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 UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 SCHOOL OF LAW 
 LIBRARY
 
 U ." 
 
 MEDICAL SCIENCE 
 
 AND CRIMINAL 
 
 JUSTICE 
 
 By HERMAN M. ADLER, M.D. 
 
 PART V 
 
 OF THE CLEVELAND FOUNDATION SURVEY OF 
 
 CRIMINAL JUSTICE IN CLEVELAND 
 Price 50 Cents
 
 MEDIC.AJL SCIENCE AND CRIAONAL JUSTICE
 
 THE CLEVELAND FOUNDATION 
 
 1202 Swelland Building, Cleveland, Ohio 
 
 COMMITTEE 
 
 J. D. Williamson, Chairman 
 
 Thomas G. Fitzsimons 
 
 Malcolm L. McBride 
 
 W. H. Prescott 
 
 Belle Sherwin 
 
 Leonard P. Ayres, Secretary 
 James R. Garfield, Counsel 
 
 Raymond Moley, Director 
 
 THE SURVEY OF CRIMINAL JUSTICE 
 Roscoe Pound 
 
 Felix Frankfurter ^ 
 
 Amos Burt Thompson, Chairman of the 
 Advisory Committee
 
 MEDICAL SCIENCE 
 
 AND CRIMINAL 
 
 JUSTICE 
 
 BY 
 
 HERMAN M. ADLER, M.D. 
 
 STATE CRIMINOLOGIST OF ILLINOIS 
 
 PART V 
 
 OF THE CLEVELAND FOUNDATION SURVEY OF 
 
 CRIMINAL JUSTICE IN CLEVELAND
 
 Copyright, 1921, by 
 The Cleveland Foundation
 
 
 FOREWORD 
 
 THIS is one of eight sections of the report of the Cleveland 
 Foundation Survey of Criminal Justice in Cleveland. The 
 survey was directed and the reports edited by Roscoe Pound 
 and Felix Frankfurter. Sections which have been pubUshed are: 
 
 The Criminal Courts, by Reginald Heber Smith and Herbert B. 
 
 Ehrmann 
 Prosecution, by Alfred Bettman 
 
 Other sections to be pubhshed are : 
 
 Police, by Raymond Fosdick 
 
 Penal Treatment and Correctional Institutions, by Burdette G. 
 
 Lewis 
 Newspapers and Criminal Justice, by M. K. Wisehart 
 Legal Education in Cleveland, by Albert M. Kales 
 Criminal Justice in the American City, a Summary, b}' Roscoe 
 
 Pound 
 
 The sections are being published first in separate form, each 
 bound in paper. About November 1 the report will be available 
 in a single volume, cloth bound. Orders for separate sections or 
 the bound volume may be left with book-stores or with the Cleve- 
 land Foundation, 1202 Swetland Building.
 
 PREFATORY NOTE 
 
 THIS section of the Cleveland Foundation Survey of Criminal 
 Justice which deals with Medical Science and Criminal Justice 
 was designed by Dean Pound primarily to answer the question, 
 "How far are modern methods of psychological and psychopathic in- 
 vestigation and treatment made use of or available in Cleveland?" 
 
 While the original conception of Dean Pound has been kept prac- 
 ticall}^ intact, the scope of the inquiry has been slightly enlarged so as 
 to include not only the mental phases of medical relations, but all ques- 
 tions of health which had any direct relation to the administration of 
 justice. This was necessitated partly by the fact that one very impor- 
 tant chapter in the inquiry, namelj^ the office of coroner, had little, if 
 any, primarj' connection with psychology or psychiatry, but, above all, 
 by the fact that, once the survey was under way, it appeared that 
 medical relations must be interpreted in the broadest possible way in 
 order to comply with the program outlined by Dean Pound. 
 
 In the collection of data and in making special investigations thanks 
 are due to Maurice R. Davie, of the Department of Sociology of Yale 
 University, for his valuable contribution; to Miss Helen Chew, of the 
 staff of the Cleveland Foundation, for assistance both in the collection 
 of information and in the planning and execution of the report ; to E. K. 
 Wickman, Psychologist in the Division of the Criminologist of Illinois, 
 for his work in connection with the intelhgence survey of the Cleveland 
 police force and the Cleveland House of Correction; to C. E. Gehlke, 
 Leonard V. Harrison, and all the members of the Survey staff for much 
 help for which specific acknowledgment is impossible. 
 
 The work of this section complements in some measure that of the 
 section on Penal Treatment and Correctional Institutions, and the 
 author has had the cooperation of its director, Commissioner Burdette 
 G. Lewis, of New Jersey, to whom he is deeply indebted for assistance 
 and advice. 
 
 To the Medical Sub-committee of the Advisory Committee, the 
 author wishes to express appreciation for kindly support and helpful 
 suggestions. To Chairman H. L. Sanford and Dr. Howard Karsner 
 the author is especially indebted for information and assistance in deal- 
 ing with the subject of the coroner's office. 
 
 (vii)
 
 The author is glad to acknowledge here his indebtedness to two 
 previous surveys conducted in Cleveland, and especially his personal 
 debt to Colonel Leonard P. Ayres, who directed the Cleveland Founda- 
 tion Educational Survey, and Dr. T. W. Salmon, of the National Com- 
 mittee for Mental Hygiene, who directed the Mental Hygiene Section 
 of the Cleveland Hospital and Health Survey, for assistance and in- 
 formation without which this section of the present survey could not 
 have been written. 
 
 Herman M. Adler, M.D. 
 
 viii I
 
 TABLE OF CONTENTS 
 
 PAGE 
 
 Foreword v 
 
 Prefatory Note vii 
 
 List of Tables xi 
 
 List of Diagrams xi 
 
 chapter 
 
 L Psychiatry and Crime 1 
 
 IL Juvenile Behavior Problems 3 
 
 The Need for Mental Health Stations 3 
 
 The Juvenile Behavior Problem in the Schools 5 
 
 Recommendations 6 
 
 The Juvenile Behavior Problem in the Courts 7 
 
 Recommendations 8 
 
 IIL The Adult Criminal 9 
 
 Progress of Mental Examination 9 
 
 The Nature of Mental Examinations 10 
 
 Criminal Detection by the PoUce 14 
 
 1. Departmental Health Work 14 
 
 2. Pubhc Health Problems 15 
 
 3. Examination of Suspects and Prisoners 16 
 Recommendations 19 
 
 Crime Detection by the Coroner's Office 19 
 
 1. Relation to Police 25 
 
 2. Relation to Courts 26 
 
 3. Relation to Prosecutors 27 
 
 4. Relation to the Bar 27 
 
 5. Relation to the Medical Profession 27 
 
 6. Administrative Relations 27 
 
 7. Equipment 28 
 
 8. Death Records 29 
 
 9. Cost of Administration 30 
 10. The Remedy 30 
 Recommendations 35 
 
 Prosecution 36 
 
 Adjudication 36 
 
 1. Municipal Court 36 
 
 2. Common Pleas Court 37 
 
 3. Probate Court 38 
 Recommendations 41 
 
 [ix]
 
 CHAPTER PAGE 
 
 IV. Prevention 42 
 
 Early Detection of Special Cases 42 
 
 Public Information and Education 44 
 
 Research 45 
 
 Training of Workers and Experts 46 
 
 Recommendations 47 
 
 Appendix I. — Report of Intelligence Survey of the Cleveland Police 
 
 Department 48 
 
 Appendix II. — Intelligence Survey of the Cleveland Workhouse 55 
 
 Appendix III. — Text of the Massachusetts Medical Examiner Law 58 
 
 Appendix IV. — Text of the New York Medical Examiner Law 65
 
 LIST OF TABLES 
 
 TABLE PAGE 
 
 1. Distribution of Intelligence Ratings 50 
 
 2. Summary of Distribution of Intelligence Ratings 51 
 
 3. Median Scores and Range of Scores of Police Divisions 52 
 
 4. Intelligence Distribution of Patrolmen by Date of Entry into the Department 54 
 
 5. Distribution of Intelligence Ratings in the Workhouse 56 
 
 LIST OF DIAGRAMS 
 
 DIAGRAM PAGE 
 
 1. InteUigence ratings of divisions of Cleveland police department 49 
 
 2. Median scores, Cleveland police department 53 
 
 3. Range of scores between first and third quartiles of Cleveland police depart- 
 
 ment. (The median scores are indicated by the cross lines.) 53 
 
 4. Comparison of intelligence distributions of Cleveland Workhouse and United 
 
 States Draft Army 56 
 
 5. Comparison of intelligence ratings, Warrensville Workhouse, with United 
 
 States Draft Army 56
 
 MEDICAL SCIENCE AND CRIMINAL 
 JUSTICE 
 
 CHAPTER I 
 PSYCHIATRY AND CRIME 
 
 CLEVELAND, like many other communities, is beginning to rec- 
 ognize the medical and more especially the psychiatric aspects of 
 delinquency and crime, though as yet this recognition is confined 
 to a relatively small part of the community, even of the official com- 
 munity. Some provision has already been made for psj'chiatric service, 
 but only in more or less isolated centers which are not as yet correlated, 
 and which, therefore, fail to give comprehensive attention to the entire 
 field. The immediate problem, therefore, is to determine upon a policy 
 which will utiKze all the existing elements and yet insure expansion and 
 development. 
 
 Specialists in the different fields of delinquency, dependencj^ and 
 criminality are fully awake to the problem; there is even some general 
 public interest in the subject as a result of the publicity given to it during 
 the war. In Cleveland this is especially true, because the education and 
 health surveys have dealt with the question, each from its particular 
 angle. 
 
 Nevertheless, from the special point of view of the administration of 
 criminal justice much more must be done to remove the general belief 
 that delinquency and crime are entirely under the volitional control of 
 the individual. The result of this attitude has been to make the treat- 
 ment applied in each case dependent in a large measure on the degree of 
 anger or annoyance to which the community has been aroused. Vindic- 
 tive and punitive treatment, even though exercised by a group, loses 
 little of the personal element. The community says to the delinquent: 
 "You could behave yourself if you wanted to. If you break the laws, it 
 is because you intended to, and therefore we are going to get even with 
 you." The dehnquent says to the community: " You do not need to be 
 so rough with me, because it is in your power to be more lenient. If you 
 2 [1]
 
 are rough, it is because you want to be unfair to me, and therefore I have 
 a perfect right to hit back if I can." 
 
 There was a time when medicine was practised on much the same 
 basis, and even when chemistry was regarded from this point of view. 
 All the ailments of the human body were believed to be the machinations 
 of evil spirits. The reactions of chemical substances in the retort were 
 thought to be presided over by good and evil spirits. The scientific atti- 
 tude which has removed these personal elements in the fields of pure 
 science and of medicine is capable of doing the same in criminology. The 
 introduction of exact methods in medicine has never interfered with the 
 highest effectiveness of personality and character in the application of 
 the science to the individual sufferer. In the same way the introduction 
 of knowledge into the field of delinquency does not diminish the value of 
 personal skill and of the so-called "human element" in its application to 
 the administration of justice. 
 
 When the public becomes convinced that there are in the community 
 specially trained persons who understand delinquency and are able to 
 evaluate the various factors in a case of behavior difficulty, the result will 
 be like that already witnessed in the field of pubhc health. Few persons 
 today have to be coerced to be protected against disease or to be treated 
 when they are ill. Our dispensaries and hospitals clearly testify to that 
 fact. When the public has learned to regard behavior difficulties, delin- 
 quency, and crime as manifestations of mental difficulties requiring 
 treatment, just as physical ailments do, and provides institutions and 
 officers to deal with these troubles as mental disease, rather than from the 
 point of view of punitive justice, we shall be able to record advances as 
 notable as those of the public health movement. And just as public 
 health machinery has made large cities and small country villages healthy 
 places in which to live, so this new public mental health movement will 
 make our communities safe and sane places in which to live. 
 
 2]
 
 CHAPTER II 
 JUVENILE BEHAVIOR PROBLEMS 
 
 The Need for Mental Health Stations 
 
 THERE is probably no one who has not passed through difficulties 
 during childhood. Indeed, the great majority believe they have 
 been saved from becoming delinquent by some fortuitous circum- 
 stance, by the strict discipline of their parents, by the friendly offices of 
 others, or perhaps that they were not saved but have in some way 
 merely outgrown delinquency or "gotten by" in other ways. To those 
 who look back from a secure position in society upon an adventurous and 
 unlucky childhood or youth, it must appear that every individual has 
 been, at one time or another, more or less dehnquent. "There, but for 
 the grace of God, goes John Bunyan," expresses their unconscious feeling 
 when they consider criminality. Whatever truth there may be in this, 
 it does not adequately explain the phenomenon of delinquency in its 
 serious forms to one who differentiates between the significance of a single 
 act and a series of reactions as disclosed by a study of the career of a 
 delinquent individual. Regarded with the objectivity of the behaviorist, 
 acts which may appear to be identical are found to have an entirely dif- 
 ferent significance. This is a point of view which the law — the emphasis 
 of which is on the crime rather than on the criminal — does not, as 3'et, 
 sufficiently recognize, though the law, to be sure, does recognize two 
 groups of offenders needing special treatment — the irresponsible and the 
 juvenile. 
 
 In dealing with adult criminals, a finding of feeble-mindedness or of 
 insanity seems to some like condoning the crime, while to others that 
 decision is merely the pronouncement of what they believe to be a well- 
 estabhshed truth, namely, that all criminals are ipso facto insane or 
 feeble-minded. However, all the partisanship and bitter feeling often 
 aroused in cases of serious adult criminality are either absent or in abey- 
 ance in the case of juvenile delinquents. The entire development of the 
 Juvenile Courts rests on the wilhngness of the community to believe that 
 the child is not accountable for his misconduct in the same sense as the 
 adult. 
 
 From the point of view of the behaviorist, one cannot hazard any 
 
 (31
 
 generalizations as to the causation of delinquency, but must make each 
 case the subject of independent study. These considerations, pushed a 
 little further, make us reahze that similarity of behavior between youth- 
 ful individuals does not imply identical causes, and therefore does not 
 demand identical treatment. Perhaps nothing will help this point of 
 view to gain general recognition so much as the introduction of faciUties 
 for consultation with mental and behavior experts, of which the general 
 pubUc may avail itself. 
 
 Parents, teachers, even children themselves, may be taught to consult 
 the mental health station about their private affairs without fear of 
 hostile criticism or condemnation, confident that though the experts may 
 not be able to solve their problems, they will at least give non-partisan 
 counsel. There will be no question whether the expert is for or against 
 them any more than in the case of the hospital physician. The question 
 will be merely what is the matter and what can be done. 
 
 In this work all the agencies of the community should assist. The 
 public health system, especially with its public health nurses reaching 
 into the homes, should direct cases suited to the mental health station. 
 All the welfare agencies, through their social service, should daily dis- 
 cover cases requiring the assistance of a mental health officer. The 
 police could easily be instructed in the nature of the cases that should 
 be directed to the public health stations. 
 
 All of this field work, however, depends upon the existence of properly 
 equipped mental health stations as bases. These stations, as a rule, so 
 far as they exist in Cleveland and other communities, resemble dispen- 
 saries more than hospitals. This out-patient service, if properly con- 
 ducted and enlarged, will take care of a large percentage of the cases. 
 There are certain cases, however, which either for diagnosis or for tem- 
 porary or preliminary treatment, require something more than out- 
 patient treatment. For these, observation or temporary care stations 
 should be provided. 
 
 The present plans in Cleveland include a psychopathic hospital as 
 part of the city hospital, and ultimate^ a psychiatric institute in con- 
 nection with Lakeside or Fairview Hospitals. The psychopathic hos- 
 pital will take care of certain cases of juvenile dehnquency in which the 
 psychotic and psychopathic factors predominate. It is not likely, how- 
 ever, that such institutions will be ai^le to care for a large number of 
 behavior cases which require observation, but in which, nevertheless, the 
 psychotic factor is either of minor importance or absent altogether. 
 
 In order to meet the reciuiremcnts of the situation the Boys' School 
 and the Detention Home would either have to be converted into behavior 
 
 14]
 
 observation clinics with assistants and staff suitably trained in psychia- 
 tr}-; or, if they are to be retained as custodial or educational institutions, 
 a new type of institution would have to be provided. The Bureau for 
 Juvenile Research at Columbus, which is a hnk in the institutional chain, 
 might serve in certain respects as a model for a local institute. The chief 
 defect of the bureau, as was emphasized by Dr. Thomas W. Salmon in 
 the health survey, is that it deals with cases only after they have been 
 committed. 
 
 What is needed, then, in addition to the psychopathic hospital at 
 Cleveland and the Bureau for Juvenile Research at Columbus, is a Chil- 
 dren's Institute at Cleveland, either as a branch of the Columbus bureau 
 or of the psychopathic hospital, or an independent unit affiliated and 
 coordinated with the Juvenile Court, the Department of Education, the 
 psychopathic hospital, and the University. It is preferable to keep such 
 an institute distinct from the psychopathic hospital because the emphasis 
 on mental disease has a deterrent effect upon the pubHc, and also because 
 the work of such an institute is sufficiently important to merit exclusive 
 attention. 
 
 With some such provision the city of Cleveland would be able to deal 
 effectively with the general problem of " criminal behavior " by attacking 
 the problem at its source — in childhood. The saving in human careers, 
 quite aside from the effect upon the safety of hfe and property, would 
 more than repay the community for the relatively small expenditure 
 involved. 
 
 The Juvenile Behavior Problem in the Schools 
 Speaking solely from the point of view of the relation of mental 
 studies to dehnquency, the Cleveland schools are now very inadequately 
 equipped to deal with behavior difficulties and the educational treatment 
 of such cases. The facts which compel this conclusion have already been 
 indicated by Dr. Salmon in Part VI of the health survey. 
 
 The Department of Education, as in all our larger cities, has provided 
 special cla.sses for children with retarded or low inteUigence. The Boys' 
 School might be considered a special class for behavior difficulties in boys. 
 Educational and vocational questions are considered in practically all 
 cases of juvenile delinquency, especially at the Boys' School, and the 
 physical condition also is carefully considered by the school physicians. 
 But all this is done in a more or less uncorrected way. The physician 
 works from too narrow a point of view. To him a boy who is a ward of 
 the court bn account of dehnquency, if he has any physical defect or 
 ailment, is exactly the same as any other case suffering from the same 
 
 15]
 
 physical troubles. The intelligence rating, as well as the educational 
 and vocational tests, are made in the same way. What is entirely lacking 
 is the interpretation of the behavior difficulties, and for this the social 
 factors, which are fully as important as the physical or intellectual 
 factors, must be studied. A careful analysis, not only of the environ- 
 mental conditions under which the child is living, but also of his 
 antecedents, his inheritance, and his social past, must be made. So far 
 as this is done at all in Cleveland it is done by the overworked and under- 
 staffed Probation Department of the Juvenile Court and by the Boys' 
 School. 
 
 From this point of view it is obvious that the community must assume 
 an entirely different attitude toward its correctional and reformatory 
 institutions. When it comes to treating juvenile behavior problems, we 
 have an even bhnder faith in the curative effects of punishment than have 
 the criminal courts themselves. We erect buildings in which we gather 
 the children who have had trouble at home or in school, or in the streets 
 and parks of our cities, and by the application of what is commonly re- 
 ferred to as "strict discipline," we propose to relieve them and ourselves 
 of their difficulties. 
 
 The officials who preside over these institutions are usually as ill 
 equipped for constructive and scientific work as the domestics and win- 
 dow-washers of a hospital to carry out medical and surgical measures of 
 relief. It would never occur to any one, in these days of modern medi- 
 cine, to entrust a ward full of sick persons to the professional care of a 
 cook, and yet that is what we do over and over again in our correctional 
 and reformatory institutions. When we examine their provisions for 
 grappling with this sort of work, is there a single institution in this 
 country which has provided for its wards the same grade of personnel, 
 the same training and expertness, that we find in a good general hospital? 
 
 Recommendations 
 
 1 . A Division of Mental Health should be created in the Department 
 of Education. 
 
 2. This division should be either coordinated with the division dealing 
 with physical health, or be kept distinct from it so that mental health 
 shall be given independent importance and authority. 
 
 3. The Mental Health Division should include the present psycho- 
 logic clinics. 
 
 4. The mental health work should be closely coordinated with the 
 Division of Special Education, or even merged with it, provided the 
 mental health work does not thereby suffer partial or total eclipse. " 
 
 16]
 
 5. The mental health staff should be under the direction of a com- 
 petent psj'chiatrist. 
 
 6. The director and staff of the Mental Health Division should devote 
 full time to the work. 
 
 7. A sufficiently large and comprehensive staff should be provided to 
 assure that the work is performed in a satisfactory manner. 
 
 8. The Division of Mental Health should cooperate with the Juvenile 
 Court, the Detention Home, the Welfare Federation, and the Depart- 
 ment of Public Welfare, and all such public or private agencies as deal 
 with problems of child welfare. 
 
