Vol. Nos. 4 and 5 Eugene, Oregon April, 4. The University of Oregon / Extension Monitor A Summary of the Oregon State Survey of Mental Defect, Delinquency and Dependency CONDUCTED IN 1920 BY THE UNIVERSITY OF OREGON Under the direction of the United States Public Health Service at the request of the Legislature of the State of Oregon, Dr. Chester L. Carlisle, U. S. P. H. S., Director (Condensed and edited by Earl Kilpatrick, director, Extension Division.) Published for the benefit of extension students of the University of Oregon and furnished free to all who register. TABLE OF CONTENTS 3 HUGH S. CUMMING, Surgeon General, U. S. P. H. S. x. Origin, Object, Scope and Methods in Oregon 4 By CHESTER L. CARLISLE, M.D. ^er II. Nature and Extent of Social Inadequacy in Oregon 5 < By CHESTER L. CARLISLE, M.D. Results of Citizen Survey (Table No. 1) 5 Individuals in Institutions (Table No. 2) 5 Inmates of Institutions-Source by Counties (Table No. 3) 6 Poor Farms and Outdoor Relief (Table No. 4) 7 Summary of Social Liabilities (Table No. 5) 7 Dependency the Key 9 Dependency Due to Physical Handicap 9 The Deaf (Tables Nos. 6 and 7) 11 The Blind (Table No. 8) 13 Sex Offense 13 State Aid to Institutions 13 Dependent Children 14 Dependency and Tuberculosis (Table No. 9) 15 Other Dependents 15 Chapter III. The Cost of Social Inadequacy in Oregon 16 By CHESTER L. CARLISLE, M.D. Introduction 16 Cost of State Institutions (Tables Nos. 10 and 11) 17 Cost of Dependency to Counties (Table No. 12) 18 Cost per Capita to Citizens of Oregon (Table No. 13) 19 Additional State Figures (Table No. 14) 19 Costs in Two Representative Counties 19 Chapter IV. Special Supporting Studies and Contributions 20 Teachers' Referendum on Retardation (Table No. 15) 20-21 By CHESTER L. CARLISLE, M.D. Causes and Cost of Retardation 22 By L. C. DOUGLASS, B.A. Dependents with Special Handicaps 23 By RUTH MONTGOMERY, B.A. The Mentally Defective Child in Industry (Table No. 16) 24-25 By MILLIE R. TRUMBULL, Secretary of Industrial Welfare Commission Intensive Studies in Juvenile Delinquency 26 By RUTH MONTGOMERY, B.A. Oregon State Industrial School for Girls (Table No. 17) 26 Oregon State Industrial School for Boys (Table No. 18) 26 Study of Delinquency-State Penitentiary (Tables Nos. 19, 20, 21, 22 and 23) 27-30 By C. A. GREGORY, Ph.D. and MOZELLE HAIR, B.A. Court of Domestic Relations, Multnomah County 31 By JUDGE JACOB KANZLER and S. C. KOHS, Ph.D. Population of Military Age in Oregon (Table No. 24) 31-33 By CHESTER L. CARLISLE, M.D. A in Oregon 34-37 By RUTH MONTGOMERY, B.A. Ji V. Suggestions for Desirable Legislation 38 By CHESTER L. CARLISLE, M.D. SUMMARY OF THE OREGON STATE SURVEY OF MENTAL DEFECT, DELINQUENCY AND DEPENDENCY Conducted in 1920 by THE UNIVERSITY OF OREGON Under the Direction of The United States Public Health Service At the Request of the Legislature of the State of Oregon Dr. Chester L. Carlisle, U. S. P. H. S., Director (Condensed and Edited by Earl Kilpatrick, Director, Extension Division) NOTE.-The Extension Division of the University of Oregon greatly regrets its inabil- ity, because of lack of available funds, to print in full the valuable report prepared by Dr. Carlisle. The scope of the survey, and its most important findings, are presented here- with. Members of the legislature, and other persons especially interested, are heartily welcome to inspect the full manuscript report, which will be preserved in the University library until such time as a fuller printing becomes possible. Foreword By HUGH S. CUMMING Surgeon General, United States Public Health Service. The United States Public Health Service, commissioned by Congress to study the diseases of man, has long been actively engaged in investi- gating all problems related to mental and physical hygiene. It was, there- fore, with feelings of sincere pleasure and deep satisfaction that the United States Public Health Service accepted the invitation of the Uni- versity of Oregon, endorsed by the State Board of Health, to act as director of the Oregon State Survey, for it is by active and enthusiastic cooperation of all Federal and State agencies for the protection of our public health that the ultimate ideals of community, state and national welfare may be more quickly and effectively reached. In this spirit of friendly and disinterested cooperation the United States Public Health Service as director of the Oregon State Survey pre- sents to the citizens of Oregon certain fundamental causes of subnormal conduct, inefficiency and delinquency, with suggestions as to ways and means for their relief, with the hope that the facts contained in the survey . . . . will assist the state government to advance its already high ideals of citizen health and community standards of living. 4 EXTENSION MONITOR CHAPTER I Origin, Object, Scope and Methods in Oregon By CHESTER L. CARLISLE, M. D. THE Oregon State Survey was initiated by the interest of the citizens of Oregon in promoting the public health. Through their rep- resentatives in the State Legislature in 1919, it took form as Senate Joint Resolution No. 28, which enacted "That the University of Oregon is hereby granted authority to make such survey, and .... to report the result of its study with recommended legislation to the next regular legislative assembly, with the understanding that .... the state will be asked for no appropriations for the purpose." The University of Oregon, through the Extension Division, extended an invitation, endorsed by the State Board of Health, to the United States Public Health Service to act as director of the survey. Without funds for a paid staff and confronted by the task of covering 96,699 square miles, containing thirty-six counties, the director of the survey decided to enlist the aid of every public spirited citizen in gathering the information. To the Honorable Ben W. Olcott, Governor of the State, the director of the survey begs to render the thanks and appreciation of the United States Public Health Service and of the University of Oregon for his constant interest in the survey and for his official permission to use the state seal. Certificates in the form shown on page 40, carrying the state seal and the seal of the University of Oregon, over the signature of the United States Public Health Service, were sent to over ten thousand citi- zens of special training in the state. . . . Thus was "enlisted" the aid of every physician, judge, lawyer, clergy- man, nurse, teacher, and other individual citizen known to be interested in community welfare and also the cooperation of every state, county, city, and village official and of many officers and members of social welfare and philanthropic groups including the local chapters and branches of the American Red Cross. To these special voluntary assistants were given cards (see p. 39) upon which to record the facts of mental or physical defect, delinquency, dependency or retardation in school work coming under their own observation. . . . The survey cards upon which the date was recorded were arranged by the director to take care of any pos- sible combination of medico-psychological-sociological symptoms which might be found in any one individual. The survey was further assisted by the voluntary contributions of time and labor by a number of especially trained observers, who' have made in- tensive studies as to the incidence of mental defect in delinquents, depen- dents and retarded pupils in school. Thus was inaugurated the first state-wide, cooperative citizen survey in the fields of mental, physical and social hygiene in history. EXTENSION MONITOR 5 CHAPTER II Nature and Extent of Social Inadequacy in Oregon By CHESTER L. CARLISLE, M. D [First below is given the tabulated, summarized result of the survey of the 36 Oregon counties compiled from the reports made to Dr. Carlisle by the vast army of voluntary assistants, commissioned by himself and Governor Olcott. The form of the commission issued to these helpers is shown on page 40, and the form of report card used is reproduced on page 39. It is to be regretted that space does not permit the publication of the sum- maries for the individual counties.] Table 1. OREGON-ALL COUNTIES-RESULTS OF CITIZEN SURVEY Population, 1920, 783,285 Medieo-psychological-sociological Findings. Figures represent number of individuals discovered in the communities ♦ * *. This chart does not show any person resident in any institution except dependents sick in general hospitals. Types of Handicap. Male. Female. Total. Mental defect 354 251 605 Mental defect with delinquency 42 32 74 Mental defect with dependency, general 194 64 258 Mental defect with dependency and deafness 2 1 3 Mental defect with dependency and blindness 2 0 2 Mental defect with dependency and epilepsy 10 5 15 Mental defect with dependency and other crippling handicaps .. 13 6 19 Mental defect with delinquency and dependency 26 15 41 Insanity with dependency 78 55 133 Epilepsy with dependency 31 19 50 Other neuro-mental disorders with dependency 6 2 8 Tuberculosis with dependency 26 17 43 Blindness with dependency 36 18 54 Deafness with dependency , 84 72 156 Crippling physical handicap with dependency 79 47 126 Delinquency 25,349 1,933 27,282 Delinquency with dependency 13 12 25 Delinquency with insanity 2 0 2 Delinquency with epilepsy 1 0 1 Delinquency wtih other neuro-mental disorders 1 0 1 Dependency from all other causes ..... 15,219 11,432 26,651 Grand total of individuals 41,568 13,981 55,549 (Total number of individuals reported showing mental and physical defect, disease or disorder and individuals who are or recently have been delinquents and individuals who are dependents from all other causes, 55,549; 70 per 1,000; 7 per cent of the whole popula- tion. ) Table 2. SUMMARY-INDIVIDUALS WHO ARE OR RECENTLY HAVE BEEN MAINTAINED IN INSTITUTIONS Type of Defect. In State Institutions on State Funds. In Private Institutions Receiving Public Funds. Total Individuals. Insane 3,859 A* 3,859 Mental Defective 656 B* 656 Delinquent 1,249 1,585 2,834 Dependent (exclusive of the dependent poor farms) poor on - 540 1,985 2,525 Total Individuals 6,304 3,570 9,874 A* A small number of insane are known to be in private institutions but as details are lacking, they are not included. It is suggested that all private institutions caring for the insane should make regular monthly reports of admissions, deaths and discharges as well as 6 EXTENSION MONITOR an annual or biennial report to the central State Board of Control; and, further, that all such private institutions caring for the insane should operate only after being licensed for such operation and care of the insane, by the central State Board of Control or other state agency functioning in matters relating to the public health, mental hygiene and public welfare generally, which board should have statutory powers to make all necessary and desirable "rules and regulations." * * * B* About 25 mental defectives are known to be in private institutions but are included in this table under the head of dependents in private institutions as they are juveniles. There are also in various private institutions other juveniles and young adults wholly or partially dependent upon public funds, who are believed to be mentally defective. It would be a wise public policy if all institutions caring for dependents made special provision for those of defective mentality, and, where practicable, transferred them to the state institu- tion caring for mental defectives. * * ♦ (With respect to individuals in institutions. Dr. Carlisle presents an interesting table showing the source of the population of these institutions by counties. This table does not include inmates of jails and county poor farms. Jail inmates are included in Table No. 1 and inmates of poor farms in Table No. 4. Dr. Carlisle remarks with respect to this table: "It is to be noted that the odd conduct commonly associated with psychoses (insanity) is more generally recognized by the public as needing specific care as a symptom of mental abnormality than is the odd or anti-social conduct of delinquency. It therefore follows that the number of insane for each county cared for in hospitals follows the ratio of county population much more closely than does delinquency or dependency.") Table 3. INMATES OF INSTITUTIONS-SOURCE BY COUNTIES Totals Private Institutions Receiving Public Funds 179 87 743 984 199 103 172 34 19 21 240 27 22 26 44 166 14 77 61 25 270 38 161 86 595 19 !,418 4,970 88 17 53 235 151 40 139 409 580 18 152 2 53 ,570 10,167 Soldiers' Home Baker 98 13 13 1 42 3 3 0 6 Benton 40 15 6892304 Clackamas 138 32 24 5 12 11 6 3 10 Clatsop 144 14 8 5 16 10 1 1 0 Columbia 59 12 12 0 7 5 2 0 6 Coos 94 21 20 1 11 16 3 0 6 Crook 23 23060000 Curry 16 01000002 Deschutes 11 05112100 Douglas 94 11 11 6 36 2 6 1 73 Gilliam 17 10081000 Grant 13 03051000 Harney 17 11050002 Hood River 15 831 14 2100 Jackson 88 15 11 3 II 8 2 2 26 Jefferson 610140002 Josephine 35 12 1 0 9 1 1 0 18 Klamath 36 010 10 2318 Lake 15 01080001 Lane 131 27 27 8 25 11 12 1 28 Lincoln 12 820 10 1302 Linn 101 17 6 1 11 0 14 1 10 Malheur 44 6 2 6 26 1 0 0 1 Marion 381 51 27 14 20 49 27 12 14 Morrow 15 11020000 Multnomah 1,604 244 186 39 223 135 26 17 78 2 Polk 43 98078526 Sherman 12 20011010 Tillamook 26 40281174 Umatilla 152 12 2 0 58 4 1 3 3 Union 69 7 16 2 40 3 2 0 12 Wallowa 25 3 1063200 Wasco 78 11 10 1 27 7 3 0 2 Washington 102 26 12 3 10 4 6 0 8 Wheeler 10 13030010 Yamhill 95 14 9 1 15 5 2 3 8 Unknown 020000000 Waiting List 0 53 0000000 Total 3,859 656 436 109 706 299 136 56 340 3 State School for Blind State School for Deaf.. State Tuberculosis Hosiptal State Penitentiary .... State Industrial School for Girls State Training School for Boys State School for Feeble-Minded Both State Hospitals for Insane COUNTIES. EXTENSION MONITOR 7 Table 4. POOR FARMS AND OUTDOOR RELIEF (Number Affected) COUNTIES. Number of Inmates Male. Female. Total County Aid in Communities Av. per month. Av. No. Widows' Pensions. Total Av. No. Dependent Any Form Baker - 11 0 11 10 28 49 Benton! 