total admissions, or 4.5 per cent of the patients admitted to state institutions. The reason so few were committed to private sanatoria was because of the economic condition of the patients and their next of kin or friends; in fact, many of those sent to these institutions were withdrawn within a few weeks due to lack of funds and transferred to state hospitals.

The New York City Children's Hospital and School, an institution for mental defectives, received five patients: 2 morons, I low-grade moron, 2 imbeciles. These patients had became troublesome at home or were found on the streets by the police and brought to the psychopathic wards. Waverly House, a temporary shelter for delinquent girls over 16 years of age, sent one young woman who had

attempted suicide, for examination and disposition. She was diagnosed as being constitutionally inferior and returned to the shelter. One boy came from the House of Refuge, a custodial institution for delinquents; he was found to be constitutionally inferior, and was returned to the institution.

Inwood House, a custodial institution and reformatory home for wayward girls and women, sent one girl for examination because of what were thought to be symptoms of mental disorder. Examination showed that she was a mental defective (moron) afflicted with tertiary syphilis; she was returned to the institution whence she came.

The 2 boys returned to the truant school from which they had been sent for mental examination and observation were found to be morons.

The patients sent to the Department of Public Charities, (now the Department of Public Welfare) were transferred to the City Hospital, Blackwell's Island. Of the 2 females, I was an epileptic, the other a case of senility; among the 6 males, there were 2 cases of arteriosclerosis, 1 chronic alcoholic, I chronic nephritic, I of cerebral syphilis, 1 of cancer of the tongue. All of these showed some slight mental disturbance besides being chronic somatic cases; they were not however, considered suitable patients for a state hospital.

Such patients as were found to need further hospital treatment but were not suitable cases for the psychopathic wards were transferred to other wards of the hospital. This happened in the case of 11 patients, nearly all of whom were either alcoholics or drug addicts, or cases of attempted suicide detained as prisoners under Article 202, Section 2,303 of the Penal Law which provided that "every person guilty of attempting suicide is guilty of a felony, punishable by imprisonment in a state prison not exceeding two years, or by a fine not exceeding one thousand dollars, or both."

Upon being returned to the magistrate's courts after recovery, the patients who attempted suicide were as a rule lectured by the magistrate and discharged from custody. This section of the Penal Law, making an attempt at suicide a crime punishable by fine or imprisonment or both, was repealed May 5, 1919,1 and there is no longer any legal restriction affecting suicidal attempts.

XIV. MENTAL EXAMINATION OF PRISONERS

Judges in the courts of the city sent 27 persons to the psychopathic wards for mental examination, after having first remanded them to the City Prison (The Tombs) to await indictment and trial; in several instances lawyers requested that their clients be sent to the hospital for mental examination in order to determine the mental responsibility of the prisoners, often hoping thereby to obtain either a reduced or suspended sentence, or to have the prisoners paroled, if guilty of the indictment. The following table indicates the diagnoses in these cases:

*Two were former patients in state hospitals; one came from another state.

1Laws of 1919, chap. 414.

Better and more adequate facilities for the mental examination of adult prisoners. as is already provided in the children's courts,' would help guide magistrates and judges in intelligently disposing of the cases of those appearing before them in whom some mental abnormality exists." There were in addition 10 males and 5 females sent for examination directly from the courts and upon examination 4 were found to be mental defectives (morons); 2 constitutionally inferior; I psychoneurotic; 4 who were cases of attempted suicide, were diagnosed as not insane; and 3 were found to be of normal mental make-up.

XV. MENTAL DEFICIENCY LAW

To meet the problem of providing proper custodial care for mental defectives and of otherwise looking after the welfare both of the community and of the mental defectives therein, Chapter 633, Laws of 1919, was passed and became a law on May 14, 1919. This act, known as the Mental Deficiency Law, provides for the appointment of a Commission of Mental Defectives, of which Dr. Pearce Bailey has since been appointed chairman. Among other things, provision is made in Section 24-a for the diagnosis and treatment for mentally defective persons before or after trial. This section of the law reads as follows:

Any person alleged to be mentally defective. . . arraigned on a criminal charge may be committed before or after trial or conviction to a hospital or other suitable place selected by the state commission for mental defectives . . . for a period not to exceed ten days, for examination as to his mental and physical condition, by any court or magistrate. If the examination discloses that the alleged mentally defective person

1Baldwin and Flexner, op. cit., p. 127.

'Vide studies of prisoners in psychiatric clinic of Sing Sing, by Bernard Glueck, Mental Hygiene, Jan., 1918, pp. 85-151; Mental Hygiene, April, 1918, pp. 177-218.

is of such a nature as to require his supervision, control and care for his own welfare or for his own welfare and the welfare of others or for the welfare of the community, the judge or justice shall issue an order for his commitment to one of the state institutions for mental defectives.

The Commission has designated Bellevue Hospital, Manhattan, and Kings County and the Cumberland Street Hospitals, Brooklyn, as the institutions in New York City

to which such cases shall be sent.

XVI. DISCHARGES FROM PSYCHOPATHIC WARDS

The crowded conditions in the psychopathic wards as well as in the state hospitals are sufficient to induce physicians in the psychopathic wards to permit relatives who refuse to sign papers for the commitment of mild and borderline cases to take such patients home after contracting to be responsible for any damage or injury they may cause. This has led to the discharge of a number of such patients. to the custody of friends and relatives. Almost invariably, with the possible exceptions where patients are taken out of the city or are sent to private sanatoria, the relatives of such discharged patients return within a short time stating that due to their inability properly to care and provide for the patients taken home against the advice of the doctors, they are prepared to have such patients committed to state. hospitals. Table 16 lists the discharges according to diagnosis; there were 138 males and 70 females, a total of 208, equivalent to 18.4 per cent of the total number of admissions.

It is almost needless to remark that were there in New York an institution to which a number of the above patients might have been sent, as to a psychopathic hospital, relatives would consider a stay in such an institution ad