 The Juvenile Behavior Problem in the Courts 
 The Juvenile Court is practically dependent upon the city health 
 department and cooperating private organizations for the physical wel- 
 fare of the children passing through the court, and largely on the Depart- 
 ment of Education for mental tests. There are no regularly appointed 
 medical or mental examiners attached to the court. 
 
 In regard to physical health, only children committed to the Deten- 
 tion Home or the Boys' School are examined. A physician and a nurse 
 serve on part time in connection with these two institutions. There is a 
 full-time dentist. In addition, the court often sends cases to hospitals, 
 namely, the city hospital, Fairview Hospital, and Lakeside Hospital. The 
 Humane Society furnishes the services of a physician for occasional 
 cases. Judge George S. Addams, the Juvenile Court judge, hopes to have 
 a nurse on duty at the court who will give a preliminary examination to 
 all children, whether committed or not, as they pass through, and also a 
 physician to examine all cases in the court every day. At present there 
 is no money to permit such an arrangement. 
 
 The mental examinations connected with the Juvenile Court consist 
 almost entirely of mental tests. These are applied under the direction of 
 Dr. Bertha L. Luckey, the chief psychologist of the Board of Education. 
 Dr. Luckey and her assistants examine especially children who have 
 turned out to be problem cases in the special schools. Boys sent to the 
 Boys' School by the court are examined by Miss Claire E. Walters. Miss 
 Walters has her office in a temporary building at the Boys' School. She 
 also examines the girls and dependent boj's at the Detention Home 
 nearby. If, in the opinion of the psychologist, a case requires further 
 study, it is referred to the Bureau of Juvenile Research at Columbus, or 
 a psychiatrist may be called in to make a special examination. There is 
 no psychiatrist on the staff of the court, the school board, or the Depart- 
 ment of Health, so that, naturally, these special examinations are made 
 
 17]
 
 but rarely. As a result, the reports of examinations which come back to 
 the judge are confined merely to a statement of the findings and only in 
 the more serious cases of foeble-mindedness is a recommendation for 
 commitment to the State institution risked by the examiner. 
 
 The Juvenile Court is officially without equipment for making medi- 
 cal and special mental examinations. Whatever is done is at the personal 
 request of the judge. The results of the various examinations are re- 
 ported to him, and frequently Miss Walters appears as a witness. Neither 
 Miss Walters, Dr. Luckej^, nor their assistants receive any extra com- 
 pensation for this work. Other psychiatrists and medical examiners, if 
 they appear as witnesses, receive ordinary witness fees. 
 
 In spite of all these handicaps the work is extremely well done, al- 
 though necessarily limited by inadequacy of equipment. Judge Addams 
 recognizes the value of the work, however, and is not only inclined to 
 follow recommendations made, but strongly recommends an extension of 
 this work. The relation between the judge and the special examiners is 
 one of close cooperation on both sides. The relation of these examiners 
 to the probation officers is less close, although through the influence of the 
 judge and the chief probation officer the facts disclosed by examination 
 are utilized by the latter in selected cases. Much, however, could be done 
 to improve this part of the work. The same may be said of the relation 
 between the special examiners and the officers of the Detention Home. 
 
 Recommendations 
 
 1 . A mental and physical examination should be made of every child 
 brought to the attention of the Juvenile Court, and careful records should 
 be kept of the results of each examination. 
 
 2. The examinations should be made whenever it appears advisable 
 to the examiners. 
 
 3. The present excellent cooperation between the Juvenile Court and 
 the Department of Education should be extended so as to make available 
 for both such facilities as each may be able to provide. This applies espe- 
 cially to the suggested creation of a Division of Mental Health in the 
 Department of Education. Such a division might profitably, and with 
 little increase of staff, contribute to the Juvenile Court much needed 
 information in regard to the intelligence, mental qualities, and personal- 
 ity of each chikl under consideration by the court. 
 
 (8
 
 CHAPTER III 
 THE ADULT CRIMINAL 
 
 Progress of Mental Examination 
 
 A DISCUSSION of the medical relations bearing upon the adult 
 criminal is a matter of few words, so far as the present practice in 
 ^ Cleveland is concerned. Except for the occasional perfectly 
 obvious case, practically no use is made of medical and more especially 
 mental treatment in dealing with adult offenders. The majority of 
 citizens and officials no doubt believe, as a high prison official in another 
 State said — "Of course, the out-and-out feeble-minded or insane prison- 
 ers need special attention, but surely the doctors have no interest in the 
 normal prisoner." Does it not depend upon the attitude with which one 
 approaches the question of treatment whether mental experts are to 
 concern themselves solely with the end stages of mental disease or de- 
 ficiency, or with the interpretation and treatment of all cases of behavior 
 difficulties, assuming them to be in the main problems of mentality? 
 The use of the word normal should be prohibited as misleading in the 
 field of behavior difficulties. 
 
 Experience in some of our reformatories and penitentiaries has con- 
 clusively shown that the study of mentahty yields information which no 
 modern institution can neglect. One need merely refer to the well-known 
 work at Sing Sing, Concord, Elmira, and Bedford Hills, not to mention 
 the institutions of New Jersey, Michigan, and Illinois, and especially the 
 United States Disciplinary Barracks at Fort Leavenworth, Kansas. The 
 elaborate plans for a psychiatric clinic in the new prison at Sing Sing 
 clearly indicate what the New York State officials think of this work as 
 an adjunct of the penal system. And what has come more and more to be 
 considered indispensable in an institution has proved itself of similar 
 value to the courts. Mental examinations and personality studies are 
 now insisted upon as a sine qua non in the work of practically all the 
 Juvenile Courts of the country. 
 
 There is every indication that this work has so far established itself 
 that criminal and police courts are also availing themselves of the ad- 
 vantages. Thus, the Municipal Courts of Chicago, Boston, Detroit, and 
 
 19]
 
 Baltimore have psychopathic clinics or laboratories to which are referred 
 all doubtful cases. No city has as yet worked out a system by which all 
 cases coining before the court are considered from the mental angle. 
 When, as often in court work, selection is made by untrained persons, im- 
 portant cases are frequently overlooked. Routine sorting examination 
 of all cases, with more intensive study of those shown by first examina- 
 tion to require further investigation, is the only safe way. 
 
 As long as the public regards this work as a mere frill or an expression 
 of maudlin sympathy for the criminal, of course, it will not be encour- 
 aged. What the uninitiated do not reahze is that work of this kind is a 
 very matter-of-fact and practical step toward the better administration 
 of the law, as well as real economy. 
 
 The Nature of Mental Examinations 
 Although in general the pubUc has become familiar with the fact that 
 mental examinations are made in many cases where there is no reason to 
 suppose that insanity exists, there is a great deal of doubt in the minds of 
 many as to the nature of the methods and the information they may be 
 expected to yield. It may not, therefore, be amiss to give briefly the out- 
 lines of this work. 
 
 Mental examinations, as they are now made, may be divided into two 
 main groups: The first, or psychometric method, sometimes called the 
 psychological tests, consists in the application of certain standardized 
 sets of tests with the object of determining the native mental abiUty, or, 
 as it is called, the "intelligence" of the subject. Various forms of tests 
 are now used, but practically all of them are based upon the work of the 
 French scientist, Alfred Binet, who, together with his collaborator, Theo- 
 dore Simon, published in the years 1905 to 1908 the first scale for the 
 measurement of intelligence in children. 
 
 This scale is arranged in accordance with the idea that as a child 
 grows older and his mentality develops he is able to perform more and 
 more complicated acts and to carry out more and more complex intel- 
 lectual processes; so that, if we arrange a series of tests, questions, and 
 problems in the order of their difficulty and present them to a child, we 
 may be able to infer his degree of development by the point in such a 
 series beyond which he is unable to answer questions satisfactorily. The 
 scale thus arranged by Binet has since been tried out on a large number 
 of school children, and as a result of this experiment it has been possible 
 to arrange the tests in groups of six for each year. Since publication, 
 these tests have been used to such an extent as to indicate thoroughly the 
 existing need of such measurement. 
 
 [10]
 
 It soon developed that there were in the schools and elsewhere in- 
 dividuals who, on being subjected to these tests, failed more or less widely 
 to come up to the grade corresponding to their actual age, and since the 
 tests had originally been arranged for age groups, it was said that their 
 chronological age or actual age was, let us say, twelve years, and the 
 mental age as determined by the scale was, let us say, nine years. 
 
 As the tests have become more definitely standardized, and as new 
 tests have been devised and come into use, the exact definiteness with 
 which the mental ages were stated ten years ago has gradually become 
 subject to modification. Thus, while in the case of school children of 
 twelve or less it is reasonably satisfactory to express their deviation or 
 subnormality in terms of years, it is not so clear when the method is 
 applied to older persons. When applied to adolescents, and especially to 
 adults, these methods have frequently given rise to increduhty on the 
 part of many ; an instance of such a case is when an individual of twenty- 
 five years who is guilty of a felony, and perhaps has a wife and children, 
 and in other respects appears to be mature, is said to have the mind of a 
 child of nine years as determined by the mental tests. 
 
 The reason for this apparent discrepancy is the fact that the original 
 Binet scale and its modifications and ampHfications hold with consider- 
 able accuracy for children of twelve and less, because the innate intel- 
 ligence reaches its full development at about the age of puberty. This 
 statement is not true in an absolute sense, but for present purposes is 
 sufficiently accurate. The development which goes on after the age of 
 puberty, during the age of adolescence, and until full adolescent ma- 
 turity is reached, is a growth in strength, power, and the use of the innate 
 ability through acquired habits and experience. 
 
 As this is the period during which the greatest apparent progress is 
 made, when the change from childhood to adult maturity is visibly going 
 on, it is difficult at first glance to reconcile this fact with the previous 
 statement in regard to the maturing of intelligence. A child of twelve or 
 fourteen may have as much intelhgence as an individual of twenty-five or 
 thirty years, and yet the adult will far exceed the child in intellectual per- 
 formance and ability. This is because the older person is able to use his 
 intelligence much more effectively because his emotional control, equi- 
 librium, and judgment are much greater than those of a child. Less diffi- 
 culty would undoubtedly be experienced in this regard had we a measure 
 of the development which takes place during the adolescent period corre- 
 sponding to the one we now have for the mental development during 
 childhood. 
 
 The psychometric tests, therefore, give us a fairly accurate statement 
 
 [111
 
 of the degree of intelligence of any individual. All inferences regarding 
 the maturity of the individual in other respects, namely, emotional con- 
 trol, forbearance, responsibility, honesty, self-denial, respect for others, 
 and the other attributes of personality which determine an individual's 
 place in the social scale, can be determined only roughly. We can com- 
 pare one individual with another in regard to his intelligence rating and 
 can say with considerable precision by how much one excels another. 
 For the period of adolescent development, no such exact measurement is 
 possible, and we have to be content with a "more or less," "better or 
 worse," standardization. 
 
 So striking have been the results achieved by means of the Binet- 
 Simon tests that in the ten years since the first publication this type of 
 measurement has become firmly established in schools, courts, and insti- 
 tutions, in fact, wherever child welfare is concerned. 
 
 Other scales have been devised which furnish the information in a 
 somewhat different way, perhaps with greater precision than the original 
 Binet scale. Aside from the first important modification of the scale, the 
 so-called Stanford Revision, by Professor Terman, of the Leland Stanford 
 University, there has been developed a point scale by Professor Yerkes, 
 and a number of special tests, such as those of Dr. William Healy, Dr. 
 Guy Fernald, Professor Whipple, and many others. 
 
 The problem of giving an intelligence rating to the soldiers of the 
 draft army during the late war gave an impetus to another form of test 
 which has been claiming attention in the schools, namely, that of the 
 so-called "group tests." This method, based in general upon the same 
 logic as the Binet tests, was so arranged that any one who can read and 
 write may perform the test. The method consists in an instructor read- 
 ing certain instructions to the group, who are equipped with pencils and 
 test blanks, and who then carry out the instructions, answering questions 
 and solving problems in accordance with printed statements, while the 
 instructor keeps time. In this way as many as 1,000 men can be examined 
 simultaneously. 
 
 The scores made on these tests, which are now usually referred to as 
 the army tests, are expressed in figures: the highest possible score, for 
 instance, was 212. The performance varied throughout the entire range 
 from to 212. In order to express the result in a usable form the score 
 is divided into five groups, designated by the letters A to E as follows: 
 A, very superior; B, superior; C, average; D, inferior; E, very inferior. 
 It was found that so many men fell into the C or average group that it 
 became necessary to divide this into two more groups, C plus and C 
 minus, high average and low average respectively. The score necessary 
 
 ( 12]
 
 for a commission was judged, as a rule, to be either A or B. The men of 
 E intelligence included the feeble-minded, the defective, and, in the 
 main, men not fitted for the army because of low mentality. 
 
 In evaluating the mental status of an individual who, for one reason 
 or another, is a subject for examination, more than intelligence rating is 
 required. This further information is obtained by means of certain men- 
 tal examinations which have as their object the determination not so 
 much of the qualitative mental abiUty as of the existence of diseased or 
 abnormal functionings or reactions. We might visualize this by saying 
 that in the intelUgence field we are taking a measure, just as we might 
 measure the height of an individual, and that the differences are dif- 
 ferences in mental stature. In the second form of examination, namely, 
 the psychiatric examination, we are looking not for differences in height, 
 but for pathological processes comparable to disease processes in the field 
 of physical health. This type of examination seeks to determine the 
 existence or absence of certain symptoms of disease, and when found, to 
 evaluate their significance and the severity of the condition. It yields 
 information upon which may be based such diagnosis as mental disease or 
 the less severe pathological conditions, sometimes called psychopathic 
 personaUty. 
 
 The stud}^ of the mentality of an individual from the point of view of 
 psychiatry requires something further, however, than merely testing the 
 mind or the nervous system. One cannot dissect the living human being 
 and deal with one portion only. One of the characteristics of a living 
 organism is that every part is in relation with every other. Nowhere is 
 this more important than in the pathology of the mind. Of late a great 
 deal of attention has been paid to the influence on mentality of certain 
 factors which lie outside the nervous system. The existence of physical 
 disease elsewhere in the body, as, for instance, in the delirium of fever, 
 various intoxications and auto-intoxications, the effect of digestive dis- 
 turbances, and, above all, the more newly disclosed effects of various 
 glands and organs, such as the thyroid and the sex glands, are examples 
 of these factors. It will be clear, therefore, that the examination of 
 mentality from this point of view cannot be conducted with the same 
 apparent exactness as is often possible in the investigation of the mental 
 age. It must also be clear that this type of investigation requires the 
 apphcation of all the medical knowledge available and must, therefore, 
 be made by a medical man with special experience in this field. 
 
 There is another point which must be understood in order to appre- 
 ciate why inedical, especially psychiatric, knowledge must be apphed in 
 addition to the intelligence rating. As we have seen before, the intelli- 
 
 1131
 
 gence test is a matter of measuring mental stature. While these methods 
 must be applied with the greatest care in order to be of any value and, 
 therefore, require the services of a highly trained specialist, they never- 
 theless do not require any medical or pathological knowledge. In the elu- 
 cidation of behavior difficulties we are confronted with a problem which 
 is comparable less to an educational problem than to a problem of 
 health. Even though our object is not to pin a label on the individual 
 and find him either insane or feeble-minded, nevertheless we must arrive 
 at a diagnosis of health by exclusion, for in no other way can a diagnosis 
 be made. We cannot make a diagnosis of health or of sanity. We can 
 only make a diagnosis of "no evidence of disease found." We can posi- 
 tively identify only the signs and symptoms of disease. In the absence of 
 such we are justified in assuming that a person is healthy. It must be 
 clear, therefore, that in making this sort of judgment upon the men- 
 tality of individuals and in elucidating the mental factors in behavior 
 reactions a true knowledge of mental pathology is necessary in order to 
 allow this judgment by exclusion. 
 
 The fact that psychiatrists are interesting themselves more and more 
 in the behavior problems of the non-insane should not be interpreted as 
 an indication that the psychiatrist is endeavoring to adjudge everybody 
 insane. But, on the other hand, the commonly held fallacy that the 
 psychiatrist has no interest in the problems of the non-insane or mentally 
 healthy individual should be also dispelled. 
 
 Criminal Detection By the Police 
 1. Departmental Health Work 
 
 The only medical officer officially connected with the Division of 
 Police is the police surgeon. Only one police surgeon is employed. The 
 present surgeon, Dr. G. P. O'Malley, has held this oflftce since December, 
 1920. The duties of the police surgeon are, first, physical examination of 
 all applicants for appointment to the police force, and, second, care of 
 sick and disabled members of the force. It will be seen from this that he 
 is concerned only with the health of members of the force itself and not 
 at all with medical or health problems connected with the work of the 
 police. 
 
 Even in this restricted application the work of the police surgeon is 
 not adeciuately provided for. There are too many men to be examined 
 and the e(juii)ment provided is in many respects inadequate. During 
 March, 1921, there were 800 men to be examined. Blood tests are not 
 being made, although the police surgeon believes that such tests should 
 be made in every case. Neither the physical examinations of applicants 
 
 [14]
 
 to the force nor the examination of men representing themselves as sick 
 can now be made in any but a superficial way. 
 
 The police surgeon has no office — merely a desk in the office at the 
 central station. There is no room where men can undress, and as a result 
 the examinations cannot satisfactorily be made. A change is contem- 
 plated in this respect, and new quarters are to be provided at the Eighth 
 Precinct. 
 
 The present officer, Dr. O'Malley, offers the following criticisms and 
 recommendations : 
 
 1. Better working facilities with complete equipment for making 
 thorough examination and also for emergency treatment. 
 
 2. Medical and clerical assistance. The city should be redistricted and 
 a police surgeon hired for each district. There should be two assistants 
 hired immediately to enable the city to be divided into three districts. 
 
 3. A card index and records of all cases entered should be kept, and for 
 this office space and help are required. There should be a system of 
 records to show exactly the number of times each man reported sick and 
 how much time he loses. 
 
 4. To obviate the possibility of maUngering there should be a constant 
 checking up of the records. These should also show whether or not a man 
 is in such poor health that he is unable to perform active duty. 
 
 5. If an officer is sick too often, he should be called before a medical 
 board and given a thorough examination, at which time his family physi- 
 cian should be present, if desired. 
 
 6. All cases of pension should be handled by such a board. 
 
 7. The poUce surgeon as well as the police officers should be entitled 
 to pension. This is not the case at present. 
 
 Malingering in the police department seems to be somewhat of a 
 problem from the point of view of health work. The men live scattered 
 throughout the town and at times it is impossible for the surgeon to call 
 upon all of them on the same day they report sick. Sometimes it is two 
 days or more before the surgeon can see a case. The men are aware of 
 this, and the surgeon believes they take advantage of the fact to take a 
 day off. Dr. O'Malley believes that as much as 12 per cent, of the sick- 
 ness might be designated as malingering, although he has no means of 
 saying definitely, because no records other than the daily sick report 
 
 have been kept. 
 
 2. Public Health Problems 
 
 For all health work outside the department itself, including general 
 cases coming to the attention of the police and the examination of 
 suspects and prisoners, the police depend upon the Division of Health. 
 
 [ 15]
 
 The city is districted, and the Division of Health maintains district 
 physicians. The police may call upon these in cases requiring medical 
 attention. The district physicians are supposed to confine themselves to 
 the care of the indigent sick in their homes and to protect the com- 
 munity from contagious disease. In actual practice the police call upon 
 the district health offices in many cases other than those specifically 
 mentioned. 
 
 The police, furthermore, are instructed to remove any arrested person 
 who requires medical treatment to the nearest hospital, preferably the 
 city hospital, and a police guard is furnished in case such a person is kept 
 at the hospital. There is a special ward at the city hospital for such 
 persons, in which windows are barred, doors locked, and a guard con- 
 stantly in attendance. 
 
 The police, however, render assistance to the general public in health 
 matters. Owing to the fact that the police are always available for call, 
 people refer cases to them, especially emergency cases, which should 
 properly be taken care of by private physicians. The police keep on file 
 the names and addresses not only of the district physicians, but also of 
 certain private physicians who have certified their willingness to take 
 emergency cases. Vice cases are referred to the Public Venereal Dis- 
 ease Clinics and to the Woman's Protective Association. The Division 
 of Health maintains a diagnostic clinic for venereal diseases at No. 64 
 Public Square and the Fairview CUnic for Social Diseases at 3305 Frank- 
 lin Avenue, mainly for treatment. The diagnostic clinic, under the 
 federal government during the war, was taken over by the city in 
 September, 1919. The Fairview Clinic was started August 16, 1920. 
 These clinics handle private as well as court cases. Under the general 
 code all vice cases are to be referred for diagnosis at the discretion of 
 the judge. There seems to be considerable laxity, however, in referring 
 cases. Rape cases are occasionally handled at these clinics, although, as 
 a rule, such cases are referred to the city hospital. 
 
