tion of this fact in a public psychopathic clinic is very necessary. There is so much to be done, the cases of maladjustment are so numerous, that the community may best be served by expending our efforts, which are extremely limited, upon those cases where there appears some degree of hopefulness as to the result of our efforts. For the others I would suggest a disposition by the cheapest social means possible.

This seems to me to be a distinctly selfish age in which we live. Whether our selfishness is explained by the war or after-war conditions I do not feel able to say, but we find evidences of it in our public clinics, to which more and more people bring their problems. It is not infrequently observed that children are brought to the clinic, not so much for the benefit which the parents feel might be given the child, as with the expectation that the clinic will, by some means or other, relieve the family of its responsibility in reference to the child. I feel sure that many children are not wanted in the home. The furious rate at which we live, with the keen commercial competition, tends to make the advent of children into the home an expense which parents too frequently deplore. Under such conditions the child is apt to be neglected and is hastened to the actual maladjustment for which he comes to the clinic.

I recall the case of a thirteen-year-old girl, whose father owned a small delicatessen store. In their eagerness to get ahead financially, the mother spent most of her time with the father in the store, which was kept open twelve to fourteen hours each day. As business increased, the child was also recruited as a clerk. There was no home life. The family's entire life was spent in the store or in the one room behind the store, which served as the home. Small amounts of money began to be missed from the cash register and it was discovered that the child was taking money to buy small luxuries for herself. The parents brought this girl to the clinic. Their attitude showed that they really wished the clinic might have the girl committed to an institution so that they might be relieved of their responsibility and be insured against the danger of her further stealing from them.

I feel that we must strive to get away from our cliff-dwelling habit and restore, so far as possible, the family group and the home as an institution. The parents must inject into their children, from the earliest age, a sense of social values. This must be done not only by teaching in the school and in the home, but by the actual living examples of their parents. We, as workers interested in social welfare problems, should instil, so far as it is within our power, a proper sense of social values in the cases of those with whom we come in contact, and we must not tolerate the habit on the part of the family of "passing the buck" to the social agency in regard to the entire care of one of its members. We must require of them more in the way of their duty to their children than we have been doing in the past.

I wish to express my appreciation of the kindness of Dr. Nellie L. Perkins and the Wayne County Psychopathic Clinic, in extending to me the use of their case histories.

B. IN INSTITUTIONS

Herman M. Adler, M.D., Criminologist, State Department of Public Welfare,

Springfield, Ill.

The term "maladjusted child" includes a great many and quite diverse problems. I shall confine myself to the consideration of institutions dealing with socially maladjusted children which are commonly grouped under the term of delinquent.

In Illinois, as in many other states, we have a number of institutions dealing with delinquent children. Two of these are maintained by the state, namely the School for Delinquent Boys at St. Charles and the School for Delinquent Girls at Geneva. One very large school is maintained by the city of Chicago in co-operation with the Department of Education of Chicago and the county of Cook, namely, the Chicago and Cook County School for Boys. Then there are a number of detention homes throughout the state, and private homes, and other institutions, such as the House of the Good Shepherd for Girls and the Chicago Home for Girls. All of these institutions are quite openly and specifically dedicated to the care of delinquent children. There are, of course, a very large number of institutions both private and public throughout the state of Illinois which deal with so-called dependent children.

In the light of a recent investigation of several orphanages a grave doubt arises as to whether such a distinction can be maintained or even whether it is wise to insist upon it. Dependency, feeblemindedness, and delinquency have so many points of contact, apparently, that it is more than likely that progress is seriously retarded by these very artificial distinctions whose justification seems to be almost entirely based upon sentimental rather than really practical grounds.

We cannot go into this problem further than to point out its existence. Naturally we are not advocating the lumping of these problems together and expecting one institution to care for all types.

The question is merely suggested as to whether we are facing here another step in the progress of public opinion such as marked the change of attitude toward the insane when the old asylum was given up for the modern state hospital idea and whether the next step in the institutional care of delinquents is not, therefore, to change our attitude toward the nature of the problem and the proper methods of dealing with it in these institutions. Should we not develop a new name to indicate this change of view and to replace the term delinquent by one less censorious?

Whatever the facts may be elsewhere, in this country we are compelled by the truth to admit that in Illinois we do not regard the correctional institution with the same confidence, not to say respect, that we are accustomed to feel toward, let us say, a first-class surgical institution. This is not due to any shortcoming on the part of those who are officiating in these institutions, but is due rather to the peculiar line of development in the field of juvenile delinquency.

