with the subject that all institutions caring for children and aged persons and the work of placing children in foster homes, without question as to whether public funds are involved or not, should be under efficient state supervision, and, further, that all associations and agencies appealing to the public for contributions should be subject to inspection by, and make reports to, such a body as the State Board of Charities.

Some duplication of supervisory authority in respect to certain groups supervised by the State Board of Charities exists as follows: Institutions for the mentally defective are also supervised by the State Commission for Mental Defectives which, under the Mental Deficiency Law, is authorized to regulate the establishment of colonies for mental defectives, conduct mental clinics in coöperation with other departments of the state, make a census of the mental defectives in the state and generally to supervise the care of this group of the state's wards. The reformatories for adults are also supervised by the State Commission of Prisons. The schools for the blind and deaf are also inspected by the State Education Department, the appointment of pupils to these schools are made by that department, and the payment of state funds for the care and maintenance of these pupils are paid through it. Tuberculosis hospitals and sanatoria are also supervised by the State Department of Health and plans for the construction of county tuberculosis hospitals are approved by that department.

Convention of 1915 drafted proposed amendments to the Constitution which were rejected by the voters at the general election of that year. The plan submitted proposed, among other radical changes, that the supervisory work of the State Hospital Commission, the State Commission of Prisons and the State Board of Charities with respect to state institutions be combined in a Department of Charities and Corrections, the head of which would be a Secretary of Charities and Corrections with "power of inspection and supervision of all state charitable institutions, state hospitals for the insane, state prisons, and other state correctional institutions." In 1919, a "Reconstruction Commission" appointed by Governor Smith recommended certain changes in the organization of state departments including the transfer from the State Board of Charities of supervision over certain classes of state institutions, placing those for the mentally defective with the State Hospital Commission, to be known as the Department of Mental Hygiene; all reformatories and other penal institutions with a proposed Department of Corrections; the schools for the blind and deaf with the Education Department; the State hospitals and sanatoria for consumptives with the State Health Department; and the two veterans' homes with the Department of Military and Naval Affairs.

On the advice of the Hospital Development Commission, which a few years ago made a survey of the hospitals for the insane and the institutions for mental defectives, the Legislature in 1920 adopted a resolution proposing a

DEPARTMENTS

Efforts have been made to reorganize the state departments by amending the Constitution and revising the statutes. The Constitutional

place the care of the mentally defective with the State Hospital Commission. This proposal failed of passage in 1921, hence the question was not submitted at the general election of that year. It

is expected that further efforts will be made to amend the Constitution in this respect.

The state has assumed the responsibility for the care of the insane and the mentally defective. One additional hospital for the insane is being erected and provision for this class of patients is reasonably adequate. The plans for the newest state institution for mental defectives, Letchworth Village, have progressed to such an extent as to add 1,400 to the bed capacity of the state institutions, and, in addition, the Institution for Defective Delinquents (for males) at Napanoch, and the department for defective delinquents in connection with the New York State Reformatory for Women at Bedford Hills, provide for some five hundred of this class of inmates.

Although the number of mentally defective persons in the state is estimated at from thirty thousand to forty thousand, and the number needing institutional care at ten thousand, the state and municipal schools for mental defectives have an aggregate bed capacity of less than seven thousand. The state is, therefore, in need of additional facilities for the feeble-minded who should have custodial care. Further provision is also needed for the guidance and supervision of borderline cases who might be placed in special classes in the public schools and who may properly, with such training and supervision, be permitted to remain in their own homes. The development of this home training would require the mental examination of all children in the public schools who show signs of retardation or mental deficiency and special classes suited to the needs of pupils who are unable to make their way successfully in the regular classes.

A number of colonies have been established by the Rome State School for Mental Defectives for those in

mates who, after a period of training, are adjudged capable of being benefited by colony life with its opportunities for a larger degree of self-direction. The extension of this system is under the control of the State Commission for Mental Defectives and further development in this direction is needed.

Another problem needing solution concerns the licensing and control of dispensaries. Article 15 of the State Charities Law places this authority with the State Board of Charities. Some of the dispensaries are maintained by local health boards and are for the treatment of tuberculosis and venereal disease. It is recognized that these are strictly health problems and should be supervised by the State Department of Health. Other dispensaries are maintained in connection with the public schools and are closely connected with the general school inspection supervised by the State Education Department. A change in the dispensary law is needed before this duplication of interest and effort is removed.

Reference has been made to duplication of work in the supervision of tuberculosis hospitals and sanatoria. The state maintains a hospital for the treatment of incipient cases of tuberculosis. Many of the counties and some of the cities in the state maintain tuberculosis hospitals. The State Board of Charities is required by the Constitution and the statutes to visit and inspect these hospitals and in addition they are under the supervision of the State Department of Health, which department is authorized by law to approve plans for their construction. The State Charities Aid Association, a private organization, is also given statutory authority to visit and inspect these and other public charitable institutions. While there is no serious lack of harmony between the various

inspecting agencies, the institutions are embarrassed by the numerous official inspections and are at a loss to know to which department or agency they should turn for advice in connection with their problems. Changes in the general laws by which much of this duplication of supervisory authority may be eliminated are possible without the necessity for amending the Constitution, but it is expected that certain fundamental changes in the Constitution will be made in the next few years.