13 14 27 Clackamas! 33 56 89 Clatsop 19 3 22 14 9 45 Columbia! 26 18 44 Coos 7 6 7 42 37 86 Crook! 6 3 9 Curryj .... 5 3 8 Deschutes! 5 8 13 Douglas 7 1 8 19 12 39 Gilliam! 2 4 6 Grant 6 6 6 12 6 24 Harney 2 0 2 12 9 23 Hood River! 7 13 20 Jackson 14 i 15 38 23 76 J elf erson 2 3 5 Josephine 12 0 12 33 21 66 Klamath 6 1 7 17 35 59 Lake! 2 3 5 Lane 16 3 13 20 30 63 Lincoln! 3 5 8 Linn 13 6 13 14 37 64 Malheur 30 6 36 Marion 18 o 18 60 16 94 Morrow! 2 7 9 Multnomah 232 46 278 20 141 439 Polk 5 0 5 19 24 Sherman! 2 3 5 Tillamook! 9 12 21 Umatilla 14 6 14 11 20 45 Union 5 0 5 24 31 60 Wallowa! 6 9 15 Wasco 8 5 13 63 24 100 Washington! 61 24 85 Wheeler! 6 3 9 Yamhill 6 2 2 18 36 56 Total 389 62 451! 647 728 1,826 ♦Detailed information not available. tThese figures are an approximate monthly average for summer months. They in- crease approximately seven to eight per cent in winter. Of these 451, the survey shows 175 to have mental defect, disease or disorder. JCounties so marked do not maintain poor farms. (Combining the above compilations and including all other figures available, Dr. Car- lisle presents further) Table 5. SUMMARY-INDIVIDUALS WHO ARE OR RECENTLY HAVE BEEN SOCIAL LIABILITIES EITHER IN COMMUNITIES OR IN INSTITUTIONS Type. No. in the Communities Including Poor Farms. No. in All Types of Public or Private Institutions. Total Individuate Insane 135 3,859 3,994 Mental Defectives 1,077 656 1,733 Delinquents 27,307 2,834 30,141 Dependents 27,030 2,525 29,555 Total Individuals 55,549 9,874 65,423 8 EXTENSION MONITOR There are, in addition to the above, a few hundred more complete or partial dependents . ... in general hospitals .... concerning whom no detailed reports were available. It is suggested as highly desirable legislation that all institutions, and homes, including gen- eral hospitals, caring for dependents of any type, should be required to publish an annual or biennial report showing the number and types of such complete or partial dependents cared for and to submit the same to the state central Board of Control. Thus there was found by the survey a grand total of 65,423 individuals who were either potential or actual social liabilities. If we exclude one- half of the delinquents as unimportant petty offenders, and further ex- clude one-half of the dependents as being probably remedial cases, we have a total of about 45,000 persons. These 45,000 individuals are the ones who caused practically all tax expenditures in maintaining police, constables, sheriffs, courts of criminal jurisdiction, jurors, witnesses, jails, reform schools, penitentiaries, and all state, county and city institutions, homes, hospitals, free dispensaries, clinics and other agencies engaged in caring for, treating or otherwise assisting the mentally and physically handi- capped, the delinquent and the dependent. These 45,000 individuals rep- resent 5.8 per cent of the general population. Excluding further the known cases of insanity, of which a large num- ber will recover, and the known eases of gross mental defect now in the communities and in special hospitals or institutions, who by the fact of segregation will do little further damage to society, .... we find there is a total of approximately 29,800 individuals in the state who, as actual delinquents and dependents at large in the commonwealth, have shown themselves by their subnormal, inefficient, non-constructive con- duct to be actual social liabilities. These are the unrecognized, inadequate personalities of the world. They are a constant drain upon the public purse. They are a constant menace to the orderly and successful progress of the state. These 29,800 delinquent and dependent individuals repre- sent 3.8 per cent of the total population. Exclusive, therefore, of all types of remedial eases of social inadequacy and of all cases requiring lifelong segregation, we find that the great bulk of all public expenditures for the relief, care, treatment and training of the misfits of the state is caused by approximately four per cent of its inhabitants. As fast as any of these inadequate social types appear upon public records, whether in the community, church, school, court, hospital, institu- tion, prison or poor farm, let an accurate mental, physical and economic diagnosis be made, and the case legally disposed of upon the basis of what the actual fundamental causes of the delinquency or dependency may be. Segregate the unfit. Treat the sick. Rehabilitate the handicapped. Educate and train the neglected and ignorant. Protect .... normal citizens from the inadequacy of the subnormal by adequate statutes which are enforced. Systematize and broaden the state's administration of all prob- lems relating to public health and public welfare. Let the home, the church, the bench, the school, the physician, the store, the shop, the farm, the village, the city, the state, unite in a great campaign of eliminating the cause of sorrow, sickness, inadequacy, delinquency and dependency. EXTENSION MONITOR 9 Dr. Carlisle includes in the complete survey some very interesting remarks on various types of social inadequacy, illustrated by Oregon figures, which throw some light upon extent and also upon cost to the state of the various types. It is quite impossible to in- clude all the remarks or all the figures. Dependency the Key Whether the socially inadequate person is a mental or a physical de- fective, or whether he is a delinquent, does not alter the fact that he is at all times more or less of a complete or partial dependent. Dependency is, therefore, perhaps one of our best avenues of approaching the whole problem of public costs so far as they relate to the defective, diseased, inefficient and non-constructive types of citizens. Dependency Due to Physicae Handicap The blind and the deaf form a special group in all problems relating to dependency inasmuch as the prevention of actual dependency as a result either of blindness or of deafness is a problem lying within the scope both of the medico-social field and of the public school system. . . The Deaf Dr. Carlisle notes that deafness is ordinarily due to trauma (direct or indirect violence) ; to disease ; or to heredity. Discussing diseases which result in deafness, he says : Among the first of these stands scarlet fever. It is so prevalent as a disease of children that its dangers to hearing (as well as kidney func- tion) are not sufficiently realized. Cerebro-spinal-meningitis is another disease, happily more rare, which is very prone to leave the organs of hearing (as well as others) permanently disabled. Epidemics of the diseases especially likely to cause deafness are largely preventable by adequate .... isolation and quarantine .... and approved methods of treatment and prevention. . . . The reports of the Oregon State Board of Health show that except for measles, scarlet fever is the most prevalent contagious disease among children. Deafness is of particular social and economic importance in that con- genital or early loss of hearing abolishes the possibility of "thinking" in terms of auditory symbols of speech (i. e. spoken language; the usual method of "thinking"). Hence it follows that the person handicapped by early deafness develops mentally with extreme slowness and to his limit of capacity only by special instruction and through particular methods which tend to develop and preserve, so far as may be, the auditory-image method of "thinking." This is because the deaf have to rely so largely 10 EXTENSION MONITOR upon manual, written or printed expressions of speech imagery. Their "thinking" thus develops upon the more clumsy intellectual method of visual speech-images. Discussing deafness due to heredity. Dr. Carlisle says in part: So-called congenital deafness is particularly to be investigated from the genetic view-point. It is perfectly possible for offspring to receive heritable recessive unit characters which make for weakness in the audi- tory or auditory-speech apparatus. When two persons who are deaf, or deaf and mute, mate, they should first ascertain whether their own dis- order is strictly an acquired disorder or whether there was deafness (par- tial or complete) with or without speech disorder in their ancestors. If they find that their ancestors had such auditory-speech defect or disorder, they should not mate as they would be almost certain to reproduce deaf offspring; and being deaf from birth, such offspring would never "hear" speech, hence would be lacking in auditory images for "thinking" and "speaking." This, briefly, accounts for mutism where no actual defect of the anatomical speech mechanism exists. However, there may be in addition an actual organic defect in the anatomical speech mechanism it- self. All of this emphasizes the importance of preventing handicaps which are to a large measure preventable. It means the exploration of every possible field relating to causes. Researches made by the Oregon State Survey demonstrate that the deaf will always show two or more years of retardation in mental development. Figures in the deaf institutions never cover the extent of the deafness in the state as there are always many cases to be found in the communities. . . . . (On September 30, 1920, there were in the State School for the Deaf 82 pupils, 49 male and 33 female, whose homes were in the following counties:) Baker 3 Benton 2 Clackamas 1 Coos 1 Columbia 2 Douglas 3 Hood River 1 Jackson 2 Josephine 1 Klamath 2 Lane 9 Linn 9 Lincoln 3 Marion 13 Multnomah 17 Polk 3 Union 1 Wallowa 1 Washington 4 Wasco 2 Yamhill 2 It will be noted that not all the counties are represented. It is to be regretted that all the children who are handicapped by deafness are not given the opportunity for education and vocational training afforded by the state. EXTENSION MONITOR 11 Table 6. AGE OF PUPILS-SCHOOL FOR THE DEAF Age Present October 1, 1918 Received during Biennium Male. Female. Male. F emale. Total 6 years 1 1 5 5 12 7 years 1 5 1 7 8 years 4 4 1 2 11 9 years 3 3 1 1 8 10 years 4 4 3 1 12 11 years 6 3 3 12 12 years 5 2 2 i 10 13 years 3 4 7 14 years 6 3 3 12 15 years 5 2 1 1 9 16 years 5 3 2 10 17 years 6 2 1 9 18 years 2 2 1 5 19 years 1 4 1 6 20 years 3 3 21 years 1 1 2 23 years ■ 1 1 Totals 56 39 23 18 136 The earlier a pupil begins to receive special methods of instruction, the better will be his chances for mental development. Table 7. ASSIGNED CAUSE OF DEAFNESS IN CHILDREN TABULATED IN TABLE 6 Cause Male. Female. Total Accident 2 3 5 Congenital 35 22 57 Cold 2 2 Catarrh 3 4 7 Complicated illness 3 3 Bronchial trouble 1 1 Abscess 2 1 3 Adenoids, tonsilitis and throat trouble .... 4 4 8 Eczema .. 1 1 Gathering in head 1 1 Infantile paralysis 1 1 2 La grippe .. 1 1 2 Measles 2 3 5 Mumps 2 2 Pneumonia 3 - 3 Scarlet fever 3 3 6 Smallpox 1 1 Spinal meningitis 10 3 13 Typhoid 1 1 Unknown 5 5 10 Whooping cough 1 2 3 Total 79 57 136 12 EXTENSION MONITOR The State School for the Deaf now cares for only 82 children (Sep- tember 30, 1920). The Oregon State Survey found there were 109 public school children (not in the State School for the Deaf) out of a total of 9,742 included in the study who were retarded in their school work on ac- count of complete or partial deafness or ear disorders. The cost of main- taining a deaf pupil in the Oregon State School is now $341.65 per year. It is worth while in cost alone to prevent deafness. It is much more worth while to prevent unnecessary causes of deafness in order to diminish handi- caps and unhappiness The Blind Any review .... of blindness as a factor in dependency leads into the following fields. . . . (a) Blindness due to trauma and, hence, touching all phases of com- munity and industrial life from the standpoint of prevention and "safety first," certain trades presenting special hazards. (b) Blindness due to acquired disease from specific infection by bac- teria or "germs" of various kinds. The most notable disorder of the mother producing blindness in offspring by direct infection is gonorrhea. This produces blindness from birth. It is preventable by using a one per cent solution of silver nitrate in the eyes of the newborn, as is required by law in Oregon and other progressive states. Secondarily the problem of gonorrhea in women, albeit innocently acquired after marriage, is one which reaches through the whole range of sex-health measures, prostitution and social hygiene. (c) Blindness due to infection by the "germs" of syphilis. This disease . . . . is capable of causing degeneration of the optic nerve and as- sociated mechanism of sight. This means that all persons threatened with blindness should have a blood examination to ascertain possible syphilitic infection. Syphilis is a distinct causal factor in the problems of depend- ency due to blindness, as well as of certain other