 It appears, therefore, that the problems of health, either of the police 
 force or of the general public, in so far as the latter comes in contact with 
 the police and the courts, are provided for adequately — if not in practice, 
 at least in theory. The further improvement of this service and the 
 raising of the general level of its efficiency is a question of applying pres- 
 ent knowledge and furthering development along well-established fines. 
 
 S. Examination of Suspects and Prisoners 
 There are certain other problems of medical relations, however, of 
 growing importance in connection with crime detection which concern 
 
 I 161
 
 the police and the crime-detecting agencies more than is commonly sup- 
 posed. 
 
 The police have contacts with criminal and semi-criminal elements, 
 which in many cases, if properly utilized, might result not only in better 
 understanding of the general subject of crime, but actually in a more 
 effective deahng with it. A patrolman on the beat can no longer ade- 
 quately perform his full duty in a city such as Cleveland by merely 
 representing in theory, and not in practice, the majesty of the law. To 
 be the eyes of the law and of the community his powers of oljservation 
 must be trained, so that he may be able to distinguish the significant 
 from the adventitious. 
 
 This is not the place to discuss the details of police administration 
 and police personnel. But it is relevant to consider here the equipment 
 and skill necessary for individual police officers to secure the information 
 needed to determine many important problems of the mentality and 
 reliability of witnesses, and the relative honesty or dishonesty of wit- 
 nesses, suspects, and prisoners. One cannot depend upon chance in this 
 matter nor the haphazard school of experience. A very precise prepara- 
 tion must be made by the authorities to provide the necessary training. 
 There seems to be no escape from the conclusion that the Division of 
 Police should in some way be provided with the services of a speciahst 
 in mental science, particularly in its application to the problems of 
 criminal behavior. 
 
 The work of the police surgeon in his professional supervision of the 
 health of the poUce force; of the district health officers, in their relation 
 to the physical health of the community in general, and of prisoners, 
 suspects, and accidental cases in particular, should be strengthened by 
 the introduction of three health officers — two to act as assistants to the 
 present police surgeon in his routine work, and the third a specialist who 
 should devote his time and energies to the mental aspects of the police 
 department both within and without the force. Such a specialist would 
 serve not only as an advisor in the department, but also as a teacher. 
 Mental health work should really be a subdivision of the health depart- 
 ment, and it is not unlikely that before long the health department of 
 every large city will develop a special division for mental health. 
 
 The problems which present themselves for solution by mental science 
 in connection with police work are: 
 
 First, the general problem of the existence of mental disease or mental 
 defectiveness in persons under observation. 
 
 Second, the very important and broad problem of pathological per- 
 sonalities. In a great number of cases this seems to be one of the impor- 
 3 [171
 
 tant underlying factors in the interpretation of behavior disorders. A 
 greater interest in these problems and a more intelligent application of 
 the knowledge obtained in their scientific solution are essential if we are 
 ever to reduce the seriousness of a large group of problem cases. In order 
 to make clear the meaning of this one needs merely to refer to the rela- 
 tionship between the psychopathic personality and vagrancy, non-sup- 
 port, desertion, inebriety, drug addiction, and the types of delinquency 
 in which sex difficulties are a decisive factor. 
 
 There are certain special relations in addition to these general ones 
 in which mental science may be of assistance to the police. Two espe- 
 cially demand attention: 
 
 First, the general question of malingering, which is to some extent a 
 factor within the police force and is of the utmost importance in relation 
 to the analysis of individual dehnquents and criminals. The value of a 
 testimony, the reliability of a witness, the question whether an individual 
 is shamming insanity, injury, or disability, may often be solved or at 
 least determined by applying the rules of mental examination to the in- 
 dividuals under observation. 
 
 The second has to do with forced confessions or the so-called "third 
 degree." A suspect is apprehended and many points of circumstantial 
 evidence point to his being the criminal or at least implicated in a 
 criminal affair. But the chain of evidence is by no means complete, and 
 the suspect denies more or less successfully his guilt or complicity. Under 
 such circumstances a confession, if gained, may be corroborated by evi- 
 dence now easy to secure. Such a confession almost invariably simpHfies 
 the work of the police to such a degree that in many cases they are bent 
 on securing a confession rather than objectively securing the available 
 evidence. 
 
 It is not our wish here to discuss this method from the legal nor the 
 police aspect. From the point of view of the scientist it is a clearly in- 
 effectual and dangerous method. Not only is it apt to be misleading, but 
 its chief fault is that it tends to accustom police officers to seek the easiest 
 way out of a difficult situation, rather than to apply the best methods of 
 scientific investigation. 
 
 However, confessions probably will continue to be sought, and in 
 connection \^ith this work a specialist in mental examination would prove 
 of a.ssistance. A careful mental examination will disclose whether a per- 
 son is able to give reliable information, whether he is suggestible and to 
 what degree, and therefore whether he will accept readily the suggestions 
 of the "third degree." Furthermore, laboratory methods are of con- 
 siderable aid in determining whether a person is withholding informa- 
 
 ( IS]
 
 tion, whether he shows well-marked emotional reactions, and many 
 other points now too often ignored in the prosecution of unscientific in- 
 vestigations. 
 
 Recommendations 
 
 1. Three additional police surgeons should be appointed to serve as 
 assistants to the poHce surgeon. 
 
 2. These surgeons should be employed on full time. 
 
 3. They should include in their duties medical and surgical attention 
 to the suspects and prisoners lodged in the police jail. 
 
 4. One of the assistant police surgeons should be an expert in psy- 
 chiatry, and should be known as the mental health officer. 
 
 5. The mental health officer of the police department should serve full 
 time. 
 
 6. The mental health officer should devote his time to the mental 
 problems in connection with the police force and the police work. 
 
 7. The mental health officer should make a mental and personality 
 examination of every candidate for appointment to the police force and 
 should record his findings. 
 
 8. Reexaminations of every member of the police force should be 
 made by the surgeon and mental health officer once every year. 
 
 9. The mental health officer should be present whenever possible at 
 all special examinations of prisoners and suspects, especially in the case 
 of examinations conducted with the purpose of obtaining so-called "con- 
 fessions." 
 
 Crime Detection by the Coroner's Office 
 "The office of coroner has long been a subject of comment and unfavorable 
 criticism in this countr3\ Phj'sicians and medical societies have made frequent 
 efforts to secure a more efficient administration of the duties devolving upon this 
 office, baws have been enacted establishing other offices as well as State boards 
 and commissions which have gradual!}' taken away many of the duties formerly 
 belonging to the coroner. The importance of the office has so decreased that 
 little attention is given by the political parties or by the voters to the candidates 
 who seek election to the position. And even less attention is given by the public 
 to the actual administration of the office by the men elected." 
 
 Thus begins the report of the investigation made by the Coroner's 
 Committee of the Municipal Association of Cleveland in 1912, and in the 
 nine years which have passed since the pubfication of this report prac- 
 tically nothing has been done to correct conditions or to apply any of the 
 recommendations made at that time. With minor changes the report is 
 valid today. 
 
 I 19]
 
 The office of coroner in Ohio is governed entirely by statute. The 
 Ohio constitution of 1802 provided that one coroner should be elected in 
 each county; but no provision for this office is contained in the present 
 constitution. Under statute one coroner is elected in each county in the 
 even-numbered years, who holds office for two years from the first Mon- 
 day of the January following his election. The statutes make no pro- 
 vision for deputy coroners or other assistants, although reference is made 
 to "the official assistant of the coroner," for whom, however, no appro- 
 priation is made. Because of the advantage of medical knowledge in this 
 work it has been the custom to nominate physicians for the office of 
 coroner. 
 
 The coroner's chief duty is to determine in cases of sudden or unex- 
 plained death the causes of death and whether it resulted from unlawful 
 means, and, in the latter case, to fix responsibility for the crime and name 
 the perpetrator. It is obvious, therefore, that a consideration of the 
 office of coroner is well within the scope of a survey of the administration 
 of justice. 
 
 Upon the proper execution of the coroner's duties depends, in no small 
 measure, the strict enforcement of the law in homicide cases. A lax per- 
 formance of these duties, whether due to carelessness, intentional neglect, 
 or merely to ignorance, gravely affects the community. Public safety, 
 especially in large and congested centers of population, requires now, as 
 perhaps never before, that the inquiry into the cause of death shall be 
 conducted according to the best modern theories and with the most ex- 
 pert knowledge and skill. It is easy to simulate an accident or suicide 
 and therefore the definite determination that violence has been used 
 may be well-nigh impossible unless the utmost skill and scrupulous 
 scientific accuracy are brought to bear. It is clearly unsafe to trust such 
 work to any but a highly competent pathologist and medico-legal expert. 
 
 The coroner's duties are given in the following excerpt from The 
 Coroner's Office, Efficiency Series, Report No. 2, issued by the Municipal 
 Association of Cleveland in December, 1912: 
 
 Inquests 
 
 Tho main duty of the coroner is holding inquests. Sections 2856 and 2857 
 of the (ieneral Code provide for the holding of inquests and set forth the method 
 of procedure as follows: 
 
 "Section 2856. When informed that the body of a person whose death is 
 supposed to have been caused by violence has been found within the county, the 
 coroner shall appear forthwith at the place where the body is, issue subpcenas 
 for .such witnesses as he deems necessary, administer to them the usual oath, and 
 proceed to inquire how the deceased came to his death — whether by violence 
 
 [20]
 
 from any other person or persons, by whom, whether as principals or accessories 
 before or after the fact, and all circumstances relating thereto. The testimony 
 of such witnesses shall be reduced to writing, by them respectively subscribed, 
 except when stenographically reported by the official stenographer of the 
 coroner, and with the finding and recognizances hereinafter mentioned, if any, 
 returned by the coroner to the clerk of the Court of Common Pleas of the county. 
 If he deems it necessary, he shall cause such witnesses to enter into recognizances, 
 in such sum as may be proper, for their appearance at the succeeding term of the 
 Court of Common Pleas of the county to give testimony concerning the matter. 
 The coroner may require any and all such witnesses to give security for their 
 attendance, and if they or any of them neglect to comply with his requirements, 
 he shall commit such person to the prison of the county, until discharged by due 
 course of law. 
 
 "Section 2857. The coroner shall draw up and subscribe his finding of 
 facts in wTiting. If he finds that the deceased came to his or her death by force 
 or \'iolence, and by any other person or persons, so charged, and there present, 
 he shall arrest such person or persons, and convey him or them immediately 
 before a proper oflftcer for examination according to law. If such persons, or any 
 of them, are not present, the coroner forthwith shall inform one or more justices 
 of the peace, and the prosecuting attorney, if within the county, of the facts so 
 found, in order that the persons may be immediately dealt with according to 
 law." 
 
 The terms used in Section 2856 have been construed by the Ohio Supreme 
 Court (62 O.S. 307) as follows: 
 
 "A death 'caused by violence' is a death caused by unlawful means, such 
 as usually call for the punishment of those who employ them. A body ' is found' 
 within the county when it is ascertained by any means that it is within the 
 county." 
 
 '"Death is supposed to have been caused by \aolence,' whenever from such 
 observation as he may be able to make, and from such information as maj' come 
 to him, the coroner is, for reasons of substance, led to surmise or think that death 
 has been so caused." 
 
 As thus interpreted by the Supreme Court, the statute, in referring to "death 
 by violence," means intentional killing as distinguished from mere negligence. 
 No criminal negligence act has thus far been passed in Ohio, and the terms of 
 the present statute are certainly not intended to confer general jurisdiction upon 
 the coroner in cases of accidental deaths by railroads, street cars, in manufactur- 
 ing plants and the like, except in cases where death is supposed to have been 
 caused by "unlawful violence" and not mere negligence. 
 
 However, there is one exception to the general rule, namely, that Sees. 926-7 
 seem to require the coroner to hold inquests in all reported cases of fatalities 
 occurring by explosion or accident connected with a mine, regardless of the 
 question of criminality. Moreover, the statutes now provide (Sees. 212-3) that 
 in cases of death occurring without medical attendance it shall be the duty of 
 
 [21]
 
 the undertaker to notify the registrar of vital statistics of such death and, if 
 such death appears to the registrar to have been caused by unlawful or suspicious 
 means, he shall refer the case to the coroner for inquest. 
 
 The statutes further provide (Sees. 6268-9), in cases where the death of an 
 inmate of a licensed maternity boarding-house or lying-in hospital is reported 
 to the board of health, that such board of health shall forthwith call upon the 
 coroner to hold an inquest unless the certificate of a legally qualified physician 
 is exhibited specifying the cause of death. 
 
 The practical effect of Sec. 2856, giving the coroner jurisdiction to act in cases 
 where "death is supposed to have been caused by violence" is to make it dis- 
 cretionary' with the coroner in what cases he shall act; and renders it practically 
 outside the power of the courts to regulate the actions of the coroner in this 
 regard. The language of this section is so broad that the extent of the coroner's 
 authority is left almost wholly to his discretion and good faith; and any criticism 
 of his having a.ssumed jurisdiction unnecessarily could be met with the general 
 rule that a public officer's acts are presumed to be according to law and in good 
 faith. In brief, the coroner is his own guide as to the number of inquests he will 
 hold. 
 
 Autopsies 
 
 The statutes provide (Sec. 2495) that "The county commissioners may allow 
 a physician or surgeon, making a postmortem examination at the instance of the 
 coroner or other officer, such compensation as they deem proper." Although the 
 coroner may determine in what cases autopsies shall be performed, and who shall 
 p>erform them, the commissioners thus have entire discretion as to compensation, 
 and in practice their wishes largely control as to the kinds of cases in which 
 autopsies shall be made. Autopsy fees and the relative number of autopsies 
 performed vary greatly, therefore, in different counties. 
 
 Formerly in Cuyahoga County the coroner distributed the autopsies among 
 favored physicians or hospital internes. Under the present administration the 
 coroner has assigned this work to his "deputy," Dr. Droege, and under an agree- 
 ment between the county commissioners and Dr. Droege he performs all autop- 
 sies at a uniform charge of $15 and confines his examinations to cases of supposed 
 homicidal death. 
 
 Further Duties 
 
 Where the coroner attends upon the body of a deceased person it is his duty 
 (Sec. 2860) to notify friends or relatives of the deceased if known, or if not known, 
 to advertise the fact of death in a newspaper. 
 
 He is required (Sees. 2859 and 2861) to make an inventory of all articles of 
 property found on or about the body, and to return the inventory (Sees. 2861-3) 
 and the articles described therein to the Probate Court, where such property 
 other than money becomes subject to the order of the Probate Court, for its 
 pre.servation or other disposition, the rights of administrators and executors 
 (Sec. 2684) being fully recognized. The statute directs that such property (Sec. 
 2863) as is unidentified or unclaimed shall be advertised and sold at public sale 
 
 [22]
 
 annually by the Probate Court and the proceeds paid into the county treasury. 
 However, money found shall be applied first (Sec. 2S62) to paying the expenses 
 of saving the body, and of the inquest and burial, and the remainder shall be 
 paid into the county treasury, where, on proper proof being offered, such money 
 as well as the proceeds of property sold shall be paid over to the claimant entitled 
 to it. 
 
 Anomalous Duties of Ohio Coroners 
 
 In addition to the duties which it would seem properly belong to the office 
 of coroner, he is bj' statute in Ohio made a process server, both for the Common 
 Pleas Court (Sec. 2835), where the sheriff is an interested party, and for the 
 Probate Court (Sees. 1596 and 1599), generally, and in certain cases (Sec. 11435) 
 he may further be called on for summoning a jury. Moreover, he is given the 
 additional duties (Sec. 13606) of endeavoring to arrest convicts escaping from the 
 penitentiar>', and (Sec. 9914) of apprehending persons selling liquor contrary to 
 law within two miles of the place where an agricultural fair is being held. 
 
 In all these latter cases he is assigned duties — although his ser\'ices in such 
 instances are extremely rare — which are already enjoined upon other officers 
 by law, or for the performance of which the courts are given the power to make 
 special appointments in case of need. These special duties are clearly a survival 
 of the days when deputy sheriffs were a rarity and when the oflSce of coroner was 
 not regularly filled by a practising physician. 
 
 Compensation 
 The coroner's office is the only office still maintained on a fee basis. His 
 remuneration for his services is dependent entirely upon fees earned, the amounts 
 of which are scheduled (Sec. 2866) as follows: 
 
 (a) For viewing a dead body, three dollars. 
 
 (b) For all necessary wTitings and the return thereof, 10 cents per 100 
 words. 
 
 (c) For traveling to the place of view, 10 cents per mile. 
 
 No special fee is provided for the hearing of testimony in connection with 
 inquests, and the coroner's compensation in such cases, other than the fee for 
 viewing the body, is dependent on the allowances for necessary wTitings con- 
 nected with making up the records from the testimony and the other incidents 
 of the case. The statutes do not contemplate the making of autopsies by the 
 coroner in person and no fee is specified for this work. 
 
 The .staff of the coroner is appointed by the county commissioners, 
 the tenure of office being subject to their pleasure. The staff is under 
 the jurisdiction of the coroner, although he has no authority to discharge 
 individuals. There is little interest in the election of the coroner, the 
 name of the nominee appearing usually at the end of the ballot. 
 
 The coroner receives no specified salary, his compensation being de- 
 pendent on the collection of fees, the only county office still thus main- 
 
 [23]
 
 tained. For viewing a dead body he receives a fee of $3.00, no matter 
 where the bodj'- maybe located nor the length of time consumed in 
 reaching it. For traveling expenses 10 cents per mile is allowed. The 
 statutes do not provide special fees for the performance of autopsies by 
 the coroner. As a matter of practice, the county commissioners allow a 
 fee of S25. There is no specified fee provided for the taking of testimony 
 at inquests, compensation for this depending upon the allowance for the 
 necessary clerical work. There is no provision for extra fees and no 
 allowance to meet the expenses in especially complicated cases. Salaries 
 and wages for the staff are as follows: morgue keepers, $137.50 per 
 month; janitors, $110. 
 
 The present coroner of Cuyahoga County, A. P. Hammond, M.D., 
 has been in office since January, 1921. Dr. Hammond has been a prac- 
 tising physician and still devotes some time to general practice. He keeps 
 daily office hours at the Morgue, from 8.30 to 12 and from 1 to 3 o'clock. 
 All who have come in contact with Dr. Hammond are unanimous in their 
 commendation of his serious attitude toward his work and his desire to 
 cooperate in every way. The community is fortunate in having such an 
 officer in this very important position, especially in view of the anti- 
 quated conditions under which this work is being performed in Cuyahoga 
 County. 
 
 The statutes lay down no requirements for the office of coroner except 
 that he must not practise as an attorney or counselor-at-law. 
 
 The present practice in the coroner's office in regard to stenographic 
 service is to secure a stenographer from a typewriter company on the 
 authority of the county prosecutor. A fee of 10 cents per 100 words is 
 all the compensation available, although this sum appears to be less than 
 the salary of a regular full-time stenographer. It has been the practice 
 in the past for the coroner to employ a stenographer at his own expense. 
 
 Autopsies are performed by physicians selected by the coroner for this 
 duty. As a rule, a qualified pathologist has been employed for this work. 
 For this reason practically all the autopsy work has been of a high order, 
 a circumstance which is all the more fortunate since it is due to the good 
 judgment of the coroner, rather than to the provisions of the law. 
 
 There arc four morgue keepers and two janitors. One of the morgue 
 keepers serves as a clerk, keeping and filing the records. He assists at 
 autopsies and acts as coroner when the latter is absent. The present in- 
 cumbent was formerly an undertaker and expert embalmer. He has held 
 his present position for eight years. The other three morgue keepers do 
 general utility work, such as answering the telephone, taking messages, 
 receipting for property and money found on bodies brought in by .the 
 
 [24 1
 
 police, making entries in property books, etc. They work eight hours a 
 day, seven days a week, as the morgue is never closed. No bond is re- 
 quired and no special qualifications are named for these positions. How- 
 ever, the feeling among the morgue keepers is that they should be licensed 
 and bonded and that a qualification for this position should be experience 
 as a licensed embalmer, especially on account of the possible danger to 
 the community of careless handling of the bodies of persons who have 
 died of contagious disease. 
 
 The two janitors are responsible for caring for the two floors of the 
 morgue. One of the janitors serves as relief man to give the morgue 
 keepers one da\^ off a week. The morgue keepers and janitors are ap- 
 pointed and paid by the county commissioners. The discipline is not 
 good, and the staff, as might be expected under the conditions, lacks 
 esprit de corps. On account of the valuables and other property which is 
 continuously passing through the morgue, the staff must often find them- 
 selves in positions where their honesty may be questioned, a circum- 
 stance which further tends toward bad morale and consequently lessened 
 efficiency in the service. 
 