A Commission to simplify and coordinate the various laws affecting dependent children, appointed in part

by the Governor, and representing the Legislature and several of the state departments, has been at work since 1920, but progress has been slow. One result of this Commission's activities is the enactment of a permissive law authorizing boards of supervisors to place the care of dependent children generally in the hands of the county boards of child welfare. The enactment in 1922 of a uniform county Juvenile Court Law was also a result of the work of the Commission. It is hoped that a much needed readjustment of other laws affecting children will be brought about.

THEN the Department of Public

WH

Welfare in Massachusetts was created in 1919 it was not fashioned anew. It replaced the State Board of Charity which had been in existence since 1863. In those early days the State Board supervised all the state charitable and correctional institutions and was the only state board concerned with social work. As the specialties of health, correction and mental diseases developed, they assumed such size in Massachusetts that it became necessary to develop specialized departments for them, and they are, at the present time, too large, we believe, to be combined into a single department. The Department of Mental Diseases has fifteen separate institutions, the Department of Correction five institutions, the Department of Public Health four institutions, and the Department of Public Welfare five, not to mention the other large and varied extrainstitutional activities of all the departments. By the removal of the larger special problems to other departments, the Department of Public Welfare has been left in charge of all the remaining neglected, delinquent and dependent persons over whom the Commonwealth takes supervision. During the year 1921, over 80,000 persons came under its supervision. These cases are summarized as follows:

In the State Infirmary, the Massachu-
setts Hospital School and the three
training schools....

On parole from three training schools....
Minor wards, principally in foster homes
Infants in boarding homes supervised...

8,239

4,188

7,150

2,388

DIVISION OF AID AND RELIEF

Outdoor relief in Massachusetts is in all cases granted by the Overseers of the Poor of the city or town where the person falls into distress. The state functions in a supervisory manner. Before the enactment of the mothers' aid law in 1913, the state's function was to reimburse cities and towns for the care of persons who had no legal settlement and in that way exercise supervision. In the mothers' aid law, the principle of state supervision was more definitely recognized and every case under that law, whether settled or not, is reinvestigated by our visitors. Family plans are then formulated, a budget adopted and constant follow-up work is done to see

if the plan is working out well, and to adjust the amount of aid to the changing needs of the family.

The State Infirmary at Tewksbury, John H. Nichols, M.D., Superintendent, is primarily the hospital of the Division of Aid and Relief for the state charges who are not admissible to any other state hospital. It is an excellent general hospital, with a capacity of 2,351. The Division undertakes the discharge of all women from the Infirmary and gives them the necessary after-care. The work with mothers and babies is the most difficult. Women visitors get well acquainted with the girls at the Infirmary and then appeal to the mother's love, the mother's pride and her desire to have her own home. The visitors watch carefully the kind of training and the degree of consideration which is given to the girl by her employer, encourage her to make savings deposits, and surround her as far as they can with the advantages which may restore her to a place in the community. Prosecutions for non-support are made whenever it is advisable and necessary.

There are employed in the Division of Aid and Relief eleven mothers' aid visitors, seventeen settlement visitors and five social service visitors. Mr. Frank W. Goodhue is the Director of this Division.

DIVISION OF CHILD GUARDIANSHIP

Good family care rather than institutional care for the children under the charge of the Division of Child Guardianship has long been the policy of the Department and its predecessors. Dependent children, neglected children. and even those delinquent children who are not in need of institutional discipline are placed in good foster homes. Seven thousand, one hundred and fifty children came under the care of the Division during 1921.

Dependent children may be received on application of the Overseers of the Poor or on application of individuals. The investigating department makes every effort to enforce family responsibility and makes use of private agencies and of all the resources of the community. Neglected children are received entirely from the courts. The Department takes no action in prosecuting for neglect. Dependency and neglect contribute about equally as factors in placing children under our charge. No families are broken up because of poverty alone. With the poverty, there must exist some other reason like the death or incapacity of the mother.

A few delinquent children are committed as minor wards from the courts in preference to a commitment to one of the training schools.

The Massachusetts Hospital School at Canton, John E. Fish, M.D., Superintendent, is the institution connected with this Division. It has heretofore been entirely devoted to the care of crippled children among whom it has secured a notably large proportion of recoveries, making them self-supporting citizens when they might otherwise have become street beggars or inmates of almshouses. This year a new hospital for minor wards has been opened at Canton which will care for sick children who are not crippled, provided they are mentally normal.

Two very important supervisory functions are exercised by this division: the licensing of lying-in hospitals and of boarding houses for infants. By a careful system of inspection, many of the abuses connected with the abandonment of infants in such institutions have been reduced to a minimum.

There are employed in the Division of Child Guardianship fifteen visitors to younger children, thirteen visitors to older girls, fifteen visitors to older