mental and physical dis- orders resulting in dependency, notably general paresis (a form of in- sanity) which .... comprises approximately 25 per cent of all male admissions in metropolitan hospitals for the insane. (d) Blindness due to other forms of acquired disease, local or con- stitutional. (e) Blindness due to heredity, transmission of recessive unit char- acters which make for weakness in the apparatus for sight as a whole; for example, amaurotic idiocy. Research should be made in the fields of heredity, pre-natal, natal and post-natal disease or disorder in all cases admitted to institutions caring for the mentally or physically handicapped. It is by the routine search for and scientific determination of fundamental and specific causes that we shall learn how to eliminate preventable dis- orders making for individual, civic and social inefficiency. . . . EXTENSION MONITOR 13 Dr. Carlisle presents figures to show that there were 35 pupils in the Oregon State School for the Blind on September 30, 1920, and that there were no pupils from the follow- ing counties: Baker, Benton, Crook, Columbia, Coos, Curry, Deschutes,Gilliam, Grant, Harney, Hood River, Jefferson, Josephine, Lake, Lincoln, Malheur, Morrow, Union, Wasco, and Wallowa. Table 8. ASSIGNED CAUSE OF DEFECT, OREGON STATE SCHOOL FOR THE BLIND Accident 10 Atrophy of optic nerve 5 Blood disease 1 Bupthalmos 1 Congenital* 23 Congenital cataracts* 10 Glaucoma 1 (In all children cared for from October 1, 1918, to September 30, 1920.) Iritis 1 Interstitial keratitis 1 Keratitis 1 Myopia and choroiditis 1 Nystagmus and neuritis 1 Trachoma 1 Ulcers in infancy* 1 Totalf 58 ♦Note the cases of blindness from birth. Very few of such cases are due to heredity. Most of them are due to preventable disease, notably gonorrhea. tOf the 58, 27 have no vision and 31 partial vision. The yearly per capita cost for a pupil in this school is $418.96, or $77.31 more than the per capita cost for the deaf pupils. . . . It is worth while in tax costs and happiness to prevent blindness. The State School for the Blind is caring for 35 pupils. Approximately two and one- third per cent of all the retarded public school pupils in Oregon have serious eye defects, which need immediate attention to prevent the handi- capped child from further school (and social) failure. Sex Offense Nearly all the cases of blindness beginning in infancy are due to gonorrhea and are preventable. . . . Thus we are led into considera- tion of the problem of dependency due to transmission of disease, defect and handicap to contemporaries and descendants, by sex offense. State Aid to Institutions In 1913 the Oregon State Legislature passed a law whereby all chari- table institutions approved by the State Board of Health receive public funds for the care and maintenance of inmates. . . . under the age of seventeen years. Institutions caring for such dependents may make application to the State Board of Health and if such application is ap- proved, they are entitled to $10 per month for each dependent child under five years of age, while for the dependent children between five and seven- teen years of age $8 per month is allowed. 14 EXTENSION MONITOR Under authority of an act of 1917 the Oregon State Board of Control, by means of an authorized inspector, investigates the quarterly claim ac- counts of all these institutions, audits their account, and records the cen- sus of inmates. Institutions operating under direct appropriations from the state legislature are not entitled to benefits under this "state aid" law. Dr. Carlisle gives figures relating to the institutions receiving this state aid in 1919, which, for lack of space, must be very much condensed, as follows: Louise Home, Portland- Received 138 girls during the year, of whom 95 were under 18 and 32 were under 16 years. They were received from 24 of the 36 counties of the state. Sixty-eight were com- mitted because venereally infected ; 39 were prospective mothers ; and 31 were "wayward." The total expenses of the home for one year were $11,810.43, whereof $4,510.74 was paid by the state; $4,203.15 was received in donations from the public and from parents and a deficit of $3,096.54 was covered by the credit of the Pacific Coast Rescue and Protective Society. Albertina Kerr Nursery, Portland- Cared for 137 babies during the year, classified as follows: Abandoned mothers' babies 37 Unmarried mothers' babies 58 Divorced mothers' babies 16 Mothers in asylum 3 Mothers in feeble-minded institution... 2 Broken homes 21 Total 137 The disposition of babies is shown to be: Released to one or both parents or to guardians or grandparents,50 ; to Feeble-minded School, 1 ; died, 5 ; adopted, 21, remaining in home on January 1, 1920, 60. These babies came from 25 counties. The expenses, amounting to $10,431.67, were met by $5,906.86 from the state; a deficit of $1,417.30 covered by the credit of the Pacific Coast Rescue and Protective Society ; $340 donated by parents ; and the remainder mostly by public donations. St. Agnes Foundling Asylum, Parkplace- Cared for 157 children during the year, of whom 64 remained at the end of the year, at a cost of $10,200, whereof $9,621.27 came from the state. Salvation Army Rescue and Maternity Home, Portland- Began the year with 17 girls in the home ; cared for 52 maternity cases, 12 wayward cases, and 66 children. Expenses were $11,272.56, met chiefly by state aid of $2,835.49; donations of $3,036.30 ; $5,000.00 from the home service fund of the Salvation Army, in- mates' fees and baby board $1,094.50 ; and by "home industry." Foodstuffs were donated to a considerable extent by merchants of the city. House of the Good Shepherd, Portland- Received 84 girls during the year; 89 left during the year; 74 remained at the end of the year. State aid received was $3,704.96. Dependent Children We come now to a group which makes an especial appeal to all of us, but here as elsewhere in considering the ever present query "Why are they in our public records ?" we must search for the fundamental cause. Hered- ity will be found to play no small part. The Baby Home, Portland- Cared for 151 children during the year, of whom twenty were given out for adoption, 58 returned to their parents, 25 died in two epidemics, and 48 remained at the close of the year. Cost for the year was $25,862.92, of which $6,779.94 was from the state. EXTENSION MONITOR 15 St. Mary's Home for Orphan Boys at Beaverton- Census 124 at beginning of the year, registered 225 during the year and had 132 at the close of the year. One death occurred during the year. Expenses were $17,852.25, of which $8,902.95 was from the State Treasury. The Boys' and Girls' Aid Society of Oregon- Reports that 177 children passed through its receiving home during the year. The cash disbursements of this society were $18,887.39, including a state appropriation of $1,947.76. Christie Home for Orphan Girls at Oswego- Had 244 girls registered during the year. Expenses, $15,364.53, were met by state allowance of $12,020.83; supplies from farm, $3,252.50 ; and other sources $91.20. DEPENDENCY AND TUBERCULOSIS Dr. Carlisle presents the following table: Oregon State Tuberculosis Hospital (Movement of Population for the two years 1918-1920). Table 9. Male. Female. Total Present October 1, 1918 58 21 79 Received during biennium 130 77 207 Readmissions during biennium 15 5 20 Total number cared for 203 183 306 Discharged- Improved, arrested or cured 66 29 95 Not improved 21 17 38 Died 53 28 81 Total number discharged or died _ 140 74 214 Present September 30, 1920 63 29 92 Average daily population, 80.5. Dr. Carlisle shows that these patients came from 29 counties. The total cost of maintenance was $98,369.43. The per capita cost was $610.63. In 1920, a report from the Oregon Anti-Tuberculosis Association states that there were 561 tubercular patients being cared for in the state. Of these 216 were in institutions of some kind, and 232 were 100 per cent dependent upon the funds of relatives, agencies, or of the public treasury. In 1919 there were 661 deaths. In the first 6 months of 1920 there were 363 deaths from tuberculosis. Other Dependents At this point, limitations of space require the omission of detailed analyses of popula- tion statistics of the State Hospitals for the Insane ; the State Institution for the Feeble- Minded ; the State Training School for Boys ; the State Industrial School for Girls ; the Oregon State Penitentiary; and the Oregon State Soldiers' Home. We do wish, however, to reproduce one of Dr. Carlyle's comments concerning the last-named institution: These old soldiers, all of whom have in previous years formed a part of the great bulwark for national defense, may rightly claim the con- sideration of the state for their past sacrifices. But is it not a pointed commentary on our social system that the state today is expending more per capita for the maintenance of burglars than it is for its age-worn soldiers. To be exact, each burglar is costing the tax-payers $118 per year more than the old soldier. 16 EXTENSION MONITOR CHAPTER HI The Cost of Social Inadequacy in Oregon By CHESTER L. CARLISLE, M. D. FROM time to time various legislative bodies all over the country have asked that the cost of mental disease, mental defect, delinquency and dependency be ascertained for the information of the public. This request is in effect a confession that our system of keeping public records of expenditures has not been sufficiently systematized to produce a "per- petual inventory" of the number and cost of inadequate citizens. A glance at the usual financial report of the average county of any state will demon- strate two things. One is that all public expenditures may be divided into two classes, i. e. (a) expenditures made for constructive civic purposes (good roads, education, public health, industrial projects, heat, light and general maintenance of government); and (b) expenditures made on ac- count of the inadequate, non-constructive citizen (the mental defective, the delinquent, the dependent, and the cost to the government in main- taining these subnormal types). The second point to be noticed in the review of a published financial report is that in the case of the inadequate, delinquent and dependent types, there is not sufficient itemization to inform the public as to the actual per capita cost of all such inadequate types, including the total over-head costs of courts, sheriffs, police, jurors, witnesses and all the other avenues for expenditure which the inadequate conduct of the sub- normal individuals entails upon the public treasury. For these reasons it has been found practically impossible to reach all costs of all individuals who were dependent because of mental or physical defect, disease or disorder, or who were dependent for economic reasons beyond their control, or who were delinquent, whether sentenced or com- mitted or not. We can say, however, that in a word the total number of the grossly inadequate type of citizen in Oregon represents about 5 per cent of the total population of the state, while a further 5 per cent are border line cases of social inadequacy all of whom are forever potential social liabilities. Exclusive of all state expenditures made for constructive citi- zen purposes, we may say without fear of contradiction that practically every cent spent from public or private sources for the detection, deten- tion, care, treatment and maintenance of the mentally and physically sub- normal, the delinquent and the dependent, is expended on account of the social inadequacy of this small minority of the population. This illus- trates how, if we hope ultimately to reduce such public costs, it is abso- lutely necessary to eradicate the fundamental causes of such social inade- quacy and citizen failure. In such a program the segregation of the unfit, and the scientific rehabilitation of the potential failures upon a basis of individual developmental capacity must be systematically, adequately and EXTENSION MONITOR 17 patiently carried out, one generation after another, and in the meantime we must be awake to the danger of having our social body reinfected by an unrestricted influx of those who have a social history of criminality, pauperism and crippling mental or physical disease or defect. Dr. Carlisle presents detailed figures on the state institutions which cannot be quoted in full. Table 10. EXPENSES OF STATE INSTITUTIONS 1918-1920 Oregon State Hospital $ 921,167.69 Eastern Oregon State Hospital 271,289.28 Oregon State Penitentiary 302,308.97 State Institution for Feeble-Minded 331,056.95 Oregon State Training School 123,189.40 Oregon State Tuberculosis Hospital 134,053.14 Oregon State School for the Blind 38,660.52 Oregon State School for the Deaf 67,611.51 Oregon State Industrial School for Girls 41,868.72 Oregon State Soldiers' Home 64,674.23 Institutional Expenses of State Board of Control and unclassified 18,081.14 Toal for biennium of 1918-1920 $ 2,313,961.55 Total average for one year $ 1,156,980.77 Table 11. COMPARATIVE TABLES AND STATEMENTS OF POPULATION AND FINANCES-STATE INSTITUTIONS Institution. Biennium ending Sept. 30, 1920. Aver, daily population. Monthly per capita cost. Oregon State Hospital 1,736.1 $19,998 Eastern Oregon State Hospital . 