 In addition to the above, there is a special constable attached to the 
 coroner's office who serves the necessary legal papers in subpoenaing 
 witnesses. This ofiicer is allowed considerable discretion in deciding 
 which witnesses to subpoena. Usually the selection depends entirely 
 upon his judgment. The fee for this work is paid by the county treasurer 
 through the auditor, and the total sum varies considerably in amount in 
 a year. It is said that formerly considerable sums were paid over annu- 
 ally for such service. 
 
 1. Relation to Police 
 
 The Division of Police sends the coroner a copy of its reports on 
 criminal cases. The coroner also makes a report to the police of all cases 
 coming to his notice. If a dead body is discovered in surroundings indi- 
 cating violence, the police assume responsibility for all weapons and 
 other objects which might serve as evidence and exhibits. The coroner 
 takes possession of the body and personal belongings. The police later 
 turn over to the prosecutor all property in their possession. 
 
 The police emergency or ambulance conveys bodies to the morgue in 
 practically all cases. This has become the custom only of late, since the 
 poUce emergency has superseded the old ambulance service which used 
 to be in the hands of undertakers. Occasionally bodies are brought to 
 the morgue in undertakers' wagons. A policeman accompanies the body 
 and makes a list of the clothing and property found. The morgue keeper 
 
 (25 1
 
 makes an examination of the clothing of the corpse in the presence of the 
 poHce officer, making an inventory of all property found, and an entry 
 in the property book which the policeman signs as a witness. There is 
 thus a double check on all property. 
 
 In murder or suspected murder cases the clothing is put in a bag and 
 kept in the morgue, available for use in evidence. In criminal cases 
 clothing and property are released to relatives only on order of the 
 prosecutor. Bullets taken from bodies are carefully preserved and im- 
 portance is attached to the necessity of proving that the bullet submitted 
 as evidence was actually the one taken from the body. Some years ago 
 a case occurred in which a person indicted for murder was not convicted 
 because of careless handling of the evidence, which in this instance was a 
 bullet. In the case of bodies which are in an unidentifiable condition, due 
 to exposure or long immersion in water, or to trauma, the skill of the 
 expert embalmer has proved of value to the morgue by so restoring the 
 bodies that identification was possible. 
 
 In manslaughter and murder cases police officers or detectives are 
 present at the autopsies. There is naturally a great deal of cooperation 
 between the coroner's office and the police in detecting crimes, evidence 
 often being obtained in the morgue in regard to the exact cause of death, 
 the nature of the weapon used, and many other details which prove of 
 value to the criminal detective agencies. The police sometimes bring 
 suspects to the morgue for "third degree" purposes, suddenly confront- 
 ing the suspect with the body of the victim. 
 
 2. Relation to Courts 
 
 The coroner and his assistants have relations with the Municipal 
 Court, the grand jury, the Common Pleas Court, and the Probate and 
 Juvenile Court. 
 
 The coroner or his assistants are subject to call as witnesses in the 
 Municipal Court before the cases are bound over to the grand jury. The 
 coroner testifies before the grand jury, submitting for its use copies of the 
 report of the autopsy and the inquest. In all Common Pleas Courts the 
 coroner or his assistants testify in murder cases. The present coroner 
 is of the opinion that this testimony would be of more value if the coroner 
 himself performed the autopsy. The coroner, as well as all the assistants 
 and employees, are, of course, subject to subpoena in court to prove corpus 
 delicti. 
 
 The Probate Court law of 1920 makes the coroner custodian of all 
 property in coroners' cases. All unclaimed money is held for a year and 
 then turned over to the Probate Court. A property list is made. and 
 
 [26]
 
 must be filed by the morgue keeper and the coroner. Property of any 
 amount or value may be released to relatives or other claimants upon 
 order by the Probate Court. If, however, the property is of considerable 
 value, it is turned over to an especially appointed administrator. The 
 order from the Probate Court releasing property is carefully filed at the 
 morgue in the property book. 
 
 The relations of the coroner to the Juvenile Court are of little impor- 
 tance, as the coroner and his assistants are rarely called upon to appear in 
 this court. 
 
 3. Relation to Prosecutors 
 
 The nature of the coroner's duties and functions necessitates much 
 contact with the prosecutor's office. The effectiveness of the service is 
 somewhat influenced, therefore, by the personal relations existing be- 
 tween these officers. The present coroner and the city prosecutors are on 
 friendly terms, and as a result, cooperate satisfactorily. The county 
 prosecutor decides in which cases to hold autopsies. A representative of 
 the county prosecutor's office is usually present to assist in coroner's 
 inquests. The coroner and his assistants are often called to the poUce 
 station to give information regarding the bodies and to aid the police in 
 preparing cases. During the trial they are often called upon to testify in 
 court. The coroner and his assistants are called in by the prosecutor to 
 establish the cor-pus delicti and to bind the prisoners over to the grand 
 jury. 
 
 Jf. Relation to the Bar 
 
 Lawyers acting as counsel in both civil and criminal actions may come 
 to the morgue for information or evidence. A lawyer may attend the 
 coroner's inquests and may question witnesses, but cannot enter objec- 
 tions. 
 
 5. Relation to the Medical Profession 
 
 Physicians report to the coroner cases of sudden death, usually by 
 telephone. The coroner then decides whether or not to claim the case. 
 When the coroner decides not to assume jurisdiction, the physician may 
 perform the autopsy himself, either at the morgue or at his own oflBce. 
 
 6. Administrative Relations 
 The coroner issues certificates to undertakers through the Board of 
 Health. Sometimes the district phj'sicians feel they cannot issue death 
 certificates because of suspicious circumstances, and so report to the 
 Board of Health, which in turn reports to the coroner. The city chemist 
 analyzes stomach contents, secretions, and excretions obtained from the 
 body in suspicious cases. In all cases of death occurring without medical 
 
 127]
 
 attendance within the city Hmits the district physician may view the 
 body and report "Cause of death unknown." In cases of sudden death 
 without medical attendance occurring in the county outside of the city 
 of Cleveland, the sheriff performs the functions which, within the city 
 limits, are performed by the police. He notifies the coroner when such 
 cases are found, and accompanies the coroner to the bodj'. The sheriff 
 takes the weapons and all suspicious objects; the coroner claims the 
 body and the property on it. In the case of probable suicide the coroner 
 also takes possession of the gun or other weapon. 
 
 The county commissioners "O. K." all bills of expense of the coroner's 
 office. There is no supervision of the county work. At present both the 
 municipal and county administration are Republican. One of the morgue 
 keepers who is a Democrat stated to the investigator that there are no 
 pohtical troubles. 
 
 The present coroner is on friendly terms with the county prosecutor. 
 They cooperate in inquests and in other activities connected with their 
 duties. This has not always been the situation, and difficulties have oc- 
 curred because of strained relations between coroner and prosecutors. 
 
 7. Equipment 
 
 The public morgue was created by special statute passed in 1896 (92 
 Ohio Laws, 678). It was placed in care of the coroner, who is directed to 
 see that all dead bodies received are properly preserved until identified or 
 claimed for bm-ial; to collect from friends or relatives of such deceased 
 persons not residing in the county a sum not to exceed $10; and to have 
 photographed all bodies not properly identified. 
 
 The morgue occupies a two-story building. On the first floor are the 
 oflSce of the morgue keeper and a safe for property, a well-equipped 
 autopsy room, and a viewing hall. The morgue has capacity for 100 
 bodies at a time. This space is arranged in four sections, the first of 
 which only is cooled by refrigeration, because of the fact that it is easier 
 to embalm bodies which have not been frozen. Hence most of the bodies 
 are kept in the non-refrigerated sections. On the second floor are the coro- 
 ner's office, a safe for property, and the office of the assistant clerk, a well- 
 appointed inquest room, and files and records which go back to 1828. 
 These files and records are kept in the inquest room. The filing cabinets 
 contain the following data in each case: viewing sHp, inquest slip, a 
 carbon copy of the police report of criminal cases, testimony of witnesses, 
 and the autopsy records, all filed together in a folder. 
 
 [281
 
 8. Death Records 
 
 Only the knowledge that we are dealing with a very serious subject 
 prevents us from treating in a lighter vein some of the results of the coro- 
 ner's work as performed under present conditions. Indeed, we cannot 
 entirely suppress a sense of the ridiculous when we read over the list of 
 causes of death as officially recorded by the coroner of Cuyahoga County 
 for the year 1919. 
 
 The first entry for the year is: 
 
 No. 22942 : " Could be suicide or murder," a reassuring statement and 
 one calculated to promote confidence in the guardians of public safety. 
 
 Again a few lines further along we read: No. 22957 — "Auto accident 
 or assault." Certainly this expresses a doubt which the public would be 
 interested to have resolved further. 
 
 No. 23178: "Aunt said she complained of pneumonia, looked Hke 
 narcotism." Is it necessary to dwell on the extraordinary convenience of 
 having the subject thus obligingly perform the work of the coroner by 
 confiding the diagnosis and thus settling at the same time the cause of 
 subsequent demise? 
 
 No. 23203: "Believe strychnia used — viewed as suicide." Is it not 
 possible to know whether strychnia was or was not used? 
 
 No. 23241: "Looks suspicious of strychnine poisoning," and this 
 suspicion must forevermore poison the mind of anyone who turns the 
 pages of the coroner's record because the county of Cuyahoga did not be- 
 lieve it important to know whether this was a case of homicide, suicide, or 
 an accident. 
 
 Consider from the point of view of law enforcement and the public 
 safety such records as these: 
 
 No. 22964 
 No. 22987 
 No. 22990 
 No. 23035 
 No. 23050 
 No. 23135 
 No. 23187 
 No. 23253 
 No. 23300 
 No. 23484 
 No. 23512 
 No. 23551 
 No. 23568 
 No. 23574 
 
 'Found dead." 
 'Found dead in shanty." 
 'Head severed from body." 
 'Could be assault or diabetes." 
 'Premature or abortion." 
 'Found dead in alley — lobar pneumonia." 
 'Diabetes, tuberculosis, or nervous indigestion." 
 'Consider it tuberculosis." 
 'Found dead." 
 'Found crushed." 
 'Could be diabetes or poison." 
 'Died suddenly after taking medicine." 
 'Medicinal poisoning." 
 'Body entirely burned." 
 129]
 
 No. 23577 
 No. 23605 
 No. 23670 
 No. 23686 
 No. 23687 
 No. 23731 
 
 "Found dead in bath-room." 
 
 "Died suddenly." 
 
 "Loss of blood." 
 
 "Shock." 
 
 "Body covered with sores." 
 
 "Acute arsenical poisoning-accident." 
 
 In none of these cases was an autopsy performed, although one would 
 suppose that in some, if not in all, more precise information is needed not 
 onlj' to determine the exact cause of death, but definitely to exclude 
 foul play. 
 
 9. Cost of Administration 
 
 The apparent cost of administration of the coroner's office appears to 
 be about one-half what it was in 1912. The scattering of items through- 
 out the county work makes it impossible to be exact, but it is safe to 
 assume that the entire cost of administration, including the morgue and 
 numerous miscellaneous items, is between S10,000 and S15,000 annually.^ 
 
 REPORT OF AUDITOR'S OFFICE OF CUYAHOGA COUNTY ON THE 
 EXPENSE OF THE CORONER'S OFFICE 
 
 
 September, 
 1912 
 
 September, 
 1919 
 
 September, 
 1920 
 
 Coroner's fees 
 Constable's fees 
 Witness' fees 
 Autopsy fees 
 Miscellaneous 
 
 86,101.75 
 
 1,585.30 
 
 1,801.90 
 
 1,155.00 
 
 127.61 
 
 84,629.10 
 
 14.40 
 1,290.00 
 
 81,876.82 
 
 5.50 
 
 12.60 
 
 2,760.00 
 
 44.55 
 
 Totals 
 
 $10,771.56 
 
 85,933.50 
 
 $4,699.47 
 
 Even a cursory glance at the foregoing suffices to show that the work 
 of coroner as now performed is far from adequate. It is indeed high time 
 that the facts are faced and an effective arrangement commensurate with 
 modern scientific efficiency be instituted. 
 
 This means abolishing the office of coroner. 
 
 10. The Remedy 
 During the recent (1921) session of the Ohio Legislature a bill was in- 
 troduced through the efforts of the present coroner of Cuyahoga County, 
 Dr. A. P. Hammond, which was designed to meet some of the objections 
 
 ' The budget for the office of chief medical examiner of New York for the year 
 1921 is $127,.303, of which $120,653 is for salaries and wages. 
 
 130 1
 
 without abolishing the office of coroner. This bill allows the coroner, in 
 counties having a population of 100,000 or more, to appoint an official 
 stenographer, and "in counties where there is maintained a county 
 morgue, the coroner may also appoint necessary assistant custodians of 
 the morgue, in no case to exceed three in number." Above all, in counties 
 having a population of 100,000 or more, "no person shall be eligible to the 
 office of coroner except a licensed physician of good standing in his pro- 
 fession." 
 
 The principal objections to this bill are: 
 
 1. That the coroner is elected and not appointed. Keeping the office 
 in pohtics makes it impossible to secure the quality of service required. 
 No competent expert can be induced to subject his work or his profes- 
 sional career to the uncertainties of partisan pohtics. Continuity of ser- 
 vice and freedom from extraneous interference are the sine qua non of 
 scientific efficiency. 
 
 2. That the decision whether or not to perform an autopsy rests not 
 with the coroner, but with the prosecuting attorney. This most perni- 
 cious custom makes the scientific determination of the cause of death 
 subservient to the requirements of the prosecutor's office and dependent 
 upon the state of his finances, instead of regarding such determination as 
 a complete end in itself, the results to be used in whatever way may be 
 considered proper by the prosecutors or anyone else. 
 
 3. That the coroner should be a physician, but not necessarily experi- 
 enced in pathology. It is amply demonstrated by the history of the coro- 
 ner's office in Cuyahoga County that securing a physician as coroner does 
 not in itself constitute a sufficient safeguard against unsatisfactory results. 
 
 In 1877 the General Court of Massachusetts abolished the coroner 
 and created in his place a medical examiner.^ Dr. George Burgess 
 Magrath, medical examiner of Suffolk County, Massachusetts, has 
 kindly furnished the following statement in regard to the Massachusetts 
 law and its functioning: 
 
 The Massachusetts Medical Examiner Law was enacted in 1877. It abol- 
 ished the office of coroner, assigned to physicians appointed by the governor all 
 of the responsibilities involved in the investigation of the cause and manner of 
 deaths supposedly due to injury, and delegated to justices of courts of first in- 
 stance the magisterial function of fixing the responsibility for a death due to 
 an unlawful act. The only important modification of the original statute is one 
 made a few years ago by an amendment which substituted for the word "vio 
 lence" the words "act or negligence of another" in that portion of the law 
 governing inquests. 
 
 ' The Massachusetts law is appended. 
 [31]
 
 The statute is not highly specific in its definition of the jurisdiction of a 
 medical examiner, in that it merely provides for his functioning in the case of 
 death of any person "supposed to have come to his death from violence." The 
 interpretation of this statute by the medical examiners of the commonwealth is, 
 however, such as to extend its provisions to include all deaths caused directly or 
 indirectly by traumatism, including traumatic septicemia, deaths caused by the 
 action of chemical substances, of thermal or electrical agencies; deaths fol- 
 lowing abortions, irrespective of circumstances; deaths from disease resulting 
 from injury or infection relating to occupation; deaths from neglect; sudden 
 deaths of persons not disabled by recognized disease; and the deaths of persons 
 found dead. This interpretation is, of course, necessary in order to make the 
 law of any practical value, and brings within the scope of its operation deaths 
 universall}'^ recognized as appropriate for medico-legal inquiry. 
 
 The principal advantages of the Massachusetts type of medico-legal inquiry 
 over the coroner system are as follows: 
 
 (1) The separation of medical and judicial functions and the delegating of 
 each to appropriate officials. 
 
 (2) The giving to the medical investigator the primary and full jurisdiction 
 over the body of the decedent, thereby insuring to him ample opportunity to 
 observe conditions or circumstances tending to show the manner as well as the 
 cause of death. These often include facts susceptible of recognition and proper 
 interpretation by a medical examiner only. 
 
 (3) The economy incidental to the use of existing courts which dispenses 
 with the coroner's court and jury. 
 
 (4) The placing where it belongs, in the hands of a medical man, the duty of 
 determining promptly the cause of death, whereby crimes against life may be 
 immediately brought to light and the appropriate judicial and police authorities 
 notified thereof; whereby also deaths from injury other than that incidental to 
 the act or negligence of another, as well as deaths from so-called natural causes, 
 may be recognized as such with equal promptness, without unnecessary pub- 
 licity, and without the use and incidental expense of a court or coroner's jurj'. 
 
 (5) The opportunity existent is an appointive position of selecting therefor 
 physicians qualified by special training and experience. 
 
 Dr. Charles Norris, Chief Medical Examiner of New York city, under 
 the recently enacted law of New York^ abolishing the coroner and estab- 
 lishing the office of chief medical examiner, has thus summed up his expe- 
 riences and conclusions:'^ 
 
 General dissatisfaction with the work of the coroner of the city of New York 
 
 ' Laws of New York, 191.5, Chap. 285. "An act to amend the Greater New York 
 Charter and repeal certain sections thereof." (See also: Laws of New York, 1882. 
 Chap. 410.) 
 
 *"The Medical Examiner versus the Coroner," by Charles Norris, M.D., Na- 
 tional Municipal Reiiew, Vol. IX, No. 8, August, 1920. 
 
 132]
 
 resulted in many attempts in the legislature at Albany to abolish this office and 
 to substitute an office to be known as medical examiner, after the fashion of that 
 created many years before in Massachusetts, f'inally on April 14, 1915, the 
 office of the coroner was abolished and in its place the office of chief medical 
 examiner was established. 
 
 The Coroner's Office Breaks Down 
 
 Unlike the coroner's office, the medical examiner's office was not given quasi- 
 judicial powers, but was vested with sufficient authority to administer oaths 
 and take affidavits, proofs, and examinations as to any matter within the juris- 
 diction of the office. The judicial functions formerly vested in the coroners 
 were, under the medical examiner's act, transferred to the proper legal authori- 
 ties, namely, the magistrates and the grand jur}'. Prisoners are now held by the 
 magistrates, and the defendants are indicted by the grand jury upon presentation 
 of the facts by the district attorney from the reports furnished by the medical 
 examiner, the police and witnesses. 
 
 The judicial functions of the coroner's office are now more satisfactorily and 
 quickly handled bj' the legally trained magistrates and by the grand jury under 
 the guidance of the district attorney. In other words, the judicial functions of 
 the coroner's office are redundant and have no proper place. 
 
 The correct determination of the cause of death is designated as medical 
 jurisprudence, the science which correlates our medical knowledge to the purpose 
 of the law\ Thorough equipment in medicine and surgery must be supple- 
 mented by a knowledge of firearms, the efTect of bullets on the human body, 
 recognition of powder marks and burns, etc. Familiarity with the biological 
 methods employed in testing suspected blood, semen, and other stains; prac- 
 tical knowledge of botany in the examination of dust and foreign material upon 
 the clothes of suspects and in the examination of the intestinal contents for parti- 
 cles of food, that is, plant seeds and fibers of animal and vegetable origin; an 
 acquaintance with the flora and fauna of waters, namely, diatoms, etc., may be 
 of great assistance in the microscopic examination of the contents of the lungs 
 and stomach of persons supposed to have been drowned; and again, the de- 
 termination of the freezing-point and the differences in the salt content between 
 the blood of right and left side of the heart may be of use to confirm or negate 
 the diagnosis of drowning. Entomolog>' also may be of considerable assistance 
 in establishing the date of death through the cadaveric flora and fauna. 
 
 This incomplete summary of the duties of the pathological expert serves to 
 emphasize the point I wish to make. That the officer who.se duty it is to make 
 such examinations which have as their one and single aim the determination of 
 the cause of death and a correct and analytically interpretative analysis of the 
 surrounding circumstances attending, must be a physician by education, tech- 
 nically and practically trained in these branches. No lay or professional man 
 other than a well-trained pathologist as above defined pos.ses.ses the requisite 
 natural or legal qualifications to discharge properly the duties of such an office. 
 4 ['s:i\
 
 The records of the medical examiner's office are open to the public, and daily 
 use of such records is made by representatives of insurance companies, the 
 families or representatives of the deceased, the army and navy authorities 
 (especially during the late war), and the State Industrial Commission. Whereas 
 under the coroners, the chemical examinations, even in poison cases, were not 
 made except here and there, when the services of the pathological chemist of 
 BelleYTje Hospital in Manhattan were called upon to aid in a scientific inquiry, 
 the office at the present time is constantly required to furnish evidence of the 
 presence or absence of alcohol and of poisons. We are furnishing constantly to 
 the department of health, the census bureau at Washington, and the various 
 insurance companies, information in order to give them accurate data for pur- 
 poses of classification, etc. The educational value of our reports is illustrated by 
 the curious fact that the office is now criticized in those instances where chemical 
 examinations are not made. 
 
