escape. No
matter how delusional or hallucinated he may be, he always manages to
keep in mind that the thing which he most desires is to be free from the
hands of his captors, and anyone who has had to deal with this class
will bear me out in this. The shrewdness with which they carry out their
escapes is amazing, and some of the more depraved ones do not hesitate
to commit serious assaults in order to gain their freedom. Here,
measures other than those used with the ordinary insane patient are
required.

Now as to special hospitals for insane criminals which certain States
have. Of course the same objections, namely, as to the delay in getting
the patient under treatment and the danger of transfer, etc., hold true
also here; but these hospitals, it seems to me, have the additional
disadvantage that they necessitate the segregation of all insane
criminals, irrespective of whether they suffer from a recoverable
psychosis or from a dementing process. In other words, here we have an
admixture of cases who unfortunately fell into the hands of the law
because of some mental disorder and who certainly should be confined as
any other patient in an ordinary hospital for the insane, and patients
in whom the crime and mental disorder are expressions of the same
underlying degenerative defect, and who in a great majority of instances
suffer from recoverable transitory mental disorders.

To insist upon keeping a paretic all his lifetime in such an institution
is highly irrational, to say the least. The most rational, and the only
scientific way, of dealing with the insane criminal is to bring about a
state when the psychiatric hospital will be made accessible to him just
as easily as the surgical and medical wards are, and this can only be
accomplished by having psychiatric annexes in connection with prisons.
The only serious objection which can be raised against this plan is that
in time the annex will be made up exclusively of a very dangerous and
troublesome population, but this objection likewise applies to the
special hospital for the insane criminal. Certainly it is far safer to
have this class of cases within the prison enclosure than to allow their
accumulation in a general hospital for the insane.

Lastly, the psychiatric annex in the penitentiary would form the proper
nucleus for the scientific study of the criminal, whence that much
needed information concerning this type of man could emanate and be
utilized for the r