501.9 19.59 Oregon State Penitentiary 276.7 39.084 State Institution for Feeble-Minded 440.0 20.00 Oregon State Training School 140.5 32.845 Oregon State Tuberculosis Hospital 80.5 50.886 Oregon State School for the Blind 41.0 34.91 ' Oregon State School for the Deaf 100.0 28.47 Oregon State Industrial School for Girls 41.9 36.01 Oregon State Soldiers' Home 130.0 29.28 Next to the cost of the state institutions, the most impressive and easily obtained figures are those which relate to the cost of poor relief and dependency as paid by the several counties. The following table was compiled from official sources by Miss Ruth Mont- gomery : 18 EXTENSION MONITOR Table 12. COST OF DEPENDENCY TO OREGON COUNTIES (Year ending June 30, 1920) COUNTIES Amount spent on De- pendency for the year ending June 30, 1920 Amount spent on Widows' Pensions for the year ending June 30, 1920 Baker Benton ... $ 8,249.60 3,335.05 6,077.50 4,727.12 Clackamas .... 17,050.66 14,496.47 Clatsop Columbia Coos Crook Curry Deschutes* .... Douglas Gilliam Grant - 10,317.97 7,270.12 1,660.00 6,496.50 - 22,705.02 4,393.90 937.50 1,638.05 5,703.00 1,600.00 _ 8,807.14 9,467.50 1,145.00 278.00 2,449.25 2,930.00 700.00 1,148.00 Harney Hood River .. Jackson Jefferson* .... Josephine Klamath Lake* - 8,942.60 3,265.60 14,538.90 546.01 9,221.46 9,645.08 728.02 2,370.00 2,711.99 6,762.50 816.42 5,277.50 7,953.00 1,088.55 6,552.19 9,797.00 Lincoln Linn Malheur - 1,092.03 16,662.49 12,303.71 1,632.83 6,442.50 2,030.00 Marion Morrow Multnomah 23,230.52 789.66 235.228.33 2,642.81 1,382.50 37,885.72 Polk 6,290.77 6,344.00 Sherman* Tillam ook 727.02 6,375.00 1,088.44 3,030.25 TTmatilla 17,654.00 5,072.50 10,344.22 6,646.50 1,869.20 2,799.10 12,624.87 4,671.00 Washington - 7,759.37 4,403.57 3,606.73 574.00 6,221.85 5,941.50 $509,032.48 $ 84,642.68 •The figures for these counties are approximately based on findings in the remaining counties. Exact figures were not available at time of survey, a fact which illustrates the need for standardized bookkeeping. Using the last two tables as a basis, and taking the population of Oregon to be 783,000, Dr. Carlisle makes the following interesting calculation: EXTENSION MONITOR 19 Table 13 Cost of State Institutions for one year $ 1,156,980.77 Cost per capita of state population. $1.60. Cost of Dependency to Counties 593,675.16 Cost per capita of state population. $0.71. Cost per person (man, woman and and state dependents, exclusive ol costs for police, $2.31. child) in Oregon per year of county t county costs for delinquents and city Additional state figures, as shown by the Oregon Blue Book, 1919-1920, page 161 et seq., in list of legislative appropriations of the 1919 legislature, including items for state aided institutions, are: Table 14. Agents for apprehension of criminals ..$ 5,000.00 Deficiency .. 2,311.82 Rewards for arrest of train wreckers .. 1,200.00 Florence Crittendon Home .. 7,500.00 Support of Orphans and Foundlings .. 90,000.00 Patton Home .. 12,000.00 Support of wayward girls .. 20,000.00 Return of fugitives from justice .. 15,000.00 $143,011.82 To these figures should properly be added the total amount of philanthropic contribu- tions by citizens of the state to the various private and state-aided agencies caring for social inadequates. COSTS IN TWO REPRESENTATIVE COUNTIES Dr. Carlisle continues: It being impossible, owing to lack of systematized bookkeeping in all counties to get exact data as to the number, as well as the costs of inade- quate dependents of all types over the state, it has been decided to present for brief review the county costs as found in the metropolitan district of the state and as found in a representative settled farming community. For this purpose extracts from the published reports of Multnomah and Lane Counties are appended. (These tables, as given in the manuscript report, show the total ex- penses so chargable in Multnomah County, not including any expenses paid by the City of Portland, to be $623,629.67, a per capita cost for each inhabitant of Multnomah County of $2.26; in Lane County, similarly chargable expense was $68,300, a per capita of $1.88). These examples of two representative counties merely point the way for further investigation as to costs, which must await the systematization of municipal, rural, county and state bookkeeping. . . . With such a system of auditing our citizen liabilities the public could have presented for regular inspection a consolidated report of all expenditures with the actual number of men, women and children causing such expenditures and the type of defect, delinquency or dependency. Thus would be inaugur- ated a constant or "perpetual" survey of the business of the state and of each of its subdivisions. 20 EXTENSION MONITOR CHAPTER IV Special Supporting Studies and Contributions To the brief digest of the findings of the survey as given above, are added in this chapter excerpts and summaries giving the high lights of a number of special studies and investigations made in connection with the survey ; also, similarly, brief digests of several important contributions from official sources. There can be no hope that these brief state- ments will do justice to the complete articles, all of which we would gladly publish, if possible. An idea of the condensation necessary may be gained from the statement that any one of several of these special studies and contributions, if printed in full, would require more space than this whole publication. TEACHERS' REFERENDUM AS TO WHY PUPILS BECOME OVER AGE FOR GRADE By CHESTER L. CARLISLE, M. D. Authorized and Assisted by State Superintendent J. A. Churchill. Representing a study of all over-age for grade pupils among 32,480 pupils, or 22 per cent of the total school enrollment in the thirty-six counties of Oregon. IN SCHOOL life and school progress may first be seen the symptoms of inadequate, inefficient, unsuccessful conduct. If not recognized and adequately corrected during adolescence, such traits inevitably tend to develop into more or less fixed habits of thought and behavior which render the child incapable of attaining the fullest success both as a healthy, active individual and as a constructive citizen. . . . The retarded pupil is over-age for his grade because of some specific cause which acts as a handicap to progress. It is the duty of . . . school authorities, including all teachers, to ascertain this cause. . . . All over-age for grade, retarded pupils recorded by the teachers' refer- endum made for the Oregon State Survey were rated according to the following scale, which indicates the age-grade for normal, usual and ex- pected progress in school grades. A pupil to be at normal expected age-grade should be in: Grade 1 when 6 to 7 years old Grade 2 when 7 to 8 years old Grade 3 when 8 to 9 years old Grade 4 when 9 to 10 years old Grade 5 when 10 to 11 years old Grade 6 when 11 to 12 years old Grade 7 when 12 to 13 years old Grade 8 when 13 to 14 years old A pupil is retarded in age-grade and consequently over-age for grade when he is one or more years older than he should be for the grade he is in (see table above). For instance, if he is 10 years old and is now in the second grade, he is 2 years retarded. If he is 16 years old and is in the seventh grade, he is 3 years retarded. If he is 14 years old and is still in the first grade, he is 7 years retarded. EXTENSION MONITOR 21 Table 15. TEACHERS' REFERENDUM ON WHY CHILDREN BECOME RE- TARDED IN SCHOOL OREGON-ALL COUNTIES-GRAND TOTALS Causes. Boys. Girls. Total Parental- Heredity and constitutional inferiority 134 97 231 Loss of one or both parents (including divorce) 149 82 231 Indifference to child's welfare 56 42 98 Lack of home training 68 21 89 Child not kept in school 111 74 185 Irregular attendance 200 165 365 Economic- Poor home and living conditions 74 49 123 Parental poverty 15 5 20 Child had no opportunity 73 74 147 Child was kept at home to work 71 32 103 Moved frequently 280 233 513 Environmental- Child entered school late (various reasons) 264 262 526 Sickness in family 17 31 48 Foreign born (either parents or child) ; language difficulty 178 171 349 Lived long distance from school 43 60 103 Poor, dangerous or mountain roads 23 20 43 No school available 41 30 71 Lack of school advantages 61 61 122 Irregular sessions 26 20 46 Inadequate instruction 98 54 152 Lax enforcement of truancy laws 20 10 30 Miscellaneous- Indian blood 11 12 23 Cause undifferentiated 97 61 158 No cause assigned 519 334 853 Temperamental-- Bad habits ; bad conduct; lazy 112 9 121 Careless ; indifferent; inattentive 98 23 121 Poor application ; dreamer ; other interests 108 42 150 Bashful; timid ; self-conscious 22 16 38 Truancy 63 31 94 Physical- Undeveloped 77 34 111 Undernourished 56 34 90 Too rapid growth 10 3 13 Tuberculosis - 16 13 29 Defective vision (eye disorders) 133 89 222 Defective hearing (ear disorders) 74 35 109 Defective teeth 15 5 20 Defective speech 55 26 81 Adenoids ; tonsils ; throat trouble 142 83 225 Crippled (various types) 78 47 125 Ill health, general 450 470 920 Bad sex habits 8 9 17 Mental- Mental dulling and mental defect 1407 849 2256 Affective deviation 93 31 124 Psychopathic states 55 34 89 Chorea, all forms - 10 6 16 Epilepsy - 23 12 35 All other neuro-mental disorders 65 42 107 Total .. - - - 5799 3943 9742 Note.-Figures represent number of children over-age for grade on whom reports were received. School attendance includes 94 per cent of the children of school age in Oregon. The approximate percentage of pupil failures in classes is, for the whole state, 10 per cent. 22 EXTENSION MONITOR Sixty-two boys, 40 girls feeble-minded; 15 boys, 8 girls blind; 41 boys, 34 girls deaf; 24 boys, 13 girls crippled ; 3 boys, 1 girl had neuro-mental disorders to such an extent as to be unable to acquire an education and were so reported by 23 county school superin- tendents who sent in definite information on such cases in accordance with law. County school superintendents, teachers and all school officials should use great diligence in making a full and accurate report of the mentally and physically handicapped children in each school and school district in order that proper returns may be transmitted by the county school superintendents to the state department of public instruction. The consolidated reports of the county school superintendents should present a constant survey of all social liabilities in persons of school age. This census should be made to include all persons from 1 to 20 years of age inclusive, which are the ages of developmental possibilities. Of the 9,742 children over-age for grade on whom reports were received, 23.15 per cent showed signs of mental dulling or mental defect. Heredity.-Exclusive of the 4395 retarded school children in Multnomah county, it was found that the remaining 5347 retarded children (out of a total of 9742) show the following facts relating to heredity: Boys. Girls. Total Child has brother, sister or other relative in school who is also over-age for grade 975 704 1679 Child has relative in community with neuro-mental disorder 261 148 409 The survey showed the number of children entitled to relief under Crippled Children's Law as follows : Boys, 323 ; Girls, 197 ; Total, 520. Causes and Cost of Retardation of School Children (In the City of X, Oregon, 10,000 Population.) By L. C. DOUGLASS Instructor in Education, Extension Division, University of Oregon. THE following data are the results of an intensive study of 258 over- age for grade children in the elementary schools of the city of X, Oregon, the majority of whom by some special deviation of con- duct have attracted attention. In practically every case the child has spent almost all of his school life in Oregon, so whatever school influences have been for or against his retardation have arisen in this state. Eighty unselected children from the group were given mental exami- nations. The results follow: Mental Defect and Dullness Per Cent. Feeble-minded (heritable trait. Offspring almost always feeble-minded) 14.8 Dull or borderline cases (the latter probably feeble-minded) 38.3 Normal mentality (poor mentality not a cause of retardation in this group) 46.9 Applying the above proportions to all over-age for grade children, we find that approximately 4.44 per cent of all children enrolled in the city will probably never have intelligence greater than that of a 12 year old child. Disease and Physical Defect Disease and physical defect caused the retardation of 30 per cent of all the cases studied. In many other cases they were contributing causes. There were reported 96 cases of physical defect. Physical examination of 214 children showed that they had suffered from disease an aggregate of 529 times EXTENSION MONITOR 23 Emotional Instability Thirty-one and eight-tenths per cent of the cases studied were emo- tionally unstable in some respect. These children are unable to adapt them- selves to ordinary conditions of life, not having normally adequate inter- pretations of ideas. Their attitude is often antisocial. Of 37 children whose conduct is more or less delinquent (truants, liars, etc.) 70 per cent are emotionally unstable and show affective deviation. (Summing up) the basic causes of retardation are shown to be: Per Cent. Mental defect and dullness 32 Disease and physical defect 30 Poor heredity and improper home conditions 23 Economic and other causes 15 The emotional instability mentioned above is not counted as one of the basic causes but rather as one of the most important contributing causes. Cost Each child was, on the average, over-age for grade 1.89 years. This is equivalent to 488 children being retarded one year each. Before the war it cost the city of X $52.50 per pupil to run the elementary schools one year. Therefore, the approximate extra cost of these retarded children to the taxpayers of X may be said to be $25,620. An Intensive Study of Dependents With Special Handicaps By RUTH MONTGOMERY, B. A. Graduate Assistant in Education, University of Oregon. Oregon State School for the Blind (Census of blind children in the institution at time of survey, 33). IT IS found that the blind have no difficulty in interpreting and re- sponding to psychometric tests so far as the blindness itself is con- cerned. This is due to the fact that so long as hearing is intact their mental processes are normal in the sense of being carried on through the medium of the usual auditory spoken-word-symbols. The children take ordinary grammar school studies and have the same social relations as children with sight. Scholastic training goes up to the 10th grade. Voca- tional training includes, among other things, piano tuning and instruction on piano, pipe organ, chorus work and voice culture. Results of psychometric examination (Stanford scale): Superior intelligence, intelligence quotient over 110 4 Normal intelligence, intelligence quotient 90-110 14 Subnormal intelligence, intelligence quotient 80-90 5 Borderline intelligence, intelligence quotient 70-80 8 Mental defect, intelligence quotient below 70 2* ♦Note.