 Without the aid of a properly organized chemical laboratory many certifi- 
 cates of death would be signed improperly. A most noteworthy illustration of 
 this point is the fact that before the attention of the country was called to the 
 so-called epidemics of wood alcohol poisoning, this office had become aware of 
 the iniquitous sale of methylated spirits in place of grain alcohol through the 
 routine clieniical examination of cases which had come to autopsj'^ in which the 
 pathological lesions were indefinite. 
 
 The difficulty in abolishing a long and well-established office, as was the 
 coroner's, is abundantly illustrated by the discussions which took place before 
 the senate committee on city affairs in 1915. The arguments presented by the 
 representatives of the coroner's system were that the coroners' physicians had 
 surveyed a very large number of cases, that they were competent in view of this 
 fact, that the establishment of a medical examiner's office would entail an 
 extraordinary expenditure of moneys — some claiming that a satisfactory substi- 
 tute of the system could not be maintained under less than half a million dollars 
 a year. As a mere matter of fact, the medical examiner's office was created with 
 a budget of about S65,000 less than the coroner's budget for Greater New York. 
 The favorite arguments of the coroners were that they were the protectors of 
 the rights of the people, that the new system was instituted purely for the bene- 
 fits of the medical colleges and that the introduction of a new system was merely 
 a scheme to obtain sufficient autopsies for medical purposes. Glaringly false 
 statements were made in the hearing. 
 
 The Medical Examiner Faces Perplexing Problems 
 One of the most serious tasks that the medical examiner performs is the 
 determination of criminal negligence in accident cases. This consists in the 
 investigation of the circumstances surrounding the deaths in various industrial 
 accidents, the analysis of poisonous fumes in manholes, the deaths resulting 
 from careless cyanide disinfection, either in rooms or in the holds of vessels, 
 deaths resulting from salvarsan poisoning, deaths resulting from structural 
 
 [34 1
 
 defects in wood from dry rot and in the careless construction of buildings and 
 other structures in general. In fact, the policj'- of the office is to bring out all 
 the facts, medical, pathologic, or chemical, and to present all such evidence in 
 proper fashion, making direct and trustworthy inferences and at the same time 
 to avoid the danger of looking at facts through the spectacles of theory. 
 
 The numerous cases of asphyxiation by illuminant gas which this office 
 handles yearly present a subject of considerable importance to the common- 
 wealth. The duty of the office is not merely to give a correct determination of 
 the cause of death, namely, whether accidental, suicidal, or homicidal, hut to 
 report to the proper authorities any negligence or carelessness on the part of 
 the landowner or tenant in connection with the attachments of the gas tubing 
 to the heating and illuminating apparatus or structural defects causing leakage 
 of coal gas from water heaters or furnaces. There have been a number of acci- 
 dental deaths due to the habit of a few of the keepers of boarding-houses of 
 turning off the gas at stated hours and again turning on the gas in the early 
 morning hours when the tenants arc still asleep, the burners being turned on. 
 One of the difficulties we have experienced is that there is no single department 
 which has responsibility to whom such cases can be referred with a certainty 
 they will receive prompt attention and action. The inadvisability of the use of 
 rubber tubing for gas connections was called to the attention of the board of 
 aldermen a few years ago and it is expected that action will be taken to prohibit 
 its use in connections of this kind. 
 
 I wish to call attention to the necessity of performing autopsies upon all 
 suspected cases, namely, all those cases in which the diagnosis cannot be made 
 beyond reasonable doubt. Curious illustrations have occurred in this office to 
 indicate how important a matter this is to the community. For instance, we 
 have had two cases within the past several months of supposed criminal abor- 
 tions in women in their early forties, upon whom criminal abortions have been 
 performed, and who at autopsy were found not pregnant. The department 
 examines cases rejected by the department of health and death certificates 
 signed by apparently reputable physicians have disclosed cases of acute gastro- 
 enteritis which turned out to be peritonitis following criminal abortion, and cases 
 of suicide in women supposedly pregnant (one case up to the seventh month, 
 in an elderly married woman), autopsy revealing that there was no pregnancy, 
 pregnancy being feared due to the appearance of the menopause and poison 
 being taken to deliver a supposed foetus. 
 
 Recommendations 
 
 1. The office of coroner should be abolished. 
 
 2. A law similar to the New York or Massachusetts law creating a 
 medical examiner should be enacted. 
 
 3. The medical examiner should be a physician, expert in pathology 
 and in medico-legal investigations. 
 
 4. The Board of County Commissioners should njipoint from a (•i\il 
 
 f 3o 1
 
 service list a medical examiner, and in counties having more than 100,000 
 inhabitants should appoint a chief medical examiner. 
 
 5. The chief medical examiner should have the power to appoint and 
 to remove such deputies, assistant medical examiners, scientific experts, 
 officers, and employees as may be provided for by law. 
 
 G. The medical examiner or his deputy or assistant should take charge 
 of the body of any person who has died from criminal violence, or by a 
 casualty, or by suicide, or suddenly when in apparent health or when 
 unattended by a physician, or in prison, or in any suspicious or unusual 
 manner. 
 
 7. If, in the opinion of the medical examiner, an autopsy is necessary, 
 it should be performed by the medical examiner or his deputy or assis- 
 tants. 
 
 8. The medical examiner should be in charge of the morgue. 
 
 9. Suitable laboratories, autopsy rooms, record rooms, and vaults, 
 properly equipped for the performance of whatever investigations may 
 be required in the course of the medical examiner's work, should be pro- 
 vided at the morgue. 
 
 10. A budget should be drawn up for the office of medical examiner 
 each year, based upon the total amount of work to be done and not upon 
 any proportionate relation to other public expenditures. 
 
 Prosecution 
 
 There is no provision for special medical examination in connection 
 with prosecutions. It is left to the discretion of the prosecutor to call in 
 physicians or other specialists to serve as expert witnesses. This is in 
 accordance with the course pursued almost everywhere, and probably is 
 satisfactory, according to present standards. There are certain individ- 
 ual prosecutors who consult and who may even be advised by experts 
 throughout a trial without placing them upon the witness-stand. While 
 this is a little more progressive than the general practice, it has the dis- 
 advantage of being partisan. 
 
 Prosecutors, in common with others, would benefit if there were avail- 
 able a body of expert opinion which could be invoked, as a routine 
 measure, in all criminal cases. 
 
 Adjudication 
 
 /. Municipal Court 
 In the Muni('i]>al Court no special provision is made for expert 
 mctlical or mental examinations. Cases dealt with by tliis court are in 
 the main minor ones. They do not attract attention, and are passed 
 
 [3GI
 
 through the court in a more or less routine fashion, on the genei'al 
 assumption that a delinquent requires punishment. 
 
 That the Municipal Court should constitute a process of weeding out 
 socially incompetent individuals or serious delinquent types not yet 
 guilty of a major crime is not comprehended. In a community in which 
 pubUc opinion on this subject is more advanced the Municipal Court is 
 regarded as the most important clearing-house and sorting station for 
 keeping the stream of civic life pure. 
 
 2. Common Pleas Court 
 The Common Pleas Court, criminal branch, hears cases of insanity 
 under certain conditions. There are three ways in which such cases come 
 before this court: 
 
 1. According to Sec. 13577, General Code, the grand jury may, if it 
 finds the accused person insane, report that finding to the Common Pleas 
 Court instead of indicting the person. The court then, as provided by 
 law, impanels a jury to try that fact, whether or not the person is insane. 
 If found insane, he is committed to Lima State Hospital for the criminal 
 insane. The Ihlenfeld case is the first and only case to be dealt with 
 according to the provisions of this section. Judge Baer, who tried the 
 case, says this method saves time and money. 
 
 2. After a person has been indicted, and before sentence, his attorney 
 may present to the court a certificate from a reputable physician to the 
 effect that the person accused is insane, whereupon a jury is impaneled to 
 decide the matter. The burden of proof rests on the defense. If three- 
 fourths of the jury find the accused insane, he is committed to Lima State 
 Hospital. (Sec. 13608 ff.) 
 
 3. The defense of insanity may be made at a regular trial. If the per- 
 son tried upon an indictment for an offense is acquitted on the sole 
 ground that he was insane, he is committed to Lima State Hospital, Sec. 
 13679. In all cases, if restored to reason, he may be prosecuted for the 
 ofifense. 
 
 These seem to be the only ways in which such cases come before the 
 Common Pleas Court. The number of such cases is small. During 1919 
 there were but seven cases. No separate or special records are kept; 
 the records of the number of such trials and disposition of cases arc found 
 in the general Common Pleas docket. The prosecution can oppose the 
 plea of insanity and call in doctors or other specialists as witnesses. 
 There is no special provi.sion in law for calling in experts or for their com- 
 pensation in such cases. Judge Levine and Judge Baer are of the opinion 
 that the Common Pleas judge can order examination to be made as to an 
 
 (37)
 
 accused person's sanity. No specific powers of that nature are men- 
 tioned in statutes. 
 
 In Judge Baer's opinion there should be a laboratory to investigate 
 the mental condition of persons indicted, especially in the case of recidi- 
 vists. Such work he considers belongs to a specialist and not to the 
 judge, who cannot detect such cases when they appear in court. 
 
 8. Probate Court 
 
 There are no medical experts specially attached to the Probate Court 
 to act in lunacy and feeble-minded cases. The law requires that in every 
 case of feeble-mindedness, epilepsy, or insanity two reputable physicians 
 shall be called in as medical witnesses. Technically, these are selected 
 by the probate judge in each case, and serve only for that case. As a mat- 
 ter of practice, of course, physicians appointed to this commission are 
 almost always the same; but this is purely dependent on the judge's 
 choice and judgment. The medical witnesses are paid $5.00 for each 
 case in which they testify, or, in other words, $5.00 for each certificate. 
 At present the two physicians appointed by the judge are experts in 
 mental diseases, having had experience in State hospitals. 
 
 There is no equipment for this work ; the court does not control any 
 offices or laboratories, though when it is not possible to arrive at a deci- 
 sion without special observation, the court is able, as a rule, to send the 
 patient for examination to the psychopathic ward of the city hospital, 
 which is the so-called Detention Hospital. 
 
 No selection of cases is possible ; the examinations are made in those 
 cases which are brought into the Probate Court on a complaint of in- 
 sanity, epilepsy, or feeble-mindedness. Every complaint made is ex- 
 amined. The original papers in all cases are kept in the office of the 
 court. Certified copies are sent to the hospital or other institution to 
 which the patient is sent for examination and observation or to which he 
 is committed. Reports of work are also made to the Secretary of State. 
 
 The examiners perform their work wherever necessary, according to 
 the requirements of the case. They visit patients in their homes and in 
 hospitals, at the State hospital, in jails, or wherever else they may be. 
 The recommendations of the medical examiners are nearly always carried 
 out. The judge acts upon the medical experts' advice also, and has con- 
 fidence in the examiners whom he selects because they, in his opinion, are 
 careful and conscientious in their work. Since the medical examiners are 
 appointed ijy the judge, their mutual relations are very close. Appar- 
 ently no other consideration than their fitness for the work enters into 
 their appointments. 
 
 [38]
 
 This system, which is obviously open to many theoretical objections, 
 especially the opportunity it affords for political and other considerations 
 to play an important part, is safeguarded by the fact that the present 
 probate judge is above allowing such factors to influence his judgment. 
 The medical examiners are free from the objection of being interested in 
 the State hospitals, especiallj' since the law requires that no physician 
 officially connected with these may serve as examiner for the Probate 
 Court. 
 
 In regard to the relation of medical examiners to commitment of in- 
 sane persons, there is this to be said : The law which authorized the pay- 
 ment to the medical examiner of a fee for each case committed obviously 
 places a premium on committing individuals; it would seem that the 
 interest of the physician was to commit persons rather than to keep them 
 out of institutions. Any possible tendency in this direction is counter- 
 acted, however, by the equally potent restraint of laws concerning mal- 
 practice and other legal actions. 
 
 Nevertheless, the recompensing of these special witnesses is a bad 
 practice. Physicians are not only open to the influence above mentioned, 
 but personal considerations enter in which have no place in this connec- 
 tion, such as the fact that these fees, which are paid through public funds, 
 are in the nature of a largesse and should, therefore, be distributed among 
 as large a number of physicians as possible. In the eyes of the more 
 unscrupulous it will appear as a downright "graft," which may be con- 
 nived at only if every one gets his full share. In Cleveland, as in other 
 cities where this system is used, the work is done with little, if anj^ evi- 
 dence of bad influences. Nevertheless, from the point of view of effi- 
 ciency, and above all that of educating pubhc opinion, it should be 
 changed. 
 
 The tendency in all matters pertaining to insanity, at least since 
 Charles Reade published Hard Cash, has been to remove all specific 
 incentive in the matter of commitments. This fact, probably more than 
 any other, has resulted in the respect shown for the State hospital and 
 the prejudice in favor of this institution as compared with private insti- 
 tutions for mental cases. 
 
 The decision, whether a person should be segregated to a certain ex- 
 tent and deprived of his liberty, should be made on purely objective evi- 
 dence, and while it is true that the court makes the final decision and 
 examines the records, it is nevertheless upon the evidence submitted i)y 
 the medical experts that such a decision is made by the court. If, then, 
 medical examiners are swayed, either consciously or unconsciously, by 
 other reasons than those based upon purely objective evidence, the court, 
 
 [39]
 
 even if ignorant of this, cannot act in an unbiased way. The result is that 
 medical examiners should be paid either a salary or a fixed fee for every 
 examination they make, regardless of whether commitment is recom- 
 mended or not. At present they are paid for the certificate issued and 
 not for the examination made. 
 
 The same statements which apply to the question of expert witnesses 
 in general apply here. There may be, and probably should be, two kinds 
 of experts available to the courts, the one serving as a public official on 
 salary, for either full or part time, the other physicians who, in addition 
 to the usual medical qualifications, have quaUfied and been appointed as 
 experts. When a court or other pubhc oflficial or a private individual re- 
 quires the services of an expert other than the officially salaried expert, he 
 may select one from this qualified list. This system does not force any 
 expert upon either courts or private individuals, nor does it require the 
 poor man to suffer because he cannot afford the expensive specialist. 
 Furthermore, it guarantees that the pubhc oflftcial will be non-partisan 
 and that the privately retained expert will at least measure up to the 
 minimum standard requirements. 
 
 There is another phase of the relationship between the medical and 
 particularly the mental expert and the Probate Court. In the Probate 
 Court questions of property rights, guardianship, and conservatorship 
 continually arise. While the question of mental disease or mental de- 
 ficiency may not arise, there may, nevertheless, be important considera- 
 tions in which the expert knowledge of the qualified psychiatrist would 
 be of considerable value to the court. This refers particularly to that 
 very large field of personality factors which we are just beginning to 
 study scientifically. Every judge of the Probate Court will readily rec- 
 ognize what is referred to here, and probably every judge who has served 
 in the Probate Court has made use of his experts in non-insane and non- 
 feeble-minded cases, for the purpose of evaluating the personality factors 
 before making a decision. 
 
 This important work requires specialization and, furthermore, cannot 
 be done satisfactorily unless experts making the examinations are em- 
 ployed on full time; that is, the experts cannot be expected to be effi- 
 cient if they are called in only occasionally on such cases — they must be 
 dealing with them as a matter of daily routine. 
 
 In the last year 560 cases have been examined by medical commis- 
 sions for the Probate Court at $10 a case, or a total expenditure of S5,600 
 for medical fees alone. This does not include the sheriff fees, witness 
 fees, and other incidentals. 
 
 I 40 1
 
 Recommendations 
 
 1. A chief psychiatrist should be appointed by the judge of the Pro- 
 bate Court from a civil service list. 
 
 2. The chief psychiatrist should be empowered to appoint from a 
 civil service list three assistant or deputy psychiatrists, one psychologist, 
 and one assistant psychologist. 
 
 3. Suitable salaries should be provided to attract properly qualified 
 experts. 
 
 4. The necessary clerical assistance and office quarters should be pro- 
 vided in the new court-house office building or county jail. 
 
 5. The chief psychiatrist should examine and pass upon all cases com- 
 ing from the Probate Court, the Municipal Court, and the Court of 
 Common Pleas, in which the question of sanity or insanity, epilepsy, or 
 mental deficiency is raised. 
 
 6. The chief psychiatrist should cause to be examined, physically and 
 mentally, in so far as possible, all persons coming before the Municipal 
 Court. 
 
 7. The chief psychiatrist should present to the courts in writing a 
 statement of the findings and opinion of the psychiatrist in each case 
 examined. 
 
 8. In cases of dispute or doubt the court should be able to appoint a 
 special psychiatrist to examine a case. 
 
 9. The person to be examined, his counsel, relatives, or friends, should 
 be permitted to be represented by a psychiatrist who should have access 
 to the findings of the chief psychiatrist, and who may be present at and 
 participate in the examination by the chief psychiatrist, but who may 
 not interfere with the conduct of such examinations. 
 
 10. The sheriff of Cuyahoga County and the Director of Public Welfare 
 should be able to call upon the psychiatrist to examine any person in their 
 custody and to enter a petition for commitment of any person thus ex- 
 amined who shall be found to be insane, epileptic, or feeble-minded. 
 
 11. Whenever, in the opinion of the psychiatrist, any person exam- 
 ined requires more extended study or observation than can be given at 
 the county or city jail, application should be made to the court having 
 jurisdiction, for temporary care at the city psychopathic hospital for a 
 period of ten days, or not more than three months, or until such time as 
 the director of the psychopathic hospital shall depose in writing that the 
 examination or observation has been completed. 
 
 (41
 
 CHAPTER IV 
 PREVENTION 
 
 Early Detection of Special Cases 
 
 IF WE may correctly assume that delinquencj'' in most instances is 
 not merely accidental, but is associated with characteristics and per- 
 sonal peculiarities inherent in the individual, it must follow that 
 any attempt at prevention must include elimination at the source. By 
 this we mean the examination of children of school age and even younger 
 from the point of view of mental and personality characteristics, as mani- 
 fested especially in behavior. It is by no means a certain or a simple 
 matter to determine, even after careful examination, which children will 
 present major behavior problems later in life. But it is certainly possible 
 to determine which ones are in need of immediate special training and 
 which show present behavior or mental deviations. 
 
 A careful study of this kind, followed by intensive training and obser- 
 vation of the physical, mental, and social factors involved, will, if applied 
 to enough children, be comparable to the results obtained in the same 
 circumstances by the methods of physical health training. If these 
 methods now succeed in the Juvenile Courts, where they are applied 
 after delinquency develops, there is every reason to expect even more 
 satisfactory results when applied earlier, before the major problems of 
 delinquency appear. When such a plan has been in operation for a gen- 
 eration, it is not unUkely that the problem of delinquency in the com- 
 munity will have changed so much as to make jails, as we now know 
 them, quite unnecessary. We shall probably always require places of 
 detention, but with a better understanding of the real causes of delin- 
 quency and crime and with more effective methods of prevention and treat- 
 ment it is fair to assume that future detention institutions will differ from 
 the present ones as modern hospitals differ from the ancient pest houses. 
 
 Meanwhile the police will continue to pick up and detain a large num- 
 ber of individuals who are a source of trouble and loss to the community 
 and of little profit to themselves. Even in these cases an inteUigent atti- 
 tude requires that suitable studies shall be made of each individual case 
 in order really to solve the problem, instead of depending entirely on 
 forcible detention and segregation and the supposedly curative effects of 
 
 [42]
 
 punitive imprisonment. The number of recidivists who pass through 
 our jails is ample evidence against such misplaced confidence. 
 
 Even if a thorough examination of each prisoner is not possible, a 
 sorting by simple examinations will identify extreme typos of feeble- 
 minded or psychopathic individuals. Individuals who are brought to 
 light b}^ these sorting examinations cannot ho properly disposed of with- 
 out treatment, and the treatment which may be given is one of three 
 general types or combinations of these, namely, physical, mental, or social. 
 
 Phj'sical treatment is directed against physical disease, on the one 
 hand, and physical handicaps and defects, on the other. It is not nec- 
 essary to enlarge upon this familiar topic. The main thing to emphasize 
 here is the unportance of correcting all physical disabilities, even those of 
 apparently minor significance, in the interest of improving the mental 
 and behavior reactions. Physicians often err in minimizing the effects of 
 minor phj'sical ailments. 
 
 For example, in the field of the psychoneuroses, as exemplified by the 
 cases of so-called shell-shock during the war, the slighter the physical 
 injury, the greater the psychic disturbance. In the field of behavior diffi- 
 culties this is often markedly true. It is obvious, therefore, that physical 
 examination must be performed with subtlety and niceness of observa- 
 tion. Clearly a physician, to be effective in the physical examination of 
 behavior cases, must approach his work from a dififerent angle from his 
 general medical practice. The examination thus performed must then be 
 correlated with the mental and social factors of each case in order that 
 suitable physical treatment may be prescribed. 
 