Informed students of this subject, whose first-hand recollections go back even a single generation in the work, have frequently remarked upon the apparent change which has come over the types of delinquents who are now sent to institutions, as compared with formerly. Some of this change may be due to changes in the nature of the population-one of the most commonly urged explanations. Another possibility is that the observers themselves have changed and, having become older, look back upon the conditions prevailing in days of youth as better than at present, a reaction of conservatism that is not unusual. On the other hand, it may be that these observations are well founded and the explanation is that probation now takes care of those children who formerly would have been "cured" in the institutions; leaving only the more incorrigible ones for the correctional schools. As Judge Arnold of the Juvenile Court of Chicago once remarked in regard to St. Charles: "If Colonel Adams can reform these boys that I am now sending him, he is a wizard, because by the time the Juvenile Court gets through with a boy and decides to send him to a correctional school,

it seems almost impossible that he can be changed by any ordinary human means." That is undoubtedly the attitude that the Juvenile Court judge of any of our progressive courts would take.

The remarkable and far-reaching development of prevention and education which has been induced by the growth of the probation departments is unquestionably making itself felt in the institutional field. With the exception of a few of our less advanced communities, in the outlying districts of the state of Illinois, all the juvenile courts, especially the Juvenile Court of Chicago are satisfactorily solving the problems of the great majority of those cases which come up before them so that they are not only "reforming" in the old sense all those cases which in by-gone days would have redounded to the credit of the institutions as cures, but are actually sorting out for institutional commitment with ever-increasing accuracy only those cases which do not respond to the educational and social treatment, and who therefore are finally sent to an institution not so much for what it is hoped to secure for them, but rather as a precautionary method of protection for the community. It is a last desperate hope with the emphasis rather on the community's interest than on the child's. It is no wonder, therefore, that our institutional staffs are not so sanguine about the beneficial effects of the institution as were those of a generation ago.

While all this may be important to a certain extent, it does not explain the main problem which crops out again and again in the study of delinquents, especially in institutions. That problem is: What is the difference between the delinquent child who is finally sent to an institution and the one who is successfully maintained on probation? It is not the nature or the quality or the degree of his behavior difficulty, for every kind of delinquency that is represented by the institution population is found in larger numbers among successful parole cases. It is not a difference in intelligence, for in spite of certain evidence in this direction, further experience has not borne it out. And again we know that for every feebleminded person who has to be committed to an institution because of dangerous behavior, there are two or three at least of equally lowgrade intelligence who are safely kept at work in the community.

Probably no characteristic distinguishes the institutional from the non-institutional case more frequently than that of temperamental insubordination. One might almost say that the child who is sent to a state correctional institution, in the main, goes there because in addition to his behavior difficulties he has exhausted the patience of the authorities, first in the home and the school and then in the court and on probation, and finally in those institutions which act as buffers between the correctional schools and the community, such as the truant schools, the detention homes, and in the case of Chicago, the Chicago and Cook County School for Boys, which receives boys for no longer than three months.

The only generalization that seems justified on the basis of these statements is that when it comes to dealing with the delinquent child no generalization will hold. Each is an individual problem a trite and oft-repeated statement indeed; and yet do we apply it in our organizations? The juvenile courts which do their work almost entirely on the basis of the individual case, of course, have demonstrated and will demonstrate increasingly the fact that it is by individual study and individual treatment that results can be obtained-often thoroughly astonishing results.

In our institutions there is little evidence of this. Even in those institutions, glowing accounts of which have penetrated to us in Illinois where the work of reclamation is said to go on at a remarkable rate, it would appear that there is little more than a picking-over of the junk-pile for the uttermost remnant of reclaimable materials. The final residue remains, in a large proportion if not the major proportion of the institutional group, unresponsive to the group methods, the generalizing discipline, and repressive social atmosphere which under the guise of military or other discipline serves merely as a cloak for ignorance or incompetency on the part of the institutional staff.

It is not my purpose here to call names, and as I stated before, I do not believe that the institutional staffs are to be held responsible for this state of affairs. But the community itself must accept the full responsibility so long as it continues to hoodwink itself by clinging to the long discredited methods of repressive discipline as a cure for behavior difficulties.