-This is 6 per cent of the school census. 24 EXTENSION MONITOR The results of studies made by the survey, and others, indicate that complete or even partial deafness in children is a handicap much more likely to produce a definite and regular degree of retardation in mental development than blindness. Deafness (ear trouble) in school children is a very powerful factor in making the child over-age for his school grade. We note also that these blind children who are not delinquents and are dependent only because of a special physical handicap, show only a small percentage of individuals who are actually mentally defective. This fact is in great contrast to the much higher percentage of mental defect found in children who are both dependent and delinquent. Oregon State School for the Deaf Census of deaf children in institution at time of survey, 113, 64 boys and 49 girls. Psychometric examinations were made on 93 ; 58 boys and 35 girls. It has been definitely determined that the mental development of deaf children is not as rapid as that of children with normal hearing, owing to the great handicap of having no auditory experience, i. e. they cannot "think" in terms of auditory word symbols or "words" as we hear them spoken. Rudolph Pintner, Psychological Monographs, Vol. 24, in a study of deaf children found them to be about three years retarded when they were compared with hearing children. Our studies would seem to confirm this and three years' developmental retardation may be looked upon as the fairly constant mental handicap of all deaf children. Results of psychometric examination: No. Showing Percentage of Census No. Examined. Mental Defect. Mental Defect Boys 64 58 10 17 Girls 49 35 3 8.8 Total 113 93 13 14* *This 14 per cent shows actual mental defect in addition to the normal retardation due to deafness. The Mentally Defective Child in Industry By MRS. MILLIE R. TRUMBULL Secretary Industrial Welfare Commission of Oregon. SOME day the employers of the United States will awaken to a sense of the great economic loss sustained through the mentally defective worker. In no place is the mental defective a greater menace than in the field of industry. Seen through the eyes of the Child Labor Bureau in Portland he presents one of the biggest factors in the labor turnover, on the accident list, and in the great mass of irresponsible workers which tries the soul of every employer. He is no sooner taught the beginning of a process than he decides to change his employment. Back to the Bureau he comes and the pathetic performance is repeated until he is past the EXTENSION MONITOR 25 permit age. He then becomes the incompetent adult worker. . . . Some day employers will demand psychological examinations of workers so that time, effort and their cost in money will not be wasted. The juvenile hobo is almost always a boy of low grade mental caliber. He goes from one lumber mill or logging camp to another mixing with mental derelicts among the adults. He becomes physically contaminated and the degradation of the race goes on unchecked. In the files of the Child Labor Bureau in Portland can be found the record of almost every youthful criminal who has been sent to the State Training School and later to the penitentiary during the past fifteen years. The typical case is found to be low grade in school work and pro- nounced a difficult child by the teacher. Probably he was turned out of his classes to go to work because he was a nuisance in school. He then became a greater nuisance in industry and the line of least resistance at- tracted him with the State Training School for delinquents at the end of it. When the epidemic of auto stealing broke out, we could go regularly to our files and find the accused boy's card. Invariably he was one of the retarded children. . . . Two years ago we tabulated the commitments to the Training School as shown on our files: 65 per cent to 70 per cent were boys w'ho had gone to work on a child labor permit. Of these 50 per cent were shown by a later psychological examination at the State Training School to be mental defectives. Following is a list, issued by the Portland office, of children between 16 and 18 years of age who have gone to work on low grade (part time or night school) permits from September 1, 1919, to December 20, 1920. Table 16. 1919 Total No. of Grade Attained in School No. of Age. Cases. 3 4 5 6 7 8 Cases Boys 16 99 1 3 5 28 68 88 193 17 94 Girls 16 81 0 0 4 21 55 73 153 17 72 Age. 1920 Total No. of Cases No. of Cases. Grade Attained in School 3 4 5 6 7 8 Boys 16 17 121 288 1 4 14 35 136 219 409 Girls 16 17 89 147 0 1 3 23 77 132 236 Total number of cases for both years .... 991 We have been in the work long enough to have seen the inadequate workers in industry multiply (and inadequacy usually means mental de- fect). We have applicants today of the same (or lower) grade of men- 26 EXTENSION MONITOR tality as the parents who were among our first working children in 1903. The same struggle multiplied as to numbers, intensified as to problems, goes pathetically on. We will remain helpless unless the employers develop insight, take a hand and insist upon: 1. A psychological chart for each employee to show intelligence capacity. 2. A demand on the State Legislature that segregation must be es- tablished for all those below a certain grade of mentality and, to prevent further propagation, sterilization of all mental defectives in the communi- ties. There is work which the mental defective can do but it is not where there is dangerous machinery. Either in our schools or in our Child Labor office the mental and physical analysis must be made if we would relieve industry of its most expensive incubus. Intensive Study in Juvenile Delinquency By RUTH MONTGOMERY, B. A. Graduate Assistant in Education, University of Oregon. (Scale used: Stanford-Binet, U. S. Army Type) Table 17. Census, at time of survey 55 (Twelve on parole, 10 out of institution, leaving 33 available for psychometric and special examination.) Results of psychometric examinations: Normal intelligence capacity, intelligence quotient above 90 2 Subnormal, intelligence quotient between 80 and 90 8 Borderline, intelligence quotient between 70 and 80 15 Mental defective, intelligence quotient below 70 8 Total .'. 33 (Of the total cases examined, 8, or 24.2 per cent show definite mental defect.) Oregon State Industrial School for Girls Table 18. Oregon State Training School for Boys Census at time of survey 168 (Psychometric examinations made on 146.) Results of psychometric examinations: Per cent Supernormal intelligence 3 2 Average normal intelligence 27 18.5 Subnormal intelligence 37 25.3 Borderline intelligence 43 29.4 Mental defective 36 24.6 Total 146 100 (Of the total cases examined, 116 boys, or 79.4 per cent show mental dulling or mental defect, while 36 boys or 24.6 per cent show actual mental defect.) EXTENSION MONITOR 27 Intensive Study of Delinquency By C. A. GREGORY, Ph.D., Professor of Education, and MOZELLE HAIR, B.A., Secre- tary of Extension Teaching, University of Oregon. PSYCHOMETRIC and school achievement tests were given to 200 de- linquents, inmates of the Oregon State Penitentiary, by permission of the warden. At the time the survey was made there was a total of 270 prisoners, of whom one was a woman, but it was not possible to give the tests to all as some were on the grounds or in the shops or for other reasons were not available. Two psychometric tests and three school achievement tests were given. The psychometric tests were the Army Alpha and the Terman Group Test of Mental Ability. The school achievement tests were the Courtis Arith- metic Test, "a test in the four fundamentals of arithmetic," the Monroe Silent Reading Test, and the Gregory Language test. The tests given in reading and language were the regular tests designed for the sixth, seventh and eighth grades. The tests were given in the dining room where the men were seated in about the same way they are seated for their meals. Before the test papers were passed out the men were assured that the scores made would in no way influence their condition or future at the penitentiary and each was encour- aged to do his best. Owing to the crowded condition, it was impossible to prevent absolutely all conversation. The men were aware of the fact that they did not have to take the tests and some did not respond. The figures below are based on the number that actually took the tests. It was impossi- ble to tell whether or not the work represented the man's best efforts in every case, but it is believed that the papers turned in represent the best efforts of most of the prisioners who tried the tests. The percentage of mental defect is, therefore, all the more striking. PSYCHOMETRIC TESTS A. The Army Alpha Test. The results of the Army Alpha are for convenience stated here in terms of the Terman Intelligence Quotient, which indicates the individual's men- tality, with due consideration for his actual age. Men Superior mental ability Intelligence quotient above 110 Psychometric scores from 112 to 120 10 Normal or average mental ability, intelligence quotient 90 to 110; psychometric scores from 90 to 110 50 Subnormal mental ability, intelligence quotient 80 to 90; psychometric scores from 80 to 90 24 Borderline mental ability, intelligence quotient 70 to 80; psychometric scores from 70 to 80 , 12 Mental defect or feeble-mindedness, intelligence quotient below 70 ; psychometric scores from 70 to 53 27 Total : 123 Table 19 28 EXTENSION MONITOR Of these 123 men it is seen that: 50 individuals or 40 per cent are of average intelligence. 10 individuals or 8 percent are above the average. 63 individuals or 51 per cent show distinct mental dulling. 27 individuals or 22 per cent show actual mental defect. None of this last group has a greater mental ability than a child of 12 years or under, and being now of adult years, will never reach an adult mental level of development. In the investigation of these prisoners no attempt was made to ascer- tain or to include those cases of affective deviation which so often is found to account for odd, anti-social, or delinquent conduct, particularly among individuals of average or even superior quantitative intelligence where it is obvious that the delinquent conduct was not dependent upon mere feeble-mindedness as usually considered. Neither has any attempt been made to study the delinquent conduct of the 123 prisoners in the light of possible psychoses (insanity), psychoneuroses (including hysteria), con- stitutional inferiority or epilepsy. This study demonstrates the one out- standing fact that in the state penitentiary (a specific group of delin- quents of all types) about one-fourth of the men examined show gross mental defect while over one-half show mental dulling or mental defect and are distinctly below the average of mental capacity. Odd, inefficient, anti-social, delinquent conduct (crime) usually means an individual who is suffering from a specific form of handicap. B. Terman Group Test of Mental Ability Eighty-seven inmates took the Terman Group Test of Mental Ability. The median score was 81.9. The tentative median scores made on the Terman Test up to the time this test was made are as follows: Table 20. School Grade Child Is in : 7 8 9 10 11 12 Children's Scores 66.1 85.9 91.4 119.5 131.7 143.2 Penitentairy Scores 81.9 (lower than 8th grade). Comparing the scores made by the inmates of the penitentiary with the scores made by school children as reported by Dr. Terman, we note that the ability of the delinquents examined ranks a little below that of the eighth grade. It must be remembered, of course, that we are no doubt getting the reports of the brighter ones of the group. If all the 200 prisoners had taken the test, the median score would no doubt have been lower. Viewed from either the capacity to learn or the capacity to live usefully, the delinquent shows himself to be definitely handicapped. SCHOOL ACHIEVEMENT TESTS C. The Courtis Arithmetic Tests One hundred and four of these same delinquents took the Courtis Arith- metic Tests in the four fundamentals of arithmetic. In these tests they were graded both on the number of problems attempted and the number EXTENSION MONITOR 29 solved correctly. The following are the grades made by the inmates of the State Penitentiary on the Courtis Tests. Addition Median attempted. 