 Mental treatment consists in the main of two kinds: first, education 
 and training of various mental faculties or talents, which are carried out in 
 accordance with estabhshed principles of educational training and certain 
 sorts of habit formation; second, treatment by various means of what 
 may be considered pathological mental traits. Psychotherapy, hydro- 
 therapy, mechanotherapy, occupational therapy, and other modern 
 forms of treatment may be applied by trained experts to good effect. 
 
 Social treatment is perhaps the most modern and least well defined of 
 all the various forms of treatment. As applied to delinquency, it consists 
 mainly of adjusting environmental conditions to the needs of the individ- 
 ual case. The important point is not merely to change the environment, 
 but to adapt the environment to the needs, temporary or j)ermanent, of 
 an individual more or less incapable of adapting himself. This form of 
 treatment is consequently varied, and includes the adjustment of the in- 
 dividual to, living conditions in his particular community, as well as social 
 relief, recreation, or employment. 
 
 [43 1
 
 Public Information and Education 
 
 One of the most potent influences in prevention is, of course, public 
 education. As in public health, the only effective way to educate the 
 public is by spreading broadcast the knowledge now available to which 
 the pubHc is entitled. 
 
 Unfortunately, in this era of advertising, everyone is becoming suspi- 
 cious of propaganda conducted under the guise of public education. It is, 
 therefore, necessary to force upon the public something more than off- 
 hand opinions and prejudices. Ultimate progress depends upon the 
 strict adherence to facts. For example, during recent years considerable 
 propaganda has been adopted to prove that feeble-mindedness is one of 
 the principal causes of criminality. It has been contended that if we 
 detect and segregate the feeble-minded early in life, we can reduce crime 
 by one-third to one-half, if not more. This belief was based upon the 
 finding that in certain institutions from one-fourth to one-third of the 
 institutional population was rated feeble-minded by intelligence tests. 
 
 This contention was given a most favorable reception, and for a time 
 promised to induce a more scientific attitude on the part of officials to- 
 ward the various phenomena of crime, and also to arouse a greater inter- 
 est in and support of the institutional care of the feeble-minded. Certain 
 officials — police, prosecutors, attorneys, prison authorities, in short, all 
 who were brought in close contact with the criminal population — were 
 reluctant to accept these statements, but their attitude was ascribed to 
 natural conservatism. 
 
 More recent work has shown that while figures for the institutions 
 were undoubtedly correct, the interpretation placed upon them was not 
 correct, because it failed to take into account the nature of the population 
 from which the prisoners came. From information now available in re- 
 gard to the intelligence distribution throughout the United States it 
 appears that the prison populations are probably fairly representative, so 
 far as intelligence goes, of the communities from which they come. It 
 may be true, therefore, that a quarter of the persons in a given institution 
 are feeble-minded, but, in order to reduce crime by 25 per cent, not only 
 would 25 per cent, of the prison population have to be committed to an 
 institution for the feeble-minded, but 25 per cent, of the population 
 from which they came would have to be segregated, which is clearly 
 ridiculous. 
 
 This illustrates one of the dangers of the proposed methods, even 
 when applied to a worthy purpose. Nothing could be more desirable 
 than the scientific treatment of criminals and the application of psycho- 
 logical, psychiatric, and other mental methods to criminals and delin- 
 
 [44]
 
 quents. But it is a mistake to make the success of such a venture depend 
 upon arousing the pubUc's interest by unwarranted statements. In the 
 business world, where an effect is desired for a short time, such methods 
 may be legitimate, but in the case of treatment of crime, where we are 
 building for generations ahead, they are nothing short of dangerous. The 
 psychology- of salesmanship has no place in the sphere of science. The 
 reaction in the public mind of arousing interest on the basis of statements 
 which are only partly true causes a loss of confidence which retards prog- 
 ress more than initial conservatism. 
 
 Research 
 
 WTicre shall the facts and information be obtained upon which a 
 campaign of pubhc education may be based? 
 
 Obviously, in an experimental subject, such as criminology', and one 
 in which science is just beginning to make itself felt, concrete information 
 is extremely scanty. In order to keep pace with the progressive demands 
 of modern community life and the growing pubhc interest, provision 
 must be made for investigation and research into the nature and treat- 
 ment of delinquency and crime. 
 
 Such scientific research requires the same arrangements as any other 
 sort of scientific investigation. In the first place, there must be properly 
 trained and equipped experts. They must have a place in which to work 
 which is officially designated the laboratory, and in which are provided all 
 the necessary paraphernaUa for scientific research. This is not the place 
 to enter into detailed statements as to the exact size or arrangement of 
 such laboratories or staff. These depend largely upon the resources 
 which the community makes available for the purpose and the interest 
 which it arouses. 
 
 Since scientific research is at best an uncertain matter, a hberal allow- 
 ance or margin of safety is advisable in order to insure a minimum of re- 
 turn. There are no rules for this work, and there is, as yet. no standard. 
 It would be better, however, for Cleveland not to venture into this field at 
 all unless the start can be made on a scale commensurate not only with 
 the size and importance of the city, but with the size and menace of the 
 problem. 
 
 A research laboratory or institution, properly staffed and equipped, 
 could conduct .scientific investigations into behavior problems for the 
 police, schools, pubhc health bureaus, courts, jails, correctional and penal 
 institutions, and the numerous public and private social agencies. 
 
 In another part of this section of the survey there is a brief account 
 of a psychological analysis of the population of the Cleveland workhou.se. 
 
 [45 1
 
 It will be seen from this analysis that the workhouse has a large number 
 of low-grade feeble-minded men. Reference to the chart will show that 
 the number is out of proportion to the rest of the community. Clearly, 
 here is a problem for mental science — for the student of the pathology of 
 human behavior. We are spending several hundred million dollars in the 
 United States annually in dealing with the end results of criminality and 
 behavior disorders. Probably not S500,000 is being spent in a scientific 
 attack upon the causes} 
 
 Training of Workers and Experts 
 
 The plan outlined thus far has discussed : (a) The workers for prac- 
 tical daily routine; (b) the research institution and staff, where new 
 knowledge may be sought and gained ; and (c) the dissemination of in- 
 formation to train and direct public opinion. There is left one more item 
 to round out the scheme, and that is a provision for the training of work- 
 ers and experts who are to take their places in the ranks. 
 
 Whenever a community has been aroused on the subject of mental 
 problems, and particularly behavior problems, and has finally decided 
 to establish scientific work, the perplexing question presents itself: 
 "Where shall we find the workers?" It must be admitted that the 
 workers available for immediate employment in this field are limited in 
 number. This is, however, not to be wondered at, nor is it an indication 
 that the subject does not appeal to scientific minds. 
 
 Rather it is a manifestation of one of the many vicious circles in our 
 social organization. There must be a demand for this work and a realiza- 
 tion on the part of the public of its importance great enough to insure a 
 career for the workers. This, in turn, depends upon the attainment of 
 results of a concrete and practical sort, to stimulate public interest. 
 Many who might have been glad to devote their lives to this science have 
 been compelled to seek other fields by a failure to obtain either oppor- 
 tunity or remuneration enough. 
 
 In order permanently to break up this vicious circle and to make the 
 scheme outlined here quite clear, we must, therefore, add a provision for 
 the training of workers and experts. This training should be given in the 
 
 ' It is as well, perhaps, to state here that the term "scientific," as used repeatedly 
 in this report, is not vised as applied to the worker in the exact sciences. The scientist 
 referred to here is not a man manii)ulatiiip; test-tubes and galvanometers alone. The 
 investigation of behavior problems requires scientists equipped to deal not only with 
 the methods of exact science, but also those who are capable of devoting themselves 
 to problems of education and social organization. 
 
 1461
 
 main under the auspices of a research laboratory, as we suggested, and in 
 connection with the schools and universities of the community. Such 
 training should be offered, in the first place, to physicians, lawyers, psy- 
 chologists, psychiatrists, social workers, administrators, and public offi- 
 cials. A flexible curriculum should permit these different classes of pro- 
 fessional workers to obtain the training needed to make their particular 
 contact with the problem of delinquency. In order to do this it might be 
 desirable to utilize existing departments of the university, perhaps the 
 medical school. The latter is preferable to the law school, but close 
 correlation between the law school and such work in the medical school is 
 essential. 
 
 In addition, special courses should be offered to social workers, parole 
 and probation officers, police officers, teachers, and nurses. Here again 
 the curriculum might be so arranged that police officers, for instance, 
 should receive a brief and intensive training, whereas social workers and 
 probation officers should receive a more extended training. A scheme 
 such as this, furthermore, makes possible part time graduate work or 
 special investigations, just as now a properly qualified student may enter 
 a laboratory for post-graduate study on a special topic. 
 
 When an organization of this sort has functioned long enough to pro- 
 duce the first graduates, the community can equip itself in such a way as 
 undoubtedly to reap the benefit in a continually lessened cost of adminis- 
 tration of criminal justice; and not the least of the benefits to be ex- 
 pected from such an organization is that other communities, no less 
 anxious to improve their crime statistics than Cleveland, and no better 
 off for staff or special workers, will turn to Cleveland for their personnel. 
 
 Recommendations 
 
 1 . If possible, a privately supported institute or clinic should be estab- 
 lished either independently or, preferably, in connection with Western 
 Reserve University. 
 
 2. The object of the institute should be: 
 
 (a) Investigation of the nature and treatment of human behavior 
 difficulties. 
 
 (b) The training and education of special workers and experts in the 
 field of behavior problems. 
 
 3. The institute should have a staff comprehensive enough to include 
 the methods of physical and mental health and the social sciences. 
 
 4. The institute shall be equipped with the necessary laboratory 
 space and apparatus and with bed capacity for a limited number of 
 patients. 
 
 [47]
 
 APPENDICES 
 
 APPENDIX I 
 
 REPORT OF INTELLIGENCE SURVEY OF THE CLEVELAND 
 POLICE DEPARTMENT 
 
 By E. K. Wickman 
 
 Psychologist, Division of the Criminologist, Illinois 
 
 A SURVEY of the intelligence of the personnel of the Division of 
 Police of Cleveland was made in connection with the survey of the 
 ^ administration of justice conducted by the Cleveland Foundation. 
 Mental ratings on 979 officers, detectives, and patrolmen were secured 
 by the use of the army Alpha Intelligence Examination. 
 
 The survey was made with the cooperation of the Chief of PoUce, 
 Frank W. Smith, who ordered the men of his department assembled for 
 the examination and who lent his cooperation and influence to their effec- 
 tive administration and completion. The examinations were not com- 
 pulsory for the men, with the exception of those in the training school. 
 Orders by the Chief of Police were issued for all men who were on active 
 duty during the three days of the survey to report for the examination, 
 but the actual examination was taken voluntarily. There were, however, 
 no men in the department who declined to submit to the tests. 
 
 The 979 men who were examined compose over 90 per cent, of the 
 entire department, and the men who were not rated were not actually 
 available for the examination during the three days of the survey. The 
 general orders for the assembling of the men called for one-half of one 
 of the four platoons for each group examination. The examinations were 
 made on the salary time of the men, and the groups were assembled at 1, 
 2, and 3 o'clock in the afternoons, and at 7.30 and 10 o'clock in the 
 evenings. The 979 men include officers (captains, lieutenants, and ser- 
 geants), detectives, men of the vice bureau, the traffic, mounted, emer- 
 gency, and regular patrolmen, and the members of the training school. 
 
 The intelligence examination used was the army Alpha examination, 
 the scale employed for Hterates in the examination of officers and recruits 
 in the United States army. The army procedure in the administration 
 of the examination was adhered to in all respects. The groups varied in 
 size from 10 to 90 men. With the exception of the captains and detec- 
 
 [48]
 
 tives, the groups were assembled in the training school class 
 Eighth Precinct Police Station. All five forms of the Alpha 
 were employed, so as to avoid possible^ coaching. 
 
 The papers were later scored by special clerks, and in(( 
 ings were assigned to all the men on the basis of the army 
 scale, as follows: 
 
 Grade of 
 intelligence Explanation 
 
 A Verj- superior intelligence 
 
 B Superior intelligenee 
 
 0+ High average intelligence 
 
 C Average intelligence 
 
 C — Low average intelligence 
 
 D Inferior intelligence 
 
 E Verj' inferior intelligence 
 
 Alpha score 
 
 13.5-212 
 
 105-134 
 
 75-104 
 
 4.5- 74 
 
 25- 44 
 
 15- 24 
 
 0- 14 
 
 -room of the 
 examination 
 
 •Uigence rat- 
 letter rating 
 
 Approximate 
 
 mental age, 
 
 years 
 
 11-13 
 9-10.9 
 Below 9 
 
 The distribution of intelligence ratings for the officers, detectives, and 
 various divisions of the patrolmen is shown in Tables 1 and 2 and 
 Diagram 1. 
 
 PER CENT LOW AVERAGE 
 AND INFERIOR 
 
 PER CENT 
 AVERAGE 
 
 PER CENT. HIGH 
 AVERAGE 
 
 pro CENT. SUPERIOR 
 
 
 
 r 
 
 28.6 
 
 28.6 
 
 n 
 
 
 
 
 Capt 
 
 lirs 
 
 
 
 2.2I 
 
 1 21.7 
 
 39.1 
 
 
 1 
 
 
 Lieute 
 
 lanta 
 
 
 
 E 
 
 he. 3 
 
 28.2 
 
 1 
 
 
 
 Serge 
 
 ints 
 
 
 
 3.2 I 20.6 
 
 1 
 
 47.5 
 
 23.6 
 
 1 
 
 
 
 
 Detoc 
 
 tlvee 
 
 ] 
 
 
 5.0 ta 20.0 
 
 1 
 
 41.3 
 
 22.5 
 
 
 
 
 
 ric 
 
 
 2.6||xcyt 
 
 cz 
 
 34.2 
 
 34.2 
 
 
 1 
 
 
 
 Uoun 
 
 bed 
 
 
 
 4.o||[ex 
 
 1 
 
 44.0 
 
 24.0 
 
 1 
 
 
 
 
 Emerg 
 
 incy 
 
 
 
 (^ 
 
 1 
 
 
 56.4 
 
 23.1 
 
 1 
 
 
 
 
 
 Training 
 
 school 
 
 
 
 4.9B 20.3 
 
 L 
 
 33.6 
 
 29.1 
 
 _j 
 
 
 11.2 
 
 ^^^^^ 11.9 
 Patroliten 
 
 Diagram 1. — Intelligence ratings of divisictns of Cleveland police department 
 
 About 40 per cent, of the officers of the department rate in the su- 
 perior grades of intelligence. These ratings were secured by about 13.5 
 per cent, of the draft army. Another 32 per cent, of the officers are of 
 high average intelligence; about 20 per cent. ar(> average^ while (> per 
 5 149]
 
 c 
 
 0) 
 
 s 
 1 
 
 <^ g (MCO(N 
 
 o 
 d 
 o 
 
 t^ (M OC «0 t^ C^) CD 
 
 2- —c lO CO C: -H C^ 
 
 lO 
 
 
 ^^qqqppo • 
 <D a ■*■ CD '^ "*■ 00 •^' 
 
 (^ g '-"(NT}' 
 
 o 
 
 1 
 
 6 ,^ Tt< CD '- (M r-( . 
 
 (N 
 
 
 ^ ^ CD OO (N C<J CD CD • 
 
 a, g r-l CO C<3 '— 1 
 
 P 
 
 c 
 
 o r-H CD re CO ■* ^ • 
 
 CO 
 
 CO 
 
 is 
 
 ^^ojqiocooxiM 
 ajor-^doi^dco'-^ 
 
 o 
 d 
 
 o 
 
 ^^oooccocoror-i 
 
 § 
 
 bC 
 
 c o 
 
 ^^^q t^ ^ -^ (M • ■ 
 « c (N t^ CO d d 
 
 &" § (MiO ^ 
 
 o 
 d 
 o 
 
 0,-l C005 c^ ^ . . 
 
 2; oi ■ ■ 
 
 05 
 
 CO 
 
 3 
 
 ^ ^ Ti< q cc ^ QC • ■ 
 « cio ^ d»o CO ■ 
 
 o 
 
 d 
 o 
 
 ^Tj" OS00-* '-H • • 
 
 CD 
 (M 
 
 1 
 
 t.^ -COoqcOCD (N • 
 
 <y a ■ Tj<' CO t^ d CO ' 
 
 P 
 
 o 
 
 6 • CO to o CO (N • 
 
 2; • rHCO^ 
 
 CO 
 
 CD 
 
 to 
 
 o 
 02 
 
 ^_^05oq(N CO 05 • • 
 
 <u c cJ CO o6 CO oJ 
 
 fri 2 CO(M -H 
 
 o 
 
 d 
 
 o 
 
 Ot^-* OCO t^ • • 
 Z, IM<N .-H 
 
 t^ 
 
 
 ^ ^ I^ CO --H t^ (M • • 
 
 <a C CO 00 Ci ^ C4 ■ 
 f^ g (NCO(N 
 
 o 
 
 d 
 o 
 
 ^■*COOOO'-I • • 
 
 CD 
 
 03 
 
 a 
 
 O 
 
 ^^^t^CDCD • • • 
 o C t^ »0 00 00 ■ 
 f^ g CO(N<N 
 
 O 
 
 s 
 
 .—1 
 
 6 1— ( ic "tf T}< • • 
 Z ... 
 
 -^ 
 
 
 + 1 
 
 
 50]
 
 cent, are low average. There are no representatives among the officers 
 in the inferior grades of inteUigence. 
 
 TABLE 
 
 2.— SUMMARY OF DISTRIBUTION OF INTELLIGENCE RATINGS 
 
 
 All 
 
 Vice 
 
 Detec- 
 
 All 
 
 Total 
 
 Draft 
 
 
 officers 
 
 Bureau 
 
 tives 
 
 patrolmen 
 
 army 
 
 
 
 Per 
 
 
 Per 
 
 
 Per 
 
 
 Per 
 
 
 Per 
 
 
 
 No. 
 
 cent. 
 
 No. 
 
 cent. 
 
 No. 
 
 cent. 
 
 No. 
 
 cent. 
 
 No. 
 
 cent. 
 
 Per cent. 
 
 A 
 
 12 
 
 9.2 
 
 4 
 
 15.4 
 
 
 
 21 
 
 2.8 
 
 37 
 
 3.S 
 
 4.5 
 
 B 
 
 42 
 
 32.0 
 
 9 
 
 34.6 
 
 3 
 
 4.8 
 
 73 
 
 9.6 
 
 127 
 
 13.0 
 
 9.0 
 
 c+ 
 
 42 
 
 32.0 
 
 8 
 
 30.8 
 
 15 
 
 23.8 
 
 214 
 
 28.2 
 
 279 
 
 28.5 
 
 16.5 
 
 c 
 
 27 
 
 20.6 
 
 4 
 
 15.4 
 
 30 
 
 47.6 
 
 274 
 
 36.1 
 
 335 
 
 34.2 
 
 25.0 
 
 c- 
 
 8 
 
 6.1 
 
 1 
 
 3.8 
 
 13 
 
 20.6 
 
 143 
 
 18.8 
 
 165 
 
 16.9 
 
 20.0 
 
 D 
 
 
 
 
 
 2 
 
 3.2 
 
 27 
 
 3.6 
 
 29 
 
 2.9 
 
 15.0 
 
 E 
 
 
 
 
 
 
 
 7 
 
 0.9 
 
 7 
 
 0.7 
 
 10.0 
 
 
 131 
 
 100.0 
 
 26 
 
 100.0 
 
 63 
 
 100.0 
 
 759 
 
 100.0 
 
 979 
 
 100.0 
 
 100.0 
 
 Of the patrolmen, there are 12 per cent, in the superior grades, 28 per 
 cent, are high average, while the greatest percentage (34) are average. 
 There is a heavier percentage of patrolmen in the low average group than 
 in the superior groups, and about 3 per cent, are definitely in the inferior 
 grades of intelligence. Of the various divisions of the patrolmen, the 
 emergency and mounted police have the higher intelligence distributions. 
 
 The detectives, a group of 63 men, rate lowest in the entire depart- 
 ment. There are less than 5 per cent, in the superior grades, and about 
 23 per cent, are high average, while 70 per cent, are either average, low 
 average, or inferior. 
 
 A further comparison of these divisions of police is shown in Table 3 
 and in Diagrams 2 and 3, by comparing their median scores and the 
 range of scores of the high, middle, and low third of each division. The 
 median scores of the officers varies between 95 and 98. These are high 
 scores in the high average grade of intelligence. The patrolmen have a 
 median of 67, which falls in the average grade of intelligence, while the 
 detectives are the lowest of the divisions, with a median of 59. 
 