And why should an institution's efficiency be made dependent upon the number of "cures" that it can demonstrate in its annual report? Such cures, it is true, may be the ultimate objective, but unless somebody has at present a specific curative method, which will work with 100 per cent efficiency, or even 90, or 80 per cent, or any major fraction, with the consequence that the institution has merely to carry out the precepts to obtain results, why should we demand such things of our institutional staffs, especially since the latter are dealing with cases in which the elaborate and highly skilled juvenile court staffs have failed? This is not a field in which any one person may claim to have the answer. Neither the psychiatrist nor the psychologist, neither the sociologist nor the educator, neither the jurist nor the penologist. The answer is yet to be found, but are we doing anything to find it ?

Where is the correctional institution in which the entire energies of the staff are bent upon utilizing these unreclaimed cases for the obtaining of facts upon which to base logical action? Which institution in this country, even among those in which research is being conducted, can say the major object of the entire institution is to conduct such research and in which it is not the truth to say, rather, that research is also being done? And, finally, even where the will is strong, where is the institution in which the staff is not so weak in intelligence, in education, or in special training, as to be almost powerless to this end?

It is very satisfactory and gratifying to know that certain individuals have achieved results with certain small and carefully selected groups of individual cases, and it may be interesting to learn that they believe their success was due to the fact that they used a certain amount of tact in their work or that they started out with the idea that these children were "at heart like any other children" or because they have themselves "a knack" or "charm" or "strong personality" and so on.

But what good does that do us, who are not gifted in this way, who are not able to select our cases, or who have not the climatic or other conditions which enabled a particular piece of work apparently to succeed? No facts have come out of these experiments beyond the one that intelligence, refinement, and industry will achieve results in the field of juvenile delinquency, as elsewhere. No one, to my knowledge, is in a position to say "by this and this rule can this selection be made," or "this and that quality indicates a favorable case," or the reverse. It is all a matter of opinion based largely upon personal prejudice or, if you do not like this term, to borrow a phrase from my friend, Mr. Albert Kales, upon "subliminal hunches."

When once the correctional schools will change their attitude from that of more or less consciously assuming responsibility for achieving results in the nature of cures or corrections to that of experimenters, then may we hope that real progress will reward our labors; then will the correctional school no longer assert pedantically that it is devised and equipped to change the delinquent into a well-behaved person and more or less hypocritically to hide its failures behind outward semblances of orderliness within the institution; and then will the courts, and perhaps the families of children with behavior difficulties seek out the help of the correctional school as, in acute disease, they now seek the surgeon or physician; and then the correctional school will no longer be the symbol of failure and of a forlorn hope, but will stand for knowledge upon which effective, purposeful, and intelligent treatment may be based; and above all it will be the source of preventive measures which will still further reduce the number of cases requiring to be sent to the school,

EDUCATIONAL VALUE TO THE COMMUNITY OF MENTAL HYGIENE AGENCIES

A. THE PSYCHOPATHIC HOSPITAL

William F. Lorenz, M.D., Director, Wisconsin Psychiatric Institute, Madison

The psychopathic hospital is probably the most potent influence from the standpoint of the general public in furthering mental hygiene. Its greatest influence lies in the fact that it is a simple, tangible expression of all modern views concerning mental diseases; that is, the hospital features of caring for these conditions are so much emphasized and so much in evidence that probably no other means help as much to develop the general belief that a mental disease is in fact an illness and not an offense against society.

The two outstanding features of a psychopathic hospital which in my belief impress the public are: first, the hospital atmosphere which obtains in these modern institutions; and second, the results of treatment which the public soon learns to know as being far more satisfactory then the results obtained in the old type of institution. The better results obtained in the psychopathic hospitals are due in a great measure to the individual attention a patient receives. His mental and physical state is more carefully analyzed and the means of readjustment to normal health are provided; but this alone does not account for the better results. Unquestionably these are due also to the fact that the mental case is received at a much earlier period in the course of the disease. The early treatment of a mental case has long been known to result in more recoveries and were it possible to receive mental cases in their incipiency, even at our more or less poorly equipped state institutions, better results might be expected. The trouble, however, lies in the hesitancy on the part of the public to send an early or mild case of mental disease to an institution which already has a well-established reputation as an insane asylum. All the efforts that have been expended to change the old type of institutions, to promote a different atmosphere to increase equipment and facilities, from the public standpoint at least, have been quite barren of results. This is probably due to the fact that the modernizing efforts have not been universal. Here and there a state institution stands out in the reformation that has been so

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