In no branch of humanitarian service is segregation, classification, even to the point of individual treatment, more essential than in the care of the insane. New Jersey puts no inconsiderable number of her mentally afflicted on a par with offenders against the criminal law for, according to the Commission on the Care of the Mental Defectives for the year 1913, fifteen counties had confined insane persons in penal institutions, in some cases for periods of from 85 to 223 days. The State Charity Commission in Illinois recently reported that in spite of a provision of the statutes forbidding such practices, only eleven of the 102 counties did not so offend. Louisiana is reported to have many lunatics in its parish jails. In but few states are there no insane in the county almshouses, for at least temporary confinement, and particularly is this true in the South and Middle West. In such institutions a condition sometimes prevails that staggers imagination. For the state of Pennsylvania, Dr. C. Floyd Haviland has summed up the situation in these words: “As a result of the existing system, in these institutions, custodial care is generally substituted for active remedial treatment directed to the improvement or the recovery of the insane as such. As a rule, medical treatment for physical ills is satisfactory, although such is not invariably the case. With but few exceptions, the county institutions have no special medical facilities, nor can it be expected that such facilities can be provided under present conditions, for, with the comparatively small number of patients treated in the respective institutions, such provisions would require a prohibitive _per capita_ expense; but as a result of such lack of facilities, mechanical means of restraint and confinement are substituted for proper personal treatment and attention. With but a limited number of attendants, enclosed exercise yards and personal restraint and seclusion must inevitably result. Under existing conditions, one cannot blame the caretakers of the insane for resorting to such means, for while restraint and seclusion can and should be abolished, they cannot be successfully abolished without the substitution of other means of dealing with the disturbed insane, such as hydrotherapy, occupational training, and close personal supervision. In this connection it is agreeable to note that little evidence was obtained of actual physical abuse, but that gross neglect exists is indisputable.