 At present the detectives are ranking, as far as salary is concerned, 
 with the lieutenants, but a comparison of these two groups shows that 
 the lieutenants have 37 per cent, of representatives in the superior grades 
 of intelligence, as opposed to 4.8 per cent, of the detectives, and only 
 23.9 per cent, in the average and low average grades, as compared with 
 71.4 per cent, of the detectives. The lieutenants' metlian falls at 95, 
 while the detectives' is 59. Furthermore, the low third of the lieutenants 
 has a higher range of scores than the middle third of the detectives. 
 
 [511
 
 TABLE 3— MEDIAN SCORES AND RANGE OF SCORES OF POLICE 
 
 DIVISIONS 
 
 
 
 Range of scores of each division 
 
 Rank or division 
 
 Median 
 
 
 
 
 
 
 
 
 
 Low third 
 
 Middle third 
 
 High third 
 
 Captains 
 
 98 C + 
 
 50-75 
 
 76-104 
 
 105-154 
 
 Lieutenants 
 
 95 C + 
 
 36-81 
 
 82-108 
 
 109-165 
 
 Sergeants 
 
 99 C+ 
 
 28-79 
 
 79-109 
 
 110-166 
 
 Vice squad 
 
 7oC=F 
 
 23-61 
 
 64- 84 
 
 84-134 
 
 Detectives 
 
 59 C 
 
 23-50 
 
 51- 71 
 
 72-131 
 
 Training school 
 
 63 C 
 
 25-56 
 
 57- 74 
 
 77-138 
 
 Traffic 
 
 61 C 
 
 5-56 
 
 56- 74 
 
 75-137 
 
 Mounted 
 
 78 C+ 
 
 22-59 
 
 60- 91 
 
 92-155 
 
 f^mergency 
 
 67 C 
 
 19-64 
 
 65- 80 
 
 83-150 
 
 Patrolmen 
 
 67 C 
 
 6-52 
 
 53- 82 
 
 82-170 
 
 When compared with the results obtained from the recent draft 
 army, there is, of course, a very small percentage (3.6 per cent.) of men 
 in the police department who rate in the inferior grades of intelligence 
 in which the lowest 25 per cent, of the men in the draft army were classi- 
 fied. The men of the police department group themselves closely about 
 the average grade of intelligence, and the medians of the patrolmen are 
 about identical with the medians of the draft army. With the exception 
 of the officers, there is a smaller percentage of representatives in the 
 police department in the superior grades of intelligence than were found 
 in the draft army. The detectives have no representatives in the very 
 superior grade of intelligence, a classification secured by 4.5 per cent, of 
 the draft army, and only three individuals of the detectives have superior 
 intelligence, as opposed to 9 per cent, of the draft. As a whole, however, 
 the police department ranks somewhat higher than the majority of the 
 men of the draft. This is evident in its somewhat larger percentage of 
 representatives of high average intelligence. 
 
 Table 4 shows a distribution of intelligence ratings of patrolmen ac- 
 cording to the date of entry into the police department. There is very 
 little difference in the ratings of the first year groups, who entered be- 
 tween 1895-1919. There is a sUght decrease with length of service, much 
 of which may be attributed to the deterioration of increasing age. The 
 table also shows that the men who entered during the present year, 1921, 
 have a considerably higher percentage of men of superior intelligence. 
 The war year, 1918, produced no men either of superior or of inferior 
 intelligence. All of the entrants in that year rate in the average classes 
 of intelligence. 
 
 [ 52 1
 
 I Captains | 
 
 Lieutenants 
 
 Sergeants | 
 
 Detectives I 59 
 
 S8 
 95 
 99 
 
 Vice squad I 
 
 75 
 
 Traffic police I ^-^ 
 
 Mounted police I 78 
 
 Emergency police I 67 
 
 Patrolmen I 67 
 Training school I 63 
 
 40 
 
 Diagram 2. — Median scores, Cleveland police department 
 
 ALPHA SCORE 
 D 50 60 70 80 90 100 110 12C 
 
 ' ■ I ■ I I I I I ■ I I [ I L-i I 
 
 Sergeants 
 
 Lieutenantf 
 
 Captaine 
 
 Emergency 
 
 Mounted 
 
 Training school 
 
 Vice squad 
 
 3 
 
 P&trolben 
 
 IVtectiveB 
 
 Traffic police 
 
 Diagram 3. — Range of scores between first and third quartiles of Cleveland police 
 department. (The median scores are indicated by the cross lines.) 
 
 153 1
 
 w 
 
 Pi 
 
 Ir 
 
 QS 
 
 . 'C p »c p c p o 
 
 o 
 d 
 
 o 
 
 a i.o 
 
 4) 
 
 o CO 
 ft* 1— t 
 
 iq 
 
 P 
 
 id 
 
 (N 
 
 Entire 
 police 
 dept. 
 
 S B fo ^3 X t' o c^i c 
 
 o 
 d 
 
 o 
 
 g 00 
 
 ^ d 
 
 d 
 
 p 
 CO 
 
 ►^ CO (M t- CO o c^ 
 
 ^ »— « c^ CO *-H 
 
 
 Entered 
 1895- 
 1904 
 
 _^ ■ CO 00 .-; CO CO t>; 
 
 PL, g r-irt-(N 
 
 o 
 d 
 o 
 
 Ico 
 
 00 
 
 p 
 
 6 . CO ^ -^i lo CO --H 
 
 ;5 • -H(Mr^ 
 
 i-O 
 
 Entered 
 1905- 
 1909 
 
 ^^Tfppocpp ■ 
 o c ^ id id CO oc lo 
 
 Ch g <N CO(M 
 
 o 
 d 
 
 o 
 
 Ico 
 
 00 
 
 d 
 
 00 
 
 p 
 id 
 
 £ r^ ■* t^ CO Ci -"l* ■ 
 
 
 Entered 
 1910- 
 1914 
 
 ^ ^ P t^ P p '^_ P 05 
 
 oc^r>;x'*(Ncoo 
 e^ g (M CO cj 
 
 d 
 o 
 
 go 
 
 PL, 
 
 o 
 id 
 
 00 
 
 00 
 
 ^ cocoes 
 
 o 
 
 Entered 
 1915- 
 1919 
 
 . ^H Tfi lO CO O ■* CO 
 
 41 HcdoO'^i^ididcdo 
 Ch g coco^ 
 
 o 
 d 
 o 
 
 |iq 
 ^ I— < 
 
 00 
 
 00 
 
 CO 
 
 ar Oi !=: <M <^- S'- '-' 
 ;g ^ (M C: C; CO 
 
 CO 
 
 1^. 
 -So 
 
 C'-H 
 
 • ■ CO CO r-< ■ ■ 
 
 c a ■ ' t--i o ci 
 
 a, g c^o^ 
 
 O 
 
 d 
 o 
 
 a 
 
 s : 
 
 o 
 
 o 
 d 
 o 
 
 
 
 CO 
 
 So 
 
 C-H 
 
 ^ CO C<] p t^ IC CO ■ 
 
 Seeded oot}^ CO 
 fc g rt coco —i 
 
 o 
 d 
 
 o 
 
 g lO 
 
 (1. 
 
 00 
 
 CO 
 CO 
 
 6(nr-^t>• coco CO • 
 
 2; ^ (M CO -1 
 
 o 
 
 T3 
 
 ^ ^ ■*_ QC p p GO C-l ■ 
 
 (pci^-^ido'^'-H 
 
 Ch g <-i(M CO ^ 
 
 o 
 d 
 o 
 
 1 ^ 
 
 p 
 1> 
 
 C) 
 
 6 o CD ^ i-O CI ^ ■ 
 
 2; rH Cl C^ ,-H 
 
 X 
 
 c 
 
 1 1 1 1 
 
 
 o 
 
 CI 
 
 bc 
 
 CJ 
 
 4) 
 
 1— ( 
 
 Letter 
 rat- 
 ing 
 
 + 1^ 
 
 
 4- 1 
 
 54
 
 APPENDIX II 
 INTELLIGENCE SURVEY OF THE CLEVELAND WORKHOUSE 
 
 By E. K. WicKMAN 
 
 Psychologist, Division of the Criminologist, Illinois 
 
 AN INTELLIGENCE survey of the workhouse of Cleveland, Ohio, 
 /-\ was made in connection with the survey of the Administration of 
 "^ -^ Justice, to illustrate some of the results which may be obtained 
 by mental studies. The population of this institution was about 450 men, 
 of whom about one-fifth were examined by the use of the Army Alpha 
 Intelligence Examination. This one-fifth was chosen bj^ assembling the 
 men in single file and selecting every fifth man in line for examination. 
 To this group were added all of the men who were at the workhouse on 
 federal charges, and also the group of men called "long termers." One 
 hundred and twenty-six men were thus assembled for the examination; 
 of these, 32 were illiterate and were unable to take the examination, inso- 
 far as they claimed to be unable to read and write, and one other man 
 was unable to take the examination because of poor vision. 
 
 Records were thus secured on 93 of the men, of whom 44 (47 per cent.) 
 were native-born whites, 32 (34 per cent.) were negroes, and 13 (14 per 
 cent.) were foreign born. Four men did not indicate bii'th or race. 
 
 The distribution of intelligence ratings as secured by the army Alpha 
 examination is given in Table 5. 
 
 The literate native-born white group who took the examination fall 
 mostly in the average grades of intelligence, but about 15 per cent, of 
 them are inferior. The army statistics show about 14 per cent, inferior in 
 this group of native-born whites. There are, however, only about 4 per 
 cent, in the superior groups, as opposed to 15 per cent, in the army. 
 
 Of the negroes, 61 per cent, fall in the inferior groups of intelhgencc as 
 opposed to 43 per cent, in the army. 
 
 The average rating for the white prisoners fall in the "C" or average 
 group of intelligence, as it also did in the army, while the average for the 
 negro prisoners falls in the " D " or inferior group, while the army average 
 was "C— " or low average group. 
 
 ( ■'i-'j 1
 
 TABLE o.— DISTRIBUTION OF INTELLIGENCE RATINGS IN THE 
 
 WORKHOUSE 
 
 Per cent 
 30 
 
 2.5 
 
 20 
 
 1.5 
 
 10 
 
 
 Native 
 born 
 white 
 
 Foreign 
 born 
 
 All 
 whites 
 
 Negroes 
 
 Race 
 unknown 
 
 Total 
 
 
 
 Per 
 
 
 
 Per 
 
 
 Per 
 
 
 
 Per 
 
 
 No. 
 
 cent. 
 
 No. 
 
 No. 
 
 cent. 
 
 No. 
 
 cent. 
 
 No. 
 
 No. 
 
 cent. 
 
 A 
 
 
 
 
 
 
 
 
 
 
 
 B 
 
 o 
 
 4.5 
 
 1 
 
 3 
 
 5.3 
 
 
 
 
 3 
 
 3.2 
 
 c+ 
 
 16 
 
 36.4 
 
 
 16 
 
 28.0 
 
 
 
 
 16 
 
 17.2 
 
 c 
 
 13 
 
 29.6 
 
 1 
 
 14 
 
 24.5 
 
 2 
 
 6.2 
 
 
 16 
 
 17.2 
 
 c- 
 
 6 
 
 13.6 
 
 3 
 
 9 
 
 15.8 
 
 / 
 
 21.9 
 
 
 16 
 
 17.2 
 
 D 
 
 o 
 
 4.5 
 
 4 
 
 6 
 
 10.5 
 
 9 
 
 28.1 
 
 
 15 
 
 16.2 
 
 E 
 
 5 
 
 11.4 
 
 4 
 
 9 
 
 15.8 
 
 14 
 
 43.8 
 
 4 
 
 27 
 
 29.0 
 
 Total 
 
 44 
 
 100.0 
 
 13 
 
 57 
 
 99.9 
 
 32 
 
 100.0 
 
 4 
 
 93 
 
 100.0 
 
 i\ 
 
 
 
 
 
 
 
 / 
 
 \ 
 
 
 <^^ 
 
 \ 
 
 
 
 
 / 
 
 \ 
 
 ^^^ 
 
 Workhouse '^ 
 
 Sw. 
 
 
 
 ^ * — 
 
 
 
 VV 
 
 / 
 
 /■ 
 
 
 
 
 ^ 
 
 
 
 / 
 
 
 
 
 
 \ 
 
 ^^ 
 
 
 V 
 
 
 
 
 
 A 
 
 ^ 
 
 \ 
 
 \ 
 
 Diagram 4. — Comparison of intelligence distributions of Cleveland Workhouse and 
 United States Draft Army 
 
 43.1 
 
 .Mxi. 
 
 Whites, VtfftrrenBville Workhouse 
 
 63.8 
 
 Whites, United States Draft Army 
 
 JJ^.9 28il 
 
 Negroes, Warrensville Workhouse 
 
 sail 
 
 i 
 
 Negroes, United States Draft Array 
 
 Diagram 5. — Comparison of intelligence ratings, Warrensville Workhouse with 
 United States Draft Army 
 
 [56]
 
 Diagi'am 4 shows the distribution of inteUigence ratings of the Cleve- 
 land workhouse with the United States draft army. In Diagram 5 the 
 same distribution is shown for whites and negroes separately. 
 
 These results would undoubtedly be lowered if ratings of the illiterate 
 men were included, so that it may safely be said that the intelligence of 
 these men at the Cleveland workhouse is somewhat below the draft army 
 intelligence. 
 
 57
 
 APPENDIX III 
 
 TEXT OF THE MASSACHUSETTS MEDICAL EXAMINER 
 
 LAW 
 
 The Commonwealth of Massachusetts 
 General Laws, Chapter 38 
 
 Medical Examiners 
 
 Section 1. The governor, wath the advice and consent of the council, 
 shall appoint for terms of seven years able and discreet men, learned in the 
 science of medicine, as medical examiners in and for their respective counties, 
 and as associate medical examiners in and for their respective districts in coun- 
 ties divided into districts, otherwise in and for their respective counties, in 
 number as follows: 
 
 Two examiners and two associate examiners in Suffolk county, and one 
 examiner and one associate examiner in Nantucket county and in each of the 
 following districts : 
 
 Barnstable county, district one, comprising Harwich, Dennis, Yarmouth, 
 Brewster, Chatham, Orleans and Eastham; district two, Barnstable, Bourne, 
 Sandwich, Mashpee and Falmouth; and district three, Provincetown, Truro 
 and Wellfleet. 
 
 Berkshire county, district one, comprising North Adams, Williamstown, 
 Clarksburg, Adams, Florida, Savoy, New Ashford and Cheshire; district two, 
 Pittsfield, Lanesborough, Windsor, Dalton, Hinsdale, Peru and Hancock; dis- 
 trict three, Richmond, Lenox, Washington, Becket, Lee, Stockbridge, TjTing- 
 ham and Otis; and district four. West Stockbridge, Alford, Great Barrington, 
 Monterey, Sandisfield, New Marlborough, Sheffield, Egremont and Mount 
 Washington. 
 
 Bristol county, district one, comprising Attleboro, North Attleborough, 
 Seekonk, Norton, Mansfield and Rehoboth; district two, Taunton, Raynham, 
 Easton, Berkley, and Dighton; district three. Fall River, Somerset, Swansea, 
 Freetown and Wcstport; and district four, New Bedford, Dartmouth, Fair- 
 haven and Acushnet. 
 
 Dukes county, district one, comprising Edgartown and Oak Bluffs; dis- 
 trict two, Tisbury, West Tisbury and Gosnold; and district three, Chilmark 
 and Gay Head. 
 
 Essex county, district one, comprising Gloucester and Rockport; district 
 
 [58]
 
 two, Ipswich, Rowley, Hamilton and Essex; district three, Newburj'port, New- 
 bur>', West Newburj', Amesbury and Salisburj'; district four, Haverhill and 
 Merrimac; district five, Lawrence, Methuen, Andover and North Andover; 
 district six, Georgetown, Boxford, Topsfield and Groveland; district seven, 
 Beverly, Wenham and Manchester; district eight, Peabody, Danvers, Middle- 
 ton and Lynnfield; district nine, Lynn, Saugus, Nahant and Swampscott; and 
 district ten, Salem and Marblehead. 
 
 Franklin county, the northern district, comprising Orange, Warwick, New 
 Salem and Wendell; the eastern district, Bernardston, Erving, Gill, Greenfield, 
 Leverett, Montague, Xorthfield, Shutesbury and Sunderland; and the western 
 district, Ashfield, Buckland, Charlemont, Colrain, Conway, Deerfield, Hawley, 
 Heath, Leyden, Monroe, Rowe, Shelburne and Whately. 
 
 Hampden county, district one, comprising Brimfield, Holland, Palmer, 
 Monson and Wales; district two, Springfield, Agawam, East I^ngmeadow, 
 Ix)ngmeadow, West Springfield, Wilbraham and Hampden; district three, 
 Holyoke; district four, Blandford, Chester, Granville, Montgomery, Russell, 
 Southwick, Tolland and Westfield; and district five, Chicopee and Ludlow. 
 
 Hampshire countj', district one, comprising Northampton, Chesterfield, 
 Cummington, Goshen, Hatfield, Plainfield and Williamsburg; district two, 
 Easthampton, Huntington, Middlefield, Southampton, Westhampton and 
 Worthington; district three, Amherst, Granby, Hadley, Pelham and South 
 Hadley ; and district four, Belcherto\\Ti, Enfield, Greenwich, Prescott and Ware. 
 
 Middlesex county, district one, comprising Cambridge, Belmont and Arling- 
 ton; district two, Maiden, Somerville, Everett and Medford; district three, 
 Melrose, Stoneham, Wakefield, Wilmington, Reading and North Reading; dis- 
 trict four, Woburn, Winchester, Lexington and Burlington; district five, Lowell, 
 Dracut, Tewksburj-, Billerica, Chelmsford and Tyngsborough ; district six, 
 Concord, Carlisle, Bedford, Lincoln, Littleton, Acton and Boxborough; district 
 seven, Newlon, Waltham, Watertowm and Weston; district eight, Framingham, 
 Waj'land, Natick, Sherborn, HoUiston, Hopkinton and Ashland; district nine, 
 >Larlborough. Hudson, Maynard, Stow and Sudburv^; district ten, Ayer, Groton, 
 Westford, Dunstable, Pepperell, Shirley, To\\iisend and Ashby. 
 
 Norfolk county, district one, comprising Dedham, Needham, Wellesley, 
 Westwood, Norwood and Dover; district two, Cohasset; district three, Quincy, 
 Milton and Randolph; district four, Wej-mouth, Braintree and Holbrook; dis- 
 trict five, Avon, Stoughton, Canton, Walpole and Sharon; district six, Frank- 
 lin, Foxborough and Wrentham; district seven, Medway, Medfield, Millis, 
 Norfolk and Bellingham; and district eight, Brookline. 
 
 Plymouth county, district one, comprising Brockton, West Bridgewater, 
 East Bridgewater, Bridgewater and Whitman; district two, Abington, Rock- 
 land, Hanover, Hanson, Norwell and Pembroke; district three, Plymouth, 
 Halifax, Kingston, Plympton and Duxbury; district four, Middlelxirough, 
 Wareham, >Iattapoisett, Carver, Rochester, Lakeville and Marion; and dis- 
 trict five, Hingham, Hull, Scituate and Marshfield. 
 
 [59]
 
 Worcester county, district one, comprising Athol, Dana, Petersham, Phillips- 
 ton and Royalston; district two, Gardner, Templeton and Winchendon; dis- 
 trict three, Fitchburg, Ashburnham, Leominster, Lunenburg, Princeton and 
 Westminster; district four, Berlin, Bolton, Boylston, Clinton, Harvard, Lan- 
 caster and Sterling; district five, Grafton, Northborough, Southborough and 
 Westborough; district six, Hopedale, Mendon, IMilford and Upton; district 
 seven, Blackstone, Douglas, Millvillc, Northbridge and Uxbridge; district eight, 
 Charlton, Dudley, Oxford, Southbridge, Sturbridge and Webster; district nine, 
 Brookfield, East Brookfield, North Broolvfield, Spencer, Warren and West 
 Brookfield; district ten, Barre, Hubbardston, Hardwick, New Braintree, Oak- 
 ham and Rutland; and district eleven, Worcester, Auburn, Holden, Leicester, 
 Millbury, Paxton, Shrewsbury, Sutton and West Boylston. 
 
 Section 2. The associate medical examiners for Suffolk county shall, at 
 the request of either of its medical examiners, perform the duties and have 
 the powers of medical examiners. Each medical examiner shall in each year be 
 entitled to two months' service in the aggregate from the associates. Associate 
 examiners in the other counties shall, in the absence of the medical examiners 
 or in case of their inability to act, perform in their respective districts all the 
 duties of medical examiners. 
 
 Section 3. Each examiner and associate examiner, before entering upon 
 his duties, shall be sworn and give bond for the faithful performance thereof, 
 in the sum of five thousand dollars, to the county treasurer, with sureties by 
 him approved. Failure for three months after appointment to give such bond 
 shall render his appointment void. A surety or his executors or administrators 
 may be discharged from further liability thereon in the manner provided in 
 section six of chapter thirty-seven. 
 