8.75 Median per cent right. 48 Subtraction Y 32 Multiplication 5.3 0 Division 3.4 0 Table 21. Courtis Standard Scores in Arithmetic: Per Cent. Addition. Grade 3, 4 ; Grade 4, 6; Grade 5, 8 ; Grade 6, 10; Grade 7, 11; Grade 8, 12 ; Accuracy 100 Subtraction. Grade 3, 5 ; Grade 4, 7 ; Grade 5, 9 ; Grade 6, 11; Grade 7, 12 ; Grade 8, 13; Accuracy 100 Multiplication. Grade 4, 6 ; Grade 5, 8; Grade 6, 9 ; Grade 7, 10 ; Grade 8, 11; Accuracy 100 Division. Grade 4, 4 ; Grade 5, 6; Grade 6, 8 ; Grade 7, 10; Grade 8, 11; Accuracy 100 A comparison of the scores made by the delinquents in the penitentiary with the standard scores in the Courtis Tests shows the delinquents to have ability in arithmetic between the school grades of three and five. They, as adults, average little better than fourth grade children in the four fundamentals of arithmetic. D. Gregory Language Test The language test was one devised by Dr. C. A. Gregory and has been used in testing several thousand school children in Oregon. The test used was designed for school grades six, seven and eight, and tests the pupils' ability to use the proper language forms. 67 adult delinquents in the penitentiary took the test. The median score made, together with the scores made by Oregon school children in the sixth, seventh and eighth school grades are reported in Table 22 below: Scores Made by Oregon School Children in the Gregory Language Test. School Grade Child Is in: 6 7 8 Children's Median Score 18.7 23.8 30.7 Median score made by the inmates of the State Penitentiary, 16.6. Table 22. This shows very clearly, and confirms other tests, that the delinquents of the penitentiary rank below children in the sixth grade in the State of Oregon in the matter of being able to use correct language forms. Delin- quents have a distinct handicap in the sphere of mentation and mental ability. 30 EXTENSION MONITOR B. The Monroe Silent Reading Tests The Monroe Silent Reading Tests are divided into three divisions: Test I is designed for school grades three, four and five; Test II is designed for school grades six, seven and eight; and Test III for the high school. Test II was used to test the inmates of the penitentiary. This test covers both speed in reading and comprehension. Table IV below shows the standard scores made by children in the sixth, seventh and eighth grades. Table 23. Tentative Standard Scores in the Monroe Silent Reading Test. School Grade Child Is in: 6 7 8 Children's Comprehension 20 23 26.4 Rate (of speed) 88 99 106 Comprehension of delinquents in penitentiary .. 20.25 Median rate of reading of delinquents in penitentiary 66.67 The Monroe Reading Test shows that the 69 delinquent inmates who were examined by this test, have about sixth grade ability in reading. Sixth grade ability in an adult means a mental age level of not over 12 years: the high grade moron. From both the psychometric tests made for intelligence capacity and school achievement ability, we must conclude that the delinquents found in the Oregon State Penitentiary are: (a) Somewhere between the sixth and seventh school grades so far as their mental capacity relates to school achievement. (b) The normal, expected mental age level of development for properly carrying forward sixth-grade school work is 12 mental-age years. These delinquents, therefore, represent a median achievement ability correspond- ing to that of a high grade moron in their ability for silent reading. (c) These delinquents rank below the mental-age level of a child in the sixth school grade (high moron mental-age level in adults) in their ability to use correct language forms. (d) These delinquents rank with the mental-age level of a child in the fourth grade (medium moron mental-age level in adults) in their ability to solve the four fundamentals of arithmetic. (e) Fifty-one per cent of all these delinquents examined show distinct mental dulling or mental defect. Twenty-two per cent show gross and definite mental defect. (f) We cannot help but conclude that the constitutional deviation or peculiar handicap which determines delinquent conduct in an adult lies to a very considerable degree directly in the sphere of lack of native intelli- gence capacity, with failure to develop mentally to expected levels of adult normality. (g) These conclusions seem warranted by the results of psychometric tests made from varying angles of approach including educability and achievement possibilities as well as native intelligence capacity in cor- relation with chronological age development. EXTENSION MONITOR 31 Court of Domestic Relations, Multnomah County By THE HONORABLE JACOB KANZLER, JUDGE The survey includes a contributed article from Judge Kanzler and S. C. Kohs, Ph.D., Psychologist, wherein, among other interesting figures, is set forth that this court han- dled in one year ending September 30, 1920, a total of 1925 child cases, whereof 1300 were cases of delinquency, 500 were cases of dependency, 125 were cases of adoption. It ap- pears that 1675 of these children were left with their parents or guardians; 125 were adopted; 125 were committed to institutions ; 200 were otherwise disposed of or pending. Of 306 children examined in the psychological laboratory of the court in the year ending July 31, 1920, 123 were found to be feeble-minded and 120 more below average normal. Findings Regarding Male Population of Military Age in Oregon By CHESTER L. CARLISLE, M. D. ALL facts relating to defects, diseases or disorders found in the population of the State of Oregon subject to military duty are taken from official reports prepared by the War Department. The Oregon State Survey is particularly indebted to the report "Defects found in Drafted Men" prepared under the direction of the Surgeon General, M. W. Ireland, Major General M. C., U. S. A.; Albert G. Lore, M. D. Major, M. C., U. S. A.; and Charles B. Davenport, formerly Major S. C., U. S. A. "Oregon. This State is divided into two sections (West and East). Section I includes the northwestern corner of the state and section 2 the remainder. Section 1 has a density of about 30 inhabitants per square mile, over half of whom are native whites or native parentage. Germans, Scandinavians, Russians, and English Canadians make up a large part of the remainder. Section 2 is sparsely populated and consists chiefly of native whites of native parentage with a reduced percentage of the above- named peoples. Section 1 is on the Pacific coast and well watered, while section 2 is semi-arid. Section 2 shows the higher defect rate (729 per 1,000), while section 1 has a rate of only 681 per 1,000. "There is slightly more pulmonary tuberculosis in section 2, probably because persons with incipient tuberculosis have gone there for their health. The venereal rate is very low in both sections, somewhat higher in section 2. Simple goiter has a high rate (26 per 1,000 in section 2). Combined with exophthalmic goiter, the rate is about 30 for both sec- tions. Monoplegia is much commoner in section 2 than in section 1 and epilepsy and mental deficiency and the psychoses are likewise commoner. On the other hand, there is more defective vision in section 1, but on the contrary otitis media and defective hearing are much higher in section 2 than in section 1. Hypertrophic tonsilitis is relatively commoner in the desert section and the same is true of the valvular diseases of the heart. Tachycardia is commoner in section 1. The teeth are somewhat more de- fective in section 1 and hernia is decidedly commoner there. Also, the 32 EXTENSION MONITOR mechanical defects are for the most part commoner in the desert section, except that flat foot is more frequent in section 1, which contains the large cities. More of the inhabitants of section 1 are underweight and under- height than of section 2." Table 24. DISEASES AND DEFECTS FOUND IN POPULATION OF MILI- TARY AGE FOR OREGON AND FOR THE WHOLE UNITED STATES Name of Disease, Defect or Disorder Ratio per 1000 Oregon. Ratio per 1000 Whole U. S. Pellagra ... 0. .09 Tuberculosis, actual and suspected ... 24.44 24.86 Syphilis (second million men) ... 2.01 10.47 Chancroid (second million men) ... 0. 1.50 Gonococcus infection (second million men) ... 20.26 44.72 Grand total (venereal diseases) (second million men) ... 22.28 56.69 Alcoholism ... 0. .31 Drug addiction .37 .54 Grand total, venereal (all) alcohol, drugs, (second million men) ... 22.65 57.58 Curvature of the spine ... 6.31 5.63 Diabetes mellitus .69 .27 Goiter, exophthalmic ... 6.37 3.14 Goiter, simple - ... 26.31 4.35 Obesity - ... 1.94 1.80 Hemiplegia and apoplexy, facial paralysis, paraplegia and monoplegia 2.74 2.55 Epilepsy ... 3.94 5.15 Chorea .12 .22 Neurasthenia .81 .54 .06 .12 Hysteria .25 .23 Total neurasthenia, neurosis, hysteria ... 1.12 .89 Speech defective ... 1.37 1.08 Total deaf, dumb, and mute .75 1.00 Total deafness ... 2.31 1.22 Total defective hearing ... 7.06 5.47 Total deaf and dumb ; mute ; deaf ; defective hearing ... 10.12 7.69 Constitutional psychopathic state (total rejections) .52 .44 Mental deficiency (total rejections) ... 8.59 12.06 Dementia praecox (total rejections) .31 .65 Psychasthenia and phychoneuroses (total rejections) .95 .51 Psychosis, manic-depressive (total rejections) 05 .18 General paralysis of the insane (total rejections) .84 1.24 Total constitutional psychopathic states, mental deficiency, dementia praecox, psychasthenia, psychoneuroses, manic-depressive phychosis and other phychoses (total rejections) 11.26 15.08 Myopia (near-sightedness) .... 1.75 2.85 Defective vision (cause not stated) .... 28.62 30.07 Total myopia and defective vision, astigmatism and hyperopia .... 30.37 32.92 69 1.37 Amblyopia .... 1.19 1.07 Eye enucleation, blindness in one eye, blindness in both eyes .... 9.44 7.81 Grand total for myopia, defective vision (cause not stated), astigma- tism, hyperopia, eye enucleation, blindness in one eye, blindness in both evps 39.81 40.74 Otitis media, perforated ear drum (total) .... 8.06 8.57 Deviation of nasal septum, hypertrophy of turbinate (total) 75 .28 62 .52 Tonsilitis, hypertrophic .... 30.06 23.09 Endocarditis, valvular diseases of the heart .... 34.76 26.26 Cardiac hypertrophy, cardiac dilation .... 6.49 4.65 Myocarditis, myocardial insufficiency 37 .72 Total for organic diseases of heart (total rejections) .... 39.00 30.74 Arteriosclerosis and hypertension 37 .37 Cardiac arrhythmias .... 2.43 1.80 Tachycardia .... 5.12 4.45 EXTENSION MONITOR 33 Hemorrhoids .56 1.20 Varicocele 3.00 3.25 Varicose veins 5.37 4.14 Total for hemorrhoids, varococele, varicose veins 8.93 8.59 Bronchitis 75 .73 Asthma 3.44 2.45 Defective and deficient teeth, with dental caries 16.44 13.54 Hernia 25.12 20.83 Enlargement of inguinal rings 90.99 18.99 Total hernia, and enlargement of inguinal rings 116.11 39.82 Nephritis 94 .80 Hydrocele . 1.56 1.14 Total fracture, malunion of upper and lower extremity and other shortening of lower extremity 9.69 7.75 Upper extremity, loss of whole or part of 1.69 1.93 Lower extremity, loss of whole or part of 2.94 3.19 Arthritis 4.00 2.31 Ankylosis, bony or fibrous 11.25 6.75 Total arthritis, ankylosis, bony or fibrous 15.25 9.06 Total hammer toe and hallux valgus 5.44 6.79 Flat foot 159.05 109.35 Pronated foot (a condition of flat foot) 1.56 6.31 Total, flat foot and pronated foot 160.61 115.66 Foot deformity, not specified; pes cavus 4.56 4.03 Metatarsalgia (pain in arch-foot) 2.37 2.24 Total for tables-foot disorders 172.98 128.72 Total for hand, deformities of, injury or infection, fingers, loss of one or more 9.69 7.50 Total for deformity, location not given ; upper extremity deformity ; lower extremity deformity; trunk, deformity of; head, deformity of; chest, deformity of 10.92 9.34 Total for atrophy of muscle of upper extremity and lower extremity 3.37 2.59 Defective physical development 2.50 2.66 Defective chest measurements 1.31 .87 Underweight 19.62 26.50 Underheight 3.75 2.91 Total for tables defective physical development 27.18 32.93 Malnutrition 37 .28 Total, anorchism, monorchism, cryptorchidism 3.55 3.10 Cleft palate, hare lip 37 .53 Bullet or other recent wounds 25 .51 Mechanical defects (curvature of spine, arthritis, hernia, enlarged in- guinal rings, results of fracture, amputations, akylosis, defective feet and hands, general deformities of appendages and trunk and muscular atrophies) 348.95 215.43 . . . . the ratio of mental deficiency in the men of the state com- pared with the average ratio for the whole United States is as 2.7 com- pared with 5.2. This means that the problem of actual mental deficiency in Oregon is only about one-half the size of the same problem in the whole country. These figures leap out from the drab columns of statistical tables and assume a new and dazzling significance when we see them marching as an army before our eyes: actual units of a strong, active and virile citizenry, voluntarily enlisted in the patriotic service of their country. For it was the State of Oregon wherein the clogging, hampering effect of mental deficiency was so small that it topped all the other states of the Union in its ratio of enlistment credits to its gross draft quota, this ratio being 90.11, while that for the whole United States was 40.42; the ratio of actual enlistments to the gross quota being 158 for the first draft as compared with 64 for the whole United States. (Report of the Provost Marshal General to the Secretary of War on the first draft, under the selective service act, 1917, pages 16 and 18). 