“That the theory of county hospitals for the chronic insane only does not obtain in actual practice is but a necessary result of the prevailing custom of determining the question as to whether a patient shall be committed to a state hospital, regardless of prognosis or medical issues, in many instances the decision being made by local lay authorities without medical advice. It is certain that many acute cases have lapsed into chronicity in the county hospitals simply for lack of proper treatment. Dreary, desolate wards, lack of recreation, or other means of exciting or maintaining active interest are alone sufficient not only to hinder improvement or recovery, but must necessarily result in actually hastening the terminal process of deterioration.”[8] Writing concerning the treatment of the insane in Texas, Dr. Thomas W. Salmon, of the National Committee for Mental Hygiene calls county almshouse care of the insane the “saddest and most sordid spectacle in American community life.” For a graphic picture of the practical significance of the system in one of the almshouses in that state the reader is urged to read the extracts from Dr. Salmon’s address in the Appendix of this volume. COUNTY PRISONS But what of the treatment of the prisoner? The county theoretically has very little to do with persons convicted of serious offenses. By far the greater number of the inmates of the prison are persons awaiting trial and therefore presumably innocent of wrongdoing. The minimum standard of justice demands that such persons be kept apart from hardened criminals. We shall see how this and other standards are observed in the county. To begin with, it should be noted that the head of the jail, universally, is the sheriff. Bear in mind that this officer in forty-seven states is elective, that his term is usually very short, that he is usually ineligible to succeed himself and that he has numerous special duties to perform. It is therefore obvious that nothing but an exceptional piece of good luck can bring to the head of the jail an expert penologist. Often, too, he will be under contract with the board of supervisors to supply the prisoners with food at as good a profit to himself as may be. In this atmosphere it is certainly not to be expected that the finest flowers of penology should grow. Massachusetts has so far fallen below standard as to call forth this stinging description from the Massachusetts Prison Association: “In fact, in the county prisons nothing is done but to give the inmates custodial care. The man who goes to the reformatory is dealt with with a definite purpose to reform him. Another man goes to a county prison and comes out unchanged.