“Twenty-seven counties have now accepted the Children’s Aid Society as their agent for the care of dependent children. In the other counties nearly every possible method of caring for children is represented in the courses chosen. Where the township system is in use, the few dependent children are placed out by adoption or indenture, by the overseers themselves. Several counties have built homes for the children, an expensive method, with no merit so far as the favorable situation of the children is concerned. Some of the overseers place the children in institutions, while others use private homes to some extent, controlling and supervising the children themselves.”
THE INSANE
In no branch of humanitarian service is segregation, classification, even to the point of individual treatment, more essential than in the care of the insane. New Jersey puts no inconsiderable number of her mentally afflicted on a par with offenders against the criminal law for, according to the Commission on the Care of the Mental Defectives for the year 1913, fifteen counties had confined insane persons in penal institutions, in some cases for periods of from 85 to 223 days. The State Charity Commission in Illinois recently reported that in spite of a provision of the statutes forbidding such practices, only eleven of the 102 counties did not so offend. Louisiana is reported to have many lunatics in its parish jails.
In but few states are there no insane in the county almshouses, for at least temporary confinement, and particularly is this true in the South and Middle West. In such institutions a condition sometimes prevails that staggers imagination. For the state of Pennsylvania, Dr. C. Floyd Haviland has summed up the situation in these words:
“As a result of the existing system, in these institutions, custodial care is generally substituted for active remedial treatment directed to the improvement or the recovery of the insane as such. As a rule, medical treatment for physical ills is satisfactory, although such is not invariably the case. With but few exceptions, the county institutions have no special medical facilities, nor can it be expected that such facilities can be provided under present conditions, for, with the comparatively small number of patients treated in the respective institutions, such provisions would require a prohibitive per capita expense; but as a result of such lack of facilities, mechanical means of restraint and confinement are substituted for proper personal treatment and attention. With but a limited number of attendants, enclosed exercise yards and personal restraint and seclusion must inevitably result. Under existing conditions, one cannot blame the caretakers of the insane for resorting to such means, for while restraint and seclusion can and should be abolished, they cannot be successfully abolished without the substitution of other means of dealing with the disturbed insane, such as hydrotherapy, occupational training, and close personal supervision. In this connection it is agreeable to note that little evidence was obtained of actual physical abuse, but that gross neglect exists is indisputable.
“That the theory of county hospitals for the chronic insane only does not obtain in actual practice is but a necessary result of the prevailing custom of determining the question as to whether a patient shall be committed to a state hospital, regardless of prognosis or medical issues, in many instances the decision being made by local lay authorities without medical advice. It is certain that many acute cases have lapsed into chronicity in the county hospitals simply for lack of proper treatment. Dreary, desolate wards, lack of recreation, or other means of exciting or maintaining active interest are alone sufficient not only to hinder improvement or recovery, but must necessarily result in actually hastening the terminal process of deterioration.”[8]
Writing concerning the treatment of the insane in Texas, Dr. Thomas W. Salmon, of the National Committee for Mental Hygiene calls county almshouse care of the insane the “saddest and most sordid spectacle in American community life.” For a graphic picture of the practical significance of the system in one of the almshouses in that state the reader is urged to read the extracts from Dr. Salmon’s address in the Appendix of this volume.
COUNTY PRISONS
But what of the treatment of the prisoner?
The county theoretically has very little to do with persons convicted of serious offenses. By far the greater number of the inmates of the prison are persons awaiting trial and therefore presumably innocent of wrongdoing. The minimum standard of justice demands that such persons be kept apart from hardened criminals. We shall see how this and other standards are observed in the county.
To begin with, it should be noted that the head of the jail, universally, is the sheriff. Bear in mind that this officer in forty-seven states is elective, that his term is usually very short, that he is usually ineligible to succeed himself and that he has numerous special duties to perform. It is therefore obvious that nothing but an exceptional piece of good luck can bring to the head of the jail an expert penologist. Often, too, he will be under contract with the board of supervisors to supply the prisoners with food at as good a profit to himself as may be.