34 EXTENSION MONITOR Oregon with a low rate of mental and physical handicap among its citizenry was just about two and a half times as ready to fight for Old Glory as the average. This is proved by the official voluntary enlistment record. With the first call to arms "The following Banner Communities filled their entire gross quota by voluntary enlistments and therefore did not need to contribute any men under the selective service act;" Benton, Coos, Crook, Douglas, Hood River, Jackson, Josephine, Lane, Linn, Mar- ion, Multnomah, Polk, City of Portland, Tillamook, Yamhill. (Report of Provost Marshall General, in the first draft, page 17). Poor Relief in Oregon By RUTH MONTGOMERY, B. A. Graduate Assistant in Education, Universty of Oregon. Note.-It may be possible later to print more fully the valuable intensive study made by Miss Montgomery. In this brief summary of the Oregon State Survey only a few of the outstanding findings can be given. Poor farms of one kind or another are maintained in 18 of the 36 counties of Oregon: Baker, Coos, Clatsop, Douglas, Grant, Harney, Josephine, Jackson, Klamath, Lane, Linn, Marion, Multnomah, Polk, Umatilla, Union, Wasco, and Yamhill. The population of these farms at the time of the survey totalled 451, of whom 89 were women. Number of in- mates varied from two each in Harney and Yamhill, to 278 in Multnomah. Of these 451, it is stated that 175 showed mental defect, disease or disorder. The causes of dependency are resolved into several classes. No single case of dependency found in any poor farm may be assigned to merely one of these causes. In many cases investigated the lack of information and case records made it impossible to determine a definite cause. Veri- fication of the statements of the inmates as to family and their own life history wTas practically impossible through research in communities because of the fact that the majority of these dependent individuals are not native Oregonians but people who have come here from other states and whose families are scattered throughout the United States. The outstanding precipitating cause of total dependency as found in the Oregon poor houses is old age. The physiological decay, however, is often seen com- bined with economic inefficiency during early life. . . . . Large numbers of the dependent individuals surveyed in poor farms are men now too old to work, but the interesting point is that they have never made more than enough to live from day to day. They are unskilled laborers for the most part, or laborers of low skill. . . . The miners are perhaps a separate group and present an interesting study in genetics. They are the adventurous wandering type who year after year go back into the mountains with the hope that they will make their big stakes. It would seem that they carry certain dominant characteris- tics of make-up. Some of them have made stakes and lost them again in gambling or speculation. Very few of this class of dependents have any families who can care for them in their old age. EXTENSION MONITOR 35 The majority of the average type of dependent old man is found to be suffering from senile deterioration. . Decline of intellectual ability is shown by lack of memory, tendency to exaggerate greatly, hallucinations and a general dilapidation of the former personality. Passing from the senile we find the next causal group according to size is that composed of dependents who are suffering from easily demon- strable mental defect or insanity or epilepsy. This group includes the morons and imbeciles. No mental defective of a lower grade than these was found. There are mental defectives who for various reasons have never been committed to the State School for the Feebleminded. These moron-imbecile types of mental defect form the majority of this second group and the mental subnormality may be looked upon as a primal cause of the dependency. The insane who are found in the poor farms were for the most part cases of ordinary senile deterioration, the psychosis being merely part of the picture of senile decay although the possibility of other intercurrent factors must not be forgotten. Very few cases of epilepsy were found and in those observed the occurrence of convulsions seemed infrequent. The removal of the insane and the epileptics from poor farm to properly equipped institutions is a matter which should be expedited by all possible means. Next in size is the group of individuals who are dependent because of a definite physical disability which in some cases is only temporary de- pendency. Influenza is the outstanding cause of temporary physical dis- ability among poor house inmates during the past two years, while tuber- culosis is always the enemy of the dependent poor. The fourth group comprises those whose dependency is caused by alcoholism. This is not a very large group from the standpoint of primal factors but accompanies a large majority of all cases of moral degeneracy and is usually accompanied by physical deterioration. This lowering of the general vital index is probably due to the fact that excessive alcohol- ism is usually an expression of constitutional mental and physical infer- iority. Alcoholism, and indeed ordinary drug addiction, is frequently an expression of a substitutive reaction of an inferior personality who is unable to meet the requirements of reality. Their use is often merely a symptom of plain mental defect. For these reasons it is doubtful if alco- hol should be given a role as a fundamental cause of delinquency. Individuals representing all these different groups of fundamental causes are found in the same institution. Furthermore, this results in a complicated problem of administration to provide suitable care for each group and adequate treatment for each individual if any advance as to rehabilitation is to be made. All dependent poor persons should be diagnosed and sent to the insti- tution best fitted to treat the condition they show in order to eventually lower the per capita cost of dependency by a restoration of the individual to a constructive position in his social group. Institutional care for de- 36 EXTENSION MONITOR pendents should have the object in view of social rehabilitation in the modern sense and attitude which the term implies. It is obvious that sparsely settled communities having a relatively small number of dependents cannot maintain such institutions and therefore it is probably desirable that some system of collective county care be arranged with an institution adequately equipped to properly care for all such dependents after it has been ascertained that they do not belong in any other institution by reason of insanity, or mental or physical defect. Such a system of institutions throughout the state would provide a much more modern and scientific care of Oregon's total dependents. Such a plan should eventually lower the per capita cost in the individual coun- ties and insure adequate care of dependents for the reason that if all cases of mental or physical defect, disease or disorder were removed from the poor farm type of institution and committed to the appropriate type of hospital, home, institution or training school for social rehabilitation there would be relatively few cases left to county care as ordinary types of dependent poor. Thus the definitely handicapped would be given proper care and treatment in state institutions where the per capita cost is lowered, due to lessened overhead charges; and with the advent of such care would come the elimination of many county poor farms, the inade- quacy of which at the present time is only too apparent. Just a few of the outstanding facts concerning each county will be excerpted from Miss Montgomery's study. The figure given in each as the cost of dependency includes widows' pensions and care of old soldiers as well as the cost of relief at the farm and outdoor relief and is given next to the population figure in order that the ratio of this cost may be evident. Baker County- Population, 1920, 17,929 ; cost of dependency, $14,327.10 ; no segregated account on county books ; farm of 120 acres, 55 acres under cultivation, owned by county and rented to supervisor at $20 per month. County pays contractor $5 per week for keeping each dependent inmate and furnishes bedding, clothing, tobacco and fuel ; building occupied by inmates inadequate, dirty and full of vermin ; fire risk high with no protection apparatus ; inmates in poor condition from physical and sanitary points of view; records not well kept. Clatsop County- Population, 1920, 23.030; cost of dependency, $12,277.97 ; farm of 12 acres, all culti- vated ; concrete buildings well kept and well adapted to purpose ; fire risk low with ade- quate protection ; adult males and females separated; bed linen and all clothing worn by inmates laundered weekly ; records in case history well kept; an exceptionally fine county farm. Coos County- Population, 1920, 22,257 ; cost of dependency, $32,172.52 ; farm of 160 acres of which 40 are cultivated; wood building fairly well adapted; records since February 1, 1920, on case history basis, which was not the case before ; considerable fire hazard with good protection ; whole institution clean ; inmates well cared for. Douglas County- Population, 1920, 21,332 ; cost of dependency approximately $12,800 ; farm of five acres, all cultivated ; wood buildings well adapted ; no separate account of financial costs ; records inadequate ; no great fire risk, but no protection apparatus ; institution clean and sanitary and inmates well cared for. Grant County- Population, 1920, 5496 ; cost of dependency, $9,955.14 ; farm not owned by county and inmates cared for by contractor at $1 per day per inmate, county furnishing tobacco, clothes and some other items ; two buildings, poorly built; no case records of any kind; not clean. EXTENSION MONITOR 37 Harney County- Population, 1920, 3992; cost of dependency, $11,318.60; no county farm; total depend- ents are boarded with a woman in Burns, the county seat; no records ; county pays con- tractor $1.50 per day for care of those who are not bed-ridden and $2.50 per day for those who are; inmates live in little shack resembling woodshed, but contractor intends to take them into her house in winter; room clean and patients well kept. Jackson County- Population, 1920, 20,405 ; cost of dependency, $21,301.40 ; farm of 31 acres, of which 21 are cultivated; wood buildings suited to purpose; records fairly adequate; fire protection provided; well kept and clean. Josephine County- Population, 1920, 7655 ; cost of dependency, $14,398.96 ; farm of 28 acres, of which 15 are cultivated; wood buildings poorly constructed and poorly adapted, with high fire risk ; records not entirely adequate ; some of the inmates and the quilts and blankets very dirty. Klamath County- Population, 1920, 11,413; cost of dependency, $17,598.08; farm of 86 acres, 20 being under cultivation; wood buildings well adapted; records not adequate nor accurate; no adequate fire protection. Lane County- Population, 1920, 36,166 ; cost of dependency, $16,349.19 ; farm of 100 acres, of which 90 are cultivated; wood buildings, well adapted, but needing paint and repairs ; records neither adequate nor accurate; grand jury in October, 1920, reported vermin in all rooms; fire risk great; fire fighting apparatus provided; sanitary provisions inadequate. Linn County- Population, 1920, 24,550 ; cost of dependency, $23,104.99 ; farm of 120 acres, all culti- vated ; wood buildings fairly well adapted; records not adequate nor accurate; good fire protection; repairs needed. Marion County- Population, 1920, 47,117; cost of dependency, $25,873.33; farm of 30 acres, all culti- vated ; wood buildings well adapted; records not adequate nor entirely accurate; fire hazard considerable with protection ; inmates well cared for. Multnomah County- Population, 1920, 275,898 ; cost of dependency, $273,114.05 ; it must be borne in mind that this county expense is completely overshadowed by the cost of dependency to the city of Portland; farm has brick buildings well adapted; records adequate; supervisor is grad- uate nurse. (In most counties mentioned, supervisor has previously been farmer, in one case a sawmill man) ; good fire protection; cleanliness exemplified by fact that sheets and pillow cases are laundered daily. Polk County- Population, 1920, 14,181 ; cost of dependency, $12,634.77 ; totally dependent poor are boarded with contractor who owns farm of two acres; house fairly clean, but not well adapted; contractor receives from county $18 per month per inmate and county furnishes tobacco and clothing; no reports other than bills, which are not kept segregated in county records; no case records whatever; beds and inmates fairly clean. Umatilla County- Population, 1920, 25,946 ; cost of dependency, $22,727.39 ; farm of 160 acres, all culti- vated ; wood buildings