 Section 4. Upon breach of the condition of such bond to the injury of 
 any person, the principal may be removed from office and action brought thereon 
 in like manner as upon the bond of a sheriff. 
 
 Section 5. In SufTolk county each medical examiner shall receive from 
 the county a salary of five thousand dollars, and each associate medical examiner 
 a salary of eight hundred and thirty-three dollars; but if either associate serves 
 in any year more than two months, he shall for such additional service be paid 
 at the same rate, and the amount so paid shall be deducted from the salary of 
 the medical examiner at whose request he so serv^es. The medical examiners 
 for said county shall be provided with rooms suitably furnished for the per- 
 formance of their duties, the rent, furnishing and office equipment of which 
 shall be paid for by said county upon approval of the mayor of Boston. Each 
 of said medical examiners may, in the name of the county, contract such bills 
 for clerical service, postage, stationery, printing, telephone, traveling, and for 
 such other incidental expenses as may in his opinion be necessary for the proper 
 performance of his duty, to an amount not exceeding six thousand dollars in 
 any one year; and each associate may so contract bills for the said purposes 
 
 [60]
 
 to an amount not exceeding one thousand dollars in anj' one year; and all such 
 bills shall be paid by said county, upon a certificate by the contracting examiner 
 that they were necessarily incurred in the performance of his duty, and upon 
 the approval of the auditor of Boston, as provided in section nineteen, and of 
 the mayor. Medical examiners and associate medical examiners in other coun- 
 ties shall receive fees as follows: For a view without an autopsy, seven dollars; 
 for a view and an autopsy, thirty dollars; and for travel, ten cents a mile to 
 and from the place of view. 
 
 Section 6. Medical examiners shall make examination upon the view of 
 the dead bodies of only such persons as are supposed to have died by violence. 
 If a medical examiner has notice that there is within his county the body of 
 such a person, he shall forthwith go to the place where the body lies and take 
 charge of the same; and if, on view thereof and personal inquiry into the cause 
 and manner of death, he considers a further examination necessary, he shall, 
 upon WTitten authorization of the district attorney, mayor or selectmen of the 
 district, city or town where the body lies, make an autopsy in the presence of 
 two or more discreet persons, whose attendance he may compel by subpcena. 
 Before making such autopsy he shall call the attention of the witnesses to the 
 appearance and position of the body. He shall then and there carefully record 
 every fact and circumstance tending to show the condition of the body and the 
 cause and manner of death, with the names and addresses of said witnesses, which 
 record he shall subscribe. If a medical examiner or an associate examiner con- 
 siders it necessary to have a physician present as a witness at an autopsy, such 
 physician shall receive a fee of five dollars. Other witnesses, except officers 
 named in section fifty of chapter two hundred and sixty-two, shall be allowed 
 two dollars each. A clerk may be employed to reduce to writing the results of 
 a medical examination or autopsy, and shall receive two dollars a day. 
 
 The medical examiner may, if he considers it necessary, employ a chemist 
 to aid in the examination of the body or of substances supposed to have caused 
 or contributed to the death, and he shall receive such compensation as the 
 examiner certifies to be just and reasonable. 
 
 Section 7. He shall forthwith file with the district attorney for his dis- 
 trict a report of each autopsy and view and of his personal inquiries, with a 
 certificate that, in his judgment, the manner and cause of death could not be 
 ascertained by view and inquiry and that an autopsy was necessary. The dis- 
 trict attorney, if he concurs, shall so certify to the commissioners of the county 
 where the same was held, or in Suffolk county, to the auditor of Boston. If 
 upon such view, personal incjuiry or autopsy, the medical examiner is of opinion 
 that the death may have been caused by the act or negligence of another, he 
 shall at once notify the district attorney and a justice of a district court or trial 
 justice within whose jurisdiction the body was found, if the place where found 
 and the place of the said act or negligence are within the same county, or if 
 the latter place is unknown; otherwise, the district attorney and such a justice 
 
 161)
 
 within whose district or jurisdiction the said act or negligence occurred. He 
 shall also file with the district attorney thus notified, and with the justice or in 
 his court, an attested copy of the record of the autopsy made as provided in the 
 preceding section. He shall in all cases certify to the town clerk or registrar in 
 the place where the deceased died his name and residence, if known; otherwise 
 a description as full as may be, with the cause and manner of death. 
 
 Section 8. The court or trial justice shall thereupon hold an inquest, 
 from which all persons not required by law to attend may be excluded. The 
 district attorney, or any person designated by him, may attend the inquest 
 and examine the witnesses, who may be kept separate, so that they cannot 
 converse with each other until they have been examined. Within sixty days 
 after any case of death by accident upon a railroad, electric railroad, street 
 railway or railroad for private use an inquest shall be held, and the court or 
 justice shall give seasonable notice of the time and place thereof to the depart- 
 ment of public utilities. Within a like period after any case of death in which 
 a motor vehicle is involved, an inquest shall be held, and the court or justice 
 shall give seasonable notice of the time and place thereof to the department of 
 public works. The attorney general or the district attorney may, notwith- 
 standing the medical examiner's report that a death was not caused by the act 
 or negligence of another, direct an inquest to be held, and Ukewise in case of 
 death by any casualty. 
 
 Section 9. If it appears that the place where the supposed act or negli- 
 gence occurred and the place where the body was found are both without the 
 limits of the judicial district of the court or the jurisdiction of the trial justice 
 notified by the medical examiner under section seven, the court or justice shall 
 nevertheless proceed with the inquest and have continuous and exclusive juris- 
 diction thereof if either place is within the commonwealth and within fifty rods 
 of the boundary line of such district or jurisdiction, unless a prior and like 
 notice shall have been issued by a medical examiner in another county in ac- 
 cordance with said section. 
 
 Section 10. A district court about to hold an inquest may appoint an 
 officer qualified to serve criminal process to investigate the case and to sum- 
 mon the witnesses, and may allow him additional compensation therefor, pay- 
 able in like manner as the fees of officers in criminal cases. 
 
 Section 11. If a magistrate believes that an inquest to be held by him 
 relates to the accidental death of a passenger or employee upon a railroad or 
 electric railroad or a traveler upon a public or private way at a railroad cross- 
 ing, or to an accidental death connected with the operation of a street railway 
 or of a railroad for private use, he shall cause a verbatim report of the evidence 
 to be made and sworn to by the person making it; and the report and the bill 
 for services, after examination and written approval l).y the magistrate, shall be 
 forwarded to the department of public utiliti(>s witliin thirty days after the 
 date of the inquest, and, when made, a copy of the magistrate's report on the 
 
 [62]
 
 inquest. The bill, when approved by said department, siiall !>(> forwarded to 
 the state auditor and paid by the commonwealth, assessed on the person own- 
 ing or operating such railroad or railway, and shall be collected in the same 
 manner as taxes upon corporations. The magistrate may in his discretion refuse 
 fees to witnesses in the employ of the person upon whose railroad or railway the 
 accident occurred. 
 
 Section 12. The magistrate shall report in writing when, where and by 
 what means the person met his death, his name, if known, and all material 
 circumstances attending his death, and the name, if known, of any person whose 
 unlawful act or negligence appears to have contributed thereto. He shall file 
 his report in the superior court for the county where the inquest is held. 
 
 Section 13. If a person charged bj'' the report with the commission of a 
 crime is at large, the magistrate shall forthwith issue process for his arrest, 
 returnable before any court or magistrate having jurisdiction. If he finds that 
 murder, manslaughter or an assault has been committed, he may bind over, 
 for appearance in said court, as in criminal cases, such witnesses as he considers 
 necessary, or as the district attorney may designate. 
 
 Section 14. No embalming fluid, or any substitute therefor, shall be in- 
 jected into the body of any person supposed to have met his death by violence, 
 until a permit, signed by the medical examiner, has first been obtained. 
 
 Section 15. After an autopsy or a view or examination without an autopsy, 
 the medical examiner shall deliver the body, upon application, to the husband 
 or wife, to the next of kin, or to any friend of the deceased, who shall have 
 priority in the order named. If the body is unidentified or unclaimed for forty- 
 eight hours after the view thereof, the medical examiner shall deliver it to the 
 overseers of the poor of the town where found, who shall bury it in accordance 
 with section seventeen of chapter one hundred and seventeen. 
 
 Section 16. Medical examiners and associate examiners within their re- 
 spective districts shall, on application and payment or tender of seven dollars, 
 view the body and make personal inquirj^ concerning the death of any person 
 whose body is intended for cremation, and shall authorize such cremation only 
 when of opinion that no further examination or judicial inquiry concerning such 
 death is necessary. 
 
 Section 17. The medical examiner may allow reasonable compensation, 
 payable by the county in the manner provided in section nineteen, for services 
 rendered in bringing to land a human body found in any of the harbors, rivers 
 or waters of the commonwealth, but this provision shall not entitle any person 
 to compensation for services rendered in searching for a dead body. 
 
 Section 18. The medical examiner shall take charge of any money or 
 other per.s6nal property of the decea.sed found on or near the body, and deliver 
 it to the person entitled to its custody or possession, or, if not claiincd within 
 
 [63]
 
 sixty days, to a public administrator. For fraudulent neglect or refusal so to 
 deliver such property within three days after demand, a medical examiner or 
 an associate medical examiner shall be punished by a fine of not more than five 
 hundred dollars or by imprisonment for not more than two years. 
 
 Section 19. Every medical examiner shall return an account of the ex- 
 penses of each view or autopsy, including his fees, to the commissioners of the 
 county where held, or in Suffolk county to the auditor of Boston, and shall 
 annex to his return the written authorization of the autopsy. The commis- 
 sioners or auditor shall audit the same, and certify to the county treasurer what 
 items therein are just and reasonable, and he shall pay the same to the person 
 entitled thereto. No auditing officer shall certify any fee for an autopsy until 
 he has received from the district attorney the certificate required by section 
 seven. 
 
 Section 20. Every medical examiner and associate examiner shall an- 
 nually, on or before March first, transmit to the state secretary certified copies 
 of the records of all deaths by him investigated during the preceding year, and 
 within sixty days after the expiration of his term shall make like returns for so 
 much of the j^ear as he held office. For a refusal or neglect so to do, he shall 
 forfeit not less than ten nor more than fifty dollars. 
 
 Section 21. Each medical examiner and associate examiner, including 
 those in Suffolk county, shall receive from the commonwealth twenty cents for 
 each of the first twentj^ deaths recorded and returned by him in any year, as 
 provided in the preceding section, and ten cents for each additional death so 
 recorded and returned, as certified by the state secretary. 
 
 Section 22. The state secretary shall, at the expense of the common- 
 wealth, prepare and furnish to the medical examiners blank record books and 
 blank forms for returns, and shall cause the returns for each year to be bound 
 together in one volume with indexes; and shall prepare therefrom such tables 
 as will render them of utility, and shall make annual report thereof to the gen- 
 eral court in connection with the report required by section twenty-one of 
 chapter forty-six. 
 
 64
 
 APPENDIX IV 
 
 TEXT OF THE NEW YORK MEDICAL EXAMINER LAW 
 
 Laws of New York, 1915 
 Chap. £84 
 AX ACT to amend the Greater New York Charter, and repeal certain 
 ZA sections thereof and of chapter four hundred and ten of the Laws of 
 A, ^ eighteen hundred and eightj^-two, in relation to the abolition of the 
 office of Coroner and the establishment of the office of the chief medical examiner. 
 Became a law April 14, 1915, with the approval of the Governor. Passes, 
 three-fifths being present. 
 
 Accepted by the City 
 
 The People of the State of New York, represented in Senate and Assembly, 
 do enact as follows: 
 
 Section 1. The office of coroner in the City of New York shall be abolished 
 on January first, nineteen hundred and eighteen, and after this section takes 
 effect, a vacancy occurring in such an office in any borough shall not be filled 
 unless by reason of the occurrence thereof, there shall be no coroner in office 
 in such borough, in which case the vacancy in such borough last occurring shall 
 be filled for a term to expire on January first, nineteen hundred and eighteen. 
 If, by reason of the provisions of this section, the number of coroners in a borough 
 be reduced, the remaining coroner or coroners in such borough shall have the 
 powers and perform the duties conferred or imposed by law on the board of 
 coroners in such borough. 
 
 2. Title four of chapter twentj^-three, sections fifteen hundred and seventy 
 and fifteen hundred and seventy-one of the Greater New York charter, as re- 
 enacted by chapter four hundred and sixty-six of the laws of nineteen hundred 
 and one is hereby repealed, and in its place is inserted a new title to be num- 
 bered four and to read as follows : 
 
 Title IV 
 Chief Medical Examiner 
 Section 1570. Organization of office; officers and employees. 
 1571. Violent and suspicious deaths; procedure. 
 1571a. Autopsies; findings. 
 1571b. Report of deaths; removal of body. 
 - 1571c. Records. 
 1571d. Oaths and affidavits. 
 6 [65]
 
 Organization of Office; Officers and Employees 
 
 1570. There is hereby established the office of Chief Medical Examiner of 
 the City of New York. The head of the office shall be called the "chief medical 
 examiner." He shall be appointed by the mayor from the classified service and 
 be a doctor of medicine, and a skilled pathologist and microscopist. 
 
 The mayor may remove such officer upon stating in \vriting his reasons 
 therefor, to be filed in the office of the municipal civil service commission and 
 served upon such officer, and allowing him an opportunity of making a public 
 explanation. The chief medical examiner may appoint and remove such deputies, 
 assistant medical examiners, scientific experts, officers and employees as may 
 be provided for pursuant to law. Such deputy medical examiners and assistant 
 medical examiners, as may be appointed, shall possess qualifications similar to 
 those required in the appointment of the chief medical examiner. The office 
 shall be kept open every day in the year, including Sundays and holidays, with 
 a clerk in constant attendance at all times during the day and night. 
 
 Violent and Suspicious Deaths; Procedure 
 
 1571. When, in the city of New York, any person shall die from criminal 
 violence, or bj' a casualty, or by suicide, or suddenly when in apparent health, 
 or when unattended by a physician, or in prison, or in anj^ suspicious or unusual 
 manner, the officer in charge of the station house in the police precinct in which 
 such person died shall immediately notify the office of the chief medical examiner 
 of the known facts, concerning the time, place, manner and circumstances of 
 such death. Immediately upon receipt of such notification the chief medical 
 examiner, or a deputy or assistant medical examiner, shall go to the dead body, 
 and take charge of the same. Such examiner shall fully investigate the essential 
 facts concerning the circumstances of the death, taking the names and address 
 of as many witnesses thereto as it may be practical to obtain, and before leaving 
 the premises, shall reduce all such facts to writing and file the same in his office. 
 The police officer so detailed, shall, in the absence of the next of kin of deceased 
 person, take possession of all property of value found on such person, make an 
 exact inventory thereof on his report, and deliver such property to the police 
 department, which shall surrender the same to the person entitled to its custody 
 or possession. Such examiner shall take possession of any portable objects, 
 which, in his opinion, maj'^ be useful in establishing the cause of death, and 
 deliver them to the police department. 
 
 Nothing in this section contained shall effect the powers and duties of a 
 public administrator as now provided bj^ law. 
 
 A utopsies; Fi ndings 
 1571a. If the cause of such death shall be established beyond a reasonable 
 doubt, the medical examiner in charge shall so report to his office. If, however, 
 in the opinion of such medical examiner, an autopsy is necessary, the same shall 
 
 [66]
 
 be performed by a medical examiner. A detailed description of tlie findings 
 WTitten during the progress of such autopsy and the conclusions drawn there- 
 from shall thereupon be filed in his office. 
 
 Report of Deaths; Removal of Body 
 1571b. It shall be the duty of any citizen who may become aware of the 
 death of any such person to report such death forthwith to the office of the 
 chief medical examiner and the police officer, who shall forthwith notify the 
 officer in charge of the station house in the police precinct in which such person 
 died. Any person who shall wilfully neglect or refuse to report such death or 
 who, without ^\Titten order from a medical examiner, shall wilfully touch, re- 
 move or disturb the body of any such person, or wilfully touch, remove or dis- 
 turb the clothing, or an)' article upon or near such bodj', shall be guilty of a 
 misdemeanor. 
 
 Records 
 1571c. It shall be the duty of the office of medical examiner to keep full 
 and complete records. Such records shall be kept in the office, properly indexed, 
 stating the name, if kno^sTi, of every such person, the place where the body was 
 found, the date of death. The record of each case shall be attached to the original 
 report of the medical examiner and the detailed findings of the autopsy, if any. 
 The office shall promptly deliver to the appropriate district attorney copies of 
 all records relating to every death as to which there is, in the judgment of the 
 medical examiner in charge, any indication of criminality. All other records 
 shall be open to public inspection as provided in section fifteen hundred and 
 forty-five. The appropriate district attorney and the police commissioner of 
 the cit}' may require, from such officer, such further records and such daily 
 information as they may deem necessar>'. 
 
 Oaths and Affidavits 
 
 1571d. The chief medical examiner and all deputy or assistant medical 
 examiners may administer oaths and take affidavits, proofs and examinations 
 as to anj' matter within the jurisdiction of the office. 
 
 3. Section eleven hundred and seventy-nine of such charter is hereby 
 amended to read as follows: 
 
 Bureaus 
 1 179. There shall be two bureaus in the department of health. The chief 
 officer of one bureau shall be called the sanitary superintendent, who at the 
 time of his appointment shall have been, for at least ten years, a practicing 
 physician, and for three years a resident of the City of New York, and he shall 
 be the chief executive officer of said department. The chief officer of the second 
 bureau shall be called the registrar of records, and in said bureau shall be re- 
 
 [C7 1
 
 corded, without fees, every birth, marriage and death, which shall occur in the 
 City of New York. 
 
 4. Section twelve hundred and three of such charter is hereby amended 
 to read as follows: 
 
 Chief Medical Examiner's Returns 
 1203. The department of health, may, from time to time, make rules and 
 regulations fixing the time of rendering, and defining the form of returns and 
 reports to be made to said department by the office of the chief medical examiner 
 of the city of New York, in all cases of death which shall be investigated by it, 
 and the office of the chief medical examiner is hereby required to conform to 
 such rules and regulations. 
 
 5. Section twelve hundred and thirty-eight of such charter is hereby 
 amended to read as follows: 
 
 Deaths to be Reported 
 1238. It shall be the duty of the next of kin of any person deceased, and 
 of each person being with such deceased person at his or her death, to file report 
 in writing, with the department of health, within five days after such death, 
 stating the age, color, nativity, last occupation and cause of death of such 
 deceased person, and the borough and street the place of such person's death 
 and last residence. Physicians who have attended deceased persons in their 
 last illness shall, in the certificate of the deceased of such persons, specify, as 
 near as the same can be ascertained, the name and surname, age, occupation, 
 term of residence in said city, place of nativity, condition of life whether single 
 or married, widow or widower, colored, last place of residence and the cause of 
 death of such deceased persons, and the medical examiners of the city shall, in 
 their certificates, conform to the requirements of this section. 
 
 6. Such charter is hereby amended by inserting therein a new section to 
 be numbered fifteen hundred and eighty-five, and to read as follows: 
 
 County Clerks to Exercise Certain Statutory Powers and Duties of Coroners 
 1585a. In the city of New York the powers imposed and the duties con- 
 ferred upon coroners by the provisions of the title three of chapter two of the 
 code of civil procedure shall be exercised and performed by the county clerk of 
 the appropriate county, and said county clerk shall, in the exercise and per- 
 formance thereof, be subject to the same liabilities and responsibilities as are 
 prescribed in such title in the case of coroners. 
 
 7. Sections seventeen hundred and sixty-six to seventeen hundred and 
 seventy-nine, both inclusive, of chapter four hundred and ten of the laws of 
 eighteen hundred and eighty-two, entitled "An Act to consolidate into one act 
 and to declare the special and local laws affecting public interests in the city 
 of New York," and all acts amending such sections are hereby repealed. 
 
 [68]
 
 8. The officers and the employees now exercising the powers and duties 
 which by this act are aboHshed, or are conferred or impxised upon the office of 
 chief medical examiner including coroner's physicians, shall be transferred to 
 the office of chief medical examiner. Service in the office, board or body from 
 which transferred shall count for all purposes as service in the office of the chief 
 medical examiner. 
 
 9. All funds, property, records, books, papers and documents within the 
 jurisdiction or control of any such coroner or such board of coroners, shall, on 
 demand, be transferred and delivered to the office of the chief medical examiner. 
 The board of estimate and apportionment shall transfer to the office of the chief 
 medical examiner all unexpended appropriations made by the city to enable 
 any coroner, or board of coroners, to exercise any of the powers and duties 
 which by this act are abolished or are conferred or imposed upon such office of 
 chief medical examiner. 
 
 10. Section one of this act shall take eflect immediately. The remainder 
 of the act shall take effect January first, nineteen hundred and eighteen. 
 
 69
 
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