests below the standard accepted as normal. Some of these show pronounced psychopathic manifestations but feeble-mindedness is the primary fact.

III. MENTAL DEVIATES: Persons whose intelligence tests above the standard accepted as feeble-minded but who show other abnormal mental traits, such as instabilities and inadequacies in daily contacts, lack of average moral and ethical standards, hypersuggestibility, sub-inhibition, etc. This group practically squares with that more commonly known as constitutionally inferior, but the term mental deviate, as used by Dr. Geo. Walton and others, seems more accurately to fit the type. For the most part these cases possess insight sufficient to keep them in fair disciplinary immunity in the even regime of the institution. Drug cases almost invariably fall in this group.

IV. PSYCHOPATHIC AND TRUE PSYCHOSES: Persons showing such persistent abnormal traits as to amount to actual insanity or to an almost sure progression to insanity unless satisfactory preventive measures are instituted. They show pronounced psychomotor disturbances of manic or depressive order, paranoid or other delusional states, hallucinosis, hysterical or epileptic stigmata, etc. Insight in these cases is generally lacking, in consequence, unless the nature of the case is at once recognized, they are subjects of repeated and quite unjustifiable discipline.

According to the classification here given distribution of the disciplinary records of one hundred consecutive admissions to the