fairly adapted; no records until May 1, 1920, and records since then meager; fire risk high with chemical extinguishers ; buildings and some inmates very dirty. Union County- Population, 1920, 16,636; cost of dependency, $16,990.71 ; poor farm of 40 acres, of which 35 are cultivated; wood buildings fairly well adapted ; records meager and not en- tirely accurate; fire protection with considerable fire hazard; everything clean, neat and well kept. Wasco County- Population, 1920, 13,648 ; cost of dependency, $17,295.87 ; farm of 55 acres, of which 35 are cultivated; buildings stucco over wood frame and fairly well adapted; adult females live in same building with adult males ; records not wholly adequate ; fire protection pro- vided ; creature comforts of inmates well looked after; two mentally defective inmates should be committed to state institution and child taken from imbecile mother for eventual disposition through proper state agency. Yamhill County- Population, 1920, 20,529; cost of dependency, $12,163.35 ; supervisor rents the farm from the county for $200 per annum and is paid $31 per month for board of each of the two inmates who live in same house with him ; inmates evidently comfortable. Included in Miss Montgomery's complete report but necessarily omitted here are com- plete case histories, as far as obtainable from records and her own investigation, of most of the inmates of the poor farms of most of the counties except Multnomah. Throughout the study. Miss Montgomery emphasizes, in the case of almost every county, that even where creature comfort is well conserved, little or nothing is being done to rehabilitate the inmates and thus remove them from county expense. The whole report is on file at the University and is of course open to inspection, in whole or in part, by any one interested, and especially by responsible officials of any of the counties. The total figures for county expenses for dependency, covering all counties, are shown in Table No. 12 on page 18. Of course it is understood that general administrative costs properly chargeable, all city costs, all of the share of the county in the state costs for dependency are not included. 38 EXTENSION MONITOR CHAPTER V Suggestions for Desirable Legislation Dr. Carlisle includes in the complete survey recommendations at length concerning desirable legislation. Complete copy of these recommendations went to every member of the Oregon legislature before the close of the legislative session of 1921. All that can be done in this brief publication is to summarize some of the more important recommenda- tions. Education and Schools Dr. Carlyle puts first his recommendations touching education and the schools because of his appreciation of the fact that the problems with which this survey deals can be solved ultimately only through adequate attention to the rising generation. His recom- mendations in this respect include: 1. That reports be required from teachers, through county superintendents to state superintendent of schools, of all pupils in the state who are over-age for grade. Detailed suggestions for setting up this reporting system are given in the complete survey. The purpose is of course to locate all cases of retardation in order that the reasons therefor may be promptly discovered and the proper action taken. 2. That annual reports be required from all teachers and clerks to the county school superintendent of all handicapped children between one and twenty-one years of age- whether the handicap be total or partial deafness or blindness, epilepsy, a crippled con- tion, or mental defect-with reference to the county judge for action of all cases which come under the provisions of the "Crippled Children's Law." 3. That legislative attention be constantly directed toward securing the right of every child to receive the benefits of education. Some of the suggestions are: To strengthen the operation of the truancy law; to abolish distance limits and provide for necessary transportation ; to hasten consolidation of school districts; to make the local school au- thorities responsible for seeing that all handicapped children are put in the way of receiv- ing specialized education in state institutions or elsewhere, as may be appropriate; to encourage by legislation medical inspection in the schools and the employment of county school nurses ; to provide for psychiatric examination of all children three or more years over-age for grade and of all children showing evidence of mental defect and to authorize the school authorities to make necessary petitions to the county court for commitment of mentally defective children ; to encourage the establishment of local and community health clinics ; to place the supervision and curriculum of all training of defectives, delinquents and dependents anywhere in the state under the office of the state superintendent of public instruction ; to encourage the teaching of English to foreign speaking citizens because the speaking of a foreign language exclusively in the home is a major cause of pupils' becom- ing over-age for grade. Delinquency 1. That provision be made for competent psychiatric examination of all juvenile de- linquents with appropriate action thereafter. This recommendation is made because de- linquency is so often the result of mental defect, mental disease or mental disorder. 2. That every county provide at least one place of detention for juvenile delinquents entirely separate from the place of detention of adult delinquents ; and that therein the sexes be kept separate at all times and that none but women be in charge of girls and women at any time, including transportation to and from court and institutions. 1. That provision be made for competent psychiatric examination of all dependent persons seeking relief from public funds with appropriate action in case of those mentally defective, 2. That a system of accurate record and cost keeping with respects to the cost of de- pendency throughout the state be inaugurated and so installed as to make possible the publication of a complete summary in the biennial report of all counties and in the report of the State Board of Control. 3. That the State Board of Control be empowered to cause the return of non-resident dependents to the state or country whereof they are legal residents. 4. That a penalty be established for the misdemeanor of bringing into the state any non-resident or alien who is or has been a mentally defective delinquent or who is known to be partially or wholly dependent because of any mental or physical defect, disease or disorder. 5. That uiform blanks and records, arranged and approved by central state authority, be used and required in all matters touching maintenance, care, treatment and training of all delinquents and all dependents, complete or partial, whether cared for by public or private funds. Dr. Carlisle outlines a plan which would result in complete, uniform and orderly records and statistics in the locality or institution, the county and the central state office, and points out the great need for some such arrangement. Dependency THE UNIVERSITY OF OREGON, directed by the U. S. PUBLIC HEALTH SERVICE, requests your cooperation in filling out this card for any case of mental defect, dependency or delinquency which comes under your observation. Please return promptly to Extension Division, University of Oregon, Eugene, Oregon NAME: Surname Given name Legitimate Illegitimate Birthplace Age Single (Specify county Married if in Oregon) Widowe< Divorced Occupation Separated (or that of father 1 Common Law if under 14) Alias, if any Reaction to sex matters Illegitimate children RESIDENCE: County Addresj , street or R.F.D. Village, town or city How long How long Citizen in U.S. in Oregon state o of what Religion Race country PHYSICAL STATUS (Specify diseases) Specify physical handicaps, as: f Blind-one eye both 5 Deaf-one ear both I Crippled or deformed Specify Venereal Wasserman diseases, if any Reactions taken EMOTIONAL FIELD Stable (Temperament) Unstable Periodic upsets (Tantrums) (Variation of moods) Over-valuation of ideas Shut-in or Enthusiasms seclusive type Frank, open type Other types PERSONAL HISTORY (Check known facts) Truant Liar Cruelty-Animals Crimes-Property C rimes-Persons Sex pervert Sex offender Pyromania Homicidal Ungovernable child Family deserter * Illicit consorts SCHOOL HISTORY (Check known facts) Attended school (check where) City Village (under 2,000) Rural PRESENT GRADE How many school grades retarded for age ? Grade repeater 1, 2, 3, 4. times No progress in grades Education: None reads reads and writes Grammar school High school College SOCIAL RECORD (Check known facts) Steady worker What Weekly wage Self-supporting Intermittent worker What Weekly income Self-supporting Partial dependent Public funds Private funds Cause Complete dependent Public funds Private funds Cause Condition: Affluent Comfortable Poor Squalid , Tramp No anti-social conduct Delinquent, never apprehended Apprehended but not convicted Sentenced Sojourn in any institution-give dates and details Does this person show symptoms of MENTAL DEFECT (feeble-minded) If Psychometric tests were made specify findings Is he Alcoholic? ( regular) (irregular) Epileptic Insane Check-Idiot Imbecile Moron (Diagnosis) Borderline Subnormal Intelligence Quotient Mental Age Drug addict (Specify) Father's name Birthplace Mother's maiden name Birthplace Father a citizen of what country Has he first naturalization papers ? Has he completed naturalization papers ? Father's mentality Temperament Successful Anti-social. record W Mother's mentality Temperament Successful Anti-social record OS w The family of this subject is composed of brothers and sisters, of whom males and females are living s Specify all mental and nervous disorders ANY relative of the family ever developed CAUSES: State what you believe to be the cause of the subject's trouble SUGGESTIONS as to needs: DATE OF THIS RECORD REMARKS: (Write additional information on the back of this card) State of Oregon-Survey of Mental Defect, Delinquency and Dependency FOR MALES OF OREGo^ HEADQUARTERS OF THE OREGON STATE SURVEY OF MENTAL DEFECT, DELINQUENCY AND DEPENDENCY Reposing special confidence in the discernment, integrity and patriotism ^eniamin franklin he is hereby requested to act as Special Buluntary AHslatant to the &tate $umy of Cental defect, delinquency anh dependency serving without remuneration from a sense of high citizenship and patriotism i, accordance with Senate Joint Resolution No. 28: Be It ReecV-ed, by the Senate of the State of Oregon, the House of Representatives jointly concurring: tin e is In Oregon, tie in e\ery other state, a large number of dependent, defective and delinquent pcci ie o* w.. u only a email percentage of the meat extreme types are cared for in institu* Ilona; and , Wbcrt'M, the er.p .Ticket of dry ft boards has shown the members cf these groups who are at large to be ol'x <; : . •' ' J ' at a positive liability to the state and nation on account of their incapacity to an 3 h>.. - • 'ur work; and Wh*r&ot ' " .rr' rai-• Juvenile courts, poor farms, jails and a'l other agencies caring for 12: : • x, i .. i.r d <jconquerU shows that, wr.ether in institutions or at large, these classes arc a the f inn aces, health, morals and every Q4Mr resource of the state; k . ' whv t;- contribute to social and pc ! ca'. u. 'est : and .. cc Just and m^re'fv2 to :U ur.fortunatM and at the tame time to yrowe .he ' 7 . . i • tre . ' e as « whede oy pre/er.*'ng as far ia possible the increase in numbers cf cc . • . ' *., d. : * eo ?.vd d- • • -vd ' 1, • ■'7.2;:; ?i w*.:jr,grees to serve the state by making a survey of depinder'y, . e: „ a s » . ;. £nry. tec ;5...'g pub?c and private institutSrs and agencies dealing with s./.j tL lx1 jidcr to Sex?-ire the ezto"'; srd cause? of said dependency, defectiveness and de'ir.qnen y and to cag^wt ways and m^ans for reducing the state's burden from these sources, therefore, be it R9»o>je<it That the Unhf :aity cf Oregon Is hereby granted authority to make such survey, and is requested to rer >rt th® r?r.J.i. of lie study with recommended legislation to the next regular legislative assembly, with the understanding that the University will conduct this study according to ita own plan, and that the state -.vid be raxed for no appropriations for this purpose. Filed in the office of the secretary of state February 27, 1919. you are requested to write to the Headquarters of the State Survey, Extension Division of the University of Oregon, Eugene, Oregon, for instructions and statistical data cards for recording cases of mental defect, delinquency and dependency which come under your personal observation; such cards to be returned to the Headquarters of the Survey when completed. Headquarters for Multnomah County, Room 652 Court House, Portland; Headquarters for all other counties of the State, Extension Division, University of Ore- As Spacial Voluntary Assistant to the State Survey of Mental Defect, Delinquency and Dependence gon, Eugene, Oregon. Issued at ike Sta&nuaritrB nftlje State Sumey of Rental Befert. Belinqneney an& Dependency. Extension Division, University of Oregon, Eugene, Oregon, this fifteenth day of April, nineteen hundred and twenty Chester L. Carlisle, M. D. UNITED STATES PUBLIC HEALTH SERVICE Director Oregon State Survey of Mental Defect, Delinquency and Dependency